Life Settlement Document Ii Form - Arkansas Securities Department Page 3
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4Premiums
Premiums on the policy are (check one):
Paid up and no additional premium payments will ever be required.
Required to be paid periodically.
Premiums are:
$ _______ annually
Payments of $ ________ are due to be paid:
Monthly
Quarterly
Semi-annually
Annually
Term of premium payments
If premium payments are made as required the policy will be fully paid up on
(date) ____________.
Premium payments must be made until the death of the insured.
Funding of premium payments (check all that apply)
A portion of your investment has been set aside to pay premiums. This amount will fund
the payment of premiums until (date) ___________. These funds have been placed in an
escrow account with:
Name of Escrow Agent:
Address:
Telephone Number:
Bank Name and Account Number:
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