Form V902 - Viatical Settlement Investment Contracts Registration For Exemption (Page 2 of 2) in pdf

Form V902 - Viatical Settlement Investment Contracts Registration For Exemption Page 2

Marketing and Sales Material

Please attach all marketing material you intend to use including, but not limited to, a

prospectus, pamphlet, circular, the text of any advertisement, contracts, form letters and

any disclosure documents you may use in addition to those required by Article 9 of the

Mississippi Securities Act Rules.

Audited Financial Statement

Please attach your most recent audited income and expense statement and balance sheet

pursuant to Mississippi Securities Act Rule 902(A)(2).

Certification

I hereby certify that the information on this document and in the attachments hereto is

true and correct. I further certify that I am authorized to submit this form on behalf of the

applicant. I understand that I am under a continuing obligation to notify the Business

Regulation and Enforcement Division of the Office of the Mississippi Secretary of State

of any changes in the information provided herein.

_________________________________________

Signature

Date

_________________________________________

Typed or Printed Name

Sworn to and subscribed before me this the _________ day of ___________, 20_____.

__________________________________

Notary Public

My Comm’n Expires:_________________

SEAL

Form V902 - Viatical Settlement Investment Contracts Registration For Exemption Page 2