MIKE KREIDLER Phone: (360) 725-7200
STATE INSURANCE COMMISSIONER Fax: (360) 586-2022
OFFICE OF
INSURANCE COMMISSIONER
Company Supervision Division
Mailing Address: PO Box 40255● Olympia, WA 98504-0255
Street Address: 5000 Capitol Boulevard●Tumwater, WA 98501
Rev 12/2016
life settlement Provider
Application Instructions
Applying for Licensure to Act as a Life Settlement Provider in Washington
Chapters 48.102 RCW and 284-97 WAC regulate Life Settlement Providers. As an applicant orlicensed provider, it is your responsibility to fully understand the statutes.
The application file consists of the application itself, and the service of process form. The biographical affidavit forms are available through the NAIC applicable statutes and regulations are available through our website The application packet is designed to be downloaded and saved to your hard drive. You should be able to “tab” through the Word®application document and enter necessary information, which you will then save and print. (It may be helpful to print a hard-copy of all pages beforehand.) The completed and signed application, required documentation, and the $250 application fee(payable to the Office of the Insurance Commissioner) must be mailed to the address below. Fees for fingerprint cards are additional, and a separate check, also payable to the Office of the Insurance Commissioner, must accompany the submission of the fingerprint cards. We are unable to accept electronic submission of the application at this time.
Should you have questions regarding the application, the application process, or the applicable law, please contact us as soon as possible.
Forward your completed application to:
Mailing address:Delivery (Street) Address:
Office of the Insurance CommissionerOffice of the Insurance Commissioner
P.O. Box 402555000 Capitol Blvd.
Olympia, WA 98504-0255Tumwater, WA 98501
Please note that the USPS will only accept the POB mailing address, and does not allow other shippers to use the POB address. All non-USPS shippers must use the Street Address.
Use of an incorrect address may result in your application being returned by the shipper.
Warning!
Other than as specifically allowed under the new law, you may not solicit, negotiate, or enter into a life settlement contract until your Company has physically received itsLife Settlement License and your forms have been approved for use. Following licensure by the Company Supervision Division, you would then file forms for approval with our Rates and Forms Division. On approval of your forms you may then legally operate. Penalties for non-compliance can be severe.
Questions?
For all questions or requests for additional information, please contact a Company Licensing Specialist (choose the “Company applications” category), or phone: 360-725-7200.
Company Supervision Division
Mailing Address: PO Box 40255● Olympia, WA 98504-0255
Street Address: 5000 Capitol Boulevard●Tumwater, WA 98501
Rev 12/2016