NOTE: Applicants who are unable to complete this exhibit for filing with the original license application by the May 29, 2010 deadline (pursuant to Section 21 (1) of this Act) may submit the completed exhibit by no later than June 26, 2010. (This filing extension applies only to this exhibit.) If a completed exhibit is not submitted with the original license application, copies of Annual Reports (or equivalent) filed by the applicant for the calendar year 2009 in each jurisdiction in which the applicant is licensed and which require the filing of such reports MUST be submitted with the original license application.
Paid Life Settlements Where Insured's Death Occurred During Calendar Year 2009*
Policy Cash Value at Time of Settlement Contract / Paid to Owner
Settlement Number / Age at Death / Cause of Death / Life Expectancy of Insured at Time of Settlement Contract (months) / Duration from Settlement Date to Date of Death (months) / State of Residency / State of Jurisdiction* / Face Amount Settled / Before Deducting Loan / After Deducting Loan / Date / Amount
Part A - Life insurance policies settled in 2009:
Totals - Part A / XXX / XXX / XXX / XXX / XXX / XXX / XXX / XXX / XXX
Part B - Life insurance policies settled in years prior to 2009:
Totals - Part B / XXX / XXX / XXX / XXX / XXX / XXX / XXX / XXX / XXX
Grand Totals / XXX / XXX / XXX / XXX / XXX / XXX / XXX / XXX / XXX
*If any information requested in this exhibit is not available, please note “N/A” in the appropriate column and indicate, in a footnote to the exhibit, an explanation of why such information is not available.
** State in which the life insurance policy was issued.
LSP-Exp3 (Rev. 5/12/10)