Applications

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Applications


Some states require that we use a state approved application for the process of obtaining a free non-binding appraisal. Please access the application (below) that is specific to you or your client’s state of residence. Once completed the appropriate application can be faxed, emailed or mailed to Life Insurance Settlements, Inc.

NAIC - Understanding Viatical Settlements
State Application
Alabama Alabama Application Universal Insured Medical Questionnaire
Alaska Alaska Application Universal Insured Medical Questionnaire
Arizona Arizona Application Universal Insured Medical Questionnaire
Arkansas Arkansas Application Universal Insured Medical Questionnaire
California California Application Universal Insured Medical Questionnaire
Colorado Colorado Application Universal Insured Medical Questionnaire
Connecticut Connecticut Application Universal Insured Medical Questionnaire
Delaware Delaware Application Universal Insured Medical Questionnaire
District of Columbia District of Columbia Application Universal Insured Medical Questionnaire
Florida Florida Application Universal Insured Medical Questionnaire
Georgia Georgia Application Universal Insured Medical Questionnaire
Hawaii Hawaii Application Universal Insured Medical Questionnaire
Idaho Idaho Application Universal Insured Medical Questionnaire
Illinois Illinois Application Universal Insured Medical Questionnaire
Indiana Indiana Application Universal Insured Medical Questionnaire
Iowa Iowa Application Universal Insured Medical Questionnaire
Kansas Kansas Application Universal Insured Medical Questionnaire
Kentucky Kentucky Application Universal Insured Medical Questionnaire
Louisiana Louisiana Application Universal Insured Medical Questionnaire
Maine Maine Application Universal Insured Medical Questionnaire
Maryland Maryland Application Universal Insured Medical Questionnaire
Massachusetts Massachusetts Application Universal Insured Medical Questionnaire
Michigan Michigan Application Universal Insured Medical Questionnaire
Minnesota Minnesota Application Universal Insured Medical Questionnaire
Mississippi Mississippi Application Universal Insured Medical Questionnaire
Missouri Missouri Application Universal Insured Medical Questionnaire
Montana Montana Application Universal Insured Medical Questionnaire
Nebraska Nebraska Application Universal Insured Medical Questionnaire
New Hampshire New Hampshire Application Universal Insured Medical Questionnaire
New Jersey New Jersey Application Universal Insured Medical Questionnaire
New Mexico New Mexico Application Universal Insured Medical Questionnaire
New York New York Application Universal Insured Medical Questionnaire
North Carolina North Carolina Application Universal Insured Medical Questionnaire
North Dakota North Dakota Application Universal Insured Medical Questionnaire
Oklahoma Oklahoma Application Universal Insured Medical Questionnaire
Ohio Ohio Application Universal Insured Medical Questionnaire
Oregon Oregon Application Universal Insured Medical Questionnaire
Pennsylvania Pennsylvania Application Universal Insured Medical Questionnaire
Rhode Island Rhode Island Application Universal Insured Medical Questionnaire
South Carolina South Carolina Application Universal Insured Medical Questionnaire
South Dakota South Dakota Application Universal Insured Medical Questionnaire
Tennessee Tennessee Application Universal Insured Medical Questionnaire
Texas Texas Application Universal Insured Medical Questionnaire
Utah Utah Application Universal Insured Medical Questionnaire
Virginia Virginia Application Universal Insured Medical Questionnaire
Washington Washington Application Universal Insured Medical Questionnaire
West Virginia West Virginia Application Universal Insured Medical Questionnaire
Wisconsin Wisconsin Application Universal Insured Medical Questionnaire
Wyoming Wyoming Application Universal Insured Medical Questionnaire