State of California
Life Settlement Form Filing Cover Sheet California Insurance Code, Section 10113.2(c)
Name of Licensee:______________________________
Provide the Following (choose all that apply):
CA# or NAIC # ______________________________
License Number: ______________________________
FEIN Number: ______________________________
Application No.: ______________________________
Licensee is a:
[] Life Settlement Provider
[] Life Settlement Broker
[] Life Producer Transacting Life Settlement Business
___________________________
Description of Form(s) and any Identifying Form Number(s): ___________________________
________________________________________________________________
Approximate Date Licensee will Commence Using Form(s): ______________________________
Form Submitted by On Behalf of Licensee
______________________________
Name
______________________________
Title
______________________________
Phone Number
Cal. Code Regs. Tit. 10, § 2548.27
2. Change without regulatory effect amending NOTE filed 1-24-2012 pursuant to section 100, title 1, California Code of Regulations (Register 2012, No. 4).
3. Renumbering of former section 2548.27 to section 2548.28 and renumbering of former section 2548.26 to new section 2548.27 filed 11-25-2014; operative 1-1-2015 (Register 2014, No. 48).
Note: Authority cited: Section 10113.35, Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); 20th Century Ins. Co. v. Garamendi, 8 Cal.4th 216 (1994). Reference: Section 10113.2, Insurance Code.
2. Change without regulatory effect amending Note filed 1-24-2012 pursuant to section 100, title 1, California Code of Regulations (Register 2012, No. 4).
3. Renumbering of former section 2548.27 to section 2548.28 and renumbering of former section 2548.26 to new section 2548.27 filed 11-25-2014; operative 1/1/2015 (Register 2014, No. 48).