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The undersigned, as the Policy Owner and/or Insured under the Policy, each hereby consent to the disclosure of their identity, identifiable information, and such financial, personal and medical information (the “Protected Data”) in accordance with the following terms and conditions.

Information Authorized to be Disclosed. I understand that the Protected Data that will be disclosed includes, but is not limited to: names; addresses; personal identifying information, including my date or birth and social security number; information contained in the application for the Policy and the Policy; information held by the Insurer regarding me or the Policy; financial information; and medical records and information.

Authorized Recipients of Protected Data. I hereby authorize the disclosure of the Protected Data to: (i) any life settlement broker, or any of its, his or her affiliates; (ii) any life settlement provider and any of its subsidiary, successors (potential and actual), assigns and affiliates (a “life settlement provider”); (iii) any person who may seek to purchase from such life settlement provider any life insurance policy insuring the Insured’s life or other insurance product including policies or products owned by the Policy Owner; (iv) any financing entity of a life settlement provider, including, but not limited to, any of its underwriters, lenders, purchasers of securities and credit enhancers; (v) any future owner of the Policy and their respective assignees, transferees, and successors; (vi) any service provider, including, but not limited to, any life expectancy underwriter, escrow agent, or entity authorized to administer a life insurance policy or to make contacts for the purpose of determining the health status or whereabouts of the Insured; (vii) any life insurance or annuity company that has issued, or may be requested to issue a life insurance policy insuring the Insured’s life; and (viii) any of the respective affiliates, directors, officers, employees, agents, authorized representatives, independent contractors, accountants, actuaries, attorneys and other representatives and advisors, and successors and assigns of any of the persons or entities covered in the immediately foregoing clauses (i) through (vii), inclusive (each, an “Authorized Recipient”).

Authorized Purposes. I hereby authorize the release of Protected Data to Authorized Recipients for any purposes permitted by law, including, but not limited to: (i) allowing life settlement providers (and their financing entities) to determine whether to make an indicative offer to purchase and, thereafter, to take those steps necessary to complete the purchase of any interest in, or information relating to, a Policy; (ii) allowing life expectancy underwriters to issue life expectancy reports regarding the Insured; (iii) the use, disclosure and reproduction by the life settlement provider’s affiliates or the officers, directors, employees, agents, representatives or service providers of the life settlement provider or the affiliate in connection with the conduct of any business of the life settlement provider; and (iv) the use, disclosure and reproduction by the life settlement provider’s actuaries, attorneys, accountants, auditors or other service providers in the performance of services by them for, on behalf of, or at the direction of the life settlement provider or in their evaluation of any process, procedure or obligation of the life settlement provider.

Each of the undersigned certifies that this Authorization has been made freely, voluntarily and without coercion. Each of the undersigned understands that any revocation of this Authorization will not apply to information that has already been released in reliance on this Authorization. Re-disclosure of the Protected Data by those receiving it pursuant to this Authorization may be accomplished without any further consent or authorization and may no longer be protected. Each of the undersigned releases any Authorized Recipient from any and all liability for actual or alleged damages to the undersigned as a result of good faith compliance with this Authorization. Each of the undersigned acknowledges receipt of a copy of this Authorization. A copy of this Authorization may be accepted as an original. This Authorization may be sent via facsimile transmission.

1. Some or all of the proceeds of your viatical settlement may be taxable under federal income tax and/or state franchise and income tax laws. You should consult a professional tax advisor.

2. The sale of your insurance policy and receipt of proceeds could adversely affect your right to receive Medicaid or other government benefits or entitlements, and advice should be obtained from the appropriate agencies.

3. Settlement Benefits Association will only process your life insurance policy through licensed viatical settlement providers to the extent required by applicable law.

4. A viatical settlement broker represents exclusively the policy owner, and not the insurer or the viatical settlement provider, and, if required by State law, owes a fiduciary duty to the policy owner’s instructions and in the best interest of the policy owner. You agree that your viatical settlement broker represents you exclusively. Further, you agree that Settlement Benefits Association, owes a duty only to Settlement Benefits Association’s Producer (your viatical settlement broker), and not to you, where allowed by law.

5. Settlement Benefits Association will be compensated. The viatical settlement provider company, not the viator (policy owner), will compensate Settlement Benefits Association, based on a formula that is a percentage of the face value of the life insurance policy. For example: compensation for a $100,000 policy could be: 8% x $100,000 (face value) = $8,000.00. Compensation can include, but is not limited to, bonuses, overrides or other funds in addition to viatical settlement broker commissions.

6. There are possible alternative to selling your life insurance. This may include the option of an accelerated death benefit or policy loans offered by your life insurance company. You are advised to consult a financial advisor, certified public accountant or an attorney regarding these potential alternatives.

7. You have the right to obtain the name, business address, and telephone number of the entity that serves as independent third-party escrow agent that disburses your viatical settlement proceeds. You may, if you wish, inspect or receive a copy of the relevant escrow or trust agreements or documents for your viatical settlement from the escrow agent.

8. Once you have received your proceeds from the sale of your life insurance policy, you may have up to fifteen (15) days from receipt of the viatical settlement proceeds in which to rescind the transaction, conditioned on the return of such proceeds. If the insured dies during the rescission period the viatical settlement contract shall be deemed rescinded, subject to repayment of all viatical settlement proceeds. Funds should be sent to you within (3) business days after the insurer or group administrator’s acknowledgment that ownership of the policy or interest in the certificate has been transferred and the beneficiary has been designated. Please refer to your viatical settlement contract for details of these provisions.

9. Your entering into a viatical settlement contract may cause other rights or benefits, including conversion rights and waiver of premium benefits that may exist under the policy or certificate, to be forfeited by the Policy Owner. Assistance should be sought from a financial advisor.

10. Viatical Settlement proceeds could be subject to the claims of creditors.

11. All medical, financial or personal information solicited or obtained by a viatical settlement provider or viatical settlement broker about an insured, including the insured’s identity or the identity of family members, a spouse or a significant other may be disclosed as necessary to effect the viatical settlement between the policy owner and the viatical settlement provider. If you are asked to provide this information, you will be asked to consent to the disclosure. The information may be provided to someone who buys the policy or provides funds for the purchase. You may be asked to renew your permission to share information every two years.

12. Following the execution of a viatical settlement contract, the insured may be contacted for the purpose of determining the insured’s health status and to confirm the insured’s residential or business street address and telephone number, or as otherwise provided under State law. This contact may be limited to once every three (3) months if the insured has a life expectancy of more than one year, and no more than once per month if the insured has a life expectancy of one year or less. All such contacts shall be made only by a viatical settlement provider licensed in the state in which the policy owner resided at the time of the viatical settlement, or by the authorized representative of a duly licensed viatical settlement provider.

13. Disclosure to a Policy Owner shall include distribution of a brochure describing the process of viatical settlements. The NAIC’s form for the brochure shall be used unless another form is developed or approved by the commissioner of the state in question.

1. Some or all of the proceeds of your life settlement may be taxable under federal income tax and/or state franchise and income tax laws. You should consult a professional tax advisor.

2. The sale of your insurance policy and receipt of proceeds could adversely affect your right to receive Medicaid or other government benefits or entitlements, and advice should be obtained from the appropriate agencies.

3. Settlement Benefits Association will only process your life insurance policy through licensed life settlement providers to the extent required by applicable law.

4. A life settlement broker represents exclusively the policy owner, and not the insurer or the life settlement provider, and, if required by State law, owes a fiduciary duty to the policy owner’s instructions and in the best interest of the policy owner. You agree that your life settlement broker represents you exclusively. Further, you agree that Settlement Benefits Association, owes a duty only to Settlement Benefits Association’s Producer (your life settlement broker), and not to you, where allowed by law.

5. Settlement Benefits Association will be compensated. The life settlement provider company, not the viator (policy owner), will compensate Settlement Benefits Association, based on a formula that is a percentage of the face value of the life insurance policy. Compensation can include, but is not limited to, bonuses, overrides or other funds in addition to life settlement broker commissions.

6. There are possible alternative to selling your life insurance. This may include the option of an accelerated death benefit or policy loans offered by your life insurance company. You are advised to consult a financial advisor, certified public accountant or an attorney regarding these potential alternatives.

7. You have the right to obtain the name, business address, and telephone number of the entity that serves as independent third-party escrow agent that disburses your life settlement proceeds. You may, if you wish, inspect or receive a copy of the relevant escrow or trust agreements or documents for your life settlement from the escrow agent.

8. Once you have received your proceeds from the sale of your life insurance policy, you may have up to fifteen (15) days from receipt of the life settlement proceeds in which to rescind the transaction, conditioned on the return of such proceeds. If the insured dies during the rescission period the life settlement contract shall be deemed rescinded, subject to repayment of all life settlement proceeds. Funds should be sent to you within (3) business days after the insurer or group administrator’s acknowledgment that ownership of the policy or interest in the certificate has been transferred and the beneficiary has been designated. Please refer to your life settlement contract for details of these provisions.

9. Your entering into a life settlement contract may cause other rights or benefits, including conversion rights and waiver of premium benefits that may exist under the policy or certificate, to be forfeited by the Policy Owner. Assistance should be sought from a financial advisor.

10. Life Settlement proceeds could be subject to the claims of creditors.

11. All medical, financial or personal information solicited or obtained by a life settlement provider or life settlement broker about an insured, including the insured’s identity or the identity of family members, a spouse or a significant other may be disclosed as necessary to effect the life settlement between the policy owner and the life settlement provider. If you are asked to provide this information, you will be asked to consent to the disclosure. The information may be provided to someone who buys the policy or provides funds for the purchase. You may be asked to renew your permission to share information every two years.

12. Following the execution of a life settlement contract, the insured may be contacted for the purpose of determining the insured’s health status and to confirm the insured’s residential or business street address and telephone number, or as otherwise provided under State law. This contact may be limited to once every three (3) months if the insured has a life expectancy of more than one year, and no more than once per month if the insured has a life expectancy of one year or less. All such contacts shall be made only by a life settlement provider licensed in the state in which the policy owner resided at the time of the life settlement, or by the authorized representative of a duly licensed life settlement provider.

13. Disclosure to a Policy Owner shall include distribution of a brochure describing the process of life settlements. The NAIC’s form for the brochure shall be used unless another form is developed or approved by the commissioner of the state in question.

(To be provided prior to the execution of the life settlement contract by all parties)

IMPORTANT- READ THIS DISCLOSURE FORM BEFORE SIGNING ANY LIFE SETTLEMENT CONTRACT.

You should carefully read all of the following and seek financial, insurance, tax and other advice where appropriate. A broker must disclose the following to the owner:

1. The name, business address, and telephone number of the broker is as follows: Noam S. Weiss 3260 Fairlane Farms Rd #3 Wellington, FL 33414 Ph. 561-963-5101

2. A full, complete, and accurate description of all the offers, counteroffers, acceptances and rejections relating to the proposed life settlement contract is described and shown in the Bidding Summary page of this broker disclosure.

3. The broker has no affiliation or contractual arrangements with any person making an offer in connection with the proposed life settlement contract.

4. The name of each broker who receives compensation and the amount of compensation, including anything of value, paid or given to the broker in connection with the life settlement contract. This will be described and shown in the Bidding Summary page of this Broker disclosure.

5. A complete reconciliation of the gross offer or bid by the provider to the net amount of proceeds or value to be received by the owner. This will be described and shown in the Bidding Summary page of this Broker disclosure. For purposes of this section, “gross offer or bid” means the total amount or value offered by the provider for the purchase of one or more life insurance policies, inclusive of commissions and fees. Failure to provide the disclosures or rights described in this section is an unfair method of competition or an unfair or deceptive act or practice.

IMPORTANT
READ THIS DISCLOSURE DOCUMENT BEFORE SIGNING A LIFE SETTLEMENT CONTRACT.

You should carefully read the following information and seek financial, insurance, tax and other advice where appropriate.

You, the owner, or the insured may have possible alternatives to life settlement contracts, such as accelerated death benefits or policy loans offered by the issuer of the life insurance policy.

2. A life settlement broker represents exclusively, you, the owner, and not the insurer, the life settlement provider or any other person, and owes a fiduciary duty to you, including a duty to act according to the owner’s instructions and in your best interest.

3. Some or all of the proceeds of a life settlement may be taxable under federal and state law. You should seek advice from a professional tax advisor.

4. Proceeds from a life settlement contract could be subject to the claims of creditors.

5. Receipt of the proceeds from a life settlement contract may adversely affect the recipient’s eligibility for public assistance or other government benefits or entitlements, and advice should be obtained from the appropriate agencies.

6. A change of ownership of a life insurance policy could limit the insured’s ability to purchase future insurance on the insured’s life because there is a limit to how much life insurance coverage insurers will issue on one life.

7. Entering into a life settlement contract may cause other rights or benefits, including conversion rights and waiver of premium benefits that may exist under the life insurance policy or certificate of a group policy, to be forfeited by the owner. You should seek assistance from a professional financial advisor.

8. The insured may be contacted by either the life settlement provider or its authorized representative for the purpose of determining the insured’s health status or to verify the insured’s address. The contacts shall be limited to once every three months if the insured has a life expectancy of more than one year, and no more than once per month if the insured has a life expectancy of one year or less.

9. You, the owner, have the right to rescind (cancel) a life settlement contract from the time of execution of the contract until fifteen days after you receive the life settlement proceeds.

10. The life settlement provider or life settlement broker is required to provide an owner during the solicitation process with a consumer information booklet in a form prescribed by the superintendent, or other similar material, subject to the approval of the superintendent.

11. You the owner, will be provided with the following information:
– the gross offer or bid that the life settlement provider shall pay pursuant to the life settlement contract;
– the net amount to be paid to the owner pursuant to the life settlement contract;
– the name of each life settlement broker, life settlement intermediary, insurance producer or insurance consultant that will be compensated by the life settlement provider, or any affiliate, parent corporation, or subsidiary of the life settlement provider pursuant to the life settlement contract; and
– the amount of compensation that the life settlement provider, or any affiliate, parent corporation or subsidiary of the life settlement provider, shall provide to a life settlement broker, life settlement intermediary, insurance producer or insurance consultant, or any affiliate, parent corporation or subsidiary of such broker, intermediary, producer, or consultant pursuant to the life settlement contract. “Gross offer or bid” means the total amount or value offered by the life settlement provider for the purchase of one or more life insurance policies, inclusive of commissions and fees.

12. The escrow agent or trustee must transfer the net proceeds under the life settlement contract to you, the owner, within three business days after the life settlement provider has received the insurer or group administrator’s acknowledgment that ownership of the life insurance policy or interest in the certificate has been transferred and the beneficiary has been designated in accordance with the termination of the life settlement contract.

13. The life settlement provider must provide you, the owner with the name, business address, telephone number and e-mail address of the independent third-party escrow agent or trustee. You have the right to inspect or receive copies of the relevant escrow or trust agreements or documents.

14. The life settlement provider must provide you, the owner, with the date by which the funds will be available to you and the transmitter of the funds has the right to know any affiliations or contractual arrangements with any other life settlement provider, life settlement broker, life settlement intermediary or party financing the transaction.

15. The life settlement provider must tell you, the owner, about any affiliations or contractual arrangements between it and the issuer of the life insurance policy to be settled.

16. The life settlement provider must tell you, the owner, about any affiliations or contractual arrangements with any other life settlement provider, life settlement broker, life settlement intermediary or party financing the transaction.

17. The life settlement provider must provide you, the owner, with the name, business address, telephone number and e-mail address of the life settlement provider.

The undersigned is the owner of, or named insured under, one or more life insurance policies identified below. In order to effect a life settlement contract between the owner and a life settlement provider, or to effectuate the sale or transfer of a life settlement contract or a settled policy, or interest therein, the undersigned each hereby consent to the release of information to the authorized recipients specified herein.

Information Authorized to be Released: Any information (1) concerning or related to the identity of the owner of, or the named insured under, the life insurance policies identified below, (2) that there is a reasonable basis to believe could be used to identify the insured or owner, and (3) concerning or related to the owner’s or insured’s financial or medical information may be released to the authorized recipients (as defined below). Such information may include (but is not limited to): the name, address, telephone numbers, social security number, tax records, medical records, credit information and other non-public personal information of or related to the insured or the owner, or representative thereof; and the related insurance policy number(s).

Authorized Recipients of Information: Information authorized to be released hereunder may be released to (1) any life settlement broker, (2) any life settlement provider (a “life settlement provider”), (3) any person who may seek to purchase from such life settlement provider any life insurance policy insuring the below identified insured’s life or other insurance product owned by the below identified owner, (4) any financing entity of a life settlement provider, including, but not limited to, any of its underwriters, lenders, purchasers of securities and credit enhancers, (5) any service provider, including, but not limited to, any life expectancy underwriter, escrow agent or post-purchase policy servicer, (6) any life insurance or annuity company that has issued a life insurance policy insuring the below identified insured’s life, and (7) any of the respective affiliates, directors, officers, employees, agents, representatives, independent contractors, accountants, actuaries, attorneys and other representatives and advisors, and successors and assigns of any of the persons or entities covered in the immediately foregoing clauses (1) through (6) inclusive (each, an “authorized recipient”). Each authorized recipient in receipt of information authorized to be released by this authorization may share any such information with any other authorized recipient as if such other authorized recipient had received such information directly from the undersigned.

The undersigned each certify that this authorization has been made freely, voluntarily and without coercion and that the information shown below is accurate and complete to the best of the undersigned’s knowledge. The undersigned each understands that the undersigned each may revoke this authorization any time and that any revocation of this authorization will not apply to information that has already been released in response to this authorization. Redisclosure of the undersigned’s information by those receiving the above authorization may be accomplished without the undersigned’s further written authorization and may no longer be protected. The undersigned releases any authorized recipient from any and all liability for actual or alleged damages to the undersigned as a result of good faith compliance with this authorization. This authorization shall remain valid and shall expire, twenty-four (24) months from the date signed hereof, provided that this authorization shall be of no force or further effect if a life settlement contract is not effected. The undersigned each acknowledge receipt of a copy of this authorization.

A copy of this authorization may be accepted as an original. This authorization may be sent via facsimile transmission.

The owner of the life insurance policy, as well as each person insured by the life insurance policy (an insured), should be aware of the following:

(1) Possible alternatives to life settlement contracts exist, including, but not limited to, accelerated benefits offered by the issuer of the life insurance policy;

(2) Some or all of the proceeds of a life settlement contract may be taxable and that assistance should be sought from a professional tax advisor;

(3) The proceeds from a life settlement contract could be subject to the claims of creditors;

(4) Receipt of proceeds from a life settlement contract may adversely affect the recipients’ eligibility for public assistance or other government benefits or entitlements and that advice should be obtained from the appropriate agencies;

(5) The owner has a right to terminate a life settlement contract within fifteen days of the date it is executed by all parties and the owner has received the disclosures required by this section. Rescission, if exercised by the owner, is effective only if both notice of the rescission is given, and the owner repays all proceeds and any premiums, loans, and loan interest paid on account of the provider within the rescission period. If the insured dies during the rescission period, the contract shall be deemed to have been rescinded subject to repayment by the owner or the owner’s estate of all proceeds and any premiums, loans, and loan interest to the provider;

(6) Proceeds will be sent to the owner within three business days after the provider has received the insurer or group administrator’s acknowledgment that ownership of the policy or interest in the certificate has been transferred and the beneficiary has been designated in accordance with the terms of the life settlement contract;

(7) Entering into a life settlement contract may cause other rights or benefits, including conversion rights and waiver of premium benefits that may exist under the policy to be forfeited by the owner and that assistance should be sought from a professional financial advisor;

(8) The date by which the funds will be available to the owner and the transmitter of the funds;

(9) The commissioner may require delivery of a buyer’s guide or a similar consumer advisory package in the form prescribed by the commissioner to owners during the solicitation process;

(10) All medical, financial, or personal information solicited or obtained by a provider or broker about an insured, including the insured’s identity or the identity of family members, a spouse or a significant other may be disclosed as necessary to effect the life settlement contract between the owner and provider. If you are asked to provide this information, you will be asked to consent to the disclosure. The information may be provided to someone who buys the policy or provides funds for the purchase. You may be asked to renew your permission to share information every two years.

(11) The insured may be contacted by either the provider or broker or its authorized representative for the purpose of determining the insured’s health status or to verify the insured’s address. This contact is limited to once every three months if the insured has a life expectancy of more than one year, and no more than once per month if the insured has a life expectancy of one year or less.

(12) If you choose to enter into life settlement contracts with a provider, their name, address, and telephone number will be disclosed to you. Additionally, any affiliation between the provider and the issuer of the insurance policy to be settled will be disclosed to you.

(13) A broker represents exclusively the owner, and not the insurer or the provider or any other person, and owes a fiduciary duty to the owner, including a duty to act according to the owner’s instructions and in the best interest of the owner.

(14) If you choose to enter into life settlement contracts, the name, business address, and telephone number of the independent third-party escrow agent, and the fact that the owner may inspect or receive copies of the relevant escrow or trust agreements or documents.

(15) A change of ownership could in the future limit the insured’s ability to purchase future insurance on the insured’s life because there is a limit to how much coverage insurers will issue on one life.

Any person who knowingly presents false information in an application for insurance or life settlement contract is guilty of a crime and may be subject to fines and confinement in prison.

The following section, in part, contained in Arizona Law, addresses the way the insured’s personally identifiable information, including without limitation, his or her financial, medical and insurance related information, is permitted to be disclosed. With the insured’s and owner’s required signatures, the insured and owner are acknowledging the law as indicated below and authorizing their consent to such disclosure.

Except as otherwise allowed or required by law, a provider, broker, insurance company, insurance producer or any other person with actual knowledge of an insured’s identity shall not disclose the identity of an insured or any information that there is a reasonable basis to believe could be used to identify the insured or the insured’s financial or medical information to any other person unless the disclosure is one of the following:

(1) necessary to effect a life settlement contract between the owner and a provider and the owner and insured have provided prior written consent to the disclosure;

(2) necessary to effectuate the sale of life settlement contracts or interests in life settlement contracts as investments if the sale is conducted pursuant to applicable state and federal securities laws and the owner and the insured have both provided prior written consent to the disclosure;

(3) provided in response to an investigation or examination by the director or any other state or federal agency;

(4) a term or condition to the transfer of a policy by one provider to another provider, in which case the receiving provider shall be required to comply with all applicable laws regarding the confidentiality of medical information;

(5) necessary to allow the provider or broker or the provider’s or broker’s authorized representatives to make contacts for the purpose of determining health status. For the purposes of this paragraph, authorized representative does not include any person who has or may have any financial interest in the settlement contract other than a provider or licensed broker. Authorized representatives shall agree in writing to adhere to all applicable confidentiality and privacy laws; or

(6) required to purchase stop loss coverage.

In addition to the acknowledgement and authorization above, with the signature below, each undersigned is allowing his or her personally identifiable information, including without limitation, his or her financial, medical and insurance related information, to be transmitted electronically, via e-mail or through a password protected and secure website, to the appropriate parties, as permitted by Arizona law, who have an identifiable need to facilitate the sale of the life insurance policy or policies.

(to be signed no later than the date of application for a life settlement contract)

IMPORTANT

READ THIS DISCLOSURE DOCUMENT BEFORE SIGNING A LIFE SETTLEMENT CONTRACT.

You should carefully read the following information and seek financial, insurance, tax and other advice where appropriate.

1. Possible alternatives to life settlement contracts exist, including accelerated death benefits offered by the issuer of the life insurance policy.

2. Some or all of the proceeds of a life settlement contract may be taxable under law. You should seek assistance from a professional tax advisor.

3. Proceeds from a life settlement contract could be subject to the claims of creditors.

4. Receipt of the proceeds from a life settlement contract may adversely affect the recipient’s eligibility for public assistance or other government benefits or entitlements and advice should be obtained from the appropriate agencies.

5. The owner has a right to terminate a life settlement contract within 15 days of the date the contract is executed by all parties and the owner has received the disclosures described herein under the life settlement act. Rescission, if exercised by the owner, is effective only if both notice of the rescission is given and the owner repays all proceeds and any premiums, loans, and loan interest paid on account of the provider during the rescission period. If the insured dies during the rescission period, the contract is considered rescinded subject to repayment by the owner or the owner’s estate of all proceeds and any premiums, loans, and loan interest to the provider.

6. Proceeds will be sent to the owner within three business days after the provider has received the insurer or group administrator’s acknowledgement that ownership of the policy or interest in the certificate has been transferred and the beneficiary has been designated in accordance with the terms of the life settlement contract.

7. Entering into a life settlement contract may cause the owner to forfeit other rights or benefits, including conversion rights and waiver of premium benefits that may exist under the life insurance policy or certificate of a group policy. You should seek assistance from a professional financial advisor.

8. The amount and method of calculating the compensation, including anything of value, paid or given, or to be paid or given, to the broker, or any other person acting for the owner in connection with the transaction.

9. The date by which the funds will be available to the owner and the identity of the transmitter of the funds.

10. The fact the commissioner requires delivery of a buyer’s guide or a similar consumer advisory package in the form prescribed by the commissioner to owners during the solicitation process.

11. The following language: “All medical, financial, or personal information solicited or obtained by a provider or broker about an insured, including the insured’s identity or the identity of family members or a spouse or a significant other, may be disclosed as necessary to effect the life settlement contract between the owner and provider. If you are asked to provide this information, you will be asked to consent to the disclosure. The information may be provided to someone who buys the policy or provides funds for the purchase. You may be asked to renew your permission to share information every two years”.

12. The fact the commissioner requires providers and brokers to print separate signed fraud warnings on the applications and on the life settlement contracts as follows: Any person who knowingly presents false information in an application for insurance or a life settlement contract is guilty of a crime and may be subject to fines and confinement in prison.”

13. The fact the insured may be contacted by either the provider or broker or an authorized representative of the provider or broker for the purpose of determining the insured’s heath status or to verify the insured’s address and that this contact is limited to once every three months if the insured has a life expectancy of more than one year, and not more than once per month if the insured has a life expectancy of one year or less.

14. The affiliation, if any, between the provider and the issuer of the insurance policy to be settled.

15. That a broker represents exclusively the owner, and not the insurer or the provider or any other person, and owes a fiduciary duty to the owner, including a duty to act according to the owner’s instructions and in the best interest of the owner.

16. The fact that you will be provided with the name, address, and telephone number of the provider.

17. The fact that you will be provided with the name, business address, and telephone number of the independent third-party escrow agent. You have the right to inspect or receive copies of the relevant escrow or trust agreements or documents.

18. The fact that a change of ownership could in the future limit the insured’s ability to purchase future insurance on the insured’s life because there is a limit to how much coverage insurers will issue on one life.

1. Possible alternatives to viatical settlement contracts, including any accelerated death benefits or policy loans offered under the viator’s life insurance policy;

2. Some or all of the proceeds of the viatical settlement may be taxable under Federal income tax and State franchise and income taxes, and assistance should be sought from a professional tax advisor;

3. Proceeds of the viatical settlement could be subject to the claims of creditors;

4. Receipt of the proceeds of a viatical settlement may adversely affect the viator’s eligibility for Medicaid or other government benefits or entitlements, and advice should be obtained from the appropriate government agencies;

5. The viator has the right to rescind a viatical settlement contract for 15 calendar days from the receipt of the viatical settlement proceeds by the viator as provided in section 8(g) If the insured dies during the rescission period, the settlement contract shall be deemed to have been rescinded, subject to repayment of all viatical settlement proceeds and other payments made by the viatical settlement provider on behalf of the viator or insured to the viatical settlement provider;

6. Funds will be sent to the viator within three business days after the viatical settlement provider has received the insurer or group administrator’s acknowledgment that ownership of the policy or interest in the certificate has been transferred and the beneficiary has been designated;

7. Entering into a viatical settlement contract may cause other rights or benefits, including conversion rights and waiver of premium benefits that may exist under the policy or certificate, to be forfeited by the viator, and that assistance should be sought from a financial adviser;

8. All medical, financial or personal information solicited or obtained by a viatical settlement provider or viatical settlement broker about an insured, including the insured’s identity or the identity of family members, a spouse or a significant other may be disclosed as necessary to effect the viatical settlement between the viator and the viatical settlement provider and/or financing entities. If a viator is asked to provide this information, the viator must consent to the disclosure, and failure to consent may affect the viator’s ability to viaticate a life insurance policy. The information may be provided to viatical settlement purchasers, financing entities, special purpose entities or related provider trusts; and

9. All information provided by a viator or insured to a viatical settlement provider or viatical settlement broker will be shared with the insurer that issued the life insurance policy that is the subject of the viatical transaction.

10. The sale of your insurance policy may affect your right to receive Medicaid or other government benefits or entitlements. Advice on such effects should be obtained form the appropriate government agencies.

11. Noam S. Weiss will be compensated. The viatical settlement provider company, not the viator (policy owner) will compensate Noam S. Weiss, based on a formula that is a percentage of the face value of the life insurance policy. For example: compensation for a $100,000 policy could be: 8% of $100,000 (face value) = $8,000. Compensation can include, but is not limited to, bonuses, overrides or other funds in addition to viatical settlement broker commissions.

The owner of the life insurance policy to be viaticated, the viator, should be aware of the following:

1. that a viatical settlement broker represents exclusively the viator, and not the insurer or the viatical settlement provider, and owes a fiduciary duty to the viator, including a duty to act according to the viator’s instructions and in the best interests of the viator;

2. some or all of the proceeds of the viatical settlement may be taxable under federal income tax and state franchise and income taxes, and assistance should be sought from a professional tax advisor;

3. proceeds of the viatical settlement could be subject to the claims of creditors;

4. receipt of the proceeds of a viatical settlement may adversely affect the viator’s eligibility for Medicaid or other government benefits or entitlements, and advice should be obtained from the appropriate government agencies;

5. the viator has the right to rescind a viatical settlement contract before the earlier of 30 calendar days after the date upon which the viatical settlement contract is executed by all parties or 15 calendar days after the viatical settlement proceeds have been paid to the viator, as provided in section 60A.9579, subdivision 3. Rescission, if exercised by the viator, is effective only if both notice of the rescission is given, and the viator repays all proceeds and any premiums, loans, and loan interest paid on account of the viatical settlement within the rescission period. If the insured dies during the rescission period, the viatical settlement contract shall be deemed to have been rescinded, subject to repayment by the viator or the viator’s estate of all viatical settlement proceeds and any premiums, loans, and loan interest to the viatical settlement within 60 days of the insured’s death;

6. funds will be sent to the viator within three business days after the viatical settlement provider has received the insurer or group administrator’s written acknowledgment that ownership of the policy or interest in the certificate has been transferred and the beneficiary has been designated;

7. entering into a viatical settlement contract may cause other rights or benefits, including conversion rights and waiver of premium benefits that may exist under the policy or certificate, to be forfeited by the viator. Assistance should be sought from a financial adviser;

8. the disclosure document shall contain the following language: “All medical, financial, or personal information solicited or obtained by a viatical settlement provider or viatical settlement broker about an insured, including the insured’s identity or the identity of family members, a spouse, or a significant other may be disclosed as necessary to effect the viatical settlement between the viator and the viatical settlement provider. If you are asked to provide this information, you will be asked to consent to the disclosure. The information may be provided to someone who buys the policy or provides funds for the purchase. You may be asked to renew your permission to share information every two years.”; and

9. following execution of a viatical contract, the insured may be contacted for the purpose of determining the insured’s health status and to confirm the insured’s residential or business street address and telephone number, or as otherwise provided in sections 60A.957 to 60A.9585. This contact shall be limited to once every three months if the insured has a life expectancy of more than one year, and no more than once per month if the insured has a life expectancy of one year or less. Contacts shall be made only by a viatical settlement provider licensed in the state in which the viator resided at the time of the viatical settlement, or by the authorized representative of a duly licensed viatical settlement provider.

10. Jeffrey Goldfine will be compensated. The viatical settlement provider company, not the viator (policy owner), will compensate Jeffrey Goldfine, based on a formula that is a percentage of the face value of the life insurance policy. For example: compensation for a $100,000 policy could be: 8% x $100,000 (face value) = $8,000.00. Compensation can include, but is not limited to, bonuses, overrides or other funds in addition to viatical settlement broker commissions.

IMPORTANT
READ THIS DISCLOSURE DOCUMENT BEFORE SIGNING IT

You should carefully read the following information and seek financial, insurance, tax and other advice where appropriate.

1. You, the insured, may be contacted by the life settlement provider or its authorized representative for the purpose of determining the insured’s health status or to verify your address. You may not be contacted more often than once every three months if you have a life expectancy of more than one year, and no more than once per month if you have a life expectancy of one year or less.

2. A change of ownership of the policy that is the subject of this life settlement contract could in the future limit your ability to purchase future insurance on you life because there is a limit to how much coverage insurers will issue on one life.

3. All medical, financial or personal information solicited or obtained by a life settlement provider or life settlement broker about you, the insured, including your identity or the identity of your family members, your spouse or significant other may be disclosed as necessary to effect the life settlement contract between the owner and provider. If you are asked to provide this information, you will be asked to consent to the disclosure. The information may be provided to someone who buys the policy or provides funds for the purchase. You may be asked to renew your permission to share information every two years.

4. No medical, financial or other personal information may be disclosed without your written consent.

ACKNOWLEDGMENT OF THIS DOCUMENT DOES NOT CONSTITUTE CONSENT TO DISCLOSURE OF YOUR MEDICAL, FINANCIAL OR OTHER PERSONAL INFORMATION

Department of Insurance
Life Settlement Licensee
Disclosure to Life Settlement Applicant
(To be provided no later than at time of application for any life settlement contract)

IMPORTANT: READ THIS DISCLOSURE FORM BEFORE SIGNING ANY LIFE SETTLEMENT CONTRACT.

You should carefully read all of the following points and seek financial, insurance, tax and other advice where appropriate.

1. There may be possible alternatives to life settlements which exist and include, but are not limited to, accelerated benefits options that may be offered by your life insurer.

2. Some or all of the proceeds of a life settlement may be taxable. Assistance should be sought from a professional tax adviser.

3. There may be an impact on the receipt of public assistance. The recipient should contact the State Department of Health Care Services and the State Department of Social Services under Section 11022 of the Welfare and Institutions Code for further information.

4. Proceeds from a life settlement could be subject to the claims of creditors.

5. Entering into a life settlement contract may cause other rights or benefits, including conversion rights and waiver of premium benefits that may exist under the policy or certificate of a group policy to be forfeited. Assistance should be sought from a financial adviser.

6. Entering into a life settlement could limit the insured’s ability to purchase life insurance in the future because there is a limit to how much coverage insurers will issue on one life.

7. The owner has a right to rescind a life settlement contract within thirty (30) days of the date it is executed by all parties and the owner has received all required disclosures, or fifteen (15) days from receipt by the owner of the proceeds of the life settlement, whichever is sooner. Rescission will only be effective if both notice of rescission is given and all proceeds and any premiums, loans, and loan interest paid on account of the provider are repaid within the rescission period. If the insured dies during the rescission period, the contract shall be deemed to have been rescinded subject to repayment by the owner or the owner’s estate of all proceeds and any premiums, loans, and loan interest to the provider.

8. Proceeds will be sent to the owner within three (3) business days after the provider has received the insurer or group administrator’s acknowledgment that ownership of the policy of the interest in the certificate has been transferred and the beneficiary has been designated in accordance with the terms of the life settlement contract.

9. All medical, financial, or personal information solicited or obtained by a provider or broker about an insured, including the insured’s identity or the identity of family members, a spouse, or a significant other may be disclosed as necessary to effect the life settlement contract between the owner and provider. If you are asked to provide this information, you will be asked to consent to the disclosure. The information may be provided to someone who buys the policy or provides funds for the purchase. You may be asked to renew your permission to share information every two (2) years.

10. The insured may be contacted by either the provider or the broker or its authorized representative for the purpose of determining the insured’s health status or to verify the insured’s address. This contact is limited to once every three (3) months if the insured has a life expectance of more than one (1) year, and no more than once per month if the insured has a life expectance of one (1) year or less.

11. The broker represents the owner, exclusively, and not the insurer or the provider or any other person, and owes a fiduciary duty to the owner, including a duty to act at all times according to the owner’s instructions and in the best interest of the owner.

12. The name, business address, and telephone number of the life settlement broker are as follows:
Noam S. Weiss
3260 Fairlane Farms Rd #3
Wellington, FL 33414
888-255-0444