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INSTRUCTIONS: CONNECTICUT APPLICATION FOR LIFE SETTLEMENT PROVIDER LICENSE
To apply for a life settlement provider license in Connecticut, use the form discussed in this article. This document can be obtained from the website of the government of Connecticut.
Connecticut Application For Life Settlement Provider License Step 1: In the left hand portion of section 1, enter the name, mailing address, city, state, zip code, phone number, fax number and email address of the applicant.
Connecticut Application For Life Settlement Provider License Step 2: In the right hand portion of section 1, enter the physical address of the applicant, their city, state and zip code.
Connecticut Application For Life Settlement Provider License Step 3: In section 2, indicate whether the applicant is an individual, limited liability corporation, corporation, partnership or other with a checkmark. If a corporation, give the date of incorporation and the state in which this occurred. If other, explain.
Connecticut Application For Life Settlement Provider License Step 4: In section 3, give the name of a contact person to whom future correspondence from the Insurance Department should be addressed, as well as their phone number, fax number and email address.
Connecticut Application For Life Settlement Provider License Step 5: Section 4 details information that must be included in a detailed plan of operation.
Connecticut Application For Life Settlement Provider License Step 6: Sections 5 through 13 detail other information that must be submitted along with this application.
Connecticut Application For Life Settlement Provider License Step 7: On the fourth page, answer all questions by checking "Yes" or "No" as applicable.
Connecticut Application For Life Settlement Provider License Step 8: The fifth page is a certification of accuracy which must be completed by the applicant. Enter your signature on the first blank line.
Connecticut Application For Life Settlement Provider License Step 9: Print your name on the second blank line.
Connecticut Application For Life Settlement Provider License Step 10: Enter your title on the third blank line.
Connecticut Application For Life Settlement Provider License Step 11: The fifth page must be presented to a notary public, who will affix their seal.
Connecticut Application For Life Settlement Provider License Step 12: Pages 6 through or 9 contain a biographical affidavit which must be completed by the affidavit. Page 10 contains a certificate of accuracy regarding this affidavit.