Form P-LSBD: Life Settlement Broker: Disclosures to Owner and Provider

This document has been approved by the Department of Insurance and it does not need to be filed with the Department. A broker may use this form to provide the owner and provider with disclosures that are required by ARS § 20-3204(C). A broker who intends to use a different form must submit the form for approval using the NAIC System for Rate and Form Filings ("SERFF"), accessible at

Warning - Phishing Scam

We are aware of a phishing scam targeting insurance professionals claiming that the National Association of Insurance Commissioners received a complaint that the professional submitted a falsified claim. This fraudulent email displays the NAIC and CIPR logos, can originate from what appears to be an or email account, and instructs the recipient to click on a link to download the complaint notification.

Certain antivirus products will detect this as a malicious email.  If you receive a similar email and have any concerns, contact the NAIC Service Desk at (816) 783-8500 or [email protected].