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 http://www.serff.org.