Form P-LSDO: Life Settlement: Provider/Broker Disclosures to Owner

NEW AGENCY

Arizona Department of Insurance
100 North 15th Avenue, Suite 261
Phoenix, AZ  85007-2630

Starting July 1, 2020, we became the
Department of Insurance and Financial Institutions (DIFI).

This document has been approved by the Department of Insurance and it does not need to be filed with the Department by a broker or provider. A provider or broker may use this form to provide an owner with disclosures that are required by ARS § 20-3204(A) and (B). A provider or 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

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