Viatical Disclosure Document Ii Form - Arkansas Securities Department printable pdf download

Viatical Disclosure Document Ii Form - Arkansas Securities Department

This disclosure document is mandated by the Arkansas Securities Department.

Viatical Disclosure Document II

Read Immediately Upon Receipt

You are purchasing a viatical settlement contract. A viatical settlement contract is

an agreement for the purchase of the death benefit of a life insurance policy. The

individual whose life insurance policy is being sold is called the viator.

Right to Rescind

By law, you have the right to rescind the purchase of this investment by giving written

notice of your intention to rescind. To be effective, your written notice of rescission must

be postmarked no later than 15 days following the later of:

a. the date on which you paid for your investment; or

b. the date on which you received this disclosure document.

It must be mailed, postage prepaid, to:

Name:

Address:

What you are purchasing

You are investing $

and will receive $

upon the death of the viator.

The life expectancy of the viator in whose policy you are investing is ________.

You are purchasing (check one):

_____ % (percent) ownership of a life insurance policy with a $____________

death benefit.

the entire ownership of a life insurance policy with a $ ____________

death benefit.

_____% (percent) of the death benefit of a life insurance policy with a

$____________ death benefit.

the entire death benefit of a life insurance policy with a $ ______________

death benefit

Viatical Disclosure Document Ii Form - Arkansas Securities Department