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