**Life Settlement Provider**

The following items need to be submitted to the address below to be considered for a License:

Please review RSA 408-D.

• Application Form **life settlement contract forms and disclosure statement forms need to be submitted using SERFF at http://www.serff.com
• Surety Bond Form
• NAIC Biographical Affidavit Form
• Service of Process Form
• $1,000 application fee. **Fee is non-refundable.

**IMPORTANT** - 408-D:19 A life settlement provider or life settlement producer transacting business in this state may continue to do so pending approval or disapproval of the life settlement provider, or life settlement producer application for licensure if the application is filed with the commissioner within one month of the effective date of this chapter.

The following providers have submitted applications and may continue to transact business in NH pending approval or disapproval of their applications:

• Habersham Funding, LLC - 3495 Piedmont Rd Ste 910 Bldg 11, Piedmont Ctr, Atlanta GA 30305 - Domicile: Georgia
• Maple Life Financial, Inc. - 4350 East-West Hwy Ste 900, Bethesda MD 20814 - Domicile: Maryland
• Proverian Capital, LLC - 111 Broadway Ste 603, New York NY 10006 - Domicile: Delaware

Licenses must be renewed each year by the anniversary date. Failure to pay renewal fees by the anniversary date will result in the expiration of the license.

The completed application package and filing fee should be directed to the New Hampshire Insurance Department, Financial Examination and Analysis Division.

If you have any questions, please contact Diane Cygan.

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**Life Settlement Producers**

The following items need to be submitted to the address below to be considered for a Life Settlement Producer License:

Please review RSA 408-D.

Life Settlement Producer Application
Provider Appointment Form

Documentation is mailed to:

NH Insurance Department
21 South Fruit, Suite 14
Concord NH 03301

If you have any questions on the Producer forms, please contact Joan LaCourse.

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