dear new broker, - unicorp life capital

1600 Broadway on the Square PH1C

New York, NY 10019 888.404.0031 Phone • 888.404.0032 Fax

www.UnicorpLifeCapital.com

November 10, 2009

Dear New Broker,

Unicorp Life Capital, LLC is excited to enter into this new endeavor with you and your company.

We have included a copy of our Life Settlement Broker Application and Due Diligence

Questionnaire for completion by every life settlement broker with whom Unicorp Life Capital

conducts business.

As always, Unicorp Life Capital is committed to providing the highest yielding settlement options

at the highest level of quality and proficiency. Your answers to the Questionnaire will allow us to

be more efficient and review the cases you submit to us in the future. Please complete the attached

questionnaire and return it to our Due Diligence and Compliance Department at

[email protected].

If you have any questions, please contact [email protected]. Thank you for

giving Unicorp Life Capital this opportunity. We look forward to a long and successful

relationship.

Regards,

Sherry DelRosso Acquisitions Executive

mailto:[email protected]

mailto:[email protected]




Life Settlement Broker Application and Due Diligence Questionnaire

Please complete the following questions. Please print legibly or type. Please have a company authorized individual sign this questionnaire, confirming that the information provided to us is complete and accurate.

Section 1 – Life Settlement Broker’s Information

Company/Individual Name________________________________________________________

Physical Address________________________________________________________________

______________________________________________________________________________

Office phone_______________________________ Fax number_________________________

Website Address________________________________________________________________

Type of legal entity: ( )Sole Proprietor ( )Partnership ( )LLC ( )Corporation

( )Other______________________________________________

Incorporation state_____________________ Incorporation date__________________________

Tax ID number_______________________ Number of employees_______________________

Number of Downline Agents_______________________________________________________

Do you have other viatical or life settlement brokers working directly for you? ( ) Yes ( ) No

If yes, how many do you estimate will be contracting directly with Unicorp Life Capital?

( ) 0 ( ) 1-5 ( )6-10 ( )11-15 ( )over 15




Section 2 – Personal Background Info. on Officers/Directors/Managing Partners

Full Name_____________________________________________________________________

Social Security Number____________________________ Date of Birth___________________

Driver’s License Number___________________________________ State__________________

Current Home Address___________________________________________________________

_______________________________________________ Dates: From________ to _________

Previous Home Address__________________________________________________________

_______________________________________________ Dates: From________ to__________

Email Address___________________________________ Home Phone No._______________

Full Name_____________________________________________________________________




_______________________________________________ Dates: From________ to _________


_______________________________________________ Dates: From________ to__________





Full Name_____________________________________________________________________




_______________________________________________ Dates: From________ to _________


_______________________________________________ Dates: From________ to__________


Full Name_____________________________________________________________________




_______________________________________________ Dates: From________ to _________


_______________________________________________ Dates: From________ to__________


Note: if you have more individuals to list as officers, directors or managing partners, please print extra copies of this page.




Section 3 – General Questions

For any questions answered “Yes”, please attach a detailed explanation (include copies of all related documents if relevant)

Has Life Settlement Broker ever had a life settlement broker license application denied or suspended, or been refused a permit, license, or certificate of authority by any regulatory authority, or governmental licensing agency, or been subject to disciplinary action?

[ ] Yes [ ] No Are there any civil, criminal and/or governmental investigations, audits, complaints, actions or other proceedings, now pending or threatened or ever filed against Life Settlement Broker and/or any of its principals (including shareholders) or personnel (whether or not such person is currently active in the business), relating to Life or Viatical Settlements, life insurance or related business?

[ ] Yes [ ] No Has Life Settlement Broker and/or any of its principals (including shareholders) or personnel ever pled guilty, no contest or been convicted of any criminal offense(s) of any kind?

[ ] Yes [ ] No Has Life Settlement Broker and/or any of its principals (including shareholders) or personnel been refused an occupational, professional or vocational license or permit by any regulatory authority, or any public, administrative, or governmental licensing agency and/or had such a license or permit ever been revoked or suspended, as it relates to Life or Viatical Settlements, life insurance or related business? [ ] Yes [ ] No




For any questions answered “Yes”, please attach a detailed explanation (include copies of all related documents if relevant)

Has Life Settlement Broker and/or any of its principals (including shareholders) or personnel ever been subject to a cease and desist letter or order, or enjoined, either temporarily or permanently, in any judicial, administrative, regulatory, or disciplinary action from violating any federal, state law or law of another country regulating the business of insurance, securities or banking, or from carrying out any particular practice or practices in the course of business of insurance, securities or banking?

[ ] Yes [ ] No Does Life Settlement Broker have policies and/or procedures for its life or viatical settlement broker business with respect to anti-fraud, anti-money laundering (including OFAC checks), records management, business practices, and information security? [ ] Yes [ ] No Does Life Settlement Broker have internal policies regarding its disclosures to the Owner-Seller of the compensation paid to the Life Settlement Broker in connection with life or viatical settlement transactions in accordance with the laws of each state in which it does business? [ ] Yes [ ] No Does Life Settlement Broker have policies and/or guidelines for maintaining the confidentiality of personal, non-public information and compliance with privacy laws? [ ] Yes [ ] No Does Life Settlement Broker have policies and/or guidelines for the review of policies that have been previously premium financed? [ ] Yes [ ] No Is Life Settlement Broker currently carrying insurance (i.e. comprehensive general liability, errors & omissions, fidelity, crime or other types of business insurance) in excess of $1,000,000? [ ] Yes [ ] No




Section 4 – States of Operations

Please check the appropriate box for each state.

State Doing Business in State

Licensed in State

State Doing Business in State

Licensed in State

Alaska Montana Alabama North Carolina Arkansas North Dakota Arizona Nebraska California New Hampshire Colorado New Jersey Connecticut New Mexico District of Columbia

Nevada

Delaware New York Florida Ohio Georgia Oklahoma Hawaii Oregon Iowa Pennsylvania Idaho Puerto Rico Illinois Rhode Island Indiana South Carolina Kansas South Dakota Kentucky Tennessee Louisiana Texas Massachusetts Utah Maryland Virginia Maine Vermont Michigan Washington Minnesota Wisconsin Missouri West Virginia Mississippi Wyoming




Section 5 – Additional Information

Please provide the following:

Certificate of Good Standing

Proof of registration in the states in which Life Settlement Broker operates (business

certificates)

Copies of all licenses legally required to represent a life settler in a life settlement

transaction for each state

Copies of all state securities broker/dealer license

Section 6 – Certification

The undersigned authorized officer of the above-referenced Life Settlement Broker hereby certifies that the information contained in this questionnaire and in the documents provided in connection with this questionnaire is complete and accurate. This certification is made with the recognition and understanding that Unicorp Life Capital, LLC and its affiliates will rely on the information provided in this questionnaire and the related documents in making a determination as to whether or not to enter into a business relationship with this Life Settlement Broker. Authorized Signature:____________________________________________________________ Print Name:____________________________________________________________________ Title:_________________________________________________________________________




Important Notice

This is to inform you that a consumer report or an investigative consumer credit report will be obtained from a consumer-reporting agency, for the purpose of evaluating you for entry into an Agreement with Unicorp Life Capital, LLC.

This report may contain information bearing on ;your prior employment, military record, education, credit worthiness, credit standing, credit capacity, character, general reputation, criminal background, personal characteristics or mode of living from public record sources. You may also have a right to request additional disclosures regarding the nature and scope of the investigation.

A summary of your rights under the Federal Fair Credit Reporting Act, prepared by the Federal Trade Commission accompanies this Notification Statement.

Authorization

I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge about me to furnish Unicorp Life Capital, LLC with any and all information in their possession regarding me in connection with my application for an appointment and contract for services. I agree that a photocopy or facsimile transmission of this Authorization can be accepted with the same authority as the original. Also, I specifically waive any written notice from any present or former employer who may provide information based upon this authorized request. I understand that this Authorization is part of my written application for an appointment by and contract to provide services to Unicorp Life Capital, LLC.

Additionally, I have read the paragraph above notifying me that a Consumer Report/Investigative Consumer Report will be requested and used for the purpose of evaluating me for entry into a Broker Agreement with Unicorp Life Capital, LLC.

Authorized signature_____________________________________________________________

Print Name______________________________________________ Date_________________

Social Security No. (for identification purposes only):____________________________________

Tax ID No. (if applicant is an entity):________________________________________________

Other name(s) under which you have been known:_____________________________________

dear new broker, - unicorp life capital

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