CHESTER J. CULVER GOVERNOR PATTY JUDGE LT. GOVERNOR
SUSAN E. VOSS COMMISSIONER OF INSURANCE
VIATICAL SETTLEMENT BROKER “INDIVIDUAL” LICENSE APPLICATION AND RENEWAL CHECKLIST
REVISED 3/18/2009
All Applicants:
Completed Viatical Settlement Broker Application Life Producer License in good standing for the preceding 12 months or date passed Viatical Broker Exam (Examination results are valid for 90 days after the date of the test. Failure to apply for licensure within 90 days after the examination is passed shall void the examination results.) Non-refundable Filing Fee of $100.00 (Check made payable to the “Iowa Insurance Division”) Documentation of the applicant's qualifications to engage in the viatical settlement broker business that complies with Iowa Code Section 508E.3(6.c) either by Resume or Curriculum Vitae, or Letter describing education, training and relevant work/professional experience, professional designations professional licenses held Proof of registration with the Iowa Secretary of State or an affidavit stating other names to be used if applicant will be conducting business using any name other than the applicant's personal legal name Written anti-fraud plan that complies with Iowa Code Section 508E.15(7) Description of procedures in place to safeguard the confidentiality of viators’ personal and medical information Proof of E & O coverage Evidence of Continuing Education hours completed to date 191-48.3(5) (renewal applications only)
Additional Requirements for Nonresident Applicants:
Copy of viatical settlement broker license or documentation of authority to engage in viatical brokering in domicile state or documentation that the applicant's domicile state does not license viatical settlement brokers If Life licensed, a Certificate of Good Standing from domicile state Name and address of appointed Agent for Service of Process or Written Irrevocable Consent to Service of Process on the Commissioner by signing application that complies with Iowa Code Section 508E.3(7)
330 MAPLE STREET / DES MOINES, IOWA 50319-0065 / 515-281-5705 / Facsimile 515-281-3059 http://www.iid.state.ia.us/