Use this confidential worksheet to gather everything you’ll need before any life settlement consultation in your state. Pick your state above and the worksheet pre-fills with that state’s regulator and rescission window. Fill it in on screen, then print or save as PDF.

Your state:

Florida Life Settlement Policy Review Worksheet

Pine Lake Life Solutions — confidential, educational. Bring this completed worksheet to any consultation.

at a glance: Regulator:
Governing law:
Rescission window:
Verify any broker via the before sharing personal information.

1. Policyholder — Insured information

Insured's full name

Date of birth

State of residence

Best contact phone

2. Policy information

Insurance carrier

Policy number

Policy type

Face value

Issue date

Current annual premium

3. Health snapshot

Insured's general health

Significant changes since issue?

4. Your goals

Why are you considering this?

Ideal outcome

5. Verification checklist

I confirmed any broker/provider is licensed via the . I understand the rescission window. I plan to consult a tax professional. I plan to consult a benefits/legal professional about Medicaid impact.

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Florida Life Settlement Policy Review Worksheet

1. Policyholder — Insured information

2. Policy information

3. Health snapshot

4. Your goals

5. Verification checklist

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