For an equitable and just Financial Service industry








To start the process of a full evaluation, please complete this form. The data will be transferred into an email. It may look garbled to you but do not change anything. Just press send on your email.


Personal Information
First Name:
Last Name:
Email address:
Postal Code:
Phone Number:


Product Information
Do you have an active insurance agent: Yes
No
Select the type of product you have:
Name of company/issuer of product:
Name of product:
Name of advisor if there is one:
Are you considering a specific type of life settlement: Yes
No
Choice of life settlement if there is one:
Additional information
Note: For multiple products, submit multiple forms

Conditions associated with the request for evalaution:

By submitting this form, you give us authorization to contact you for any further details required. You will be informed which evaluator will be selected to handle your case. In Canada, the evaluation will be handled by our own evalautor unless otherwise specified


The evaluator shall provide you the cost of the evaluation upfront.Such fees are at the discretion of the evaluator up to $2,500 per evaluation. If the evaluation is referred to an evaluator outside of FSCA, FSCA reserves the right to charge a $100 fee to the evaluator to cover the cost of this reference

When finished, click this button to transmit your information: