We do not keep personal and confidential information on our server and as a result, this form will not be posted to our database. Instead it will be posted to an email that will be destroyed upon receipt. To start the process of a full audit, 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:	T100 Universal LifeWhole lifeOther
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 an audit: By submitting this form, you give us authorization to contact you for any further details required. You will be informed which auditor will be selected to handle your case. In Canada, the evaluation will be handled by our own auditor unless otherwise specified The auditor shall provide you the cost of the evaluation upfront.Such fees are at the discretion of the auditor up to $2,500 per audit/life. If the audit is referred to an auditor outside of our network, we reserve the right to charge a $250 fee to the auditor to cover the cost of this reference
When finished, click this button to transmit your information: