Viatical Settlement Agreement

Viator (Policy Owner): [Name] · Viatical Settlement Provider: [Company Name, license #] · Policy: [Insurance Company, Policy #, Face Value] · Date: [Date]

1. Sale of Policy

Viator agrees to sell, and Provider agrees to purchase, all right, title, and interest in the life insurance policy described above, in exchange for a lump-sum payment of [Amount].

2. Change of Beneficiary and Ownership

Upon completion of this sale, Provider (or its designated purchaser) becomes the owner and beneficiary of the policy, and Viator's named beneficiaries no longer have any interest in the death benefit.

3. Medical Information Release

Viator authorizes Provider and its underwriters to obtain and review Viator's medical records to determine eligibility and pricing for this settlement.

4. Right to Rescind

Viator has the right to rescind this agreement within [Period, e.g. 15-30 days, per state law] of receiving the settlement proceeds, by returning the funds received.

5. Continued Premium Payments

[State who is responsible for premium payments from this point forward — typically the Provider, once ownership transfers.]

6. Disclosures

Provider has disclosed to Viator: [alternatives to a viatical settlement (accelerated death benefit riders, if the policy has one), the tax treatment of settlement proceeds, and that this transaction is irrevocable after the rescission period].

7. Confidentiality

Provider will keep Viator's medical and personal information confidential, consistent with applicable state viatical settlement privacy laws.

Viator signature: ______________________ Date: ____________ Provider signature: ______________________ Date: ____________

*This document is provided for informational and educational purposes only and does not constitute legal, financial, or medical advice. Viatical settlements are heavily regulated at the state level specifically because of past predatory practices — before selling a policy, a policyholder should check whether their own policy has a lower-cost "accelerated death benefit" rider that could provide similar funds without permanently giving up the policy.*