Get a Free Appraisal from Life Settlement Clearinghouse

Please enter the following information to receive a free appraisal from Life Settlement Clearinghouse. And remember -- This information is strictly confidential! Please note, the blue fields are required.

Insured -- Personal Information

Name: First: Last:

Date of Birth: Month: Day: Year:

Nicotine Use: Yes No

Please briefly describe any current health problems and/or how your health has changed since you purchased the policy, or call our office at 800-233-6481:

Have you had an insurance exam in the past 60 days? Yes No

Please provide the following information regarding your current policy:

Face amount: $

Type of policy:

How long have you had this policy? years

Annual premium: $

Approximate current cash value: $

Amount of loan on policy, if any: $

Policy History

Briefly explain why you purchased this policy and why you want to sell it:

To complete your appraisal request, please enter the following information:

Name:

Address:

City:

State:

Zip:

Telephone:

(please include area code)

Fax:

(please include area code)

E-Mail:

(e.g., yourname@somewhere.com)

How did you find us?