Application for Initial and Renewal
Life Settlement Provider License
Section 632.69, Wis. Stat.

To view any of the listed statutes, see the Wisconsin Revisor of Statutes Web site.

Application Forms

The following documents must be completed and returned for application as a life settlement provider. The forms are available to be downloaded below. Note, however, that you will need an Adobe Acrobat Reader to view or print the application forms, which you can download at no cost from Adobe . If you wish to use the fill and print form, see the instructions below. The form, once filled in, can be printed. In order to save the filled in form, you will need to purchase additional software from Adobe. If you do not wish to use the fillable pdf form, click on the print version of the form, print it, and complete it.

Fill and Print Version--Application Forms (opens in new window)

Print Version--Application Forms (opens in new window)


Designation of Registered Agent for Service of Process

A Designation of Registered Agent for Service of Process (OCI 12-014) form is available to be downloaded below. Note, however, that you will need an Adobe Acrobat Reader to view or print the application, which you can download at no cost from Adobe .

Designation of Registered Agent for Service of Process (opens in new window)
Fill and Print Version (opens in new window)


NAIC Company Code Application—For Wisconsin-Domiciled Life Settlement Providers Only

A link to the NAIC Company Code Application form is provided below for your convenience. Note, however, that you will need an Adobe Acrobat Reader to view or print the application form, which you can download at no cost from Adobe . Life Settlement Providers need not file financial data with the NAIC, but are required to obtain a NAIC Company Code. This assists with the collection of demographic statistics by state and federal authorities. Once the NAIC Company Code is issued, it remains in force for the entire existence of the Life Settlement Provider. Wisconsin cannot coordinate issuance of a NAIC Company Code to a Life Settlement Provider that is incorporated in a state other than Wisconsin.

NAIC Company Code Application (opens in new window)


Please direct questions to: Steve Caughill, (608) 267-2049, steve.caughill@wisconsin.gov, or ocifinancial@wisconsin.gov (please include your name, phone number, and e-mail address).


How to use fillable pdf forms:

  1. Click the link for the fill and print version of the forms above.
  2. Select the Hand tool if it is not already selected.
  3. Click in the first fillable field.
  4. Use the mouse to select (click on) a specific field or use the Tab key to move through the fields. Shift + Tab will go to the previous field.
  5. Use the space bar or click the mouse button to mark or unmark a box.
  6. For forms containing more than one page, use the scroll bar at the right to move from page to page or click the next page button in the status bar at the bottom of the form to advance to the next page.
  7. Once completed, print the completed form. You may want to print a copy for your records.
  8. Press the Reset Form button at the top right corner of page 1 of the form to clear the form.