B Viatical Settlement Broker Report and Instructions - All States and Territories (Form VSB-001)

Section 3701 .EXHIBIT B Viatical Settlement Broker Report and Instructions − All States and Territories (Form VSB-001) Viatical Settlement Broker Report Calendar year Viatical Settlement Broker's Name All States and Territories 20____ 1 2 3 4 5 6 7 8 States Are you doing business in this state? (Y/N) Total number of policies reviewed for consideration Total number of policies represented for viatication Total number of policies where representation was refused Total number of policies sold to provider Aggregate net death benefit viaticated Aggregate net amount paid to viators Number of policies purchased/sold on the secondary market Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Guam Puerto Rico U.S Virgin Islands Canada TOTALS Instructions for Viatical Settlement Broker Report – All States and Territories COLUMN 1 By a "Y" for yes or an "N" for no, indicate if you have or have not done business in the state during the calendar year being reported. 2 For each state or territory in which you have done business during the calendar year being reported, indicate the total number of policies reviewed for consideration. 3 For each state or territory in which you have done business during the calendar year being reported, indicate the total number of policies for which an offer was made. 4 For each state or territory in which you have done business during the calendar year being reported, indicate the total number of policies for which an offer was refused. 5 For each state or territory in which you have done business during the calendar year being reported, indicate the total number of policies purchased. 6 For each state or territory in which you have done business during the calendar year being reported, list the total aggregate net death benefit of the policies viaticated. 7 For each state or territory in which you have done business during the calendar year being reported, list the total aggregate amount paid to viators. 8 For each state or territory in which you have done business during the calendar year being reported, list the total number of policies purchased and/or sold on the secondary market.