• pay the applicable fee of $250.00;
• complete and submit the Maryland Limited Lines Supplement Form;
• complete and submit the NAIC Uniform Individual Application.

To apply for a registration as a Viatical Broker, a business entity must:

• pay the applicable fee of $250.00;
• complete and submit the Maryland Limited Lines Supplement Form;
• complete and submit the NAIC Uniform Business Entity Application which require applicants to:
• submit any trade name to be used by the applicant and the name and residence address of any individual who holds a license and does business under the trade name;
• provide the name and address of each licensed producer employed by the business entity, each individual who has direct control over its fiscal management, and each owner, member, or manager of the business entity and each director of a business entity that is a corporation;
• designate a Maryland Life licensed insurance producer as its principal contact with the MIA.

To apply for a registration as a Viatical Settlement Provider, the applicant must:

• pay the applicable fee of $1,000.00;
• complete and submit the NAIC Uniform Individual Application.
• complete and submit the Maryland Limited Lines Supplement Form

A Viatical Settlement Broker registration expires the same day as the expiration of the underlying Producer Life license.

A Viatical Settlement Provider registration expires 2 years after the date of issuance.

The fee to renew a Viatical Settlement Broker or a Viatical Settlement Provider registration is $50.

The Applicants for a license renewal must submit all of the same document requirements as an applicant for an initial registration.

• online through NIPR ( www.nipr.com). A confirmation email will be sent to the email address
  provided on the application when your online application has been received. Make note of the
  transaction number so you may reference this when sending additional documents or
  inquiring for status.
• or paper application, along with the fees and any additional documents, should be mailed to:
  
  The Maryland Insurance Administration
  Attn: Producer Licensing
  200 Saint Paul Place, Suite 2700
  Baltimore, Maryland 21202
  
  *Payments should be in the form of a check, money order, or cashier’s check made payable to:
  Maryland Insurance Administration.

Application Forms

NAIC Uniform Application Initial Individual

NAIC Uniform Application Initial Business Entity

NAIC Uniform Application Renewal Individual

NAIC Uniform Application Renewal Business Entity

Note: Regardless of who completes the application, the license applicant is ultimately responsible for the contents of the application and must provide accurate and complete information (if the application was completed by someone other than the applicant, the person who completes an application may also be held responsible for the contents of the application). An application that fails to disclose or fails to provide accurate information may result in the DELAY and/or DENIAL of the application. If your license has already been issued and it is later discovered that the information contained in your application is not true, correct, or complete, your license may be REVOKED and you may be subject to monetary PENALTIES (if the application was completed by someone other than the applicant, the person who completed the application may also be subject to administrative action). If in doubt, disclose.