
WELCOME FUNDS INC.
4755 TECHNOLOGY WAY
SUITE 202
BOCA RATON, FL 33431
TOLL-FREE: 877.227.4484
PHONE: 561.862.0244
FAX: 561.862.0242
WWW.WELCOMEFUNDS.COM
State of Texas
Life Settlement Broker License
FORM WFI.WELCOME.EF11/10 © 2010 Welcome Funds Inc
WELCOME FUNDS INC.
4755 TECHNOLOGY WAY
SUITE 202
BOCA RATON, FL 33431
TOLL-FREE: 877.227.4484
PHONE: 561.862.0244
FAX: 561.862.0242
WWW.WELCOMEFUNDS.COM
LETTER FROM THE PRESIDENT
Dear Policy Owner/Insured:
Thank you for choosing WELCOME FUNDS INC to help you determine and identify the merits and value of
selling your policy. We understand that the process can be intimidating and overwhelming and it is our job to
not only maximize the sales value of your policy(ies) in the secondary market, but also to provide a seamless,
transparent and fully informed experience. Please complete our Evaluation Request for Sale of Existing Life
Insurance and sign the appropriate pages.
As your designated broker who represents your best interests and follows your instructions, WELCOME
FUNDS INC incurs the necessary, required and related costs to facilitate the potential sale of your policy related
to the following services:
Evaluation Form assessment.
Medical underwriting and insurance verifications.
Obtaining and forwarding independent third party life expectancy reports.
Submission to multiple authorized and/or registered buyers of life insurance policies.
Best execution negotiation to maximize fair market value of the sale of your policy.
Closing services including contract review and assistance with contingency requirements of buyers of
life insurance policies.
Please read the Notice of Disclosure and the Broker Authorization and Services Agreement carefully and sign
accordingly. These pages represent the first step in explaining your rights and obligations associated with the
process. With that said, you are under no obligation to accept any contingent offers secured by WELCOME
FUNDS INC. Furthermore, we have attached a brief brochure issued to provide an unbiased, independent
description of selling policies in the secondary market. Please read the brochure as well.
Please be advised that the personal information acquired shall only be shared with individuals and entities with
an identifiable need to help determine the market value of your policy, including but not limited to life
expectancy underwriters and potential buyers of your policy. All parties involved in the analysis, evaluation,
underwriting and contingent pricing for transactions are required to maintain strict privacy and confidentiality
safeguards pursuant to applicable state and federal regulations.
Once again thank you for allowing us the opportunity to help you reach your financial goals and to represent
you in the secondary market for the potential sale of your life insurance policy.
Sincerely,
John M. Wel
c
o
m
President
FORM WFI.CHECK.EF7/10 © 2010 Welcome Funds Inc
WELCOME FUNDS INC.
4755 TECHNOLOGY WAY
SUITE 202
BOCA RATON, FL 33431
TOLL-FREE: 877.227.4484
PHONE: 561.862.0244
FAX: 561.862.0242
WWW.WELCOMEFUNDS.COM
TABLE OF CONTENTS
Document Title Page #(s)
Privacy Acknowledgement & Authorization 1 of 1
Evaluation R
equest for Sale of Existing Life Insurance
Insured’s Personal Information 1 of 4
Policy Information & Policy Owner In
formation 2 of 4
Additional Information
(Signature(s) Required) 3 of 4
Personal Acknowledgements
(Signature(s) Required) 4 of 4
Notice of Disclosure (Signature(s) Required) 1 – 2
Authorization for Release of Policy Information
(Signature(s) Required) 1 of 1
Authorization for the Disclosure of Protected Health Information/Primary Insured
(Signature(s) Required) 1 of 1
Authorization for the Disclosure of Protected Health Information/Secondary Insured
(Signature(s) Required) 1 of 1
Broker Authorization & Services Agreement
(Signature(s) Required) 1 of 1
Life Settlement Brochure
1 – 2
ADDITIONAL DOCUMENT CHECKLIST
Please include the following documents, if available, with your Evaluation Request to significantly decrease the time necessary to
facilitate the potential sale of your policy. If you cannot provide the items below, then Welcome Funds Inc will attempt to obtain
items A & B with the authority granted from the signed authorizations contained herein. Items C through H must be obtained
through your own efforts.
A. Current In Force Illustrations for Each Policy (please confirm desired/required illustrations with Welcome Funds Inc).
B. Medical Records for the Last Five (5) Years for Each Insured.
C. Photocopy of Two Forms of Identification (ie. Drivers License, SS Card, Passport etc...) for Each Insured & Policy Owner.
D. Photocopy of Applicable Insurance Policy/Policies (including applications for insurance).
E. Photocopy of Trust or Corporate Formation Documents (if applicable).
F. Photocopy of Divorce Decree of Insured & Policy Owner (if applicable).
G. Photocopy of Bankruptcy Discharge of Insured & Policy Owner (if applicable).
H. Photocopy of All Premium Finance Documents (if applicable).
FORM WFI.TXPRIVACY.EF9/11
WELCOME FUNDS INC.
4755 TECHNOLOGY WAY
SUITE 202
BOCA RATON, FL 33431
TOLL-FREE: 877.227.4484
PHONE: 561.862.0244
FAX: 561.862.0242
WWW.WELCOMEFUNDS.COM
PRIVACY ACKNOWLEDGEMENT & AUTHORIZATION
The following section, in part, contained in the Life Settlements Act of Texas addresses the way the insured’s personally
identifiable information, including without limitation, his or her financial, medical and insurance related information, is
permitted to be disclosed. With the insured’s required signature, the insured is acknowledging the law as indicated below
and authorizing his or her consent to such disclosure.
Section 1111A.006
(d) Except as otherwise allowed or required by law, a provider, broker, insur
ance com
pany, insurance agent, information
bureau, rating agency or company, or any other person with actual knowledge of an insured’s identity, may not disclose the
identity of an insured, or information that there is a reasonable basis to believe could be used to identify the insured or the
insured’s financial or medical information, to any other person unless the disclosure is:
(1) necessary to effect a life settlement contract between the owner and a provider and the owner and insured have
provided prior written consent to the disclosure;
(2) necessary to effectuate t
he sale of a life settlement contract, or interests in the contract, as an investment,
provided that the sale is conducted in accordance with applicable state and federal securities law and provided
further that the owner and the insured have both provided prior written consent to the disclosure;
(3) Provided in response to an investigation or examination by the commissioner or another governmental officer or
agency under Texas law, Section 1111A.018, “Fraud Prevention and Control;”
(4) a term or condition of the transfer of a policy by one provider to another licensed provider, in which case the
receiving provider shall comply with the confidentiality requirements of this subsection;
(5) necessary to allow the provider or broker or the provider’s or broker’s authorized representative to make contact
for the purpose of determining health status provided that in this subdivision, authorized representative does not
include a person who has or may have a financial interest in the contract other than a provider, licensed broker,
financing entity, related provider trust or special purpose entity and that the provider or broker requires the
authorized representative to agree in writing to adhere to the privacy provisions of this chapter; or
(6) required to purchase stop loss coverage; or
(7) otherwise permitted by regulation promulgated by the commissioner or another governmental officer or agency
under Texas law, Section 1111A.018, “Fraud Prevention and Control.”
__________________________________________________________
In addition to the acknowledgement and authorization above, with the signature below, each undersigne
d is allowing his or
her personally identifiable information, including w
ithout limitation, his or her financial, medical and insurance related
information, to be transmitted electronically, via e-mail or through a password protected and secure website, to the
appropriate parties, permitted by Texas law, who have an identifiable need to facilitate the sale of the life insurance policy or
policies.
Acknowledged & Authorized By:
___________________________________________ _________________________________ ________
Signature of Primary Insured Printed Name Date
___________________________________________ _________________________________ ________
Signature of Secondary Insured (if applicable) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Policy Owner #1 (if not Insured) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Policy Owner #2 (if not Insured) Printed Name Date
FORM WFI.EF7/10 © 2010 Welcome Funds Inc
- 1 -
WELCOME FUNDS INC.
4755 TECHNOLOGY WAY
SUITE 202
BOCA RATON, FL 33431
TOLL-FREE: 877.227.4484
PHONE: 561.862.0244
FAX: 561.862.0242
WWW.WELCOMEFUNDS.COM
EVALUATION REQUEST FOR SALE OF EXISTING LIFE INSURANCE
Fraud Warning: Any person who knowingly presents false information in an application for insurance
or a life settlement contract is guilty of a crime & may be subject to fines & confinement in prison
.
The information provided below shall be used to evaluate, underwrite and generate
conditional offers for the sale of your life insurance policy.
PRIMARY INSURED’S PERSONAL INFORMATION
PRIMARY INSURED NAME (AS LISTED WITH LIFE INSURANCE CARRIER) DATE OF BIRTH SOCIAL SECURITY NUMBER
CURRENT HOME ADDRESS TELEPHONE NUMBER
CITY STATE ZIP CODE
PRIMARY ATTENDING PHYSICIAN SPECIALTY CITY/STATE DATE LAST SEEN TELEPHONE NUMBER
OTHER PHYSICIANS SEEN IN LAST 5 YEARS SPECIALTY CITY/STATE DATE LAST SEEN TELEPHONE NUMBER
OTHER PHYSICIANS SEEN IN LAST 5 YEARS SPECIALTY CITY/STATE DATE LAST SEEN TELEPHONE NUMBER
HOSPITAL (S) NAME, ADDRESS, TELEPHONE NUMBER THAT HAS TREATED YOU IN THE LAST 24 MONTHS FOR YOUR ILLNESS
PLEASE PROVIDE A BRIEF DESCRIPTION OF YOUR MEDICAL HISTORY
SECONDARY INSURED’S PERSONAL INFORMATION (IF APPLICABLE – SURVIVORSHIP ONLY)
SECONDARY INSURED NAME (AS LISTED WITH LIFE INSURANCE CARRIER) DATE OF BIRTH SOCIAL SECURITY NUMBER
CURRENT HOME ADDRESS TELEPHONE NUMBER
CITY STATE ZIP CODE
PRIMARY ATTENDING PHYSICIAN SPECIALTY CITY/STATE DATE LAST SEEN TELEPHONE NUMBER
OTHER PHYSICIANS SEEN IN LAST 5 YEARS SPECIALTY CITY/STATE DATE LAST SEEN TELEPHONE NUMBER
OTHER PHYSICIANS SEEN IN LAST 5 YEARS SPECIALTY CITY/STATE DATE LAST SEEN TELEPHONE NUMBER
HOSPITAL (S) NAME, ADDRESS, TELEPHONE NUMBER THAT HAS TREATED YOU IN THE LAST 24 MONTHS FOR YOUR ILLNESS
PLEASE PROVIDE A BRIEF DESCRIPTION OF YOUR MEDICAL HISTORY
Family Member Spouse Business Partner Other:________________________
PLEASE CHECK APPICABLE RELATIONSHIP TO PRIMARY INSURED (IF APPLICABLE)
If there are additional physicians or if there is additional medical information,
then please attach a separate sheet with complete details.
FORM WFI.EF7/10 © 2010 Welcome Funds Inc
- 2 -
LIFE INSURANCE POLICY INFORMATION
LIFE INSURANCE COMPANY POLICY NUMBER ISSUE DATE
FACE AMOUNT TOTAL POLICY LOAN AMOUNT CASH SURRENDER VALUE
Individual Joint Survivorship Group Other______________________________________________
TYPE OF POLICY (PLEASE CHECK ONE)
IF A GROUP POLICY, PLEASE PROVIDE NAME, ADDRESS, AND TELEPHONE NUMBER OF THE CONTACT WITH THE ISSUING GROUP
Term WL UL Other:_____________________________________________
CLASSIFICATION OF POLICY (PLEASE CHECK ONE)
Annually Semi-Annually Quarterly Monthly $_________________________________
POLICY PREMIUM PAYMENT (PLEASE CHECK THE APPROPRIATE BOX) PREMIUM AMOUNT
PLEASE PROVIDE THE NAMES AND RELATIONSHIP OF ALL PRIMARY BENEFICIARIES OF THE POLICY (IF IT IS A TRUST, PROVIDE NAME AND ADDRESS OF TRUSTEE)
ADDITIONAL BENEFICIARIES AND/OR CONTINGENT BENEFICIARIES
POLICY OWNER INFORMATION
EXACT NAME OF POLICY OWNER (INDIVIDUAL / CORP. / TRUST - AS LISTED WITH LIFE INSURANCE CARRIER) SOCIAL SECURITY OR TAX ID NUMBER
POLICY OWNER ADDRESS (ADDRESS / STATE OF DOMICILE OF INDIVIDUAL / CORP. / TRUST) TELEPHONE NUMBER
CITY STATE ZIP CODE
EXACT NAME OF CORPORATE OFFICER(S) / TRUSTEE(S) (IF CORPORATE / TRUST OWNED POLICY) DATE OF INCORPORATION / TRUST
IF THERE ARE MULTIPLE POLICY OWNERS, THEN PLEASE LIST ALL NAMES AND STATES OF RESIDENCE
IF THERE ARE MULTIPLE POLICY OWNERS, THEN PLEASE LIST ALL NAMES AND STATES OF RESIDENCE
Family Member Spouse Business Partner Policy Owner is Insured Other: ___________________
IF POLICY OWNER IS AN INDIVIDUAL, THEN PLEASE CHECK APPICABLE RELATIONSHIP TO INSURED
Single Married Widowed Legally Separated Divorced – Date: __________
IF POLICY OWNER IS AN INDIVIDUAL, THEN PLEASE CHECK MARITAL STATUS
YES NO YES NO Date:______________________
HAS POLICY OWNER EVER DECLARED BANKRUPTCY? IF SO, HAS IT BEEN DISCHARGED? WHEN WAS IT DISCHARGED?
For multiple policies, please photocopy this page, complete the above information
and sign new insurance authorizations for each policy.
FORM WFI.EF7/10 © 2010 Welcome Funds Inc
- 3 -
ADDITIONAL INFORMATION
I. PLEASE DESCRIBE REASON
S FOR CONSIDERING THE SALE OF POLICY(IES), CHECK ALL THAT APPLY:
No longer require or want to pay for the life coverage Planning to lapse, cancel, or surrender the policy
Health & living expenses are a financial burden Considering a 1035 Ex
change or replacement policy
Interested in learning market value of policy Cash liquidity p
referred due to current financial situation
Other or provide further details: __________________________________________________________________________________
All
Policy Owner(s) and Insured(s) please sign at the bottom of the page, regardless of whether you complete all of the financial
information below.
Please be advised that any Policy Owner(s) and/or Insure
d(s) who declines to provide full and complete financial data acknowledges and
accepts responsibility that such lack of data will impede Welcome Funds Inc’s ability to provide recommendations it deems suitable,
based on personal and specific financial needs, conditions and situations.
Check here if you choose NOT to complete some or all of the requested financial information below (and sign below).
II. INVESTMENT PROFILE
(PLEASE USE COMBINED FIGURES FOR JOINT ACCOUNTS):
INVESTMENT OBJECTIVES: Capital Preservation Income Capital Appreciation/Growth Speculation
(check all that apply)
POLICY OWNER’S TAX BRACKET: 10% 15% 25% 28% 33% 35%
POLICY OWNER’S NET WORTH: $0 - $49,999 $50,000 - $99,999 $100,000 - $199,999 $200,000 -$499,999
$500,000 - $999,999 $1,000,000 - $2,499,999 $2,500,000 and up
ESTIMATED INSURABLE CAPACITY FOR INSURED(S): $________________________________________________________
TOTAL AMOUNT OF IN-FORCE LIFE INSURANCE COVERING INSURED(S): $_____________________________________
III. PLEASE CERTIFY THE CURRENT ACCREDITED INVESTOR STATUS OF THE POLICY OWNER:
THE POLICY OWNER IS CONSIDERED AN ACCREDITED INVESTOR: YES NO
(Refer to the definitions below to answer the above question and if “yes,” then please check the app
ropriate description)
________
INDIVIDUALS:
1. An individual that has a net worth or joint net worth, with the individual’s spouse, in excess of $1,000,000. “Net worth” for these
purposes is defined as the value of total assets at fair market value, including but not limited to non-primary residence home (the
value of the primary residence, as of July, 2010, is excluded), home furnishings and automobiles, less total liabilities; or
________
2. An individual that (i) had income (exclusive of any income attributable to the individual’s spouse) of more than $200,000 for
each of the past two years or joint income with the individual’s spouse in excess of $300,000 in each of those years, and (ii)
reasonably expects to reach the same individual income level, or the same joint income level, as the case may be, in the current
year; or
________
ENTITIES:
3. A corporation, partnership, limited liability company, Massachusetts or similar business trust or tax-exempt organization as
defined in Section 501(c)(3) of the Code, that (i) has total assets in excess of $5,000,000, and (ii) was not formed for the specific
purpose of investing in the life insurance policy and then selling it; or
________
4. A revocable trust which may be amended or revoked at any time by the grantors thereof, and of which all of the grantors are
accredited investors under either (1) or (2) above; or
________
5. A trust (i) that has total assets in excess of $5,000,000, (ii) that was not formed for the specific purpose of acquiring the life
insurance policy and then selling it, and (iii) whereby the investment decisions are directed by a person who has such knowledge
and experience in business and financial matters and who can evaluate the merits and risks of its investments; or
________
6. A trust for which a bank or savings and loan association is acting as fiduciary in directing investment decisions; or
________
7. An entity whose equity owners are each “accredited investors” i.e., persons meeting the requirements set forth in either of (1) or
(2) above.
Verified and Confirmed By:
___________________________________________ _________________________________ ________
Signature of Primary Insured Printed Name Date
___________________________________________ _________________________________ ________
Signature of Secondary Insured (if applicable) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Policy Owner #1 (if not Insured) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Policy Owner #2 (if not Insured) Printed Name Date
FORM WFI.EF7/10 © 2010 Welcome Funds Inc
- 4 -
PERSONAL ACKNOWLEDGEMENTS
I. Do you have a referring advisor/broker authorized, on your behalf, to a) represent your interests regarding this Evaluation
Request & potential transaction; & b) to accept offers, if any, for the sale of your existing life insurance policy?
Yes No
If Yes, then please provide the name(s) of such advisor(s)/broker(s) below:
____________________________________________________ _____________________________________________________
Name of Referring Advisor /Broker #1 Name of Referring Advisor/Broker #2 (if applicable)
II. Have you signed a Power of Attorney (POA) granting a legal representative to act on your behalf or do you have a
Guardian ad Litem or similar legal representative acting on your behalf regarding this Evaluation Request & Potential
Transaction?
Primary Insured: Yes No Policy Owner #1: (if not Insured): Yes No
Secondary Insured (if applicable): Yes No Policy Owner #2 (if applicable): Yes No
If Yes, then please 1) attach the applicable legal documents to this Evaluation Request; 2) have the legal representative of
the insured sign the “Authorization for Disclosure of Protected Health Information” forms for the primary and secondary
insured as applicable; and 3) provide the names of such legal representative(s) below:
__________________________________________________ __________________________________________________
Name of Legal Representative of Primary Insured (if applicable) Name of Legal Representative of Policy Owner #1 (if applicable)
__________________________________________________ __________________________________________________
Name of Legal Representative of Secondary Insured (if applicable) Name of Legal Representative of Policy Owner #2 (if applicable)
III. How did you learn about the option to sell your insurance policy?
Through my/our own knowledge and/or research and asked to receive this Evaluation Request.
Through my/our referring advisor/broker.
IV. Was this insurance policy premium financed?
Yes No
If yes, then please 1) attach all finance documents, including contracts, trusts and/or corporate documents etc…in order to
evaluate and determine the validity and legality of this potential transaction for insurable interest; 2) provide the name of
the financing company: _____________________________________________________.
Name of Financing Company (if applicable)
I/We represent that the information contained in this Evaluation Request for Sale of Existing Life Insurance is correct and accurate
and acknowledge that WELCOME FUNDS INC may rely on such information, including but not limited to the Personal
Acknowledgements above. I/we will immediately notify WELCOME FUNDS INC of any changes.
I/We give my/our consent to WELCOME FUNDS INC, its agents and/or authorized re
presentatives to release and/or transmit
electronically all financial and insurance information gathered from this Evaluation Request for Sale of Existing Life Insurance,
including but not limited to medical records, notes and lab reports pertaining to the insured’s health, to the appropriate parties who
have an identifiable need to facilitate the sale of my/our life insurance policy.
I/We further acknowledge that this Evaluation Request for Sale of Existing Life Insurance may become part of my contract for the
sale of my existing life insurance policy if my/our life insurance policy is purchased. In addition, I/we have been advised that I/we
may obtain a copy, upon request, of any written agreement that I/we enter into regarding or relating to the sale of my/our life
insurance policy(ies).
Acknowledged By:
___________________________________________ _________________________________ ________
Signature of Primary Insured Printed Name Date
___________________________________________ _________________________________ ________
Signature of Secondary Insured (if applicable) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Policy Owner #1 (if not Insured) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Policy Owner #2 (if not Insured) Printed Name Date
FORM WFI.TXDISC.EF9/11 © 2011 Welcome Funds Inc
- 1 -
WELCOME FUNDS INC.
4755 TECHNOLOGY WAY
SUITE 202
BOCA RATON, FL 33431
TOLL-FREE: 877.227.4484
PHONE: 561.862.0244
FAX: 561.862.0242
WWW.WELCOMEFUNDS.COM
NOTICE OF DISCLOSURE (PAGE 1 OF 2)
Fraud Warning: Any person who knowingly presents false information in an application for insurance
or life settlement contract is guilty of a crime and may be subject to fines and confinement in prison.
1. There are possible alternatives to life settlement contracts including but not limited to accelerated death benefits policy
offered by the issuer of the life insurance policy. You are advised to consult a financial advisor, certified public
accountant and/or an attorney regarding these potential alternatives.
2. Some or all o
f the proceeds of the life settlement contract may be taxable. Welcome Funds, Inc
is not a tax advisor and
reco
mmends that you seek assistance from a profession
al tax advisor regarding this transaction.
3. Proceeds from
the life settlement contract could be subject to the claims of credit
ors.
4. Receipt of the life settlement contract proceeds may adversely affect your eligibility for public assistance or other
government benefits or entitlements and advice should be obtained from the appropriate agencies.
5. You have the right to terminate (rescind) a life settlement contract within fifteen (15) days of the date (i) the contract is
executed by
all parties; and (ii) you have received the disclosures specified herein. Such termination or rescission shall be
effective only if both notice of rescission is given to the provider and you repay all proceeds and any premiums, loans
and loan interest paid by the provider during the rescission period. If the insured dies during the rescission
period, then
the contract shall be deemed rescinded, subject to you or
your estate’s repayment of all proceeds and any premiums,
loans and loan interest to the provi
der.
6. Proceeds from the life settlement contract will be sent to you within three (3) business days after the provider has
received the insurer or group administrator’s acknowledgment that ownership of the policy or interest in the certificate
has been transferred and the beneficiary has been designated in accordance with the terms of the life settlement contract.
Welcome Funds, Inc and your referring advisor, if any, has no access to or control over provider funds that are set aside
in escrow or trust.
7. Entering i
nto a life settlement contract and the subsequent change of ownership may cause other rights or
benefits,
includin
g conversion rights and waiver of premium benefits, which may exist under the policy or a certificate of a group
life insurance policy to be forfeited – assistance should be sought from a financia
l advisor.
8. Total com
pensation payable to both Welcome Funds, Inc and your referring advisor/broker, if any, shall collectively
be
calculated as a percentage of the contingent offer obtained for the sale of your existing life insurance policy. Your
proceeds are represented by the Net Purchase Price (NPP) as follows: NPP = Gross Purchase Price (GPP) as paid by the
provider reduced by the total compensation as described above. Actual total compensation shall be disclosed no later than
the date the life settlement contract is signed by all parties.
9. You have the right to know the date by which funds will be available to y
ou and the identity of the transmitter of
such
funds.
10. I/we confirm
and acknowledge that Welcome Funds, Inc has provided me/us with a brochure/guide describing the process
of life settlements that serves as a consumer advisory
package.
[Additional Disclosures on Next Page]
FORM WFI.TXDISC.EF9/11 © 2011 Welcome Funds Inc
- 2 -
NOTICE OF DISCLOSURE (PAGE 2 OF 2)
11. All medical, financial or personal information solicited or obtained by a provider or broker about an insured, including
the insured’s identity or the identity of family members or a spouse or a significant other, may be disclosed as necessary
to effect the life settlement contract between the policy owner and provider. If you are asked to provide this information,
you will be asked to consent to the disclosure. The information may be presented to someone who buys the policy or
provides funds for the purchase. You may be asked to renew your permission to share information every two (2) y
ears. In
addition, inf
ormation regarding the policy owner’s and insured’s identity and insured’s medical condition will i) be
shared with the insurer that issued the life insurance policy; and ii) shall be available to each subsequent owner of the life
insurance policy.
12. The insured may be contacted by the provider or broker or an authorized representative of the provider or broker for the
purpose of determining the insured’s health status or to verify the insured’s address. This contact is limited to no more
frequently than once every three (3) months if the insured has a life expectancy of more than one year, and no more than
once per month if the insured has a life expectancy of one (1) year or less.
13. You have the right to kn
ow the affiliation, if any, between the provider and the issuer of the insurance policy to
be
settled.
14. Welcome Fu
nds, Inc and your referring advisor/broker, if any, represents exclusively you and not the insurer or provi
der
or any other person and owes you a fiduciary duty, including to act according to your instructions and in your best interest
notwithstanding the manner in which Welcome Funds, Inc and your referring advisor/broker, if any, is compensated.
15. You have the right to know the name, address and telephone number of the provider.
16. You have the right to know the name, address and telephone number of the independent third party escrow agent. In
addition, you may inspect or receive copies of the relevant escrow or trust agreem
ents or documents.
17. Change of ownership could in the future li
mit the insured’s ability to purchase future life insurance coverage on the
insured’s life because there is a limit to how much coverage insurers will issue on
one life.
18. Welcome Funds, Inc recommends that you read the life settlement contract and seek assistance from a professional
financial advisor and/or consult with your legal advisor prior to signing it.
I/We acknowledge that I/we have read and understand the disclosures above (1-18).
___________________________________________ _________________________________ ________
Signature of Primary Insured Printed Name Date
___________________________________________ _________________________________ ________
Signature of Secondary Insured (if applicable) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Policy Owner #1 (if not Insured) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Policy Owner #2 (if not Insured) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Authorized Representative of Welcome Funds Inc Printed Name Date
FORM WFI.TXINSAUTH.EF3/10 © 2010 Welcome Funds Inc
WELCOME FUNDS INC.
4755 TECHNOLOGY WAY
SUITE 202
BOCA RATON, FL 33431
TOLL-FREE: 877.227.4484
PHONE: 561.862.0244
FAX: 561.862.0242
WWW.WELCOMEFUNDS.COM
AUTHORIZATION FOR THE RELEASE OF LIFE INSURANCE POLICY INFORMATION
_________________________________________ __________________________________________
Life Insurance Company Policy Number
_________________________________________ __________________________________________
Printed Name of All Policy Owner(s) Printed Name of Insured(s)
I/we (the undersigned individual(s)) hereby authorize the above-referenced life insurance company and/or any other entity or
person that has information related to the above-referenced life insurance policy to release such information to and reply
immediately to any written, telephonic or other request for information or documents required by WELCOME FUNDS INC
and/or its authorized representatives pertaining to the above-referenced life insurance policy that I/we own.
I/we understand and specifically authorize the release of information by this form to include any and all LIFE INSURANCE
POLICY OR CERTIFICATE information, including but not limited to: applications for insurance, forms, riders,
illustrations, conversions, current values, verification of coverage, contestable and suicide status, lapse or reinstatement
application and history and amendments concerning the policy or certificate, confirmation and status of change in ownership
designations and any other general information about my coverage.
WELCOME FUNDS INC makes it hereby known that the insured or the policy owner has the right to withdraw consent to
this Release of Life Insurance Policy Information at any time, pursuant to applicable law. I/we understand that WELCOME
FUNDS INC will keep all information disclosed hereunder confidential and will only use the information provided for the
purpose of evaluating my life insurance coverage, determining my eligibility for sale of my life insurance policy and
facilitating the potential sale of my life insurance policy. Furthermore, I/we understand that WELCOME FUNDS INC will
not release any information to any person or organization except as may be otherwise lawfully required or as I/we may
further authorize.
I/we certify that I/we am/are executing and delivering this Authorization freely and unilaterally/collectively as of the date
written below. I/we further certify that I/we have a full understanding of the Authorization’s contents and I/we will retain a
completed copy for future reference. I/we specifically authorize and request that this Authorization for the Release of Life
Insurance Policy Information shall remain valid until and will expire on the date of the Insured’s death or until the case is
declined by WELCOME FUNDS INC, absent any provision of any applicable state statute or regulation to the contrary, in
which event it shall remain valid for the maximum period permitted thereunder and that a photocopy or facsimile of this
document is as valid as an original. This document may also be signed in counterparts.
Authorized By:
___________________________________________ _________________________________ ________
Signature of Primary Insured Printed Name Date
___________________________________________ _________________________________ ________
Signature of Secondary Insured (if applicable) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Policy Owner #1 (if not Insured) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Policy Owner #2 (if not Insured) Printed Name Date
FORM WFI.HIPAA1.EF3/10 © 2010 Welcome Funds Inc
WELCOME FUNDS INC.
4755 TECHNOLOGY WAY
SUITE 202
BOCA RATON, FL 33431
TOLL-FREE: 877.227.4484
PHONE: 561.862.0244
FAX: 561.862.0242
WWW.WELCOMEFUNDS.COM
AUTHORIZATION FOR THE DISCLOSURE OF PROTECTED HEALTH INFORMATION (PRIMARY INSURED)
I, __________________________________ (the undersigned individual), DOB____________SS#________________, hereby authorize
disclosure, as defined under the privacy regulations promulgated pursuant to the Health Insurance Portability and Accountability Act of
1996, of my protected health information (“PHI”) as follows:
1. Classes of Persons Authorized to Disclose My PHI. I authorize each doctor, hospital, nurse, pharmacy, physician, physician
practice group, and any other type of health care provider (each, an “HCP”) having any PHI about me to disclose any and all of my
PHI as provided under this authorization. I authorize each Authorized HCP to rely upon a photostatic or facsimile copy or other
reproduction of this authorization.
2. Classes of Persons Authorized to Receive My PHI.
I authorize each Authorized HCP to disclose my PHI under this authorization
to WELCOME FUNDS INC including any of its affiliates, agents, subsidiaries, corporate parents, independent contractors,
consultants, service providers and authorized representatives and the officers, directors and employees of each, and to any oth
er
person or entity required or compelled by law to receive or view such PHI to evaluate, facilitate, underwrite and solicit bids for the
sale of my life insurance policy(ies), including but not limited to medical underwriters, lenders, financing entities,
br
okers/brokerages, buyers of life insurance policies, life expectancy providers and stop-loss re-insurers and his or their aff
iliates,
agents, subsidiaries, corporate parents, independent contractors, consultants, service providers and authorized representatives and the
officers, directors and employees of each (each, an “Authorized Recipient”). I understand that my PHI may be secured by and
electronically transmitted to an Authorized Recipient, including but not limited to transmission via e-mail and posting to a password
protected, secure website.
3. Description of PHI Authorized for Disclosure and Purpose of Disclosure.
This authorization shall apply to any and all of my
health and medical data, information and records, whether or not personally or individually identifiable or protected under any federal
or state confidentiality or privacy laws or regulations. This authorization and all disclosures of my PHI made under this authorization
are for purposes of allowing the Authorized Recipient to analyze, assess, evaluate or underwrite my health or medical condition, or
life expectancy, in connection with the possible sale of any life insurance policy, or certificate of life insurance, under which my
life
is in
sured. In addition, I acknowledge that some state and federal laws prohibit the further disclosure of drug, alcohol or HI
V related
information without specific written consent. This authorization shall serve as such consent in order for each Authorized Recipient to
perform the functions described herein.
4. Expiration of Authorization.
This authorization shall remain valid until, and shall expire, one year after the date of my death or the
maximum period as allowed by state or federal law.
5. Right to Revoke Authorization.
I acknowledge and understand that I may revoke this authorization any time with respect to any
Authorized HCP by notifying such Authorized HCP in writing of my revocation of this authorization and delivering my revocation
by mail or personal delivery at such address designated to me by such Authorized HCP; provided, that, any revocation of this
authorization shall not apply to the extent that the Authorized HCP has taken action in reliance upon this authorization prior to
receiving written notice
of my revocation.
6. Ina
bility to Condition Treatment, Payment, Enrollment or Eligibility for Benefits on Provision of Authorization.
No HCP or
other covered entity may condition my treatment, payment, enrollment or eligibility for benefits on whether I sign this authorization.
I understand that a) this Authorization is not a consent or an authorization requested by a health care provider, health care clearinghouse
or health plan covered by the privacy regulations promulgated pursuant to the Health Insurance Portability and Accountability Act of
1996 (the “HIPAA Privacy Regulations”); b) as a result of this Authorization, there is the potential for my PHI that is disclosed by any
Authorized HCP to an Authorized Recipient to be subject to re-disclosure by the Authorized Recipient and my PHI that is disclosed to
such Authorized Recipient may no longer be protected by the HIPAA Privacy Regulations; and c) my ongoing health status may be
tracked as a result of this Authorization.
I certify that I am executing and delivering this authorization freely and unilaterally and that all information contained in this
authorization is true and correct. I further certify that this authorization is written in plain language and that I have received and retained a
copy of this signed authorization for future reference.
____________________________________________________________________________________________
List of Authorized Disclosers (AD) (Hospitals, Doctors, Etc.):
Authorized by:
___________________________________________ _________________________________ ________
Signature of Individual (Primary Insured) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Legal Representative of Primary Insured (if any) Printed Name Date
Description of Legal Representative’s Authority (if any):
___________________________________________________________________________________
(POA, Guardian ad Litem or similar status – Please attach legal documents for verification)
FORM WFI.HIPAA2.EF3/10 © 2010 Welcome Funds Inc
WELCOME FUNDS INC.
4755 TECHNOLOGY WAY
SUITE 202
BOCA RATON, FL 33431
TOLL-FREE: 877.227.4484
PHONE: 561.862.0244
FAX: 561.862.0242
WWW.WELCOMEFUNDS.COM
AUTHORIZATION FOR THE DISCLOSURE OF PROTECTED HEALTH INFORMATION (SECONDARY INSURED)
I, __________________________________ (the undersigned individual), DOB____________SS#________________, hereby authorize
disclosure, as defined under the privacy regulations promulgated pursuant to the Health Insurance Portability and Accountability Act of
1996, of my protected health information (“PHI”) as follows:
1. Classes of Persons Authorized to Disclose My PHI. I authorize each doctor, hospital, nurse, pharmacy, physician, physician
practice group, and any other type of health care provider (each, an “HCP”) having any PHI about me to disclose any and all of my
PHI as provided under this authorization. I authorize each Authorized HCP to rely upon a photostatic or facsimile copy or other
reproduction of this authorization.
2. Classes of Persons Authorized to Receive My PHI.
I authorize each Authorized HCP to disclose my PHI under this authorization
to WELCOME FUNDS INC including any of its affiliates, agents, subsidiaries, corporate parents, independent contractors,
consultants, service providers and authorized representatives and the officers, directors and employees of each, and to any oth
er
person or entity required or compelled by law to receive or view such PHI to evaluate, facilitate, underwrite and solicit bids for the
sale of my life insurance policy(ies), including but not limited to medical underwriters, lenders, financing entities,
br
okers/brokerages, buyers of life insurance policies, life expectancy providers and stop-loss re-insurers and his or their aff
iliates,
agents, subsidiaries, corporate parents, independent contractors, consultants, service providers and authorized representatives and the
officers, directors and employees of each (each, an “Authorized Recipient”). I understand that my PHI may be secured by and
electronically transmitted to an Authorized Recipient, including but not limited to transmission via e-mail and posting to a password
protected, secure website.
3. Description of PHI Authorized for Disclosure and Purpose of Disclosure.
This authorization shall apply to any and all of my
health and medical data, information and records, whether or not personally or individually identifiable or protected under any federal
or state confidentiality or privacy laws or regulations. This authorization and all disclosures of my PHI made under this authorization
are for purposes of allowing the Authorized Recipient to analyze, assess, evaluate or underwrite my health or medical condition, or
life expectancy, in connection with the possible sale of any life insurance policy, or certificate of life insurance, under which my
life
is in
sured. In addition, I acknowledge that some state and federal laws prohibit the further disclosure of drug, alcohol or HI
V related
information without specific written consent. This authorization shall serve as such consent in order for each Authorized Recipient to
perform the functions described herein.
4. Expiration of Authorization.
This authorization shall remain valid until, and shall expire, one year after the date of my death or the
maximum period as allowed by state or federal law.
5. Right to Revoke Authorization.
I acknowledge and understand that I may revoke this authorization any time with respect to any
Authorized HCP by notifying such Authorized HCP in writing of my revocation of this authorization and delivering my revocation
by mail or personal delivery at such address designated to me by such Authorized HCP; provided, that, any revocation of this
authorization shall not apply to the extent that the Authorized HCP has taken action in reliance upon this authorization prior to
receiving written notice
of my revocation.
6. Ina
bility to Condition Treatment, Payment, Enrollment or Eligibility for Benefits on Provision of Authorization.
No HCP or
other covered entity may condition my treatment, payment, enrollment or eligibility for benefits on whether I sign this authorization.
I understand that a) this Authorization is not a consent or an authorization requested by a health care provider, health care clearinghouse
or health plan covered by the privacy regulations promulgated pursuant to the Health Insurance Portability and Accountability Act of
1996 (the “HIPAA Privacy Regulations”); b) as a result of this Authorization, there is the potential for my PHI that is disclosed by any
Authorized HCP to an Authorized Recipient to be subject to re-disclosure by the Authorized Recipient and my PHI that is disclosed to
such Authorized Recipient may no longer be protected by the HIPAA Privacy Regulations; and c) my ongoing health status may be
tracked as a result of this Authorization.
I certify that I am executing and delivering this authorization freely and unilaterally and that all information contained in this
authorization is true and correct. I further certify that this authorization is written in plain language and that I have received and retained a
copy of this signed authorization for future reference.
____________________________________________________________________________________________
List of Authorized Disclosers (AD) (Hospitals, Doctors, Etc.):
Authorized by:
___________________________________________ _________________________________ ________
Signature of Individual (Secondary Insured) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Legal Representative of Secondary Insured (if any) Printed Name Date
Description of Legal Representative’s Authority (if any):
___________________________________________________________________________________
(POA, Guardian ad Litem or similar status – Please attach legal documents for verification)
FORM WFI.TXNONXBROKERAUTH.EF9/11 © 2011 Welcome Funds Inc
WELCOME FUNDS INC.
4755 TECHNOLOGY WAY
SUITE 202
BOCA RATON, FL 33431
TOLL-FREE: 877.227.4484
PHONE: 561.862.0244
FAX: 561.862.0242
WWW.WELCOMEFUNDS.COM
NON-EXCLUSIVE BROKER AUTHORIZATION & SERVICES AGREEMENT
Do you have a referring advisor/broker working with WELCOME FUNDS INC and authorized to a) represent your interests
regarding this Evaluation Request & potential transaction; & b) accept offers, if any, on your behalf?
Yes No If Yes, then please provide the name(s) of such advisor(s)/broker(s) below:
____________________________________________________ _____________________________________________________
Name of Referring Advisor /Broker #1 Name of Referring Advisor/Broker #2 (if applicable)
WELCOME FUNDS INC works exclusively in the secondary market for life insurance by representing the best interests of
consumers and maximizing the sales value of their policy(ies). As your designated broker, WELCOME FUNDS INC incurs the
necessary, required and related costs to facilitate the sale of your policy while providing the following services including but not
limited to:
E
valuation Form assessment. Medical
underwriting & insurance verifications.
Obtaining and forwarding independent Submission to multiple authorized and/or registered
third party life expectancy reports. buyers of life insurance policies.
Best execution negotiation to maximize Closing services including contract review & assistance with
fair market value of the sale of your policy. contingency requirements of buyers of life insurance policies.
In consideration of the services provided and related costs incurred as described above, I/We authorize WELCOME FUNDS INC
to act as my/our no
n-exclusive broker and to evaluate, underwrite, solicit, generate and secure conditional offers regarding and/or
related to the purchase of the following life insurance policy(ies):
1
st
Policy No. ___________ issued by ____________________. 2
nd
Policy No. ___________ issued by ____________________.
Name of Insurance Carrier (if applicable) Name of Insurance Carrier
Furthermore, by signing this authorization and agreement, I/we am/are:
1. Granting to WELCOME FUNDS INC the authority to evaluate, underwrite, solicit, generate and secure conditional and
appropriate offers as determined by WELCOME FUNDS INC pursuant to its typical business model, methods and
practices, for the sale of my/our life insurance policy(ies) as stated above.
2. Reco
gnizing the proprietary nature of such appropriate, conditional o
ffers as evaluated, underwritten, solicited, generated
and secured by WELCOME FUNDS INC for the period of time as described above and pursuant to this Broker
Authorization & Services Agreement.
3. Agreeing to the total compensation, as described in this paragraph, payable to WELCOME FUNDS INC and your referring
advisor/broker, if any. Suc
h compensation shall collectively be calculated as a percentage of the contingent offer obtained for
the sale of your existing life insurance policy. Your proceeds are represented by the Net Purchase Price (NPP) as follows:
NPP = Gross Purchase Price (GPP) as paid by the life settlement provider reduced by the total compensation as described
above. Actual total compensation shall be disclosed no later than the date the life settlement contract is signed by all parties.
4. Aware th
at WELCOME FUNDS INC issues no guarantee that my/our life insurance policy will be sold, is under no
obligation to purchase my/our policy or to ultimately find a buyer of my/our policy(ies) and is not responsible for any
breach committed by a buyer if one is identified.
Agreed to & Accepted by:
___________________________________________ _________________________________ ________
Signature of Primary Insured Printed Name Date
___________________________________________ _________________________________ ________
Signature of Secondary Insured (if applicable) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Policy Owner #1 (if not Insured) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Policy Owner #2 (if not Insured) Printed Name Date
___________________________________________ _________________________________ ________
Signature of Authorized Officer of WELCOME FUNDS INC Printed Name Date
Important Information You Should Know
Before Entering Into a Life Settlement
General Information
What is the purpose of this shopper’s guide?
The State of Texas requires the delivery of this guide to assist Texas residents who are
the original owners of a life insurance policy that they are considering selling. Questions
related to investing in life settlements should be directed to the Texas State Securities
Board.
What is a life settlement?
A life settlement is the sale of a policy for an amount less than the policy's expected
death benefit. Only the owner of a policy may sell the policy. The owner may be a
different person than whose life is covered by the policy. A life settlement offers a policy
owner the opportunity to get a portion of the death benefit while the insured is still alive.
How does a life settlement work?
The person that buys a life insurance policy from the owner is called a life settlement
provider (provider). The owner may also choose to hire a life settlement broker (broker)
to negotiate the life settlement contract with a provider. Providers and brokers will ask
you and the insured to complete an application and medical release forms so they can
get information from your life insurance company and the medical records of the
insured.
If you qualify, the provider will make an offer to purchase your policy. If you accept the
offer, the provider will ask you to sign a contract.
Are providers and brokers licensed by the state?
Life settlement providers and brokers must be licensed by the Texas Department of
Insurance (TDI). You may check to see if they have a license here:
www.tdi.texas.gov/life/viaintro.html.
What is my policy worth?
Texas law requires that the minimum value for a life settlement contract be greater than
a cash surrender value or accelerated death benefit available at the time you apply for a
life settlement contract. Providers will base the amount of the offer on facts such as how
long the insured is expected to live, the amount you pay for premiums, the rating of your
insurance company, and your policy's provisions (such as a waiver of premium). You
may want to get quotes from several providers to ensure you get the best offer.
Will personal information remain confidential?
A provider or broker may not share any financial, medical, or personal information about
the owner or insured with anyone, including your family members, unless there is
Rev. 04/13 Page 2 of 4
written approval to share the information. Any written approval must show who may get
the information and why it will be released. The provider or broker may share the
information with someone who buys the policy or provides funds for the purchase. The
provider or broker may ask the individual to renew permission to share information
every two years.
What should I know about a life settlement contract?
Once sold, your policy might be resold to entities or individuals not licensed by TDI.
A broker represents the policy owner exclusively. A broker owes a fiduciary duty to the
owner, including a duty to act according to the owner's instructions and in the best
interest of the owner.
The provider or broker must provide the owner with consumer disclosures, including the
compensation the provider will receive, all offers and counteroffers, risks related to
taxes and government benefits, and other additional information. Read these
disclosures carefully.
TDI must approve all life settlement contract and disclosure forms.
Entering a life settlement will affect:
whether your beneficiaries will receive any benefits from the policy
any policy cash values, loans, or dividends
some rights or benefits, including conversion rights and waiver of premium
benefits that may exist under the policy
In addition, a life settlement may affect:
your taxes
your ability to receive supplemental social security income, public assistance,
and public medical services including Medicaid
your debt obligations, creditors, personal representatives, trustees in bankruptcy,
and receivers in state or federal court may try to take away the money you
receive for your life settlement
the ability to obtain future life insurance
life insurance coverage on spouses or other family members, if the policy (or any
riders attached to it) covers their lives
Talk to an attorney, accountant, estate planner, financial planning advisor, tax advisor,
social services agency, or your insurance company or agent to find out what effect
selling your policy will have on you.
Can an owner keep a portion of the policy’s benefits?
Yes. Some providers offer policy owners the opportunity to retain a portion of the death
benefits.
Rev. 04/13 Page 3 of 4
What if my policy includes extra coverages like accidental death, future increases
in the death benefit, or coverage for other family members? Do these affect my
settlement?
You may contact your insurance company or agent to see if your policy includes extra
coverages.
If your policy includes a benefit for accidental death, your settlement might not include
the additional death benefit. The additional death benefit will remain payable to your
beneficiaries or your estate.
If your policy provides future increases in the death benefit, ask how much the provider
is paying you for the purchase of this benefit.
If your policy is a joint policy or provides coverage on the lives of other family members
or anyone other than yourself, there may be a possible loss of coverage for those
people.
Are there other options available besides selling my policy?
Your insurance company might offer options, such as accelerated death benefits, loans,
and surrender of the policy for its cash value. Before selling a life insurance policy,
contact your insurance company or agent to see what options are available.
After you sell your policy
When and how will I get my money?
A provider must send you the money within three business days after it receives notice
from the insurer or group administrator that ownership of the policy has been
transferred.
What if I change my mind?
You may cancel a life settlement contract at any time up to the 15th day after the date of
the contract. To cancel the life settlement contract, you must return any money the
provider paid to you, along with any premiums, loans, and loan interest the provider
paid. Remember to arrange with the provider to have the insurance company transfer
the ownership of the policy back to you.
What if the insured dies shortly after selling the policy?
If the insured dies within 15 days after the execution of the contract, the provider must
rescind the settlement contract if you or your estate repays all money to the provider,
along with any premiums, loans, and loan interest the provider paid.
What happens after I get my money?
Rev. 04/13 Page 4 of 4
After the provider has paid you, it may begin to check on the health of the insured.
If the life expectancy of the insured is one year or less, the providers may check health
status once per month. If the insured is expected to live for more than one year, contact
is limited to once every three months.
What if the insured doesn’t want to be contacted about his or her health status?
The insured may appoint another adult to be contacted. That person must be someone
who is in regular contact with the insured. The insured can change the contact person at
any time by sending a written notice to the provider.
How will I know who will be calling about the insured’s health status?
The provider must give you the name, address, and phone number of the person who
will call the insured or the insured’s contact person(s) about the insured’s health status.
Will the provider call the insured’s doctor to check on their health status?
Some providers will check with the insured’s doctor for updates on his or her health.
The medical release form allows the insured’s doctor to give medical information to the
provider or broker.
Does anyone make money or commissions from the sale of my policy?
Yes. The provider or broker must provide the owner the names of all the people who
have or will receive some type of payment from the purchase or sale of your policy,
along with the amount and terms of the payment. Your broker must disclose all offers
that were made for your policy, the amounts received by all brokers on the sale, and a
complete reconciliation of the offer by the provider to the amount you receive.
Complaints
You may submit a complaint to TDI by:
writing to the Texas Department of Insurance, Consumer Protection, Mail Code
111-1A, P.O. Box 149091, Austin, Texas 78714-9091
calling the Consumer Help Line at 1-800-252-3439 between 8 a.m. and 5 p.m.,
central time, Monday through Friday
faxing your complaint to TDI at 1-512-475-1771
filing your complaint online at www.tdi.texas.gov/consumer/complfrm.html, or
emailing your complaint to consumer.protection@tdi.texas.gov