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Example of Structured Settlement Purchase

Are you looking to sell off your settlement payments but are not sure of the process of paperwork that is involved? Welll Here is an example for you. The title on the top right of the paper will say the insurance company such as Syemtra Financial or Joh Hancock and Associates.

HAND DELIVERED ONLY (this should be under the companies name that you are selling your future money to. For example it may say Ringler Associates, Inc. C/O Clearscape Funding Corporation or J.G. Wentworth/Peachtree Financial 321 Henderson Receivables.

Annuity Contract: AA0301251

Payee: YOUR NAME would be here if you are selling your payments

Dear Sir or Madam:

As requested, here is the scheudle of beenfits information for (annuitants name), who is receiving payments under annuity contract AA0301251 as a beneficiary.

On December 22, 2014 Company name i.e. Ringler, JG Wentworth, Einstein, purchased this annuity from Symetra life insurance company to fund payment obligations under a settlement agreement for a persona injury, wrongful death or workers' compensation claim. Compliance with Section 104(a) (1) and (2) of the Internal Revenue Service Code of 1954 as amended allows the total proceeds of this contract to be income tax exempt.

As part of the plan purchased in the annuity, Symetra Life will make the following payments to Annuitant (your name would be here):
$24,833.32 on January 1, 2015

$39,589.94 on January 1 2017

$84.290.20 on January 1 2019

$198,290.02 on January 2021

Our representatives are available 7:00 AM to 4:30 PM Monday through Friday, Pacific Time. Call us toll free at 1-800-SYMETRA (796-3872) option 3 then 1, contact us via email at [email protected] or by toll free fax at 1-866-817-8780.



Symetra Representative signature here


Income Annuities Claims Unit Manager

Symetra Life Insurance Company


symetra life insurance company 777 108th Avenue NE, Suite 1200 Bellevue, WA 98004-5135 Mailing address: PO Box 34690 Seattle, WA 98124-1690 Phone 1-800-796-3872

Come Visit us at: 5600 Wilshire Blvd. Los Angeles, California 90036

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