This Assignment of Life Insurance as Security is between an individual (the “assignor”) who agrees to assign proceeds under a life insurance policy to another party (the “assignee”) as security for a debt. This agreement sets out the specifics of this assignment including assignor’s covenants to maintain the life insurance policy in good standing and send notice to the insurer to take all steps necessary to effect this assignment. It is imperative that this type of arrangement be set out in writing. A written Assignment of Life Insurance as Security will be helpful in the event of disagreements or misunderstandings between the parties.

This Assignment of Life Insurance as Security contains the following provisions:

• Parties: The names of the assignor and assignee;
• Financial Interest: The identity of the party in which the assignor has a direct financial interest;
• Indebtedness: The amount of assignor’s indebtedness;
• Life Insurance Policy: Sets out the name of the insurance company who issued the policy, the policy number, date of issue and the policy amount;
• Assignment: Assignor assigns the policy as general and continuing collateral security for repayment of the indebtedness;
• Covenants to Maintain Policy: Assignor agrees to pay all premiums and maintain the life insurance policy in good standing until the indebtedness has been paid in full;
• Additional Assurances: The assignee may ask assignor to execute other assurances regarding the security in the policy;
• Signatures: Both assignor and assignee must sign this agreement.

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This attorney-prepared packet contains:

1. General Instructions
2. Assignment of Life Insurance as Security

State Law Compliance: This form complies with the laws of all states