Assignment of Life Insurance as Security

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This Assignment of Life Insurance as Security is for use by a party who will assign life insurance policy proceeds to another as security for a debt. This assignment sets out the specific terms including the amount of the indebtedness and assignor's agreement to maintain and pay all policy premiums.

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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
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.
 
 
Assignment of Life Insurance

 

 

 
THIS AGREEMENT is made as of       between      , of       (the “Assignor”) and      , of       (the “Assignee”).
 
 
WHEREAS the Assignor has a direct financial interest in       (the “Corporation”);
 
AND WHEREAS the Corporation is indebted to the Assignee in the amount of       (the “Indebtedness”);
 
AND WHEREAS the Assignee required the Assignor to assign its rights under a policy of insurance (the “Policy”) issued by the       dated      , and numbered      , pursuant to which the sum of       is assured to be paid on the death of the Assignor;
 
 
NOW THEREFORE in consideration of the premises and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Assignor agrees as follows:
 
1.   Assignment of Insurance.  The Assignor hereby assigns to the Assignee the Policy, and all of his interest therein, and all sums of money assured by or to become payable under or by virtue of the Policy, as general and continuing collateral security for the repayment of the Indebtedness.
1.   
 
 
 
2.   Covenants to Maintain Policy. The Assignor hereby covenants to pay all premiums on the Policy and maintain the Policy in good standing until the Indebtedness has been paid in full.
 
3.   Notice to Insurer. The Assignor agrees to notify the insurer under the Policy of the assignment hereby constituted and to execute, do and perform all such acts and things as the said insurer may require to give effect to the assignment.
 
4.   Additional Security. This security is in addition to and not in substitution for any other security now or hereafter held by the Assignee.
 
5.   Attachment. The Assignor and the Assignee expressly state that they intend that the security interest hereby constituted to attach upon execution and delivery of this Agreement. The Assignor acknowledges receipt of a true copy of this Agreement.
 
6.   Further Assurances. The Assignor shall from time to time on request by the Assignee execute such further and other assurances, conveyances, mortgages, assignments, consents and documents as may be reasonably necessary for the purpose of perfecting the Assignees security in the Policy.
 
7.   Notices. All notices and other communications required or permitted hereunder shall be in writing and, if delivered, shall be deemed to have been received on the day of delivery, and, if mailed by prepaid registered mail at any time other than during a discontinuance of postal service due to a strike, lockout or otherwise, shall be deemed to have been received two (2) business days after the postmarked date thereof. Notice of change of address for service shall also be governed by this Section. The addresses of the parties are as set out at the head of this Agreement.
 
8.   Successors and Assigns. This Agreement shall enure to the benefit of and be binding upon the parties hereto and their respective heirs, executors, administrators, successors and assigns.
 
9.   Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of      .
 
IN WITNESS WHEREOF the parties hereto have executed this agreement as of the date first above written.
 
 
 
 
Witness
 
     
 
 
 
Witness
 
     
 
Number of Pages4
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#28609
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.
 
 
Assignment of Life Insurance

 

 

 
THIS AGREEMENT is made as of       between      , of       (the “Assignor”) and      , of       (the “Assignee”).
 
 
WHEREAS the Assignor has a direct financial interest in       (the “Corporation”);
 
AND WHEREAS the Corporation is indebted to the Assignee in the amount of       (the “Indebtedness”);
 
AND WHEREAS the Assignee required the Assignor to assign its rights under a policy of insurance (the “Policy”) issued by the       dated      , and numbered      , pursuant to which the sum of       is assured to be paid on the death of the Assignor;
 
 
NOW THEREFORE in consideration of the premises and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Assignor agrees as follows:
 
1.   Assignment of Insurance.  The Assignor hereby assigns to the Assignee the Policy, and all of his interest therein, and all sums of money assured by or to become payable under or by virtue of the Policy, as general and continuing collateral security for the repayment of the Indebtedness.
1.   
 
 
 
2.   Covenants to Maintain Policy. The Assignor hereby covenants to pay all premiums on the Policy and maintain the Policy in good standing until the Indebtedness has been paid in full.
 
3.   Notice to Insurer. The Assignor agrees to notify the insurer under the Policy of the assignment hereby constituted and to execute, do and perform all such acts and things as the said insurer may require to give effect to the assignment.
 
4.   Additional Security. This security is in addition to and not in substitution for any other security now or hereafter held by the Assignee.
 
5.   Attachment. The Assignor and the Assignee expressly state that they intend that the security interest hereby constituted to attach upon execution and delivery of this Agreement. The Assignor acknowledges receipt of a true copy of this Agreement.
 
6.   Further Assurances. The Assignor shall from time to time on request by the Assignee execute such further and other assurances, conveyances, mortgages, assignments, consents and documents as may be reasonably necessary for the purpose of perfecting the Assignees security in the Policy.
 
7.   Notices. All notices and other communications required or permitted hereunder shall be in writing and, if delivered, shall be deemed to have been received on the day of delivery, and, if mailed by prepaid registered mail at any time other than during a discontinuance of postal service due to a strike, lockout or otherwise, shall be deemed to have been received two (2) business days after the postmarked date thereof. Notice of change of address for service shall also be governed by this Section. The addresses of the parties are as set out at the head of this Agreement.
 
8.   Successors and Assigns. This Agreement shall enure to the benefit of and be binding upon the parties hereto and their respective heirs, executors, administrators, successors and assigns.
 
9.   Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of      .
 
IN WITNESS WHEREOF the parties hereto have executed this agreement as of the date first above written.
 
 
 
 
Witness
 
     
 
 
 
Witness
 
     
 
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