Assignment of Life Insurance Policy as Collateral/Partial Sample

Assignee:

_________________________

_________________________

_________________________

Policy Number: ____________

Insurer:

_________________________

_________________________

_________________________

Insured:

_________________________

_________________________

_________________________

Debtor:

_________________________

_________________________

_________________________

A. For Value Received, the undersigned hereby assign, transfer and setover to

Assignee, its successors and assigns, the insurance policy identified by the Policy

Number issued by the Insurer and any supplementary contracts issued in connection

therewith (said policy and contracts being herein called the "Policy"), upon the life of

the Insured and all claims, options, privileges, rights, title and interest therein and

thereunder (except as provided in Paragraph C hereof), subject to all the terms and

conditions of the Policy and to all superior liens, if any, which the Insurer may have

against the Policy. The undersigned by this instrument jointly and severally agree

and the Assignee by the acceptance of this assignment agrees to the conditions and

provisions herein set forth...