Pledge Of Life Insurance Policy For Debt

Pledge of life insurance policy as collateral for outstanding debt.

Enter the name of the DEBTOR, referred to as DEBTOR, and Enter the name of the CREDITOR, referred to as CREDITOR, agree:

Enter the name of the DEBTOR is indebted to CREDITOR in the amount of $ Enter the current amount of the debt in dollars (Enter the current amount of the debt in dollars dollars) by virture of a Enter reason for the debt dated Enter the date for the debt. DEBTOR assigns to CREDITOR the following policy of life insurance:

Policy number: Enter the policy number of the policy

Face amount: $ Enter the face amount of the debt in dollars (Enter the face amount of the debt in dollars dollars)

Amount of loans/charges against policy: Enter the amount of loans/charges against the policy (Enter the amount of loans/charges against the policy dollars)

as collateral for the debt. Any and all proceeds from the policy are assigned to the CREDITOR, to the extent of principal and interest due upon the debt, and any renewals and extensions thereof. The DEBTOR shall prepare any further instruments required to effect this pledge.

Date

Enter the name of the DEBTOR

Debtor

Enter the name of the CREDITOR, by an authorized officer

Creditor

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