______________, referred to as DEBTOR, and __________, referred to as CREDITOR, agree:
______________ is indebted to CREDITOR in the amount of $______ (_____________________&___/100 dollars) by the terms of the agreement named _________________, dated ____________. DEBTOR assigns to CREDITOR the following policy of life insurance:
Policy number: __________________________________________________

Face amount: $___________(_______________________&____/100 dollars)
Amount of loans/charges against policy: $___________(_____________ __________&____/100 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. Any proceeds that exceed the above obligations shall be immediately turned over to the Estate of Debtor.

Dated: _________________________

______________________________________________
Debtor

_____________________________________________
Creditor

Pledge of Life Insurance
Review List

This review list is provided to inform you about this document in question and assist you in its preparation. The Pledge of Life Insurance proceeds is similar to that for the Pledge of Stock assets. See the notes under the Pledge of Stock document for advice and counsel on this subject. This suggestion is made to be sure you understand there are no material differences between the effect of these pledges other than you can not “sell” an insurance pledge as you can a stock asset.

1. Make multiple copies. Be sure each relevant party has a copy.

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