ASSIGNMENT OF INSURANCE POLICY

BE IT KNOWN, for value received, the undersigned ____________________________ of ____________________________ hereby irrevocably transfers and assigns to ____________________________ all legal and beneficial right, title and interest in and to the within policy of insurance standing in my name and known as Policy No. ____________________________ issued by the ____________________________ Insurance Company.

I also assign all cash values, proceeds and benefits thereto arising, subject to the conditions of said policy and the requirement of the issuing underwriter:

The undersigned warrants that it has full authority to transfer said policy, and shall execute all further documents as may be required, by the underwriter.

This assignment shall be binding upon and inure to the benefit of the parties, their successors, assigns and personal representatives.

Signed this ________ day of _________________, 20____.

In the presence of:

____________________________
Witness

____________________________
Assignor's Signature
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