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Pledge of Life Insurance

______________, referred to as DEBTOR, and __________, referred to as CREDITOR,


agree:
______________ is indebted to CREDITOR in the amount of ______
!_____________________"___#$%% dollars& b' the terms of the agreement named
_________________, dated ____________( DEBTOR assigns to CREDITOR the
follo)ing *olic' of life insurance:
Polic' number: __________________________________________________
+ace amount: ___________!_______________________"____#$%% dollars&
,mount of loans#charges against *olic': ___________!_____________
__________"____#$%% dollars& as collateral for the debt(
,n' and all *roceeds from the *olic' are assigned to the CREDITOR, to the e-tent of
*rinci*al and interest due u*on the debt, and an' rene)als and e-tensions thereof( The
DEBTOR shall *re*are an' further instruments re.uired to effect this *ledge( ,n'
*roceeds that e-ceed the abo/e obligations shall be immediatel' turned o/er to the
Estate of Debtor(
Dated: _________________________
______________________________________________
Debtor
_____________________________________________
Creditor

Pledge of Life Insurance
Re/ie) List
This re/ie) list is *ro/ided to inform 'ou about this document in .uestion and assist 'ou
in its *re*aration( The Pledge of Life Insurance *roceeds is similar to that for the Pledge
of 0toc1 assets( 0ee the notes under the Pledge of 0toc1 document for ad/ice and
counsel on this sub2ect( This suggestion is made to be sure 'ou understand there are
no material differences bet)een the effect of these *ledges other than 'ou can not 3sell4
an insurance *ledge as 'ou can a stoc1 asset(
1. 5a1e multi*le co*ies( Be sure each rele/ant *art' has a co*'(

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