Kentucky Assignment of Insurance Policy


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                             This is an agreement whereby a party that is currently insured (the �                  )
                                                                                                         Assignor� wholly
                             transfers their rights under an insurance policy to a third party (the �               ).
                                                                                                        Assignee� This is an
                             irrevocable transfer of all legal and beneficial rights, title and interest in an insurance policy.
                             After execution, the Assignor no longer has rights or benefits under the insurance policy.
                             This document is ideal for small businesses or individuals located in Kentucky who want to
                             transfer their rights under an insurance policy.

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                                 ASSIGNMENT OF INSURANCE POLICY

BE IT KNOWN, for value received, the undersigned ________________________ [Instruction: Insert the
name      of    Policy   Holder/Assignor]      hereby       irrevocably      transfers   and     assigns    to
________________________________ [Instruction: Insert the name of the person to whom insurance
policy is assigned/Assignee] 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. ___________________ [Instruction: Insert the
policy number] issued by the __________________ [Instruction: Insert the insurance company name]
Insurance Company.

The undersigned also assigns 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 ____ [Month] ____ [Date], 20____

In the presence of:

____________________________                                   ____________________________
      Assignor Signature                                              Witness Signature

____________________________                                   ____________________________
      Assignor Name                                                    Witness Name

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