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 who want to
buy or sell their rights under an insurance policy.
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.
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 ____ [Month] ____ [Date], 20____
In the presence of:
Assignor Signature Witness Signature
Assignor Name Witness Name
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