This is a document that allows the holder of a life insurance policy to transfer the
benefits of the policy to a new beneficiary. This agreement is irrevocable and the
transferring party warrants that they own the life insurance policy and promises that they
will execute any additional documents that may be necessary. This document can be
used by parties who want to transfer their rights under a life insurance policy.
ASSIGNMENT OF INSURANCE POLICY
THE UNDERSIGNED (the “Assignor”), being the registered owner of a life insurance
policy bearing Policy No: _______________ (the “Policy”), in the principal amount of
_____________ ($________) Dollars issued by ____________________ to the Assignor, hereby
irrevocably transfers and assigns to ______________________ (the “Assignee”), all of the
Assignor’s right, title and interest in and to the Policy.
THE ASSIGNOR hereby represents and warrants to the Assignee, that the Assignor has
the full right and authority to assign the Policy to the Assignee.
THE ASSIGNOR hereby agrees that he/she shall execute any and all documents that may
be necessary or required to give effect to the foregoing at the written request of the Assignee.
THIS ASSIGNMENT shall be binding on the Assignor’s heirs, executors, successors and
DATED this _____ day of ____________, 2_____.
Witness as to Assignor’s Signature Assignor
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