PLEDGE OF LIFE INSURANCE POLICY FOR DEBT

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

as CREDITOR, agree:

______________ is indebted to CREDITOR in the amount of $

__________(_______________________________&___/100 dollars) by

virture of _________________ dated ____________. DEBTOR assigns to

CREDITOR the following policy of life insurance:

Policy number: __________________________________________________

Face amount: $___________(_______________________&____/100 dollars)

Amount of loans/charges against policy: $___________(_____________

__________&____/100 dollars)

as collateral for the debt. Any and all proceeds from the policy

are assigned to the CREDITOR, to the extent of principal and

interest due upon the debt, and any renewals and extensions

thereof. The DEBTOR shall prepare any further instruments required

to effect this pledge.

Dated: _________________________

______________________________________________

_____________________________________________

___________________, by an authorized officer