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