#8403
@001 Enter the name of the DEBTOR:
@002 Enter the name of the CREDITOR:
!840 Enter the current amount of the debt in dollars:
@841/@841 Enter reason for the debt:
promissory note
KEY IN VALUE
@842 Enter the date for the debt:
@843 Enter the policy number of the policy:
!844 Enter the face amount of the debt in dollars:
!845 Enter the amount of loans/charges against the policy:
#end control section
#8403
/* Para. 8403: Pledge of insurance policy for debt */

           PLEDGE OF LIFE INSURANCE POLICY FOR DEBT


@001, referred to as DEBTOR, and @002, referred to as CREDITOR,
agree:


@001 is indebted to CREDITOR in the amount of $ @840 (!840
dollars) by virture of a @841 dated @842. DEBTOR assigns to
CREDITOR the following policy of life insurance:


Policy number: @843

Face amount: $ @844 (!844 dollars)

Amount of loans/charges against policy: @845 (!845 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: _________________________





______________________________________________

@001




_____________________________________________

@002, by an authorized officer