DEED OF RELATIVE ASSIGNMENT OF INSURANCE POLICY

KNOW ALL MEN BY THESE PRESENTS:

FOR VALUE RECEIVED, I, _________________________________, of legal age, Filipino citizen, married/single and residing at ______________________________, do hereby assign to ______________________________________________(Assignee) of ____________________________________________________, all moneys that may be payable to me and my beneficiary/ies from the basic policy proceeds under that certain insurance policy herein below described issued by The Insular Life Assurance Company, Ltd., in which I am the Policyowner as follows:

Policy Number: ____________________ Insured : _________________________ Policyowner : _____________________

subject to the terms and conditions of said policy and to any lien, charge or indebtedness now or hereafter existing against or on account of said policy or which The Insular Life Assurance Company, Ltd. may have against the policy.

It shall be understood that I shall have no right to surrender said policy or to avail of its cash value by way of the policy loan without the written consent of the Assignee. And I hereby undertake not to sign the above-described policy during the affectivity of this deed of assignment.

Done at ________________ this ________________.

___________________ POLICYOWNER

With my consent:

__________________________ Irrevocable Beneficiary/ies

Signed in the Presence of:

_____________________ _____________________

...................................................................................

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

__________________________) : S.S

On this _____ day of __________________19____ before me, the undersigned notary public, personally came _______________________ with Residence Certificate No. _________________ issued on _____________________ at ___________________, to me personally know and known by me to be the same person/s described in and who executed the foregoing instrument, and who made oath and acknowledge to me that he/she/they executed the same voluntarily and for the purpose set forth.

WITNESS my hand and official seal this _____ day of _____________ 19 _____.

Doc. No. ___________

Book No. ___________

Page No. ___________

Series of.___________

NOTARY PUBLIC