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Collateral Security--Insurance Dividends
COLLATERAL SECURITY--INSURANCE DIVIDENDS
As security for the payment of the principal and interest of this instrument and for the payment of any expenses, including legal costs and attorneys fees, that may be incurred in the collection of the principal and interest of this instrument, maker pledges and assigns to payee all the excess, return, or unearned premiums and all dividends on the life insurance policy of maker with [insurance company], of [address of insurance company], [city of insurance company], [state of insurance company]. The number of the insurance policy is [number of the insurance policy].
This is a UCC form. It is intended to be an addendum to other forms.