Deed To Assign Policies To Individuals By Gift. Page 5

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PARt e. signAtuRes (continued)
Assignee 1
Assignee 2
1. Signed and delivered
as a deed by the said
Assignee (full name)
2. Signature
3. In the presence of
witness (full name of
witness)
4. Signature of witness
5. Address of witness
6. Date
Assignee 3
Assignee 4
1. Signed and delivered
as a deed by the said
Assignee (full name)
2. Signature
3. In the presence of
witness (full name of
witness)
4. Signature of witness
5. Address of witness
6. Date
Legal & General Assurance Society Limited
Registered in England and Wales No. 00166055
Registered office: One Coleman Street, London EC2R 5AA
Legal & General Assurance Society Limited is authorised by the
Prudential Regulation Authority and regulated by the
Financial Conduct Authority and the Prudential Regulation Authority.
W13090 06/15 NON ASD
Page 5

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