DECLARATION OF LIFE INSURANCE TRUST
This Declaration of Insurance Trust is made this _________(1)_______ day of _______
(2)_______, ________(3)________, by and between _________(4)__________, of __________
(5)_________, hereinafter called the Trustier, and _________(6)________, of _________(7)
__________, hereinafter called the Trustee.
I.
The Trustier, as owner of certain life insurance policy or policies listed below, and
desiring to establish a Life Insurance Trust, with power in the Trustee upon the death of the
Trustier to purchase assets from Trustor's estate, assigns to the Trustee all his right, title, and
interest in the policy or policies of insurance, to be held by Trustee in trust, and to receive the
proceeds of the policy or policies of insurance when they become due and are paid, for the
purposes and on the conditions set forth herein. The Trustier reserves the right to add to this trust
from time to time additional life insurance policies which, when delivered to the Trustee, shall be
held by him subject to the terms herein.
(Description of Life Insurance policies)
II.
The Trustee is vested with all right, title, and interest in the life insurance policy or
policies, and is authorized and empowered to exercise and enjoy, for the purposes of the trust
and as absolute owner of the policy of insurance, all the options, benefits, rights, and privileges
under the policy or policies. The Trustier relinquishes all rights and powers in the life insurance
policy or policies which are not assignable and will, at the request of the Trustee, execute all
other instruments reasonably required to effectuate this relinquishment. The trustee shall
receive and hold said Life Insurance policies, together with any additions thereto, in trust for the
use and benefit of:
(List names of Beneficiaries)
III.
Upon the death of the Trustor, the Trustee may, within his discretion, purchase assets
from Trustor's estate at a fair value. The propriety of the purchase, the amount o