1
WHO IS THIS FORM FOR?
This form is for individual, trustee or corporate policyholders who wish to use their RL360 policy as security (for example against
a loan from a bank).
This form alone does not constitute a security assignment and must be accompanied by the following documentation:
• A copy of the security agreement detailing the entity with the interest. Documents which are not in English should be fully
translated before being sent to RL360.
• A certified copy or original ink Authorised Signatory List for the entity to which the policy is being pledged to as security.
ADDITIONAL INFORMATION
• The original policy documents DO NOT need to be returned.
• The Deed of Assignment Form should NOT be completed.
COMPLETING THIS FORM
Please complete in BLOCK capitals throughout.
WHERE SHOULD I SEND THE COMPLETED FORM?
Please post the completed form and the required additional documents to: Servicing Team, RL360, RL360 House, Cooil Road,
Douglas, Isle of Man, IM2 2SP, British Isles.
PRIVACY POLICY
Our full privacy policy can be viewed at www.rl360.com/privacy or can be obtained by requesting a copy from our
Data Protection Ocer.
Section 1
Policyholder details
First policyholder’s name
Second policyholder’s name
(if applicable)
RL360 policy number
I would like to inform RL360 that I am using the above mentioned policy as security with:
(Name of financial institution who has interest)
I understand that as a result of using my policy as security, RL360 will not accept any transaction instructions from me (for
example, dealing/switching instruction, regular withdrawal instructions) without appropriate authorisation from the entity
detailed in Section 2.
First policyholder Second policyholder (if applicable)
Signed
Date (dd/mm/yyyy)
SECURITY
ASSIGNMENT
FORM
SERVICING
