Metlife Absolute Assignment Form – Fill Out and Use This PDF

Metropolitan Life Insurance Company, New York, NY

Absolute Assignment Pursuant to a Viatical Settlement

With Waivers and Consents

Please read instructions on page 3 before completing and executing this form.

Group Life Insurance Program (“Program”) of

Spouse Waiver for Assignment of Group Life Benefits

(To Be Completed If Applicable)

Please Read the Following Section Carefully:

The spouse of the assignor should sign below IF the assignor is making an assignment to a person other than his/her spouse, AND the assignor is a resident of one of the following community property jurisdictions: Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, Wisconsin.

I, spouse of the assignor, hereby consent to this assignment and waive and release any and all community property rights in and to the subject matter of the assignment.

Name of SpouseSignature of SpouseDate

I Hereby Assign To

and Assignee’s assigns, all right, title, interest and incidents of ownership, both present and future, relating to the insured’s group life insurance under the Program, including but not limited to: the right to make any requisite contributions for the coverage under said Program, the privilege of obtaining an individual policy of life insurance on the insured’s life, the right, to the extent permissible to change the beneficiary(ies) and the right to elect any available settlement option. This assignment relates to the existing coverages now being assigned under the insurance policy (policies) and any replacement or substitute policy of the same or another insurance company providing insurance under the Program, and any amended or successor Program provided by the Employer.

Sign your name only by the line of coverage(s) you intend to assign:

It is understood and agreed that neither MetLife nor the Program assume any obligation as to the validity or sufficiency of this assignment and that the assignment will not be binding upon them until filed with and accepted by the Program and MetLife.

Absolute Assignment Pursuant to a Viatical Settlement

With Waivers and Consents

Assignee’s Designation of Beneficiary

Effective as of the date of this assignment, I hereby (1) revoke any previous beneficiary designation as to the above-named Insured under the Group Policy, and (2) revocably designate as beneficiary thereunder:

Unless otherwise provided above, payment to two or more primary beneficiaries or two or more contingent beneficiaries shall be made in equal shares or to the survivors in equal shares or all to the last survivor. If there is no primary or contingent beneficiary living at the death of the insured, the amount of benefits payable because of the insured’s death shall be payable to the assignee if living at the insured’s death or to the assignee’s estate if the assignee is not living at the insured’s death.

It is understood and agreed that this designation will in no way apply in respect of any Survivor life insurance benefits if the Group Policy providing for such benefits makes no provision whatever for a beneficiary designation and that in such event the Survivor life insurance benefits will be payable only as provided in the Group Policy, this assignment notwithstanding.

Waivers and Consents

With respect to this assignment only, the Group Policyholder and MetLife hereby (1) waive with respect to the Group Policy and certificate, any provision therein against assignment for the above referenced coverage(s), and (2) consent to this assignment and to the exercise by the assignee of all of the aforesaid right, title, interest and incidents of ownership.