STEP 1 Tell us your policy information. Please print the required information.Here mention the name and. Address of the assignee. To fill out this form, first gather all necessary personal and organizational information beforehand. How to fill out the Assignment of Policy for Valuable Consideration? No. Neither the New York Insurance Law, nor the regulations promulgated thereunder, obligates an insurer to honor an assignment of benefits request. If the new owner wishes to change the beneficiary on the referenced policy, complete and submit form 0012422XX.