(2) The full name, and age, of the Assignee must be stated. (3) The actual consideration for the assignment received from the assignee should be written in.Complete this form for the Collateral Assignment of Life insurance and Annuity contracts ONLY. The Assignment of Insurance Policy as Collateral form is 2 pages long and contains: 9 signatures; 0 check-boxes; 23 other fields. To fill out this form, first gather all necessary personal and organizational information beforehand. Following are instructions to complete each section of the statement of premium due. Instructions for Completing Statement of Premium Due. How to fill out the Assignment Policy Form for Life Insurance? 1. Identify the policy and the assignee details. 2.