§ Form 20 Complaint for Interpleader and Declaratory Relief

Form 20. Complaint for Interpleader and Declaratory Relief

(Caption--See Form 1.)

1. (Statement of Jurisdiction--See Form 7.)

2. On date, the plaintiff issued a life insurance policy on the life of name with name as the named beneficiary.

3. As a condition for keeping the policy in force, the policy required payment of a premium during the first year and then annually.

4. The premium due on date was never paid, and the policy lapsed after that date.

5. On date, after the policy had lapsed, both the insured and the named beneficiary died in an automobile collision.

6. Defendant name claims to be the beneficiary in place of name and has filed a claim to be paid the policy's full amount.

7. The other two defendants are representatives of the deceased persons' estates. Each defendant has filed a claim on behalf of each estate to receive payment of the policy's full amount.

8. If the policy was in force at the time of death, the plaintiff is in doubt about who should be paid.

Therefore, the plaintiff demands that:

(a) each defendant be restrained from commencing any action against the plaintiff on the policy;

(b) a judgment be entered that no defendant is entitled to the proceeds of the policy or any part of it, but if the court determines that the policy was in effect at the time of the insured's death, that the defendants be required to interplead and settle among themselves their rights to the proceeds, and that the plaintiff be discharged from all liability except to the defendant determined to be entitled to the proceeds; and

(Date and sign--See Form 2.)