FOR VALUE RECEIVED， the undersigned hereby sells and transfers to _， [Assignee] and its successors， assigns and personal representatives， any and all claims， demands， and cause or causes of action of any kind whatsoever¹ which the undersigned has or may have against _， arising from the following type claim：

　　_

　　And the undersigned may in its own name and for its own benefit prosecute²， collect， settle， compromise and grant releases on said claim as it in its sole discretion³ deems advisable.

　　Signed under seal this _ day of _， 19_.

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