Exhibit 99.(4)(c)(1)

Policy Number:  [VP99999990]

POLICY SPECIFICATIONS

Flex Coverage Rider

Table of Cost of Insurance (COI) Rates

For Flex Coverage Rider [(Guaranteed Issue)]

Insured: [JOHN DOE]

Maximum Monthly Cost of Insurance Rates per $1000.00 of Net Amount at Risk applicable to this Coverage.

PolicyYear	COIRate
[1	0.11420
2	0.12510
3	0.13510
4	0.14680
5	0.15850
6	0.17180
7	0.18440
8	0.19520
9	0.20020
10	0.20610
11	0.21190
12	0.21780
13	0.22280
14	0.22860
15	0.23450
16	0.24450
17	0.25790
18	0.27370
19	0.29210
20	0.31300
21	0.33810
22	0.36660
23	0.39920
24	0.43600
25	0.47960
26	0.52900
27	0.58690
28	0.65150
29	0.72450
30	0.80520
31	0.89100
32	0.98280
33	1.07970
34	1.18520
35	1.30350
36	1.44140
37	1.60490
38	1.79600
39	2.01720
40	2.26640
41	2.54020
42	2.83630
43	3.15590
44	3.50430
45	3.89660
46	4.34480
47	4.86390
48	5.43720
49	6.15320
50	6.98110
51	7.94390
52	9.06070
53	10.33800
54	11.78270
55	13.34950
56	15.02480
57	16.75710
58	18.50020
59	20.24350
60	21.89610
61	23.37870
62	25.34290
63	27.50320
64	29.93860
65	32.62170
66	35.52070
67	38.34190
68	41.25060
69	44.19530
70	47.11980
71	49.95900
72	52.64660
73	56.64960
74	61.08170
75	66.01940
76	71.55390
77	77.81150
78	83.33330
79	83.33330
80	83.33330
81	83.33330
82	83.33330
83	83.33330
84	83.33330
85	83.33330
86	83.33330
87+	0	]

ICC17 S19FCR

1

Table of Rider Face Amount Applicable to

Flex Coverage Rider [(Guaranteed Issue)]

Insured: [JOHN DOE]

PolicyYear	Rider Increase Amount		Total RiderFace Amount
[1	$	0	$	0
2	10,000		10,000
3	10,000		20,000
4	10,000		30,000
5	10,000		40,000
6	10,000		50,000
7	10,000		60,000
8	10,000		70,000
9	10,000		80,000
10	10,000		90,000
11	10,000		100,000
12	0		100,000
13	0		100,000
14	0		100,000
15	0		100,000
16	0		100,000
17	0		100,000
18	0		100,000
19	0		100,000
20	0		100,000
21	0		100,000
22	0		100,000
23	0		100,000
24	0		100,000
25	0		100,000
26	0		100,000
27	0		100,000
28	0		100,000
29	0		100,000
30	0		100,000
31	0		100,000
32	0		100,000
33	0		100,000
34	0		100,000
35	0		100,000
36	0		100,000
37	0		100,000
38	0		100,000
39	0		100,000
40	0		100,000
41	0		100,000
42	0		100,000
43	0		100,000
44	0		100,000
45	0		100,000
46	0		100,000
47	0		100,000
48	0		100,000
49	0		100,000
50	0		100,000
51	0		100,000
52	0		100,000
53	0		100,000
54	0		100,000
55	0		100,000
56	0		100,000
57	0		100,000
58	0		100,000
59	0		100,000
60	0		100,000
61	0		100,000
62	0		100,000
63	0		100,000
64	0		100,000
65	0		100,000
66	0		100,000
67	0		100,000
68	0		100,000
69	0		100,000
70	0		100,000
71	0		100,000
72	0		100,000
73	0		100,000
74	0		100,000
75	0		100,000
76	0		100,000
77	0		100,000
78	0		100,000
79	0		100,000
80	0		100,000
81	0		100,000
82	0		100,000
83	0		100,000
84	0		100,000
85	0		100,000
86	0		100,000
87+	0		100,000		]

2