EX-99.(D)(1) 3 dex99d1.txt SPECIMEN FORM OF POLICY EXHIBIT (d)(1) AMERICAN GENERAL LIFE INSURANCE COMPANY A STOCK COMPANY Home Office: Houston, Texas 2727-A Allen Parkway POLICY NUMBER: 0000000000 P. O. Box 4880 Houston, Texas 77019 (800) 340-2765 WE WILL PAY THE DEATH BENEFIT PROCEEDS to the Beneficiary if the Insured dies prior to the Maturity Date and while this policy is in force. Payment will be made after We receive due proof of the Insured's death, and will be subject to the terms of this policy. The method for determining the amount payable is stated in the Death Benefit Proceeds provision. WE WILL PAY THE CASH SURRENDER VALUE of this policy to the Owner on the Maturity Date if the Insured is living on that date and if this policy is in force. THE AMOUNT OR DURATION OF THE DEATH BENEFIT PROCEEDS AND THE ACCUMULATION VALUES PROVIDED BY THIS POLICY WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. ACCUMULATION VALUES MAY INCREASE OR DECREASE. The consideration for this policy is the application and payment of the first premium. The first premium must be paid on or before delivery of this policy. This is a FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE INSURANCE POLICY. An adjustable Death Benefit is payable upon the Insured's death prior to the Maturity Date and while this policy is in force. Investment results are reflected in policy benefits. ACCUMULATION VALUES and CASH VALUES are flexible and will be based on the amount and frequency of premiums paid and the investment results of the Separate Account. NON-PARTICIPATING--NOT ELIGIBLE FOR DIVIDENDS. NOTICE OF TEN DAY RIGHT TO EXAMINE POLICY YOU MAY RETURN THIS POLICY WITHIN TEN DAYS AFTER DELIVERY IF YOU ARE NOT SATISFIED WITH IT FOR ANY REASON. THE POLICY MAY BE RETURNED TO US OR TO THE REGISTERED REPRESENTATIVE THROUGH WHOM IT WAS PURCHASED. UPON SURRENDER OF THIS POLICY WITHIN THE TEN DAY PERIOD, IT WILL BE DEEMED VOID FROM THE DATE OF ISSUE, AND WE WILL REFUND THE GREATER OF: (1) ANY PREMIUMS RECEIVED BY US; OR (2) YOUR ACCUMULATION VALUE AS OF THE FIRST VALUATION DATE OCCURRING ON OR NEXT FOLLOWING THE DATE ON WHICH YOUR REQUEST IS RECEIVED PLUS ANY CHARGES THAT HAVE BEEN DEDUCTED. SIGNED AT THE HOME OFFICE ON THE DATE OF ISSUE. ------------------------------------ ----------------------------------- Secretary President FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE INSURANCE POLICY READ YOUR POLICY CAREFULLY 07921 INDEX Annual Report 24 Cash Surrender Value 11 Cash Value 11 Change of Ownership or Beneficiary 20 Changing the Death Benefit Option 7 Changing the Specified Amount 6-7 Contract 4 Cost of Insurance Rate Table 28 Date of Issue 4 Death Benefit and Death Benefit Options 5-6 Death Benefit Corridor Rates 29 Dollar Cost Averaging 17 General Account 10 General Provisions 22-26 Grace Period 13 Incontestability 22 Investments of the Separate Account 8 Maturity Date 3 Monthly Administration Fee 12 Monthly Guarantee Premium 13-14 Monthly Guarantee Premium Period 3 Owner 4 Payment Options 20-22 Policy Loans 18-19 Policy Values Provisions 10-15 Premium Expense Charge 5 Premium Payments 4-5 Reinstatement 24-25 Separate Account Provisions 8-9 Specified Amount 7 Suicide 23 Surrender Charges 30-31 Surrender, Full and Partial 14 Suspension and Deferral of Payments 17-18 Transfer Provision 15-16 Valuation of Assets 8 Valuation Dates 9 Valuation Units 8 When This Policy Terminates 24 DEFINITIONS COMPANY REFERENCE. "We", "Our", "Us", or "Company" mean American General Life Insurance Company. "YOU", "YOUR." The words "You" or "Your" mean the Owner of this policy. HOME OFFICE. Our office at 2727-A Allen Parkway, Houston, Texas 77019; Mailing Address P. O. Box 4880, Houston, Texas 77210-4880. PAYMENT PROCESSING CENTER. Our center for processing premium payments at #1 Franklin Square, Springfield, IL 62712-0001; Mailing Address P. O. Box 4880, Houston, Texas 77210-4880. WRITTEN, IN WRITING. A written request or notice in acceptable form and content, which is signed and dated, and received at Our Home Office. PREMIUM CLASS. We may offer any or all of the following Premium Classes. The Premium Class of this policy is shown on the Policy Schedule as one or a combination of the following terms: PREFERRED PLUS. The term "Preferred Plus" means the cost of insurance is based on the Insured being an exceptional mortality risk and a non-user of tobacco and other products that contain nicotine. PREFERRED. The term "Preferred" means the cost of insurance is based on the Insured being a better than average mortality risk. STANDARD. The term "Standard" means the cost of insurance is based on the Insured being an average mortality risk. NOTICE This Policy Is A Legal Contract Between The Policy Owner And The Company. 07921 Page 2 DEFINITIONS (CONT'D) TOBACCO. The term "Tobacco" means the cost of insurance is based on the Insured being a user of tobacco or other products that contain nicotine. NON-TOBACCO. The term "Non-Tobacco" means the cost of insurance is based on the Insured being a non-user of tobacco and other products that contain nicotine. JUVENILE. The term "Juvenile" means the Insured's age nearest birthday was 17 or less on the Date of Issue. Cost of insurance rates Stated in Juvenile policies for insurance ages 18 and above are rates for users of tobacco or other products that contain nicotine. (Rates are not classified on the basis of the Insured being a user or non-user of tobacco or other products that contain nicotine at ages 0 through 17.) Prior to the policy anniversary nearest the Insured's 18th birthday a request for Non-Tobacco rates may be submitted. See page 25, "Rates on Policy Anniversary Nearest Insured's 18th Birthday." SPECIAL. The term "Special" means "Sub- standard" or "Rated". This means an extra amount is being charged due to the Insured's health, occupation or avocation. 07921 Page 2A POLICY SCHEDULE Insured: John Doe Policy Number: 000000000 Insurance Age: 35 Date of Issue: July 1, 2007 Base Coverage: $ 50,000 Maturity Date: July 1, 2093 Supplemental Coverage: $ 0 Initial Specified Amount: $ 50,000 Death Benefit Option: 1 This Is A [Sex Distinct] Policy BASE POLICY MONTHLY COST YEARS PAYABLE ----------- ------------ ------------- Variable Universal Life See Page 28 86 Premium Class: Preferred Plus Initial Premium: $830.64 Planned Periodic Premium: $830.64 Payable Annually Monthly Deduction Day: 1/st/ Day of Each Month Minimum Death Benefit Amount (After A Decrease In Specified Amount): [$50,000] Monthly Guarantee Premium: [$20.00] Monthly Guarantee Premium Period: [20 Years] Minimum Partial Surrender: [$500.00] Minimum Value That May Be Retained In A Division After A Partial Surrender: [$500.00] Annual Effective Monthly Guaranteed Interest Rate: 3.0% 0.2466% Mortality Table: 2001 Commissioners Standard Ordinary Male or Female, Smoker or Non-Smoker Ultimate Mortality Table Death Benefit Compliance Test: [Guideline Premium] Maximum Net Amount At Risk If Death [3] Times The Initial Benefit Option 3 Is Selected: Specified Amount Stated On This Page Coverage may expire prior to the Maturity Date shown where either no premiums are paid following payment of the initial premium, or subsequent premiums are insufficient to continue coverage to such date. This Is A[n] [State Name] Policy 07921 Page 3
POLICY SCHEDULE CONTINUED - POLICY NUMBER 000000000 ADDITIONAL BENEFITS PROVIDED BY RIDERS MONTHLY COST YEARS PAYABLE -------------------------------------- ------------ ------------- Guaranteed Minimum Death Benefit Rider Rider Charge (Deducted from Policy Accumulation Value): See Rider 86 Charges Deducted from CG Account Value: CG Cost of Insurance: See Rider 86 CG Premium Expense Charge Percentage: [5.0%] CG Monthly Administration Fee: [$10.00] CG Monthly Expense Charge: $6.50 CG Monthly Expense Charge Duration: First [5] Policy Years and First [5] Years of an Increase CG Interest Rate: [5%] Separate Account Factor: General Account Factor: [70%] Restricted Funds (See Rider For Details): [90%] [AIM V.I. Global Real Estate Fund AIM V.I. International Growth Fund Credit Suisse Trust Small Cap Core I Portfolio Dreyfus VIF International Value Fund Franklin Templeton VIP Franklin Small Cap Value Securities Fund Janus Aspen International Growth Portfolio JPMorgan International Equity Portfolio MFS (R) VIT Series Trust II New Discovery Series Oppenheimer Global Securities Fund/VA PIMCO VIT CommodityRealReturn Strategy Portfolio Putnam VT Small Cap Value Fund VALIC Company I International Equities Fund VALIC Company I Small Cap Index Fund]
07921 Page 3 (Cont'd) POLICY SCHEDULE CONTINUED - POLICY NUMBER 0000000000 Charges Deducted From The Separate Account Mortality and Expense Charge. Deductions from the Separate Account will be made at an annual rate not to exceed the rates stated below. The actual deduction will be made on a daily basis. The initial current rate on a daily basis is [0.001917%]. POLICY YEARS CURRENT ANNUAL RATE GUARANTEED ANNUAL RATE ------------ ------------------------ ------------------------ 1-10..................... [0.70%] 0.70% 11-20.................... [0.35%] 0.35% Thereafter............... [0.00%] 0.15% Expense Charges: Premium Tax (If Applicable). Depending on the laws of the jurisdiction in which this policy was issued, and subject to future changes in residence, a percentage of each premium may be deducted for premium tax. Premium tax rates are subject to change. The premium tax rate for this policy on the Date of Issue is [0%]. PREMIUM EXPENSE CHARGE: CURRENT GUARANTEED ----------------------- ------- ---------- (Adjustable Premium Expense Charge Percentage)......... [5.0%] 7.5% CURRENT GUARANTEED ------- ---------- Monthly Administration Fee:............................ [$10.00] $10.00 Monthly Expense Charge For First Five Years:........... [$ 6.50] Base Policy Charges and Fees Cost of Insurance Charges. Guaranteed maximum cost of insurance rates per $1,000 of Net Amount at Risk are shown on page 28. Surrender Charges. Surrender Charges will apply if the policy is surrendered or the Initial Base Coverage is reduced during the Surrender Charge Period following the Date of Issue. Surrender Charges will also apply during the Surrender Charge Period following an increase in Base Coverage. Surrender Charges applicable to this policy appear on pages 30 and 31. 07921 Page 3A CONTRACT. Your policy is a legal contract that You have entered into with Us. You have paid the first premium and have submitted an application, a copy of which is attached. In return, We promise to provide the insurance coverage described in this policy. The entire contract consists of: 1. The base policy; 2. The riders that add benefits to the base policy, if any; 3. Endorsements, if any; and 4. The attached copy of Your application, and any amendments or supplemental applications. DATE OF ISSUE. The Date of Issue of this policy is the date on which the first premium is due. The Date of Issue is also the date from which all policy years, anniversaries, and Monthly Deduction dates are determined. OWNER. The Owner is as stated in the application unless later changed. During the Insured's lifetime, the Owner may exercise every right the policy confers or We allow (subject to the rights of any assignee of record). You may have multiple Owners of this policy. In that case, the authorizations of all Owners are required for all policy changes except for transfers, premium allocations and deduction allocations. We will accept the authorization of one Owner for transfers and changes in premium and deduction allocations. The Owner and the Insured may be the same person but do not have to be. If an Owner dies while the policy is in force and the Insured is living, ownership rights pass on to a successor Owner recorded in Our records, if any; otherwise ownership rights pass to the estate of the Owner. PREMIUM PAYMENTS All premiums after the first are payable in advance. Premium payments are flexible. This means You may choose the amount and frequency of payments. The actual amount and frequency of premium payments will affect the Cash Values and the amount and duration of insurance. Please refer to the Policy Values Provision for a detailed explanation. PLANNED PERIODIC PREMIUMS. The amount and frequency of the Planned Periodic Premiums You selected are shown on the Policy Schedule. You may request a change in the amount and frequency. We may limit the amount of any increase. (See "Maximum Premium"). UNSCHEDULED ADDITIONAL PREMIUMS. You may pay additional premiums at any time before the Maturity Date shown on the Policy Schedule. We may limit the number and amount of additional premiums. (See "Maximum Premium" and "Maximum Net Amount at Risk"). MAXIMUM PREMIUM. We reserve the right to refund any premium that would cause this policy to fail to qualify as life insurance under the Death Benefit Compliance Test selected, and under applicable tax laws. The test selected is shown on the Policy Schedule. MAXIMUM NET AMOUNT AT RISK. We reserve the right to refund any premium that would cause an immediate increase in the Net Amount at Risk unless the Insured is living and provides evidence of insurability satisfactory to Us. We may automatically effect a partial surrender or reduce the Death Benefit, both of which may have federal tax consequences, if the Net Amount at Risk exceeds Our limitations. Net Amount at Risk is the excess of the Death Benefit over the Accumulation Value of the policy. 07921 Page 4 PREMIUM PAYMENTS (CONT'D) PREMIUM EXPENSE CHARGE. The Premium Expense Charge is calculated by multiplying the premium paid (after the deduction of any state premium tax) by the Premium Expense Charge Percentage. The Premium Expense Charge Percentage is adjustable, but will never be more than the guaranteed Premium Expense Charge Percentage shown on the Policy Schedule. NET PREMIUM. The term Net Premium as used in this policy means "The premium paid, less any applicable state premium tax and less the Premium Expense Charge" except as follows: No Premium Expense Charge will be deducted if the source of the premium is Cash Surrender Values applied from another policy issued by the Company. (We refer to this as an internal rollover). ALLOCATION OF NET PREMIUMS. The initial allocation of Net premiums is shown in the application for this policy and will remain in effect until changed by Written notice from the Owner. The percentage allocation for future Net Premiums may be changed at any time by Written notice. The initial Net Premium will be allocated to the money market investment option on the later of the following dates: 1. The Date of Issue; or 2. The date all requirements needed to place the policy in force have been satisfied, including underwriting approval and receipt in the Home Office of the necessary premium. The initial Net Premium will remain in the money market investment option until the first Valuation Date following the 15th day after it was applied. Any additional Net Premiums received prior to the first Valuation date which follows the 15th day after the initial Net Premium was applied will be allocated to the money market investment option until such Valuation Date. At that time, We will transfer the Accumulation Value to the selected investment option(s). Each Net Premium received after such Valuation Date will be applied directly to the selected investment option(s) as of the Business Day received. Changes in the allocation of Net Premiums will be effective on the date We receive the Owner's notice. The allocation may be 100% to any available option or may be divided among several available options in whole percentage points totaling 100%. WHERE TO PAY. You may make Your payments to Us at Our Home Office, Our Payment Processing Center or to an authorized agent. All premium checks must be made payable to the Company. A receipt signed by in officer of the Company will be furnished upon request. DEATH BENEFIT AND DEATH BENEFIT OPTIONS DEATH BENEFIT PROCEEDS. If the Insured dies prior to the Maturity Date and while this policy is in force, We will pay the Death Benefit Proceeds to the Beneficiary. The Death Benefit Proceeds will be subject to: 1. The Death Benefit Option in effect on the date of death; and 2. Any increases or decreases made to the Specified Amount. The Initial Specified Amount is shown on the Policy Schedule. Guidelines for changing the Death Benefit Option or the Specified Amount will be found in "Changing Your Insurance Policy." Any premium received after the date of death will be refunded and will not be included in the Accumulation Value for purposes of calculating the Death Benefit Amount. The Death Benefit Proceeds will be the Death Benefit Amount, after reversing any premium received after the date of death, less any outstanding policy loans and will be subject to the other provisions of the "Beneficiary and Proceeds" section. 07921 Page 5 DEATH BENEFIT AND DEATH BENEFIT OPTIONS (CONT'D) DEATH BENEFIT COMPLIANCE TEST. Death Benefit Compliance Tests are used to determine if a policy will qualify as life insurance under applicable tax laws. There are two compliance tests which may be used: The Guideline Premium Test and the Cash Value Accumulation Test. The test which You selected when this policy was issued is shown on the Policy Schedule. You cannot change Your election of the Death Benefit Compliance Test after the Date of Issue. DEATH BENEFIT OPTION. The Death Benefit Option which You have chosen is shown on the Policy Schedule as either Option 1, 2 or 3. OPTION 1. If You have chosen Option 1, the Death Benefit Amount will be the greater of: 1. The Specified Amount on the date of death; or 2. The Accumulation Value on the date of death multiplied by the applicable Death Benefit Corridor Rate. OPTION 2. If You have chosen Option 2, the Death Benefit Amount will be the greater of: 1. The Specified Amount plus the Accumulation Value on the date of death; or 2. The Accumulation Value on the date of death multiplied by the applicable Death Benefit Corridor Rate. OPTION 3. If You have chosen Option 3, the Death Benefit Amount will be the amount payable under Option 1 plus the sum of all premiums paid for this policy, including premiums for any riders, less any amounts waived by the Company under a waiver of monthly deduction benefit, except as follows: Premium payments after a partial surrender will not increase the Death Benefit Amount until the sum of premiums paid from the date of the partial surrender exceeds the amount of the partial surrender. There is a Maximum Net Amount at Risk associated with Death Benefit Option 3. The Maximum Net Amount at Risk on the Date of Issue is shown on the Policy Schedule. If at any time the Net Amount at Risk (Net Amount at Risk is the excess of the Death Benefit over the Accumulation Value of the policy) exceeds the Maximum Net Amount at Risk, the Company may automatically effect a partial surrender or reduce the Death Benefit, both of which may have federal tax consequences, to keep the Net Amount at Risk below the stated maximum. In no event, however, will We effect such partial surrender or Death Benefit reduction if the change would result in adverse tax consequences under Internal Revenue Code (IRC) section 7702. Future underwritten increases in Specified Amount will increase the Maximum Net Amount at Risk. Death Benefit Corridor Rates are shown in the table for the Death Benefit Compliance Test which You selected. SPECIFIED AMOUNT. The Specified Amount is the total of two types of coverage: Base Coverage and Supplemental Coverage. Base Coverage is subject to Surrender Charges and a 5 year Monthly Expense Charge, but Supplemental Coverage is not. If Supplemental Coverage has been included as a part of the Specified Amount, charges for the Specified Amount will be lower than if the same Specified Amount had been issued without Supplemental Coverage. However, if Supplemental Coverage is included the premium may be higher for various rider(s) attached to Your policy. The amounts of Base Coverage, Supplemental Coverage (if any) and the Initial Specified Amount are shown on the Policy Schedule. 07921 Page 6 CHANGING YOUR INSURANCE POLICY You may request a change in the Specified Amount or Death Benefit Option, subject to Our underwriting requirements at any time prior to the Insured's age 100 except that a decrease in the Specified Amount may not become effective prior to the end of the first policy year. Your request must be submitted to Our Home Office In Writing. 07921 Page 6 CHANGING YOUR INSURANCE POLICY (CONT'D) INCREASING THE SPECIFIED AMOUNT. We will require an application and evidence of insurability satisfactory to Us for any increase in the Specified Amount. The proportion of Base to Supplemental Coverage following an increase may be in any proportion as long as Base Coverage is at least 10% of the total Specified Amount. An increase will be effective on the Monthly Deduction Day on or next following the date the application for increase is approved by Us. The effective date will appear in an endorsement to this policy. DECREASING THE SPECIFIED AMOUNT. Any decrease will go into effect on the Monthly Deduction Day following the Business Day We receive the request. The Death Benefit Amount remaining in effect after any decrease cannot be less than the greater of: 1. The Minimum Death Benefit Amount shown on the Policy Schedule; and 2. Any Death Benefit Amount required to qualify this policy as life insurance under applicable tax laws. Any such decrease will be applied in the following order: 1. Against the Specified Amount provided by the most recent increase, with the decrease applying first to the entire Supplemental Coverage portion of such increase, if any, followed by the Base Coverage portion; 2. Against the next most recent increases successively, with the decrease of each prior increase applying first to the entire Supplemental Coverage portion of such increase, if any, followed by the Base Coverage portion; 3. Against the Specified Amount provided under the original application, with the decrease applying first to the entire Supplemental Coverage portion of such amount, if any, followed by the Base Coverage portion. Any reduction in Base Coverage will be subject to any applicable Surrender Charges on a pro-rata basis with the Surrender Charge prior to the reduction in Base Coverage being reduced proportionately. However, if such charge is greater than the Accumulation Value, the Specified Amount decrease will not be allowed. CHANGING THE DEATH BENEFIT OPTION. You may request a change from Option 1 to Option 2, from Option 2 to Option 1 or from Option 3 to Option 1. 1. If You request a change from Option 1 to Option 2: The new Specified Amount will be the Specified Amount, prior to change, less the Accumulation Value as of the effective date of the change, but not less than zero. Any such decrease in Specified Amount will be subject to the same guidelines and restrictions as outlined in the Decreasing the Specified Amount provision. 2. If You request a change from Option 2 to Option 1: The new Specified Amount will be the Specified Amount prior to the change plus the Accumulation Value as of the effective date of the change. The entire increase in the Specified Amount will be applied to the last coverage added (either Base or Supplemental) which has not been removed. For the purpose of this calculation, if the Base and Supplemental Coverages were issued on the same date, We will consider the Supplemental Coverage to have been issued later. 3. If You request a change from Option 3 to Option 1: The Specified Amount will remain unchanged. We will not require evidence of insurability for a change in the Death Benefit Option. The change will go into effect on the Monthly Deduction Day following the date We receive Your request for change. CHANGING THE TERMS OF YOUR POLICY. Any change in the terms of Your policy must be approved by the President, a Vice President, an Administrative Officer or the Secretary of the Company. No agent has the authority to make any changes or waive any of the terms of Your policy. 07921 Page 7 SEPARATE ACCOUNT PROVISIONS SEPARATE ACCOUNT. Separate Account VL-R is a segregated investment account established by the Company under Texas law to separate the assets funding the variable benefits for the class of policies to which this policy belongs from the other assets of the Company. That portion of the assets of the Separate Account equal to the policy liabilities shall not be chargeable with liabilities arising out of any other business We may conduct. Income, gains and losses, whether or not realized from assets allocable to the Separate Account are credited to or charged against such Account without regard to Our other income, gains or losses. INVESTMENTS OF THE SEPARATE ACCOUNT. The Separate Account is segmented into Divisions. Each Division invests in a single investment option. Net Premiums will be applied to the Separate Account and allocated to one or more Divisions. The assets of the Separate Account are invested in the investment option(s) listed on the application for this policy. From time to time, We may add additional Divisions. We may also discontinue offering one or more Divisions as provided in the "Rights Reserved by Us" provision. You may make a change in investment selections by filing a Written change form with Our Home Office. You may make transfers to the additional Divisions subject to the rules stated in the "Transfer Provision" section and any new rules or limitations which may apply to such additional Divisions. If shares of any of the investment options become unavailable for investment by the Separate Account, or the Company's Board of Directors deems further investment in these shares inappropriate, the Company may limit further purchase of the shares or may substitute shares of another investment option for shares already purchased under this policy as provided in the "Rights Reserved by Us" provision. VALUATION OF ASSETS. The assets of the Separate Account are valued as of each Valuation Date at their fair market value in accordance with Our established procedures. The Separate Account Value as of any Valuation Date prior to the Maturity Date is the sum of Your account values in each Division of the Separate Account as of that date. VALUATION UNITS. In order to determine policy values in the Divisions We use Valuation Units which are calculated separately for each Division. The Valuation Unit value for each Division will vary to reflect the investment experience of the applicable investment option. The Valuation Unit for a Division will be determined on each Valuation Date for the Division by multiplying the Valuation Unit value for the Division on the preceding Valuation Date by the Net Investment Factor for that Division for the current Valuation Date. NET INVESTMENT FACTOR. The Net Investment Factor for each Division is determined by dividing (1) by (2) and subtracting (3), where: (1) is the net asset value per share of the applicable investment option as of the current Valuation Date (plus any per share amount of any dividend or capital gains distribution paid by the investment option since the last Valuation Date); and (2) is the net asset value per share of the shares held in the Division as determined at the end of the previous Valuation Date; and (3) is a factor representing the Mortality and Expense Charge. The net asset value of an investment option's shares held in each Division shall be the value reported to Us by that investment option. 07921 Page 8 SEPARATE ACCOUNT PROVISIONS (CONT'D) VALUATION DATES. Valuation of the various Divisions will occur on each Business Day during each month. If the underlying investment option is unable to value or determine the Division's investment in an investment option due to any of the reasons stated in the "Suspension and Deferral of Payments" provision, the Valuation Date for the Division with respect to the unvalued portion shall be the first Business Day that the assets can be valued or determined. BUSINESS DAY. A Business Day is each day during which the New York Stock Exchange is open for business. We will treat any information or Written communications we receive after the close of a Business Day to have been received as of the next Business Day. For the purpose of collecting daily charges, a Business Day immediately preceded by one or more non-business calendar days will include those non-business days as part of that Business Day. For example, a Business Day which falls on a Monday will consist of a Monday and the immediately preceding Saturday and Sunday. MINIMUM VALUE. The Minimum Value that may be retained in a Division after a partial surrender or transfer is shown on the Policy Schedule. If a partial surrender causes the balance in any Division to drop below such minimum amount, the Company reserves the right to transfer the remaining balance to the money market Division. If a transfer causes the balance in any Division to drop below the minimum amount, the Company reserves the right to transfer the remaining balance in proportion to the transfer request. CHANGE OF INVESTMENT ADVISOR OR INVESTMENT OBJECTIVE. Unless otherwise required by law or regulation, the investment advisor or any investment objective may not be changed without Our consent. If required, approval of or change of any investment objective will be filed with the Insurance Department of the state where this policy is being delivered. RIGHTS RESERVED BY US. Upon notice to You, this policy may be modified by Us, but only if such modification is necessary to: 1. Operate the Separate Account in any form permitted under the Investment Company Act of 1940 or in any other form permitted by law; 2. Transfer any assets in any Division to another Division, or to one or more other separate accounts; 3. Add, combine or remove Divisions in the Separate Account, or combine the Separate Account with another separate account; 4. Make any new Division available to You on a basis to be determined by Us; 5. Substitute for the shares held by any Division the shares of another Division or the shares of another investment company or any other investment permitted by law; 6. Make any changes as required by the Internal Revenue Code, or by any other applicable law, regulation or interpretation in order to continue treatment of this policy as life insurance; 7. Make any changes required to comply with the requirements of any underlying investment option; or 8. Make other changes in this policy that in Our judgment are necessary or appropriate to ensure that this policy continues to qualify for tax treatment as life insurance, or that do not reduce any Cash Surrender Value, Death Benefit Amount, Accumulation Value or other accrued rights or benefits. When required by law, We will obtain Your approval of changes and We will obtain approval from any appropriate regulatory authority. 07921 Page 9 GENERAL ACCOUNT The General Account is a fixed account within Our general assets which We have established for: 1. Any amounts transferred from the Divisions as a result of a loan; or 2. Any amounts the Owner allocates to such Account. The guaranteed interest rate used in calculating Accumulation Values of amounts allocated to the General Account is shown on the Policy Schedule. We can use interest rates greater than the guaranteed rates to calculate Accumulation Values of amounts allocated to the General Account. Interest applied to that portion of the General Account equal to a policy loan will be at an annual effective rate of 4.0%. POLICY VALUES PROVISION ACCUMULATION VALUE. The Accumulation Value of Your policy is the total of all values in the Divisions of the Separate Account and in the General Account. The Accumulation Value reflects: 1. Net Premiums paid; 2. Monthly Deductions; 3. The investment experience of the Divisions selected less the Mortality and Expense Charge; 4. Amounts allocated to the General Account, including interest earned on amounts in the General Account; 5. Deductions due to partial surrenders and any charges for partial surrenders; and 6. Deductions, if any, resulting from decreases in Specified Amount. Net Premiums are allocated, in accordance with Your instructions, to the General Account or allocated to the selected Divisions of the Separate Account and converted to Valuation Units. On each Monthly Deduction Day, a Monthly Deduction will be made by reducing the unloaned portion of the General Account or redeeming Valuation Units from each applicable Division in the same ratio as the allocation of policy deductions in effect on the Monthly Deduction Day. You must state In Writing in advance how Monthly Deductions should be made if other than this method is to be used. If the unloaned portion of the General Account or the balance in any Division of the Separate Account is insufficient to make a Monthly Deduction in this manner, We will cancel Valuation Units from each applicable Division and reduce the unloaned portion of the General Account in the same ratio the Monthly Deduction bears to the unloaned Accumulation Value of Your policy. The Accumulation Value in any Division is determined by multiplying the value of a Valuation Unit by the number of Valuation Units held under the policy in that Division. The value of the Valuation Units equal to the amount being borrowed from the Separate Account will be transferred to the General Account as of the Business Day that We receive the Written loan request. Valuation Units are surrendered to reflect a partial surrender as of the Business Day that We receive the Written request for partial surrender. 07921 Page 10 POLICY VALUES PROVISION (CONT'D) ON THE DATE OF ISSUE. The Accumulation Value on the Date of Issue is: 1. The Net Premium received; less 2. The Monthly Deduction for the first policy month (See "How We Calculate a Monthly Deduction"). The first deduction day is the Date of Issue. The Monthly Deduction Day is shown on the Policy Schedule. ON EACH MONTHLY DEDUCTION DAY. On each Monthly Deduction Day after the Date of Issue, We will determine the Accumulation Value as follows: 1. We will take the Accumulation Value as of the last Monthly Deduction Day; 2. Add the interest earned for the month on the excess of the General Account value on the last Monthly Deduction Day over any partial surrenders and transfers made from the General Account since the last Monthly Deduction Day; 3. Add any investment gain (or subtract any investment loss) on the Divisions of the Separate Account since the last Monthly Deduction Day as measured by the change in the value of the Valuation Units; 4. Add all Net Premiums received since the last Monthly Deduction Day; 5. Subtract any partial surrender made and any charges for partial surrenders since the last Monthly Deduction Day; and 6. Subtract the Monthly Deduction for the policy month following the Monthly Deduction Day. (See "How We Calculate a Monthly Deduction"). ON ANY VALUATION DATE OTHER THAN A MONTHLY DEDUCTION DAY. The Accumulation Value on any Valuation Date other than a Monthly Deduction Day will be the sum of: 1. The value of the General Account as of the last Monthly Deduction Day; 2. Less any partial surrenders and any charges for partial surrenders since the last Monthly Deduction Day; 3. Plus all Net Premiums received since the last Monthly Deduction Day; and 4. Plus the sum of the values of the Divisions of the Separate Account as of the last Monthly Deduction Day, plus the amount of any investment gain (or minus any investment loss) on the Divisions since the last Monthly Deduction Day as measured by the change in the value of the Valuation Units. CASH VALUE. The Cash Value of this policy will be equal to the Accumulation Value less the Surrender Charge, if any. CASH SURRENDER VALUE. The Cash Surrender Value of this policy will be equal to the Cash Value less any outstanding policy loans and accrued loan interest. MONTHLY DEDUCTIONS MAY BE MADE ONLY IF THERE IS SUFFICIENT VALUE (UNLESS THE POLICY IS BEING CONTINUED UNDER THE MONTHLY GUARANTEE PREMIUM PROVISION). Unless this policy is being continued in force under the Monthly Guarantee Premium provision, a Monthly Deduction may be made only if the Cash Surrender Value is equal to or greater than the Monthly Deduction. If the value on a Monthly Deduction Day is not sufficient to meet the Monthly Deduction for the current month, this policy will be subject to the "Grace Period" and the "Monthly Guarantee Premium" provisions. 07921 Page 11 POLICY VALUES PROVISION (CONT'D) SURRENDER CHARGE. The Surrender Charge applies only to the Base Coverage portion of the Specified Amount. The Surrender Charge for the amount of Base Coverage on the Date of Issue will apply if such Base Coverage is surrendered or reduced during the Surrender Charge Period. Surrender Charges for any increases in Base Coverage will apply if such increases are surrendered or reduced during the Surrender Charge Period of each increase. The Surrender Charge Period will vary according to the Insured's age at issue (or age on the date of an increase) as shown in the Table of Surrender Charges per $1,000 of Base Coverage. HOW WE CALCULATE A MONTHLY DEDUCTION. Each Monthly Deduction includes: 1. The cost of insurance provided by the base policy; and 2. The cost of insurance and other charges for benefits provided by riders, if any; and 3. The Monthly Administration Fee; and 4. During the first 5 policy years, a Monthly Expense Charge. (A Monthly Expense Charge also applies to the amount of any increase in Base Coverage during the first 5 policy years following such increase.) ACCOUNT VALUE ENHANCEMENT. At the beginning of the 16th policy year (and at the beginning of each policy year thereafter), this policy will be eligible for an Account Value Enhancement ("Enhancement"). The Enhancement amount will be calculated at the end of the policy year by multiplying the unloaned Accumulation Value by the Enhancement Percentage. The Enhancement amount will be allocated using the premium allocation percentages in effect at that time. The annual report that We will send to the Owner for the 15th policy year will indicate the Enhancement Percentage, if any, which will be applied at the end of the 16th policy year. Each annual report that follows will indicate the Enhancement Percentage, if any, for the next policy year. The same Enhancement Percentage will be applied to all policies with the same calendar year of issue and the same policy year. HOW WE CALCULATE THE COST OF INSURANCE FOR THE BASE POLICY. We calculate the cost of insurance at the beginning of each policy month on the Monthly Deduction Day. The cost of insurance is determined as follows: 1. Reduce the Death Benefit Amount by the amount of Accumulation Value on the Monthly Deduction Day before the cost of insurance deduction is taken, and after any applicable rider charges, the Monthly Expense Charge, if any, and the Monthly Administration Fee are deducted (The Net Amount at Risk); 2. Multiply the difference by the cost of insurance rate per $1,000 of Net Amount at Risk as provided in the "Cost of Insurance Rate" provision; and 3. Divide the result by 1000. COST OF INSURANCE FOR BENEFITS PROVIDED BY RIDERS. The cost of insurance for benefits provided by riders will be as stated on the Policy Schedule or in an endorsement to this policy. MONTHLY ADMINISTRATION FEE. An administration fee will be deducted monthly. The amount of the Monthly Administration Fee may be adjusted, but will never be greater than the guaranteed Monthly Administration Fee shown on the Policy Schedule. MONTHLY EXPENSE CHARGE. A Monthly Expense Charge will be deducted during the first 5 policy years for the initial amount of Base Coverage, and during the first 5 policy years following any increase in Base Coverage. The Monthly Expense Charge for the first 5 policy years for the initial amount of Base Coverage is shown on the Policy Schedule. The Monthly Expense Charge for the first 5 policy years for any increase in Base Coverage will be provided in an endorsement to this policy. Any decrease in Base Coverage will not change the Monthly Expense Charge then in effect. 07921 Page 12 POLICY VALUES PROVISION (CONT'D) COST OF INSURANCE RATE. The cost of insurance rate for the Initial Specified Amount, and for each Specified Amount increase, is based on the Insured's: 1. Gender (if this policy was issued on a Sex Distinct basis); 2. Age nearest birthday on each policy anniversary; and 3. Premium Class associated with the Initial Specified Amount and each increase in the Specified Amount. A table of guaranteed monthly cost of insurance rates is included in this policy. We can use cost of insurance rates that are lower than the guaranteed rates. Any change in rates will apply to all policies in the same rate class as this policy. The rate class of this policy is determined on its Date of Issue according to: 1. The calendar year of issue and policy year; 2. The plan of insurance; 3. The amount of insurance; and 4. The age, gender and Premium Class of the Insured if this policy was issued on a Sex Distinct basis or the age and Premium Class if this policy was issued on a Gender Neutral basis. CHANGES IN RATES, CHARGES AND FEES. This policy does not participate in Our profits or surplus. Any redetermination of the cost of insurance rates, interest rates used in calculating Accumulation Values of amounts allocated to the General Account, Mortality and Expense Charges, Premium Expense Charge Percentage, Enhancement Percentage or Monthly Administration Fee will be based on Our future expectations as to investment earnings, mortality, persistency, expenses, reinsurance costs, and state and federal taxes. We will not change these rates or charges in order to recoup any prior losses. GRACE PERIOD. The Grace Period is the 61-day period that follows a Monthly Deduction Day or an annual policy loan interest due date if: 1. There is not enough Cash Surrender Value to pay the amount due; and 2. The requirements of the Monthly Guarantee Premium provision have not been met. There is no Grace Period for the Initial Monthly Deduction. If the amount required to keep Your policy in force is not paid by the end of the Grace Period, this policy will terminate without value. However, We will give You at least 31 days notice prior to termination that Your policy is in the Grace Period and advise You of the amount of premium required to keep Your policy in force. Such 31 days prior notice will be sent to You at Your last known address, and to the assignee of record, if any. If death occurs during the Grace Period, Monthly Deductions through the policy month in which death occurred will be deducted from the proceeds. If We receive a surrender request within 31 days after the Grace Period commences, the Cash Surrender Value payable will not be less than the Cash Surrender Value on the Monthly Deduction Day the Grace Period commenced. The Monthly Deduction for the policy month following such Monthly Deduction Day will not be subtracted in the calculation of such Cash Surrender Value. MONTHLY GUARANTEE PREMIUM. The Monthly Guarantee Premium for the Initial Specified Amount and any benefit riders in force on the Date of Issue is shown on the Policy Schedule. The Monthly Guarantee Premium Period (Guarantee Period) will be based on the Insured's age at issue. The Guarantee Period for Your policy is shown on the Policy Schedule. This policy will not terminate on a Monthly Deduction Day within the Guarantee Period if, on such Monthly Deduction Day the sum of premiums paid equals or exceeds: 1. The sum of the Monthly Guarantee Premiums from the Date of Issue, including the current month; plus 07921 Page 13 POLICY VALUES PROVISION (CONT'D) 2. Any partial surrenders and any increase in the loan amount since the Date of Issue. If on a Monthly Deduction Day, this policy does not meet the Monthly Guarantee Premium requirements, guarantees under this provision will not be in effect. During the Guarantee Period the Monthly Guarantee Premium will be recalculated if: 1. The Specified Amount is increased or decreased; or 2. A benefit rider is increased, decreased, added or removed; or 3. A change in Premium Class occurs; or 4. A change in Death Benefit Option occurs. These changes will not affect the Guarantee Period then in effect, if any. If a policy is reinstated during the Guarantee Period with no change in the Specified Amount, the Death Benefit Option, Premium Class or benefit riders, if any, the Monthly Guarantee Premium upon reinstatement will be the same as it was when the policy lapsed. Reinstatement will not change the Guarantee Period that was in effect when the policy lapsed. The policy value at the end of the Guarantee Period may be insufficient to keep the policy in force unless an additional payment is made at that time. FULL SURRENDER. You may return Your policy to Us and request its Cash Surrender Value at any time during the Insured's lifetime before the Maturity Date. The Cash Surrender Value will be determined as of the Business Day We receive the policy and the Written request for surrender. The Company may delay payment if the Suspension and Deferral of Payments Provision is in effect. PARTIAL SURRENDER. At any time after the first policy year and prior to the Insured's age 100, You may request withdrawal of a portion of the Cash Surrender Value of the policy. Your request must be made In Writing prior to the Insured's age 100. The minimum partial surrender is shown on the Policy Schedule. The amount being surrendered or reduced will terminate on the Valuation Date on or next following the date We receive the Written request for surrender or reduction. Valuation Units are surrendered to reflect a partial surrender as of the Business Day We receive the Written request for partial surrender. A partial surrender will result in a reduction of the Accumulation Value, Cash Value, and the Death Benefit Amount. The Accumulation and Cash Values will be reduced by the amount of partial surrender benefit. The reduced Death Benefit Amount will be determined in accordance with the "Death Benefit Option" provision. If Your Death Benefit Option is Option 1 or Option 3, the Specified Amount will be reduced by the amount of the partial surrender. If Your Death Benefit Option is Option 2, the Specified Amount will not be reduced by the amount of the partial surrender. The reduction in Specified Amount will be subject to the same guidelines and restrictions as outlined in the "Decreasing the Specified Amount" provision. (The reduced amount will not be less than zero.) The Death Benefit Amount remaining after this reduction must be no less than the Minimum Death Benefit Amount after a Decrease in Specified Amount shown on the Policy Schedule. 07921 Page 14 POLICY VALUES PROVISION (CONT'D) A partial surrender will result in the cancellation of Valuation Units from each applicable Division and reduction of the unloaned portion of the General Account in the same ratio as the Allocation of Policy Deductions in effect on the date of partial surrender. If the number of Valuation Units in any Division or in the unloaned portion of the General Account is insufficient to make a partial surrender in this manner, We will cancel Valuation Units from each applicable Division and reduce the unloaned portion of the General Account in the ratio the partial surrender request bears to the Cash Surrender Value of Your policy. You must state In Writing in advance how partial surrenders should be made if other than this method is to be used. In addition to the amounts shown in the Table of Surrender Charges, there will also be a charge for each partial surrender not to exceed the lesser of 2.0% of the amount withdrawn or $25. Any partial surrender that causes a reduction in Base Coverage will be subject to any applicable Surrender Charges on a pro-rata basis, and the remaining Surrender Charges will be reduced proportionately. The Company may delay payment if the Suspension and Deferral of Payments Provision is in effect. CONTINUATION OF INSURANCE COVERAGE IF AMOUNT OR FREQUENCY OF PREMIUM PAYMENTS IS REDUCED OR IF PREMIUM PAYMENTS ARE DISCONTINUED. If You reduce the amount or frequency of premium payments, or if You discontinue payment of premiums and do not surrender this policy, We will continue making Monthly Deductions (as long as there is sufficient value to make such deductions) until the Maturity Date. During the Guarantee Period, this policy will remain in force as long as the Monthly Guarantee Premium requirements are met. This policy will remain in force until the earliest of the following dates: 1. The Maturity Date (if there is sufficient value to make Monthly Deductions to that date); 2. Full surrender of the policy; 3. The end of the Grace Period; or 4. Death of the Insured. TRANSFER PROVISION TRANSFER OF ACCUMULATION VALUE. Transfers will be made as of the Business Day We receive the Written transfer request, subject to the restrictions that follow. If You elect to use the transfer privilege, We will not be liable for a transfer made in accordance with Your instructions. We reserve the right to terminate, suspend or modify the transfer privilege, and to charge a $25 fee for each transfer in excess of 12 in a policy year. Transfers under the Dollar Cost Averaging or Automatic Rebalancing programs will not count toward the 12 free transfers. The policy is not designed for professional market timing organizations or other entities using programmed or frequent transfers involving large amounts. We are required by law to monitor all Owners' policies for market timing, and have established procedures to detect potential violations. We will monitor all policies to determine if an Owner requests: 1. An exchange into or out of a variable investment option, except the money market investment option, within 2 calendar weeks of an earlier exchange out of or into that same variable investment option; or 2. Exchanges into and out of, or out of and into, the same variable investment option, except the money market investment option, more than twice in any one calendar quarter. 07921 Page 15 TRANSFER PROVISION (CONT'D) If either of the above transactions occurs, We will suspend such Owner's same day or overnight delivery transfer privileges with notice to prevent market timing efforts. Such notice of suspension will take the form of either a letter mailed to the Owner's last known address, or a telephone call from Us informing the Owner that effective immediately, all same day or overnight delivery transfer privileges have been suspended. The suspension of transfer privileges will last for no more than 6 months. Transfers under Dollar Cost Averaging, Automatic Rebalancing or any other automatic transfer arrangements to which We have agreed are not affected by these procedures. Our procedures will be followed in all circumstances and We will treat all Owners the same. In order to prevent market timing, the mutual funds in which the Divisions are invested have the right to request information regarding policy owner transaction activity. If We receive such a request, We will provide information regarding policy owner transactions in the appropriate Division. TRANSFER OF ACCUMULATION VALUE (SEPARATE ACCOUNT). You may transfer all or part of Your interest in a Division of the Separate Account subject to the following: 1. The minimum amount which may be transferred is $500. 2. If the entire amount in a Division of the Separate Account is not being transferred the minimum which must remain is $500. Transfers between Separate Account Divisions result in the redemption of Valuation Units in one Division and the purchase of Valuation Units in the Division to which the transfer is made. We will not honor Your request for a transfer if the Separate Account is unable to purchase shares of an investment option for any reason. TRANSFER OF ACCUMULATION VALUE (GENERAL ACCOUNT). A transfer from the General Account to a Division of the Separate Account may be made during the 60 day period following each policy anniversary. The amount that may be transferred will be the greatest of the following amounts: 1. Twenty-five percent (25%) of the unloaned portion of the General Account as of the policy anniversary; 2. The total dollar amount withdrawn from the General Account during the prior policy year (whether the amount withdrawn was a partial surrender for cash or was being transferred to the Separate Account); or 3. $500. Transfer of Your interest in a Separate Account Division on the Maturity Date will not be subject to a Transfer Fee. Our right to defer payment of values allocated to the General Account for up to 6 months will not apply to values transferred to the General Account under this provision. TELEPHONE TRANSFER AND ALLOCATION PRIVILEGE. If We have on file a completed telephone authorization form for Telephone Transactions, We will allow transfers and the percentage allocation for future Net Premiums and policy deductions to be changed by telephone at any time. We will honor instructions for Telephone Transactions from any person who provides the correct information. There is a risk of possible loss to You if unauthorized persons use this service in Your name. Under Telephone Transactions, We are not liable for any acts or omissions based upon instructions that We reasonably believe to be genuine, including losses arising from errors in the communication of telephone instructions. 07921 Page 16 TRANSFER PROVISION (CONT'D) DOLLAR COST AVERAGING. Dollar Cost Averaging (DCA) is an automatic transfer of funds made periodically prior to the Maturity Date in accordance with Instructions from the Owner. DCA transfers will be made in accordance with the Transfer provisions, except as provided below: 1. DCA transfers may be made: a) On any day of the month except the 29/th/, 30/th/ or 31/st/; b) On a monthly, quarterly, semi-annual or annual basis; and c) From one Separate Account Division to one or more of the other Separate Account Divisions. The General Account is not eligible for DCA. 2. DCA may be elected only if the Accumulation Value at the time of election is $5,000 or more. 3. The minimum amount of each DCA transfer is $100, or the remaining amount in the Separate Account Division from which the DCA transfer is being made, if less. 4. DCA may not begin prior to the first Valuation Date following the 15/th/ day after the initial Net Premium is applied. 5. DCA will end when there is no longer any value in the Separate Account Division from which DCA transfers were being made, or when You request that DCA end. 6. While DCA is active, amounts applied to the DCA Separate Account Division will be available for future dollar cost averaging in accordance with the current DCA request. 7. There is no charge for DCA. 8. DCA is not available if Automatic Rebalancing is active. AUTOMATIC REBALANCING. Automatic Rebalancing occurs when funds are transferred by the Company among the Separate Account Divisions so that the values in each Division match the premium allocation percentages then in effect. You may choose Automatic Rebalancing on a quarterly, semi-annual or annual basis if Your Accumulation Value is $5,000 or more. The date Automatic Rebalancing occurs will be based on the Date of Issue of Your policy. For example, if Your policy is dated January 17, and You have requested Automatic Rebalancing on a quarterly basis, Automatic Rebalancing will start on April 17, and will occur quarterly thereafter. After Automatic Rebalancing is elected, it will continue until We are notified In Writing that it is to be discontinued. There is no charge for Automatic Rebalancing. Automatic Rebalancing is not available if DCA is active. SUSPENSION AND DEFERRAL OF PAYMENTS PROVISION We reserve the right to defer payment of any Death Benefit Amount, loan or other distribution that comes from that portion of Your Accumulation Value that is allocated to Separate Account VL-R, if: 1. The New York Stock Exchange is closed other than customary weekend and holiday closings, or trading on the New York Stock Exchange is restricted; 2. An emergency exists, as a result of which disposal of securities is not reasonably practicable or it is not reasonably practicable to fairly determine the Accumulation Value; or 3. The U.S. Securities and Exchange Commission (SEC) by order permits the delay for the protection of Owners. 07921 Page 17 SUSPENSION AND DEFERRAL OF PAYMENTS PROVISION (CONT'D) As to amounts allocated to the General Account, We may defer payment of any Cash Surrender Value withdrawal or loan amount for up to 6 months, or the period allowed by law, whichever is less, after We receive the request In Writing. Written notice of both the imposition and termination of any such suspension will be given to the Owners, assignees of record and any irrevocable Beneficiaries. Payments which were due to have been made and which were deferred following the suspension of the calculation of the Cash Surrender Value will be made within thirty (30) days following the lifting of the suspension, and will be calculated based on the Valuation Date which immediately follows termination of the suspension. POLICY LOANS You may borrow from Us at any time while this policy is in force, an amount which is equal to or less than the policy's loan value. The policy's maximum loan value will be the Cash Surrender Value less an amount equal to 3 Monthly Deductions. We reserve the right to limit at any time the amount available for a loan to 90% of the Accumulation Value. The minimum amount of each loan is $500 or, if less, the entire remaining loan value. The value of the Valuation Units equal to the amount You borrow from the Separate Account will be transferred to the General Account as of the Business Day that We receive Your Written loan request. OBTAINING A LOAN. You may obtain a policy loan by Written request and assignment of the policy as sole security for the loan. The Company may delay processing the loan requested if the Suspension and Deferral of Payments Provision is in effect. EFFECT OF A LOAN. When a loan is made, an amount equal to the amount being borrowed from the Separate Account will be transferred to the General Account. A loan will result in cancellation of units from each applicable Division and reduction of the unloaned portion of the General Account according to the allocation of the policy deductions then in effect. The resulting amount will be added to the loaned portion of the General Account. If the number of Valuation Units in any Division or unloaned portion of the General Account is insufficient for a loan to be made in this manner, We will cancel Valuation Units from each applicable Division and reduce the unloaned portion of the General Account in the same ratio the loan bears to the unloaned Accumulation Value of Your policy. You must state In Writing in advance which Division units are to be canceled if a different method is to be used. Repayment of a loan will first be allocated to the General Account until You have repaid any loaned amounts that were allocated to the General Account. You may tell Us how to allocate repayments above that amount. If You do not tell Us, an amount equal to the loan repayment will be transferred from the General Account to the Divisions in the same ratio currently in effect for the allocation of Net Premiums. A loan, whether or not repaid, will have a permanent effect on the Cash Surrender Values and on the death benefits. If not repaid, any indebtedness will reduce the amount of Death Benefit Proceeds and the amount available upon surrender of the policy. 07921 Page 18 POLICY LOANS (CONT'D) LOAN INTEREST. Except for Preferred Loans, loan interest will accrue daily at an annual effective rate of 4.54% payable in advance. (This is equivalent to an annual effective rate of 4.75% paid at the end of the policy year.) On each policy anniversary, loan interest for the next year is due. Unpaid loan interest will be deducted at the end of each policy year from the investment options according to the allocation of policy deductions then in effect, and added to the loaned portion of the General Account. You must state In Writing in advance how unpaid loan interest should be deducted if other than this method is to be used. If the number of Valuation Units in any Division or unloaned portion of the General Account is insufficient to deduct unpaid loan interest in this manner, We will cancel Valuation Units from each applicable Division and reduce the unloaned portion of the General Account in the same ratio the unpaid loan interest bears to the unloaned Accumulation Value of Your policy. We will credit interest monthly on the loaned portion of the General Account at an annual effective rate of 4.0%. PREFERRED LOANS. A "Preferred Loan" is a policy loan that is made at a net cost to the Owner that is less than the net cost of other policy loans. By "net cost" We mean the amount of interest charged for the loan less interest credited to the amount of the Accumulation Value offset by a loan. Starting on the tenth policy anniversary, this policy will be eligible for "Preferred Loans" subject to the following guidelines: 1. The maximum amount eligible for Preferred Loans during a policy year is restricted to the lesser of the following values on the first day of such policy year: a. The policy loan value; or b. 10% of the Accumulation Value. 2. When a Preferred Loan is made, interest to the next policy anniversary will accrue daily at an annual effective rate of not less than 3.85% nor more than 4.08% (This is equivalent to an annual effective rate of not less than 4.08% nor more than 4.25% respectively, paid at the end of each policy year. HOW YOU MAY REPAY A POLICY LOAN. You may repay all or part of a policy loan at any time, except that: 1. Repayment may be made only while this policy is in force and prior to the death of the Insured; 2. A partial repayment must be at least $100.00; and 3. At the time You repay all or part of a policy loan, You must specify the payment is to repay all or part of the policy loan. Except as provided in the Grace Period provision, at any time Your policy loan exceeds the Cash Value, this policy will lapse. However, We must mail at least 31 days prior notice to Your last known address and to the assignee of record, if any. WE CAN DELAY PAYMENT. We can delay lending You money for up to 6 months, or the period allowed by law, whichever is less. However, We cannot delay lending You money if the amount is to be used to pay a premium to Us. 07921 Page 19 BENEFICIARY AND PROCEEDS BENEFICIARY. The Beneficiary as named in the application, or later changed by You, will receive the proceeds upon the death of the Insured. Unless You have stated otherwise, proceeds will be paid as follows: 1. If any Beneficiary dies before the Insured, that Beneficiary's interest will pass to any other Beneficiaries according to their respective interests. 2. If no Beneficiary survives the Insured, proceeds will be paid to You, as Owner, if You are then living; otherwise proceeds will be paid to Your estate. COMMON DISASTER. If We cannot determine whether a Beneficiary or the Insured died first in a common disaster, We will assume that the Beneficiary died first. Proceeds will be paid on this basis unless an endorsement to this policy provides otherwise. PROCEEDS. Proceeds mean the amount payable on: 1. The Maturity Date; 2. Exercise of the full surrender benefit; or 3. The Insured's death. The proceeds on the Maturity Date will be the Cash Surrender Value. The proceeds on the Insured's death will be the Death Benefit Amount less any outstanding policy loans. All proceeds and partial surrender benefits are subject to the provisions of the "Payment Options" section and the other provisions of this policy. CHANGE OF OWNERSHIP OR BENEFICIARY You may change the Owner or the Beneficiary at any time during the lifetime of the Insured unless the previous designation provides otherwise. To do so, send a Written request to Our Home Office in a form acceptable to Us. The change will go into effect when We have recorded the change. However, after the change is recorded, it will be deemed effective as of the date of Your Written request for change. The change will be subject to any payment made or action taken by Us before the request is recorded. PAYMENT OPTIONS Instead of being paid in one sum, all or part of the proceeds may be applied under any of the Payment Options described below. In addition to these options, other methods of payment may be chosen with Our consent. PAYMENT CONTRACT. When proceeds become payable under a Payment Option, a Payment Contract will be issued to each payee. The Payment Contract will state the rights and benefits of the payee. It will also name those who are to receive any balance unpaid at the death of the payee. ELECTION OF OPTIONS. The Owner may elect or change any Payment Option while the Insured is living, subject to the provisions of this policy. This election or change must be In Writing. Within 60 days after the Insured's death, a payee entitled to proceeds in one sum may elect to receive proceeds under any option, subject to the limitations stated in the "Availability of Options" provision. 07921 Page 20 PAYMENT OPTIONS (CONT'D) OPTION 1. PAYMENTS FOR A SPECIFIED PERIOD: Equal monthly payments will be made for a specified period. The Option 1 Table in this policy shows the monthly income for each $1,000 of proceeds applied. OPTION 2. PAYMENTS OF A SPECIFIED AMOUNT: Equal monthly payments of a specified amount will be made. Each payment must be at least $60 a year for each $1,000 of proceeds applied. Payments will continue until the amount applied, with interest, has been paid in full. OPTION 3. MONTHLY PAYMENTS FOR LIFE WITH PERIOD CERTAIN: Equal monthly payments will be made for a specified period, and will continue after that period for as long as the payee lives. The specified period may be 10, 15 or 20 years. The Option 3 Table in this policy shows the monthly income for each $1,000 of proceeds applied. If issued on a Sex Distinct basis, tables are based on the Annuity 2000 Male or Female Tables adjusted by projection scale G (adjusted by 50% of projection scale G for females and 100% of projection scale G for males) for 20 years, with interest at the rate of 2% per year. If issued on a Gender Neutral basis, tables are based on the Annuity 2000 Male and Female Tables adjusted by projection scale G (adjusted by 50% of projection scale G for females and 100% of projection scale G for males) for 20 years, with Gender Neutral rates based on 60% female and 40% male, and interest at the rate of 2% per year. At the time payments are to begin under this option, the payee may choose one of the following: 1. Monthly payments based on the Option 3 Table; or 2. Monthly payments equal to a monthly annuity based on Our single premium immediate annuity rates then in use. OPTION 4 PROCEEDS LEFT AT INTEREST. Proceeds may be left on deposit with Us for any period up to 30 years. Interest earned on the proceeds may be: 1. Left on deposit to accumulate at the rate of 2% compounded annually; or 2. Paid in installments at the rate for each $1,000 of proceeds of $20 annually, $9.95 semiannually, $4.96 quarterly or $1.65 monthly. Upon the death of the payee, or at the end of the specified period, any balance left on deposit will be paid in a lump sum or under Options 1, 2 or 3. INTEREST RATES. The guaranteed rate of interest for proceeds held under Payment Options 1, 2, 3 and 4 is 2% compounded annually. We may credit interest at a higher rate. The amount of any increase will be determined by Us. PAYMENTS. The first payment under Options 1, 2 and 3 will be made when the claim for settlement has been approved. Payments after the first will be made according to the manner of payment chosen. Interest under Option 4 will be credited from the date of death and paid or added to the proceeds as provided in the Payment Contract. AVAILABILITY OF OPTIONS. If the proposed payee is not a natural person, payment options may be chosen only with Our consent. If this policy is assigned, We will have the right to pay the assignee in one sum the amount to which the assignee is entitled. Any balance will be applied according to the option chosen. The amount to be applied under any one option must be at least $2,000. The payment elected under any one option must be at least $20. If the total policy proceeds are less than $2,000 payment will be made in a lump sum. 07921 Page 21 PAYMENT OPTIONS (CONT'D) EVIDENCE THAT PAYEE IS ALIVE. Before making any payment under a Payment Option, We may ask for proof that the payee is alive. If proof is requested, no payment will be made or considered due until We receive proof. DEATH OF A PAYEE. If a payee dies, any unpaid balance will be paid as stated in the Payment Contract. If there is no surviving payee named in the Payment Contract, We will pay the estate of the payee: 1. Under Options 1 and 3: The value as of the remaining payments for the specified period as of the date We receive Written notification of death, discounted at the rate of interest used in determining the amount of the monthly payment. 2. Under Options 2 and 4, the balance of any proceeds remaining unpaid with accrued interest, if any. WITHDRAWAL OF PROCEEDS UNDER OPTIONS 1 OR 2. If provided in the Payment Contract, a payee will have the right to withdraw the entire unpaid balance under Options 1 or 2. Under Option 1, the amount will be the value of the remaining payments for the specified period discounted at the rate of interest used in determining monthly income. Under Option 2, the amount will be the entire unpaid balance. WITHDRAWAL OF PROCEEDS UNDER OPTION 4. A payee will have the right to withdraw proceeds left under Option 4 subject to the following rules: 1. The amount to be withdrawn must be $500 or more; 2. A partial withdrawal must leave a balance on deposit of $1,000 or more. WITHDRAWALS MAY BE DEFERRED. We may defer payment of any withdrawal for up to 6 months from the date We receive a withdrawal request. ASSIGNMENT. Payment Contracts may not be assigned. CHANGE IN PAYMENT. The right to make any change in payment is available only if it is provided in the Payment Contract. CLAIMS OF CREDITORS. To the extent permitted by law, proceeds will not be subject to any claims of a Beneficiary's creditors. GENERAL PROVISIONS ASSIGNING YOUR POLICY. During the lifetime of the Insured, You may assign this policy as security for an obligation. We will not be bound by an assignment unless it is received In Writing at Our Home Office. Two copies of the assignment must be submitted. We will retain one copy and return the other. We will not be responsible for the validity of any assignment. INCONTESTABILITY. We rely on the statements made in the application for the policy and any amendments of application, supplemental applications, and applications for any reinstatements or increases in Specified Amount. These statements, in the absence of fraud, are considered representations and not warranties. No statement may be used in defense of a claim unless it is in such applications. Except as stated below, We cannot contest this policy during the Insured's lifetime after it has been in force for 2 years from the Date of Issue. 07921 Page 22 GENERAL PROVISIONS (CONT'D) Exceptions: 1. We cannot contest any claim related to an increase in Specified Amount during the Insured's lifetime after such increase has been in effect for 2 years from the date of issue of such increase. 2. If this policy is reinstated, We cannot contest this policy during the Insured's lifetime after it has been in force for 2 years from the date of reinstatement. We can contest a reinstatement or an increase in Specified Amount for a 2-year period following the date of an increase or reinstatement solely on the basis of the information furnished in the application for such reinstatement or increase. This 2-year limitation does not apply to benefits provided by any Disability or Accidental Death Benefit rider, or to the nonpayment of premium. SUICIDE EXCLUSION. If the Insured takes his or her own life, while sane or insane, within 2 years from the Date of Issue, We will limit the Death Benefit Proceeds to the premiums paid less any policy loans and less any partial surrenders paid. If there are any increases in the Specified Amount (see "Changing Your Insurance Policy") a new 2-year period shall apply to each increase beginning on the date of each increase. The Death Benefit Proceeds will be the costs of insurance associated with each increase. When the laws of the state in which this policy is delivered require less than this 2-year period, the period will be as stated in such laws. AGE OR GENDER INCORRECTLY STATED (AGE IN- CORRECTLY STATED IF ISSUED ON A GENDER NEUTRAL BASIS). If the: (1) age or gender of the Insured (if this policy was issued on a Sex Distinct basis); or (2) age of the Insured (if this policy was issued on a Gender Neutral basis) has been misstated to Us, We will adjust the excess of the Death Benefit Amount over the Accumulation Value on the date of death to that which would have been purchased by the Monthly Deduction for the policy month of death at the correct cost of insurance rate. By age, We mean age nearest birthday as of the Date of Issue. STATUTORY BASIS OF POLICY VALUES. The Cash Values of the policy are not less than the minimum values required by the law of the state where this policy is delivered. The calculation of the Cash Values includes a charge for the cost of insurance, as shown in the Table of Guaranteed Monthly Cost of Insurance Rates and for the General Account interest at the guaranteed annual interest rate shown on the Policy Schedule. Calculation of minimum Cash Values, nonforfeiture benefits and Guaranteed Cost of Insurance rates are based on the Mortality Table shown on the Policy Schedule for the appropriate gender (if this policy was issued on a Sex Distinct basis) and age nearest birthday. A detailed statement of the method of computing values has been filed with the state insurance department where required. POLICY CHANGES AFTER AGE 100. IRC section 7702(e)(1)(B) provides a computational requirement that a deemed Maturity Date between age 95 and 100 must be used. However, the 2001 CSO Mortality Tables provide a stated termination date of age 121. The tax implications of the differing dates provided under IRC section 7702(e)(1)(B) and the 2001 CSO Mortality Tables remains unclear. If the IRC section 7702(e)(1)(B) Maturity Date requirement is amended to conform to the termination date of the 2001 CSO Mortality Tables, the Company at its option, may allow "material changes" to this policy after the Insured attains age 100. 07921 Page 23 GENERAL PROVISIONS (CONT'D) NO DIVIDENDS. This policy will not pay dividends. It will not participate in any of Our surplus or earnings. ANNUAL REPORT. We will send You at least once a year, without charge, an annual report which will show a summary of all transactions since the last report, including: 1. Premiums paid; 2. Transfers; 3. Expense charges deducted; 4. The cost of insurance deducted; 5. Partial surrender benefits deducted, including partial surrender fees; 6. The amount of any outstanding policy loans; 7. Separate Account Unit Values; 8. The current Cash Surrender and Accumulation Values; and 9. The Death Benefit Amount. WHEN THIS POLICY TERMINATES. This policy will terminate if: 1. You request that this policy be terminated; 2. The Insured dies; 3. The policy matures; or 4. The Grace Period ends; and a) There is insufficient Cash Surrender Value to cover a Monthly Deduction; and b) The necessary Monthly Guarantee Premiums to keep the policy in force have not been paid. REINSTATEMENT. "Reinstating" means placing Your policy in force after it has terminated at the end of the Grace Period. We will reinstate this policy if We receive: 1. Your Written request within 5 years after the end of the Grace Period and before the Maturity Date; and 2. Evidence of insurability satisfactory to Us; and 3. Payment of enough premium to keep the reinstated policy in force for two months; and 4. Payment or reinstatement of any in debtedness. The reinstated policy will be in force from the Monthly Deduction Day on or following the date We approve the reinstatement application. The original Surrender Charge schedule will apply to a reinstated policy. The Accumulation Value at the time of reinstatement will be: 1. The Surrender Charge deducted at the time of lapse (such charge not being greater than the Accumulation Value at the time of lapse before the Surrender Charge was applied); plus 2. The Net Premium allocated in accordance with the premium allocation percentages at the time of lapse unless the reinstatement application provides otherwise, using Unit Values as of the date of reinstatement; plus 3. Any loan repaid or reinstated; less 4. The Monthly Deduction for one month. 07921 Page 24 GENERAL PROVISIONS (CONT'D) The dollar amount of any Surrender Charge reinstated will be the same as the dollar amount of Surrender Charge at the time of lapse, and will be reinstated into the Divisions and the General Account from which it was deducted at the time of lapse using Unit Values as of the date of reinstatement. If a person other than the Insured is covered by a rider attached to this policy, coverage will be reinstated according to the terms of that rider. RATES ON POLICY ANNIVERSARY NEAREST INSURED'S 18TH BIRTHDAY (FOR INSURED'S AGE 17 OR LESS ON DATE OF ISSUE). If the Insured's age, nearest birthday, is 17 or less on the Date of Issue of this policy, Tobacco rates will be used starting on the policy anniversary nearest the Insured's 18th birthday, except as follows. Prior to the anniversary nearest the Insured's 18th birthday, a Written statement signed by the Insured, may be submitted to the Company requesting that Non-Tobacco rates be made effective. The statement must include the date the Insured last used tobacco or other products that contain nicotine, or state that the Insured has never used tobacco or other products that contain nicotine, whichever applies. If the request is approved, Non-Tobacco rates will be made effective on the policy anniversary nearest the Insured's 18th birthday. Otherwise, Tobacco rates will apply. We will send a notice to the Owner at least 30 days prior to the policy anniversary nearest the Insured's 18th birthday that a request for Non-Tobacco rates may be submitted. OPTION TO EXTEND COVERAGE. You may elect to extend the Maturity Date stated on the Schedule Page (Maturity Date), as follows: If the Insured is living on the Maturity Date, coverage will be continued until the date of death of the Insured. To elect this option, You must submit a Written request to the Company on a form acceptable to Us, at least 30 days prior to the original Maturity Date. Starting on the original Maturity Date: 1. The Death Benefit Amount for the base policy will be equal to the base policy Death Benefit Amount in effect on the day prior to the Maturity Date, and if based all, or in part, on the Accumulation Value, will be adjusted by future changes in the Accumulation Value. The Death Benefit Amount will never be less than the Accumulation Value; 2. Unless otherwise stated in a rider attached to this policy, coverage under any riders attached to this policy will not be extended; 3. No Monthly Deductions will be made; 4. New premium payments will not be accepted; 5. Interest on policy loans will continue to accrue in the same manner as stated in the Policy Loan provisions and You may repay all or part of a loan at any time as stated in the Policy Loans provisions; 6. The value of each of the Separate Account Divisions will be transferred to the General Account on the Maturity Date. If the underlying investment option cannot be valued, or We cannot determine the Division's investment in an investment option on the scheduled Maturity Date, the unvalued portion shall be valued and transferred on the first Business Day that the assets can be valued or determined; and 7. The Accumulation Value will continue to be determined as stated in this policy, subject to 3 above. After this option is selected, it may not be revoked. 07921 Page 25 GENERAL PROVISIONS (CONT'D) IRC SECTION 7702(E)(1)(B) PROVIDES A COMPUTATIONAL REQUIREMENT THAT A DEEMED MATURITY DATE BETWEEN AGE 95 AND 100 MUST BE USED. HOWEVER, THE 2001 CSO MORTALITY TABLES PROVIDE A STATED TERMINATION DATE OF AGE 121. THE TAX IMPLICATIONS OF THE DIFFERING DATES PROVIDED UNDER IRC SECTION 7702(E)(1)(B) AND THE 2001 CSO MORTALITY TABLES REMAINS UNCLEAR. SIMILARLY, THE TAX CONSEQUENCES OF EXTENDING THE MATURITY DATE BEYOND THE AGE 121 TERMINATION DATE OF THE 2001 CSO MORTALITY TABLES IS UNCLEAR. YOU SHOULD CONSULT YOUR PERSONAL TAX ADVISOR ABOUT THE EFFECT OF THIS PROVISION. RIGHTS RESERVED BY US. Upon notice to You, this policy may be modified by Us, but only if such modification is necessary to make any changes as required by the Internal Revenue Code or by any other applicable law, regulation or interpretation in order to continue treatment of this policy as life insurance or to comply with federal securities laws. 07921 Page 26 THIS PAGE INTENTIONALLY LEFT BLANK 07921 Page 27 TABLE OF GUARANTEE MONTHLY COST OF INSURANCE RATES PER $1,000 OF NET AMOUNT AT RISK ATTAINED AGE ATTAINED AGE NEAREST BIRTHDAY NEAREST BIRTHDAY (ON EACH POLICY (ON EACH POLICY ANNIVERSARY) MALE FEMALE ANNIVERSARY) MALE FEMALE ---------------- -------- -------- ---------------- --------- --------- 18 $0.07670 $0.03500 70 $ 2.03499 $ 1.41458 19 0.07837 0.03750 71 2.23719 1.55051 20 0.07920 0.03750 72 2.50360 1.70286 21 0.07920 0.03834 73 2.78562 1.86832 22 0.07920 0.04001 74 3.08341 2.05040 23 0.08004 0.04001 75 3.41023 2.25263 24 0.08087 0.04167 76 3.76819 2.47520 25 0.08171 0.04167 77 4.18586 2.72084 26 0.08504 0.04417 78 4.67661 2.99326 27 0.08921 0.04751 79 5.24716 3.28838 28 0.08754 0.04834 80 5.87410 3.61957 29 0.08588 0.05168 81 6.59415 4.07157 30 0.08504 0.05335 82 7.35120 4.58457 31 0.08421 0.05668 83 8.17591 5.09923 32 0.08421 0.06002 84 9.09943 5.67203 33 0.08671 0.06335 85 10.14421 6.32232 34 0.08838 0.06836 86 11.31891 6.91704 35 0.09088 0.07420 87 12.62238 7.82099 36 0.09589 0.07920 88 14.04387 8.77667 37 0.10006 0.08588 89 15.57220 9.80858 38 0.10757 0.08921 90 17.19963 10.77196 39 0.11425 0.09422 91 18.76183 11.26394 40 0.12176 0.10006 92 20.42406 12.24075 41 0.13177 0.10590 93 22.21645 13.71292 42 0.14430 0.11258 94 24.15513 15.61194 43 0.15849 0.12092 95 26.24420 18.02150 44 0.17519 0.13094 96 28.20560 20.38072 45 0.19441 0.14263 97 30.35199 22.88571 46 0.21279 0.15599 98 32.70866 23.32307 47 0.23285 0.17269 99 35.30337 24.80448 48 0.24455 0.19107 100 38.17511 27.21527 49 0.25793 0.21112 101 40.53000 29.86914 50 0.27716 0.23452 102 43.11768 32.93819 51 0.29974 0.26044 103 45.96629 36.42323 52 0.33070 0.28971 104 49.11195 40.44484 53 0.36419 0.32150 105 52.54884 45.03306 54 0.40690 0.35498 106 56.37067 50.02474 55 0.45970 0.39099 107 60.64049 55.47971 56 0.51337 0.43288 108 65.43820 61.36385 57 0.57128 0.47647 109 70.86239 67.97906 58 0.62083 0.52344 110 77.04001 75.34512 59 0.67797 0.57044 111 77.63548 76.08958 60 0.74694 0.61915 112 78.23803 76.84528 61 0.83113 0.67209 113 78.84780 77.61249 62 0.93397 0.73011 114 79.46491 78.39150 63 1.04962 0.78987 115 80.08952 79.18259 64 1.17137 0.85472 116 80.72176 79.98606 65 1.30008 0.92638 117 81.36180 80.80223 66 1.43071 1.00571 118 82.00977 81.63142 67 1.56326 1.09272 119 82.66585 82.47396 68 1.70627 1.18998 120 83.33000 83.33000 69 1.85466 1.29669 The rates shown above represent the guaranteed (maximum) monthly cost of insurance for each $1,000 of net amount at risk. If this policy has been issued in a special (rated) premium class, the guaranteed monthly cost will be calculated as shown on the Policy Schedule. 07921 Page 28 NS DEATH BENEFIT CORRIDOR RATES BASED ON CASH VALUE ACCUMULATION TEST ATTAINED AGE ATTAINED AGE NEAREST BIRTHDAY NEAREST BIRTHDAY (ON EACH POLICY (ON EACH POLICY ANNIVERSARY) MALE FEMALE ANNIVERSARY) MALE FEMALE ---------------- ------ ------- ---------------- ------ ------ 18 8.8404 10.3051 70 1.6696 1.8594 19 8.5595 9.9460 71 1.6297 1.8123 20 8.2867 9.6005 72 1.5916 1.7673 21 8.0211 9.2656 73 1.5555 1.7242 22 7.7622 8.9417 74 1.5213 1.6829 23 7.5098 8.6293 75 1.4887 1.6435 24 7.2644 8.3266 76 1.4576 1.6058 25 7.0258 8.0345 77 1.4280 1.5697 26 6.7939 7.7516 78 1.4000 1.5353 27 6.5697 7.4790 79 1.3735 1.5023 28 6.3532 7.2169 80 1.3487 1.4708 29 6.1419 6.9633 81 1.3255 1.4407 30 5.9357 6.7192 82 1.3039 1.4125 31 5.7349 6.4835 83 1.2836 1.3861 32 5.5397 6.2564 84 1.2647 1.3614 33 5.3500 6.0376 85 1.2469 1.3380 34 5.1665 5.8266 86 1.2305 1.3162 35 4.9888 5.6238 87 1.2153 1.2952 36 4.8169 5.4288 88 1.2015 1.2761 37 4.6511 5.2410 89 1.1889 1.2586 38 4.4909 5.0605 90 1.1775 1.2426 39 4.3368 4.8861 91 1.1673 1.2276 40 4.1882 4.7179 92 1.1578 1.2119 41 4.0450 4.5558 93 1.1490 1.1963 42 3.9073 4.3995 94 1.1408 1.1819 43 3.7751 4.2489 95 1.1333 1.1690 44 3.6481 4.1038 96 1.1266 1.1583 45 3.5264 3.9644 97 1.1202 1.1496 46 3.4098 3.8303 98 1.1142 1.1429 47 3.2979 3.7016 99 1.1086 1.1348 48 3.1904 3.5783 100 1.1036 1.1262 49 3.0865 3.4600 101 1.0992 1.1181 50 2.9860 3.3467 102 1.0950 1.1104 51 2.8892 3.2382 103 1.0909 1.1031 52 2.7959 3.1344 104 1.0870 1.0963 53 2.7066 3.0351 105 1.0832 1.0901 54 2.6209 2.9402 106 1.0795 1.0844 55 2.5390 2.8493 107 1.0760 1.0794 56 2.4609 2.7623 108 1.0728 1.0750 57 2.3864 2.6792 109 1.0699 1.0712 58 2.3152 2.5997 110 1.0677 1.0685 59 2.2468 2.5235 111 1.0674 1.0681 60 2.1810 2.4505 112 1.0671 1.0677 61 2.1181 2.3803 113 1.0667 1.0673 62 2.0580 2.3128 114 1.0664 1.0669 63 2.0009 2.2481 115 1.0660 1.0664 64 1.9467 2.1858 116 1.0654 1.0657 65 1.8952 2.1259 117 1.0643 1.0644 66 1.8462 2.0682 118 1.0618 1.0619 67 1.7993 2.0128 119 1.0557 1.0557 68 1.7544 1.9596 120 1.0400 1.0400 69 1.7112 1.9085 07921 Page 29 NS TABLE OF GUARANTEE MONTHLY COST OF INSURANCE RATES PER $1,000 OF NET AMOUNT AT RISK ATTAINED AGE ATTAINED AGE NEAREST BIRTHDAY NEAREST BIRTHDAY (ON EACH POLICY (ON EACH POLICY ANNIVERSARY) MALE FEMALE ANNIVERSARY) MALE FEMALE ---------------- -------- -------- ---------------- --------- --------- 0 $0.08087 $0.04001 60 $ 1.36961 $ 1.17306 1 0.04668 0.02917 61 1.50971 1.26704 2 0.03250 0.02166 62 1.67901 1.37300 3 0.02250 0.01666 63 1.86747 1.47912 4 0.01750 0.01583 64 2.06067 1.59133 5 0.01750 0.01500 65 2.25178 1.71394 6 0.01833 0.01500 66 2.43648 1.84442 7 0.01833 0.01750 67 2.61646 1.99137 8 0.01833 0.01750 68 2.80636 2.15316 9 0.01916 0.01750 69 2.99499 2.32904 10 0.01916 0.01833 70 3.22406 2.52598 11 0.02250 0.01916 71 3.47559 2.75106 12 0.02750 0.02250 72 3.81896 3.00019 13 0.03250 0.02500 73 4.16563 3.26925 14 0.03917 0.02750 74 4.51739 3.56544 15 0.05085 0.02917 75 4.92848 3.86451 16 0.06169 0.03250 76 5.36857 4.19202 17 0.07253 0.03417 77 5.88039 4.54567 18 0.09255 0.04167 78 6.47624 4.92848 19 0.10089 0.04501 79 7.15987 5.34445 20 0.10590 0.04834 80 7.89664 5.79500 21 0.11091 0.05085 81 8.73001 6.43366 22 0.11675 0.05418 82 9.57996 7.13336 23 0.12176 0.05585 83 10.48131 7.82099 24 0.12844 0.06002 84 11.47340 8.56690 25 0.13595 0.06419 85 12.65672 9.32569 26 0.14263 0.06752 86 13.97298 9.96389 27 0.15098 0.07253 87 15.41343 10.98682 28 0.15181 0.07670 88 16.95661 12.02143 29 0.15098 0.08254 89 18.58588 13.07590 30 0.15014 0.08588 90 20.28329 13.93905 31 0.15014 0.09338 91 21.84585 14.12783 32 0.15181 0.09923 92 23.47278 14.90372 33 0.15599 0.10674 93 25.19045 16.17044 34 0.16183 0.11592 94 27.01232 17.81679 35 0.16684 0.12760 95 29.07896 20.37422 36 0.17603 0.13762 96 30.94917 22.78736 37 0.18605 0.14931 97 32.96994 25.28839 38 0.20026 0.15682 98 35.16089 25.41070 39 0.21446 0.16684 99 37.54290 26.66310 40 0.23118 0.17686 100 40.13846 28.86393 41 0.25291 0.18856 101 42.16118 31.28428 42 0.27800 0.20276 102 44.35044 34.03663 43 0.30811 0.21947 103 46.71561 37.09877 44 0.34410 0.23870 104 49.28153 40.55794 45 0.38177 0.26127 105 52.71442 45.14543 46 0.41696 0.28636 106 56.53232 50.13484 47 0.45635 0.31815 107 60.80009 55.58907 48 0.47814 0.35749 108 65.59222 61.47237 49 0.50330 0.40188 109 71.01473 68.08690 50 0.53938 0.45048 110 77.18885 75.45232 51 0.58219 0.50330 111 77.77101 76.18750 52 0.64099 0.56120 112 78.35992 76.93363 53 0.70740 0.62251 113 78.95572 77.69097 54 0.79071 0.68974 114 79.55852 78.45980 55 0.88507 0.76041 115 80.16846 79.24039 56 0.98122 0.83619 116 80.78569 80.03303 57 1.08342 0.91711 117 81.41032 80.83801 58 1.16375 0.99557 118 82.04252 81.65565 59 1.25687 1.08257 119 82.68243 82.48627 120 83.33000 83.33000 The rates shown above represent the guaranteed (maximum) monthly cost of insurance for each $1,000 of net amount at risk. If this policy has been issued in a special (rated) premium class, the guaranteed monthly cost will be calculated as shown on the Policy Schedule. 07921 Page 28 S DEATH BENEFIT CORRIDOR RATES BASED ON CASH VALUE ACCUMULATION TEST ATTAINED AGE ATTAINED AGE NEAREST BIRTHDAY NEAREST BIRTHDAY (ON EACH POLICY (ON EACH POLICY ANNIVERSARY) MALE FEMALE ANNIVERSARY) MALE FEMALE ---------------- ------- ------- ---------------- ------ ------ 0 13.5022 15.7701 60 1.9299 2.0835 1 13.1357 15.2674 61 1.8824 2.0323 2 12.7133 14.7508 62 1.8371 1.9831 3 12.2781 14.2323 63 1.7945 1.9359 4 11.8404 13.7197 64 1.7543 1.8906 5 11.4099 13.2227 65 1.7163 1.8470 6 10.9941 12.7410 66 1.6801 1.8051 7 10.5936 12.2758 67 1.6455 1.7646 8 10.2067 11.8305 68 1.6121 1.7258 9 9.8333 11.4003 69 1.5799 1.6886 10 9.4735 10.9848 70 1.5485 1.6528 11 9.1261 10.5846 71 1.5181 1.6185 12 8.7936 10.1991 72 1.4888 1.5859 13 8.4762 9.8302 73 1.4611 1.5547 14 8.1730 9.4761 74 1.4346 1.5251 15 7.8841 9.1361 75 1.4091 1.4969 16 7.6115 8.8087 76 1.3848 1.4699 17 7.3531 8.4947 77 1.3615 1.4441 18 7.1079 8.1921 78 1.3393 1.4194 19 6.8791 7.9042 79 1.3183 1.3957 20 6.6598 7.6274 80 1.2987 1.3731 21 6.4480 7.3611 81 1.2803 1.3513 22 6.2432 7.1043 82 1.2631 1.3312 23 6.0455 6.8571 83 1.2469 1.3128 24 5.8542 6.6182 84 1.2316 1.2956 25 5.6695 6.3883 85 1.2172 1.2796 26 5.4914 6.1671 86 1.2038 1.2647 27 5.3191 5.9537 87 1.1914 1.2502 28 5.1530 5.7483 88 1.1802 1.2372 29 4.9908 5.5504 89 1.1701 1.2254 30 4.8321 5.3599 90 1.1610 1.2148 31 4.6770 5.1759 91 1.1529 1.2047 32 4.5257 4.9992 92 1.1453 1.1929 33 4.3784 4.8288 93 1.1382 1.1808 34 4.2355 4.6649 94 1.1316 1.1690 35 4.0970 4.5073 95 1.1255 1.1579 36 3.9628 4.3562 96 1.1200 1.1490 37 3.8332 4.2108 97 1.1147 1.1419 38 3.7080 4.0712 98 1.1098 1.1369 39 3.5875 3.9362 99 1.1051 1.1302 40 3.4714 3.8060 100 1.1010 1.1228 41 3.3598 3.6804 101 1.0974 1.1158 42 3.2526 3.5594 102 1.0939 1.1090 43 3.1499 3.4428 103 1.0904 1.1025 44 3.0517 3.3307 104 1.0868 1.0961 45 2.9580 3.2229 105 1.0830 1.0899 46 2.8685 3.1195 106 1.0794 1.0843 47 2.7827 3.0203 107 1.0759 1.0793 48 2.7005 2.9255 108 1.0727 1.0749 49 2.6207 2.8350 109 1.0698 1.0712 50 2.5433 2.7489 110 1.0676 1.0685 51 2.4687 2.6669 111 1.0673 1.0681 52 2.3968 2.5889 112 1.0670 1.0677 53 2.3281 2.5146 113 1.0667 1.0673 54 2.2624 2.4439 114 1.0664 1.0668 55 2.2000 2.3765 115 1.0659 1.0663 56 2.1409 2.3124 116 1.0653 1.0656 57 2.0847 2.2512 117 1.0642 1.0644 58 2.0312 2.1929 118 1.0618 1.0619 59 1.9796 2.1370 119 1.0557 1.0557 120 1.0400 1.0400 07921 Page 29 S TABLE OF GUARANTEE MONTHLY COST OF INSURANCE RATES PER $1,000 OF NET AMOUNT AT RISK ATTAINED AGE ATTAINED AGE NEAREST BIRTHDAY NEAREST BIRTHDAY (ON EACH POLICY (ON EACH POLICY ANNIVERSARY) RATE ANNIVERSARY) RATE ---------------- -------- ---------------- --------- 18 $0.06836 70 $ 1.90504 19 0.07003 71 2.09234 20 0.07086 72 2.33419 21 0.07086 73 2.58973 22 0.07170 74 2.86082 23 0.07170 75 3.15804 24 0.07336 76 3.48344 25 0.07336 77 3.85838 26 0.07670 78 4.29504 27 0.08087 79 4.79623 28 0.08004 80 5.34445 29 0.07920 81 5.98839 30 0.07837 82 6.67043 31 0.07837 83 7.39887 32 0.07920 84 8.20834 33 0.08171 85 9.11818 34 0.08421 86 10.09482 35 0.08754 87 11.23310 36 0.09255 88 12.45482 37 0.09756 89 13.75172 38 0.10423 90 15.06752 39 0.11007 91 16.13554 40 0.11758 92 17.38187 41 0.12677 93 18.85739 42 0.13762 94 20.57377 43 0.15098 95 22.59882 44 0.16601 96 24.55392 45 0.18438 97 26.70183 46 0.20109 98 27.88682 47 0.22115 99 29.59716 48 0.23368 100 31.84721 49 0.24873 101 34.04178 50 0.26880 102 36.60255 51 0.29222 103 39.60096 52 0.32234 104 43.12057 53 0.35582 105 47.20894 54 0.39685 106 51.76130 55 0.44629 107 56.82753 56 0.49743 108 62.38781 57 0.55197 109 68.68355 58 0.60151 110 75.75322 59 0.65612 111 76.46225 60 0.72086 112 77.18143 61 0.79913 113 77.91101 62 0.89265 114 78.65122 63 0.99726 115 79.40231 64 1.10709 116 80.16453 65 1.22384 117 80.93815 66 1.34332 118 81.72344 67 1.46638 119 82.52069 68 1.59984 120 83.33000 69 1.73865 The rates shown above represent the guaranteed (maximum) monthly cost of insurance for each $1,000 of net amount at risk. If this policy has been issued in a special (rated) premium class, the guaranteed monthly cost will be calculated as shown on the Policy Schedule. 07921 Page 28 U-NS DEATH BENEFIT CORRIDOR RATES BASED ON CASH VALUE ACCUMULATION TEST ATTAINED AGE ATTAINED AGE NEAREST BIRTHDAY NEAREST BIRTHDAY (ON EACH POLICY (ON EACH POLICY ANNIVERSARY) RATE ANNIVERSARY) RATE ---------------- ------ ---------------- ------ 18 9.0976 19 8.8037 70 1.7059 20 8.5185 71 1.6649 21 8.2413 72 1.6257 22 7.9713 73 1.5885 23 7.7089 74 1.5533 24 7.4536 75 1.5197 25 7.2061 76 1.4877 26 6.9653 77 1.4572 27 6.7327 78 1.4282 28 6.5083 79 1.4009 29 6.2898 80 1.3752 30 6.0771 81 1.3511 31 5.8701 82 1.3287 32 5.6691 83 1.3077 33 5.4742 84 1.2881 34 5.2858 85 1.2697 35 5.1035 86 1.2527 36 4.9275 87 1.2369 37 4.7577 88 1.2226 38 4.5940 89 1.2095 39 4.4363 90 1.1978 40 4.2841 91 1.1871 41 4.1376 92 1.1767 42 3.9966 93 1.1666 43 3.8610 94 1.1571 44 3.7308 95 1.1484 45 3.6060 96 1.1408 46 3.4863 97 1.1341 47 3.3714 98 1.1284 48 3.2611 99 1.1223 49 3.1546 100 1.1162 50 3.0519 101 1.1104 51 2.9529 102 1.1046 52 2.8578 103 1.0989 53 2.7666 104 1.0933 54 2.6793 105 1.0880 55 2.5957 106 1.0831 56 2.5161 107 1.0785 57 2.4401 108 1.0744 58 2.3674 109 1.0709 59 2.2976 110 1.0683 60 2.2305 111 1.0679 61 2.1663 112 1.0676 62 2.1049 113 1.0672 63 2.0465 114 1.0668 64 1.9910 115 1.0663 65 1.9381 116 1.0656 66 1.8877 117 1.0644 67 1.8394 118 1.0619 68 1.7931 119 1.0557 69 1.7487 120 1.0400 07921 Page 29 U-NS TABLE OF GUARANTEE MONTHLY COST OF INSURANCE RATES PER $1,000 OF NET AMOUNT AT RISK ATTAINED AGE ATTAINED AGE NEAREST BIRTHDAY NEAREST BIRTHDAY (ON EACH POLICY (ON EACH POLICY ANNIVERSARY) RATE ANNIVERSARY) RATE ---------------- -------- ---------------- --------- 0 $0.07253 60 $ 1.32975 1 0.04334 61 1.46043 2 0.03000 62 1.61601 3 0.02166 63 1.78811 4 0.01750 64 1.96401 5 0.01666 65 2.14031 6 0.01750 66 2.31272 7 0.01833 67 2.48552 8 0.01833 68 2.66906 9 0.01916 69 2.85391 10 0.01916 70 3.07474 11 0.02166 71 3.31970 12 0.02667 72 3.64141 13 0.03083 73 3.96972 14 0.03667 74 4.30737 15 0.04668 75 4.69166 16 0.05585 76 5.10457 17 0.06502 77 5.57701 18 0.08254 78 6.11998 19 0.09005 79 6.73496 20 0.09422 80 7.39612 21 0.09923 81 8.17220 22 0.10423 82 8.97297 23 0.10840 83 9.80574 24 0.11508 84 10.71738 25 0.12176 85 11.76585 26 0.12760 86 12.86603 27 0.13511 87 14.14584 28 0.13678 88 15.48667 29 0.13762 89 16.87267 30 0.13762 90 18.21409 31 0.13929 91 19.18423 32 0.14096 92 20.32874 33 0.14597 93 21.66066 34 0.15265 94 23.17701 35 0.15933 95 25.22500 36 0.16851 96 27.13615 37 0.17854 97 29.20486 38 0.19190 98 30.13226 39 0.20527 99 31.60457 40 0.22031 100 33.62822 41 0.24037 101 35.54445 42 0.26294 102 37.78007 43 0.29054 103 40.33887 44 0.32317 104 43.29532 45 0.35749 105 47.37153 46 0.39099 106 51.91401 47 0.42869 107 56.96954 48 0.45383 108 62.52336 49 0.48318 109 68.81212 50 0.52176 110 75.87388 51 0.56624 111 76.57238 52 0.62503 112 77.28073 53 0.69058 113 77.99915 54 0.77051 114 78.72786 55 0.85978 115 79.46711 56 0.95169 116 80.21714 57 1.04962 117 80.97819 58 1.12992 118 81.75054 59 1.22130 119 82.53445 120 83.33000 The rates shown above represent the guaranteed (maximum) monthly cost of insurance for each $1,000 of net amount at risk. If this policy has been issued in a special (rated) premium class, the guaranteed monthly cost will be calculated as shown on the Policy Schedule. 07921 Page 28 U-S DEATH BENEFIT CORRIDOR RATES BASED ON CASH VALUE ACCUMULATION TEST ATTAINED AGE ATTAINED AGE NEAREST BIRTHDAY NEAREST BIRTHDAY (ON EACH POLICY (ON EACH POLICY ANNIVERSARY) RATE ANNIVERSARY) RATE ---------------- ------- ---------------- ------ 0 13.8948 60 1.9593 1 13.5058 61 1.9111 2 13.0678 62 1.8652 3 12.6177 63 1.8217 4 12.1677 64 1.7807 5 11.7260 65 1.7417 6 11.2983 66 1.7047 7 10.8863 67 1.6691 8 10.4894 68 1.6348 9 10.1062 69 1.6017 10 9.7370 70 1.5696 11 9.3806 71 1.5386 12 9.0386 72 1.5088 13 8.7124 73 1.4805 14 8.4003 74 1.4535 15 8.1024 75 1.4276 16 7.8206 76 1.4029 17 7.5528 77 1.3793 18 7.2980 78 1.3568 19 7.0594 79 1.3355 20 6.8306 80 1.3155 21 6.6095 81 1.2967 22 6.3961 82 1.2792 23 6.1900 83 1.2628 24 5.9906 84 1.2474 25 5.7983 85 1.2330 26 5.6128 86 1.2197 27 5.4336 87 1.2074 28 5.2607 88 1.1963 29 5.0923 89 1.1863 30 4.9281 90 1.1775 31 4.7681 91 1.1697 32 4.6123 92 1.1617 33 4.4609 93 1.1540 34 4.3142 94 1.1464 35 4.1723 95 1.1392 36 4.0351 96 1.1330 37 3.9027 97 1.1276 38 3.7749 98 1.1232 39 3.6518 99 1.1182 40 3.5332 100 1.1131 41 3.4190 101 1.1082 42 3.3094 102 1.1032 43 3.2042 103 1.0982 44 3.1035 104 1.0931 45 3.0074 105 1.0878 46 2.9154 106 1.0829 47 2.8272 107 1.0784 48 2.7428 108 1.0743 49 2.6611 109 1.0708 50 2.5821 110 1.0683 51 2.5062 111 1.0679 52 2.4332 112 1.0675 53 2.3634 113 1.0671 54 2.2968 114 1.0667 55 2.2335 115 1.0662 56 2.1735 116 1.0656 57 2.1164 117 1.0644 58 2.0620 118 1.0619 59 2.0097 119 1.0557 120 1.0400 07921 Page 29 U-S DEATH BENEFIT CORRIDOR RATES BASED ON GUIDELINE PREMIUM ATTAINED ATTAINED AGE RATE AGE RATE -------- ---- -------- ---- 0-40 2.50 60 1.30 41 2.43 61 1.28 42 2.36 62 1.26 43 2.29 63 1.24 44 2.22 64 1.22 45 2.15 65 1.20 46 2.09 66 1.19 47 2.03 67 1.18 48 1.97 68 1.17 49 1.91 69 1.16 50 1.85 70 1.15 51 1.78 71 1.13 52 1.71 72 1.11 53 1.64 73 1.09 54 1.57 74 1.07 55 1.50 75-90 1.05 56 1.46 91 1.04 57 1.42 92 1.03 58 1.38 93 1.02 59 1.34 94 1.01 95+ 1.00 07921 Page 29 TABLE OF SURRENDER CHARGES PER $1,000 OF BASE COVERAGE The following charges apply to each $1,000 of initial Base Coverage surrendered during the Surrender Charge Period. The charges also apply to each $1,000 of increase in Base Coverage surrendered during the Surrender Charge Period of each increase. The word "surrender" as used in this provision means Full Surrender, or a reduction in Base Coverage at the request of the Owner, or due to a partial surrender. The charge for the surrender of all or any portion of the initial Base Coverage will be equal to the rate shown below for the age at issue and the year of surrender, multiplied by the number of thousands of initial Base Coverage being surrendered. The charges for surrender of all or any portion of an increase in Base Coverage will be equal to the rates shown below for the age at issue of such increase and year of surrender, multiplied by the number of thousands of such increase being surrendered. In addition, there will be a charge for each partial surrender as described in the Partial Surrender provision.
ISSUE AGE YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR FEMALE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15+ ------ ----- ----- ----- ----- ----- ----- ----- ----- ---- ---- ---- ---- ---- ---- ---- 0 3.00 3.00 3.00 3.00 2.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 1 3.00 3.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 2 3.00 3.00 3.00 3.00 2.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 3 3.00 3.00 3.00 3.00 2.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 4 3.00 3.00 3.00 3.00 2.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 5 3.00 3.00 3.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 6 3.00 3.00 3.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 7 3.00 3.00 3.00 3.00 3.00 2.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 8 4.00 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 2.00 2.00 2.00 2.00 1.00 0.00 9 4.00 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 2.00 2.00 2.00 2.00 1.00 0.00 10 4.00 4.00 4.00 4.00 4.00 3.00 3.00 3.00 2.00 2.00 2.00 2.00 2.00 2.00 0.00 11 4.00 4.00 4.00 4.00 4.00 3.00 3.00 3.00 2.00 2.00 2.00 2.00 2.00 2.00 0.00 12 4.00 4.00 4.00 4.00 4.00 3.00 3.00 3.00 2.00 2.00 2.00 2.00 2.00 2.00 0.00 13 5.00 5.00 5.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 3.00 2.00 0.00 14 5.00 5.00 5.00 5.00 5.00 4.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 2.00 0.00 15 5.00 5.00 5.00 5.00 5.00 4.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 2.00 0.00 16 5.00 5.00 5.00 5.00 5.00 4.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 2.00 0.00 17 5.00 5.00 5.00 5.00 5.00 4.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 2.00 0.00 18 5.00 5.00 5.00 5.00 5.00 4.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 2.00 0.00 19 5.00 5.00 5.00 5.00 5.00 4.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 2.00 0.00 20 5.00 5.00 5.00 5.00 5.00 4.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 2.00 0.00 21 5.00 5.00 5.00 5.00 5.00 4.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 2.00 0.00 22 5.00 5.00 5.00 5.00 5.00 4.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 2.00 0.00 23 5.00 5.00 5.00 5.00 5.00 4.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 2.00 0.00 24 5.00 5.00 5.00 5.00 5.00 4.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 2.00 0.00 25 5.00 5.00 5.00 5.00 5.00 4.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 2.00 0.00 26 5.00 5.00 5.00 5.00 5.00 4.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 2.00 0.00 27 6.00 6.00 6.00 6.00 6.00 5.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 2.00 0.00 28 6.00 6.00 6.00 6.00 6.00 5.00 5.00 5.00 4.00 4.00 4.00 4.00 3.00 3.00 0.00 29 7.00 7.00 7.00 7.00 7.00 6.00 6.00 6.00 4.00 4.00 4.00 4.00 3.00 3.00 0.00 30 7.00 7.00 7.00 7.00 7.00 6.00 6.00 6.00 5.00 5.00 4.00 4.00 4.00 3.00 0.00 31 7.00 7.00 7.00 7.00 7.00 6.00 6.00 6.00 5.00 5.00 4.00 4.00 4.00 3.00 0.00 32 8.00 8.00 8.00 8.00 8.00 7.00 7.00 7.00 5.00 5.00 4.00 4.00 4.00 3.00 0.00 33 8.00 8.00 8.00 8.00 8.00 7.00 7.00 7.00 5.00 5.00 5.00 5.00 4.00 4.00 0.00 34 9.00 9.00 9.00 9.00 9.00 8.00 8.00 8.00 6.00 6.00 5.00 5.00 4.00 4.00 0.00 35 9.00 9.00 9.00 9.00 9.00 8.00 8.00 8.00 6.00 6.00 5.00 5.00 4.00 4.00 0.00 36 10.00 10.00 10.00 10.00 10.00 9.00 9.00 8.00 7.00 6.00 5.00 5.00 4.00 4.00 0.00 37 10.00 10.00 10.00 10.00 10.00 9.00 9.00 9.00 7.00 7.00 6.00 6.00 5.00 4.00 0.00 38 11.00 11.00 11.00 11.00 11.00 10.00 10.00 9.00 8.00 7.00 6.00 6.00 5.00 5.00 0.00 39 11.00 11.00 11.00 11.00 11.00 10.00 10.00 10.00 8.00 8.00 7.00 6.00 5.00 5.00 0.00
07921 Page 30 F TABLE OF SURRENDER CHARGES PER $1,000 OF BASE COVERAGE
ISSUE AGE YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR FEMALE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15+ ------ ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ---- ---- ---- ---- ---- 40 12.00 12.00 12.00 12.00 12.00 11.00 11.00 10.00 9.00 8.00 7.00 7.00 6.00 5.00 0.00 41 13.00 13.00 13.00 13.00 13.00 12.00 11.00 10.00 9.00 8.00 7.00 7.00 6.00 5.00 0.00 42 13.00 13.00 13.00 13.00 13.00 12.00 12.00 11.00 10.00 9.00 8.00 7.00 6.00 5.00 0.00 43 14.00 14.00 14.00 14.00 14.00 13.00 12.00 11.00 10.00 9.00 8.00 7.00 6.00 6.00 0.00 44 14.00 14.00 14.00 14.00 14.00 13.00 13.00 12.00 11.00 10.00 9.00 8.00 7.00 6.00 0.00 45 15.00 15.00 15.00 15.00 15.00 14.00 13.00 12.00 11.00 10.00 9.00 8.00 7.00 6.00 0.00 46 16.00 16.00 16.00 16.00 15.00 14.00 13.00 12.00 11.00 9.00 8.00 7.00 6.00 5.00 0.00 47 17.00 17.00 16.00 16.00 16.00 14.00 13.00 11.00 10.00 9.00 7.00 6.00 6.00 5.00 0.00 48 18.00 18.00 17.00 17.00 16.00 14.00 13.00 11.00 10.00 8.00 6.00 6.00 5.00 4.00 0.00 49 19.00 19.00 17.00 17.00 16.00 14.00 13.00 11.00 9.00 7.00 5.00 5.00 4.00 4.00 0.00 50 20.00 20.00 18.00 17.00 17.00 15.00 13.00 11.00 9.00 7.00 5.00 4.00 4.00 3.00 0.00 51 20.00 20.00 18.00 17.00 17.00 15.00 12.00 10.00 8.00 6.00 4.00 3.00 3.00 2.00 0.00 52 21.00 21.00 19.00 18.00 17.00 15.00 12.00 10.00 8.00 5.00 3.00 2.00 2.00 0.00 0.00 53 22.00 22.00 19.00 18.00 17.00 15.00 12.00 10.00 7.00 4.00 2.00 2.00 0.00 0.00 0.00 54 23.00 23.00 20.00 19.00 18.00 15.00 12.00 9.00 7.00 4.00 5.00 0.00 0.00 0.00 0.00 55 24.00 24.00 20.00 19.00 18.00 15.00 12.00 9.00 6.00 3.00 0.00 0.00 0.00 0.00 0.00 56 25.00 25.00 22.00 21.00 19.00 16.00 13.00 9.00 6.00 3.00 0.00 0.00 0.00 0.00 0.00 57 26.00 26.00 23.00 22.00 20.00 17.00 13.00 10.00 7.00 3.00 0.00 0.00 0.00 0.00 0.00 58 28.00 28.00 25.00 24.00 21.00 17.00 14.00 10.00 7.00 3.00 0.00 0.00 0.00 0.00 0.00 59 29.00 29.00 26.00 25.00 22.00 18.00 15.00 11.00 7.00 4.00 0.00 0.00 0.00 0.00 0.00 60 31.00 31.00 28.00 27.00 23.00 19.00 15.00 12.00 8.00 4.00 0.00 0.00 0.00 0.00 0.00 61 33.00 33.00 29.00 28.00 24.00 20.00 16.00 12.00 8.00 4.00 0.00 0.00 0.00 0.00 0.00 62 34.00 34.00 31.00 30.00 26.00 22.00 17.00 13.00 9.00 4.00 0.00 0.00 0.00 0.00 0.00 63 36.00 36.00 32.00 31.00 27.00 23.00 18.00 14.00 9.00 5.00 0.00 0.00 0.00 0.00 0.00 64 39.00 39.00 34.00 33.00 29.00 24.00 19.00 14.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 65 41.00 39.00 35.00 34.00 31.00 26.00 20.00 15.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 66 39.00 38.00 34.00 33.00 31.00 26.00 21.00 16.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 67 38.00 36.00 34.00 33.00 30.00 26.00 21.00 16.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 68 36.00 34.00 33.00 32.00 30.00 26.00 21.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 69 34.00 33.00 31.00 30.00 29.00 27.00 21.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 70 33.00 31.00 30.00 29.00 27.00 26.00 21.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 71 31.00 30.00 28.00 27.00 26.00 25.00 21.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 72 29.00 28.00 27.00 26.00 24.00 23.00 22.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 73 28.00 26.00 25.00 24.00 23.00 22.00 20.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 74 26.00 25.00 24.00 23.00 21.00 20.00 19.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 75 24.00 23.00 22.00 21.00 20.00 19.00 18.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 76 24.00 23.00 22.00 21.00 20.00 19.00 18.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 77 24.00 23.00 22.00 21.00 20.00 19.00 18.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 78 24.00 23.00 22.00 21.00 19.00 18.00 17.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 79 24.00 23.00 21.00 20.00 19.00 18.00 17.00 16.00 11.00 6.00 0.00 0.00 0.00 0.00 0.00 80 24.00 22.00 21.00 20.00 19.00 18.00 17.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 81 23.00 22.00 21.00 20.00 19.00 18.00 17.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 82 23.00 22.00 21.00 20.00 19.00 18.00 17.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 83 23.00 22.00 21.00 20.00 19.00 18.00 17.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 84 23.00 22.00 21.00 20.00 19.00 18.00 17.00 15.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 85 23.00 22.00 21.00 19.00 18.00 17.00 16.00 15.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00
07921 Page 31 F TABLE OF SURRENDER CHARGES PER $1,000 OF BASE COVERAGE The following charges apply to each $1,000 of initial Base Coverage surrendered during the Surrender Charge Period. The charges also apply to each $1,000 of increase in Base Coverage surrendered during the Surrender Charge Period of each increase. The word "surrender" as used in this provision means Full Surrender, or a reduction in Base Coverage at the request of the Owner, or due to a partial surrender. The charge for the surrender of all or any portion of the initial Base Coverage will be equal to the rate shown below for the age at issue and the year of surrender, multiplied by the number of thousands of initial Base Coverage being surrendered. The charges for surrender of all or any portion of an increase in Base Coverage will be equal to the rates shown below for the age at issue of such increase and year of surrender, multiplied by the number of thousands of such increase being surrendered. In addition, there will be a charge for each partial surrender as described in the Partial Surrender provision.
ISSUE AGE YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR MALE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15+ ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ---- ---- ---- ---- 0 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 1 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 2 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 3 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 4 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 5 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 6 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 7 5.00 5.00 5.00 5.00 4.00 4.00 3.00 3.00 2.00 2.00 2.00 1.00 1.00 1.00 0.00 8 5.00 5.00 5.00 5.00 4.00 4.00 3.00 3.00 2.00 2.00 2.00 2.00 2.00 2.00 0.00 9 5.00 5.00 5.00 5.00 5.00 4.00 4.00 3.00 3.00 2.00 2.00 2.00 2.00 2.00 0.00 10 6.00 6.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 2.00 2.00 2.00 0.00 11 6.00 6.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 2.00 2.00 2.00 0.00 12 6.00 6.00 6.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 2.00 2.00 2.00 0.00 13 6.00 6.00 6.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 0.00 14 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 15 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 16 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 17 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 18 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 19 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 20 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 21 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 22 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 23 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 24 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 25 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 26 8.00 8.00 8.00 8.00 8.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 3.00 3.00 0.00 27 8.00 8.00 8.00 8.00 8.00 8.00 8.00 7.00 6.00 5.00 5.00 4.00 4.00 3.00 0.00 28 9.00 9.00 9.00 9.00 9.00 8.00 8.00 7.00 7.00 6.00 6.00 5.00 4.00 3.00 0.00 29 10.00 10.00 10.00 10.00 10.00 9.00 9.00 8.00 8.00 7.00 7.00 5.00 4.00 3.00 0.00 30 11.00 11.00 11.00 11.00 11.00 10.00 10.00 9.00 9.00 8.00 8.00 6.00 5.00 3.00 0.00 31 11.00 11.00 11.00 11.00 11.00 11.00 11.00 10.00 9.00 8.00 8.00 6.00 5.00 3.00 0.00 32 12.00 12.00 12.00 12.00 12.00 12.00 12.00 11.00 10.00 9.00 9.00 7.00 5.00 3.00 0.00 33 13.00 13.00 13.00 13.00 13.00 12.00 12.00 11.00 11.00 10.00 10.00 7.00 5.00 3.00 0.00 34 13.00 13.00 13.00 13.00 13.00 13.00 13.00 12.00 11.00 10.00 10.00 8.00 6.00 3.00 0.00 35 14.00 14.00 14.00 14.00 14.00 14.00 14.00 13.00 12.00 11.00 11.00 8.00 6.00 3.00 0.00 36 15.00 15.00 15.00 15.00 15.00 15.00 15.00 14.00 13.00 12.00 11.00 8.00 6.00 3.00 0.00 37 16.00 16.00 16.00 16.00 16.00 16.00 15.00 14.00 13.00 12.00 11.00 9.00 6.00 3.00 0.00 38 17.00 17.00 17.00 17.00 17.00 16.00 15.00 14.00 13.00 12.00 11.00 9.00 6.00 3.00 0.00 39 18.00 18.00 18.00 18.00 17.00 17.00 16.00 15.00 14.00 13.00 12.00 9.00 6.00 3.00 0.00
07921 Page 30 M TABLE OF SURRENDER CHARGES PER $1,000 OF BASE COVERAGE
ISSUE AGE YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR MALE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15+ ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ---- ---- ---- 40 19.00 19.00 19.00 19.00 18.00 17.00 16.00 15.00 14.00 13.00 12.00 10.00 7.00 4.00 0.00 41 19.00 19.00 19.00 19.00 18.00 17.00 16.00 15.00 14.00 13.00 12.00 10.00 7.00 4.00 0.00 42 20.00 20.00 20.00 20.00 19.00 18.00 17.00 16.00 15.00 14.00 12.00 10.00 7.00 4.00 0.00 43 21.00 21.00 21.00 20.00 19.00 18.00 17.00 16.00 15.00 14.00 13.00 10.00 7.00 4.00 0.00 44 22.00 22.00 22.00 21.00 20.00 19.00 18.00 17.00 16.00 14.00 13.00 11.00 7.00 4.00 0.00 45 23.00 23.00 22.00 21.00 20.00 19.00 18.00 17.00 16.00 15.00 14.00 11.00 7.00 4.00 0.00 46 25.00 24.00 23.00 22.00 21.00 20.00 19.00 18.00 16.00 15.00 13.00 10.00 6.00 4.00 0.00 47 26.00 25.00 24.00 23.00 22.00 20.00 19.00 18.00 16.00 14.00 11.00 9.00 6.00 3.00 0.00 48 26.00 25.00 24.00 23.00 22.00 21.00 20.00 19.00 16.00 13.00 10.00 8.00 5.00 3.00 0.00 49 27.00 26.00 25.00 24.00 23.00 22.00 20.00 18.00 15.00 12.00 8.00 7.00 4.00 2.00 0.00 50 28.00 27.00 26.00 25.00 24.00 22.00 21.00 18.00 14.00 11.00 7.00 6.00 4.00 2.00 0.00 51 29.00 28.00 27.00 26.00 24.00 23.00 21.00 17.00 13.00 9.00 6.00 4.00 3.00 2.00 0.00 52 30.00 29.00 28.00 27.00 25.00 23.00 21.00 17.00 12.00 8.00 4.00 3.00 2.00 0.00 0.00 53 31.00 30.00 29.00 28.00 26.00 24.00 20.00 16.00 12.00 7.00 3.00 2.00 0.00 0.00 0.00 54 32.00 31.00 30.00 29.00 27.00 24.00 20.00 16.00 11.00 6.00 5.00 0.00 0.00 0.00 0.00 55 34.00 32.00 31.00 30.00 28.00 24.00 20.00 15.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 56 35.00 34.00 32.00 31.00 29.00 26.00 21.00 15.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 57 36.00 35.00 34.00 32.00 31.00 27.00 22.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 58 38.00 36.00 35.00 33.00 32.00 28.00 23.00 17.00 11.00 6.00 0.00 0.00 0.00 0.00 0.00 59 40.00 38.00 36.00 35.00 33.00 29.00 24.00 18.00 12.00 6.00 0.00 0.00 0.00 0.00 0.00 60 41.00 39.00 37.00 36.00 34.00 31.00 25.00 18.00 12.00 6.00 0.00 0.00 0.00 0.00 0.00 61 40.00 39.00 37.00 36.00 34.00 31.00 25.00 18.00 12.00 6.00 0.00 0.00 0.00 0.00 0.00 62 40.00 38.00 37.00 35.00 34.00 30.00 24.00 18.00 12.00 6.00 0.00 0.00 0.00 0.00 0.00 63 40.00 38.00 37.00 35.00 33.00 30.00 24.00 18.00 12.00 6.00 0.00 0.00 0.00 0.00 0.00 64 39.00 38.00 36.00 35.00 33.00 29.00 24.00 18.00 12.00 6.00 0.00 0.00 0.00 0.00 0.00 65 39.00 38.00 36.00 34.00 33.00 29.00 24.00 18.00 12.00 6.00 0.00 0.00 0.00 0.00 0.00 66 37.00 36.00 34.00 33.00 31.00 28.00 24.00 18.00 12.00 6.00 0.00 0.00 0.00 0.00 0.00 67 35.00 34.00 32.00 31.00 29.00 28.00 23.00 17.00 12.00 6.00 0.00 0.00 0.00 0.00 0.00 68 33.00 31.00 30.00 29.00 27.00 26.00 23.00 17.00 11.00 6.00 0.00 0.00 0.00 0.00 0.00 69 31.00 29.00 28.00 27.00 25.00 24.00 22.00 17.00 11.00 6.00 0.00 0.00 0.00 0.00 0.00 70 28.00 27.00 26.00 25.00 24.00 22.00 21.00 17.00 11.00 6.00 0.00 0.00 0.00 0.00 0.00 71 26.00 25.00 24.00 23.00 22.00 21.00 19.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 72 24.00 23.00 22.00 21.00 20.00 19.00 18.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 73 22.00 21.00 20.00 19.00 18.00 17.00 16.00 15.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 74 20.00 19.00 18.00 17.00 16.00 15.00 14.00 14.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 75 18.00 17.00 16.00 15.00 15.00 14.00 13.00 12.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 76 18.00 17.00 16.00 15.00 14.00 14.00 13.00 12.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 77 18.00 17.00 16.00 15.00 14.00 13.00 13.00 12.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 78 17.00 17.00 16.00 15.00 14.00 13.00 12.00 12.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 79 17.00 16.00 16.00 15.00 14.00 13.00 12.00 12.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 80 17.00 16.00 15.00 15.00 14.00 13.00 12.00 12.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 81 17.00 16.00 15.00 14.00 14.00 13.00 12.00 11.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 82 17.00 16.00 15.00 14.00 13.00 13.00 12.00 11.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 83 17.00 16.00 15.00 14.00 13.00 13.00 12.00 11.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 84 17.00 16.00 15.00 14.00 13.00 13.00 12.00 11.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 85 17.00 16.00 15.00 14.00 13.00 13.00 12.00 11.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00
07921 Page 31 M TABLE OF SURRENDER CHARGES PER $1,000 OF BASE COVERAGE The following charges apply to each $1,000 of initial Base Coverage surrendered during the Surrender Charge Period. The charges also apply to each $1,000 of increase in Base Coverage surrendered during the Surrender Charge Period of each increase. The word "surrender" as used in this provision means Full Surrender, or a reduction in Base Coverage at the request of the Owner, or due to a partial surrender. The charge for the surrender of all or any portion of the initial Base Coverage will be equal to the rate shown below for the age at issue and the year of surrender, multiplied by the number of thousands of initial Base Coverage being surrendered. The charges for surrender of all or any portion of an increase in Base Coverage will be equal to the rates shown below for the age at issue of such increase and year of surrender, multiplied by the number of thousands of such increase being surrendered. In addition, there will be a charge for each partial surrender as described in the Partial Surrender provision.
ISSUE YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR AGE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15+ ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ---- ---- ---- ---- 0 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 1 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 2 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 3 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 4 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 5 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 6 4.00 4.00 4.00 4.00 3.00 3.00 2.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 0.00 7 5.00 5.00 5.00 5.00 4.00 4.00 3.00 3.00 2.00 2.00 2.00 1.00 1.00 1.00 0.00 8 5.00 5.00 5.00 5.00 4.00 4.00 3.00 3.00 2.00 2.00 2.00 2.00 2.00 2.00 0.00 9 5.00 5.00 5.00 5.00 5.00 4.00 4.00 3.00 3.00 2.00 2.00 2.00 2.00 2.00 0.00 10 6.00 6.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 2.00 2.00 2.00 0.00 11 6.00 6.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 2.00 2.00 2.00 0.00 12 6.00 6.00 6.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 2.00 2.00 2.00 0.00 13 6.00 6.00 6.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 0.00 14 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 15 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 16 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 17 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 18 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 19 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 20 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 21 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 22 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 23 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 24 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 25 7.00 7.00 7.00 7.00 7.00 6.00 6.00 5.00 5.00 4.00 4.00 3.00 3.00 3.00 0.00 26 7.00 7.00 7.00 7.00 7.00 6.00 6.00 6.00 5.00 5.00 5.00 4.00 3.00 3.00 0.00 27 8.00 8.00 8.00 8.00 8.00 7.00 7.00 7.00 6.00 5.00 5.00 4.00 4.00 3.00 0.00 28 8.00 8.00 8.00 8.00 8.00 7.00 7.00 7.00 6.00 6.00 6.00 5.00 4.00 3.00 0.00 29 9.00 9.00 9.00 9.00 9.00 8.00 8.00 8.00 7.00 6.00 6.00 5.00 4.00 3.00 0.00 30 10.00 10.00 10.00 10.00 10.00 9.00 9.00 8.00 8.00 7.00 7.00 6.00 5.00 3.00 0.00 31 10.00 10.00 10.00 10.00 10.00 10.00 10.00 9.00 8.00 7.00 7.00 6.00 5.00 3.00 0.00 32 11.00 11.00 11.00 11.00 11.00 11.00 11.00 10.00 9.00 8.00 8.00 6.00 5.00 3.00 0.00 33 12.00 12.00 12.00 12.00 12.00 11.00 11.00 10.00 10.00 9.00 9.00 7.00 5.00 3.00 0.00 34 12.00 12.00 12.00 12.00 12.00 12.00 12.00 11.00 10.00 9.00 9.00 7.00 6.00 3.00 0.00 35 13.00 13.00 13.00 13.00 13.00 13.00 13.00 12.00 11.00 10.00 10.00 7.00 6.00 3.00 0.00 36 14.00 14.00 14.00 14.00 14.00 14.00 14.00 13.00 12.00 11.00 10.00 7.00 6.00 3.00 0.00 37 15.00 15.00 15.00 15.00 15.00 15.00 15.00 13.00 12.00 11.00 11.00 8.00 6.00 3.00 0.00 38 16.00 16.00 16.00 16.00 16.00 16.00 15.00 14.00 13.00 12.00 11.00 8.00 6.00 3.00 0.00 39 17.00 17.00 17.00 17.00 17.00 16.00 15.00 14.00 13.00 12.00 11.00 8.00 6.00 3.00 0.00
07921 Page 30 U TABLE OF SURRENDER CHARGES PER $1,000 OF BASE COVERAGE
ISSUE YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR YEAR AGE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15+ ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ---- ---- ---- 40 18.00 18.00 18.00 18.00 18.00 17.00 16.00 15.00 14.00 13.00 12.00 9.00 7.00 4.00 0.00 41 18.00 18.00 18.00 18.00 18.00 17.00 16.00 15.00 14.00 13.00 12.00 9.00 7.00 4.00 0.00 42 19.00 19.00 19.00 19.00 18.00 18.00 16.00 16.00 14.00 13.00 12.00 9.00 7.00 4.00 0.00 43 20.00 20.00 20.00 20.00 19.00 18.00 17.00 16.00 15.00 14.00 12.00 9.00 7.00 4.00 0.00 44 20.00 20.00 20.00 20.00 19.00 18.00 17.00 16.00 15.00 14.00 13.00 10.00 7.00 4.00 0.00 45 21.00 21.00 21.00 21.00 20.00 19.00 18.00 17.00 16.00 15.00 13.00 10.00 7.00 4.00 0.00 46 23.00 23.00 22.00 21.00 21.00 20.00 18.00 17.00 16.00 14.00 12.00 9.00 6.00 4.00 0.00 47 24.00 24.00 23.00 22.00 21.00 20.00 19.00 17.00 15.00 13.00 10.00 8.00 6.00 3.00 0.00 48 26.00 25.00 24.00 23.00 22.00 21.00 19.00 17.00 15.00 12.00 9.00 8.00 5.00 3.00 0.00 49 27.00 26.00 25.00 24.00 23.00 21.00 19.00 17.00 14.00 11.00 7.00 7.00 4.00 2.00 0.00 50 28.00 27.00 25.00 24.00 23.00 21.00 19.00 17.00 13.00 10.00 7.00 6.00 4.00 2.00 0.00 51 29.00 27.00 26.00 25.00 24.00 21.00 19.00 16.00 12.00 8.00 6.00 4.00 3.00 2.00 0.00 52 30.00 28.00 27.00 26.00 25.00 21.00 19.00 16.00 11.00 7.00 4.00 3.00 2.00 0.00 0.00 53 31.00 29.00 28.00 27.00 26.00 22.00 18.00 15.00 11.00 6.00 3.00 2.00 0.00 0.00 0.00 54 32.00 31.00 29.00 28.00 26.00 22.00 18.00 15.00 10.00 6.00 5.00 0.00 0.00 0.00 0.00 55 33.00 32.00 30.00 29.00 27.00 22.00 18.00 14.00 9.00 5.00 0.00 0.00 0.00 0.00 0.00 56 34.00 33.00 32.00 30.00 29.00 24.00 19.00 14.00 9.00 5.00 0.00 0.00 0.00 0.00 0.00 57 36.00 34.00 33.00 31.00 30.00 25.00 20.00 15.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 58 37.00 36.00 34.00 33.00 31.00 26.00 21.00 16.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 59 39.00 37.00 36.00 33.00 32.00 27.00 22.00 17.00 11.00 6.00 0.00 0.00 0.00 0.00 0.00 60 40.00 39.00 36.00 34.00 34.00 29.00 23.00 17.00 11.00 6.00 0.00 0.00 0.00 0.00 0.00 61 41.00 39.00 36.00 34.00 34.00 29.00 23.00 17.00 11.00 6.00 0.00 0.00 0.00 0.00 0.00 62 40.00 39.00 37.00 35.00 34.00 28.00 23.00 17.00 11.00 6.00 0.00 0.00 0.00 0.00 0.00 63 40.00 39.00 36.00 35.00 34.00 29.00 23.00 17.00 11.00 6.00 0.00 0.00 0.00 0.00 0.00 64 40.00 38.00 36.00 35.00 33.00 28.00 23.00 17.00 12.00 6.00 0.00 0.00 0.00 0.00 0.00 65 39.00 38.00 36.00 35.00 33.00 28.00 23.00 17.00 12.00 6.00 0.00 0.00 0.00 0.00 0.00 66 37.00 36.00 35.00 33.00 31.00 28.00 23.00 18.00 12.00 6.00 0.00 0.00 0.00 0.00 0.00 67 35.00 34.00 33.00 31.00 30.00 28.00 23.00 17.00 12.00 6.00 0.00 0.00 0.00 0.00 0.00 68 33.00 32.00 31.00 29.00 28.00 26.00 23.00 17.00 11.00 6.00 0.00 0.00 0.00 0.00 0.00 69 31.00 30.00 29.00 27.00 26.00 25.00 22.00 17.00 11.00 6.00 0.00 0.00 0.00 0.00 0.00 70 29.00 28.00 27.00 26.00 24.00 23.00 22.00 17.00 11.00 6.00 0.00 0.00 0.00 0.00 0.00 71 27.00 26.00 25.00 24.00 23.00 21.00 20.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 72 25.00 24.00 23.00 22.00 21.00 20.00 19.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 73 23.00 22.00 21.00 20.00 19.00 18.00 17.00 16.00 11.00 5.00 0.00 0.00 0.00 0.00 0.00 74 21.00 20.00 19.00 18.00 17.00 16.00 15.00 14.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 75 19.00 18.00 17.00 16.00 16.00 15.00 14.00 13.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 76 19.00 18.00 17.00 16.00 15.00 15.00 14.00 13.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 77 19.00 18.00 17.00 16.00 15.00 14.00 14.00 13.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 78 19.00 18.00 17.00 16.00 15.00 14.00 13.00 13.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 79 19.00 18.00 17.00 16.00 15.00 14.00 13.00 13.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 80 19.00 18.00 17.00 16.00 15.00 14.00 13.00 12.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 81 18.00 17.00 16.00 16.00 15.00 14.00 13.00 12.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 82 18.00 17.00 16.00 15.00 15.00 14.00 13.00 12.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 83 18.00 17.00 16.00 15.00 14.00 14.00 13.00 12.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 84 18.00 17.00 16.00 15.00 14.00 14.00 13.00 12.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00 85 18.00 17.00 16.00 15.00 14.00 14.00 13.00 12.00 10.00 5.00 0.00 0.00 0.00 0.00 0.00
07921 Page 31 U TABLES OF MONTHLY INSTALLMENTS FOR EACH $1,000 OF PROCEEDS OPTION 1 TABLE INSTALLMENTS FOR A SPECIFIED PERIOD
NUMBER AMOUNT OF NUMBER AMOUNT OF NUMBER AMOUNT OF NUMBER AMOUNT OF OF YEARS MONTHLY OF YEARS MONTHLY OF YEARS MONTHLY OF YEARS MONTHLY PAYABLE INSTALLMENTS PAYABLE INSTALLMENTS PAYABLE INSTALLMENTS PAYABLE INSTALLMENTS -------- ------------ -------- ------------ -------- ------------ -------- ------------ 1 $84.09 11 $8.42 21 $4.85 31 $3.59 2 42.46 12 7.80 22 4.67 32 3.51 3 28.59 13 7.26 23 4.51 33 3.44 4 21.65 14 6.81 24 4.36 34 3.37 5 17.49 15 6.42 25 4.22 35 3.30 6 14.72 16 6.07 26 4.10 36 3.23 7 12.74 17 5.77 27 3.98 37 3.17 8 11.25 18 5.50 28 3.87 38 3.12 9 10.10 19 5.26 29 3.77 39 3.06 10 9.18 20 5.04 30 3.68 40 3.01
OPTION 3 TABLE INSTALLMENTS FOR LIFE WITH SPECIFIED MINIMUM PERIOD AGE OF AGE OF PAYEE GUARANTEED PERIOD PAYEE GUARANTEED PERIOD ------------ -------------------------- ------ -------------------------- FEMALE 10 YEARS 15 YEARS 20 YEARS FEMALE 10 YEARS 15 YEARS 20 YEARS ------ -------- -------- -------- ------ -------- -------- -------- 10 $2.11 $2.11 $2.11 50 $3.12 $3.11 $3.09 11 2.13 2.13 2.12 51 3.18 3.16 3.14 12 2.14 2.14 2.14 52 3.23 3.22 3.19 13 2.15 2.15 2.15 53 3.29 3.27 3.24 14 2.16 2.16 2.16 54 3.35 3.33 3.30 15 2.18 2.18 2.17 55 3.41 3.39 3.36 16 2.19 2.19 2.19 56 3.48 3.46 3.41 17 2.20 2.20 2.20 57 3.55 3.52 3.48 18 2.22 2.22 2.22 58 3.63 3.59 3.54 19 2.23 2.23 2.23 59 3.70 3.67 3.60 20 2.25 2.25 2.25 60 3.79 3.74 3.67 21 2.27 2.26 2.26 61 3.87 3.82 3.74 22 2.28 2.28 2.28 62 3.97 3.91 3.81 23 2.30 2.30 2.30 63 4.06 4.00 3.88 24 2.32 2.32 2.31 64 4.17 4.09 3.96 25 2.33 2.33 2.33 65 4.28 4.18 4.03 26 2.35 2.35 2.35 66 4.39 4.28 4.11 27 2.37 2.37 2.37 67 4.51 4.39 4.18 28 2.39 2.39 2.39 68 4.64 4.49 4.26 29 2.41 2.41 2.41 69 4.77 4.60 4.33 30 2.44 2.43 2.43 70 4.92 4.71 4.41 31 2.46 2.46 2.46 71 5.07 4.83 4.48 32 2.48 2.48 2.48 72 5.22 4.94 4.54 33 2.51 2.50 2.50 73 5.39 5.06 4.61 34 2.53 2.53 2.53 74 5.56 5.18 4.67 35 2.56 2.56 2.55 75 5.74 5.29 4.72 36 2.59 2.58 2.58 76 5.92 5.40 4.77 37 2.61 2.61 2.61 77 6.11 5.51 4.81 38 2.64 2.64 2.64 78 6.31 5.62 4.85 39 2.68 2.67 2.67 79 6.51 5.72 4.89 40 2.71 2.70 2.70 80 6.71 5.81 4.92 41 2.74 2.74 2.73 81 6.91 5.89 4.94 42 2.78 2.77 2.77 82 7.11 5.97 4.96 43 2.81 2.81 2.80 83 7.31 6.04 4.98 44 2.85 2.85 2.84 84 7.50 6.10 5.00 45 2.89 2.89 2.88 85 7.68 6.16 5.01 46 2.93 2.93 2.92 86 7.85 6.21 5.02 47 2.98 2.97 2.96 87 8.01 6.25 5.03 48 3.02 3.02 3.00 88 8.16 6.28 5.03 49 3.07 3.06 3.05 89 8.30 6.31 5.04 90 8.42 6.34 5.04 Payments are based upon the age, nearest birthday, of the Payee on the date the first payment is due. If monthly installments for two or more specified periods for a given age are the same, the specified period of longer duration will apply. 07921 Page 32 TABLES OF MONTHLY INSTALLMENTS FOR EACH $1,000 OF PROCEEDS OPTION 1 TABLE INSTALLMENTS FOR A SPECIFIED PERIOD
NUMBER AMOUNT OF NUMBER AMOUNT OF NUMBER AMOUNT OF NUMBER AMOUNT OF OF YEARS MONTHLY OF YEARS MONTHLY OF YEARS MONTHLY OF YEARS MONTHLY PAYABLE INSTALLMENTS PAYABLE INSTALLMENTS PAYABLE INSTALLMENTS PAYABLE INSTALLMENTS -------- ------------ -------- ------------ -------- ------------ -------- ------------ 1 $84.09 11 $8.42 21 $4.85 31 $3.59 2 42.46 12 7.80 22 4.67 32 3.51 3 28.59 13 7.26 23 4.51 33 3.44 4 21.65 14 6.81 24 4.36 34 3.37 5 17.49 15 6.42 25 4.22 35 3.30 6 14.72 16 6.07 26 4.10 36 3.23 7 12.74 17 5.77 27 3.98 37 3.17 8 11.25 18 5.50 28 3.87 38 3.12 9 10.10 19 5.26 29 3.77 39 3.06 10 9.18 20 5.04 30 3.68 40 3.01
OPTION 3 TABLE INSTALLMENTS FOR LIFE WITH SPECIFIED MINIMUM PERIOD AGE OF PAYEE GUARANTEED PERIOD AGE OF PAYEE GUARANTEED PERIOD ------------ -------------------------- ------------ -------------------------- MALE 10 YEARS 15 YEARS 20 YEARS MALE 10 YEARS 15 YEARS 20 YEARS ------------ -------- -------- -------- ------------ -------- -------- -------- 10 $2.17 $2.17 $2.16 50 $3.31 $3.29 $3.25 11 2.18 2.18 2.18 51 3.37 3.35 3.31 12 2.19 2.19 2.19 52 3.43 3.41 3.36 13 2.21 2.21 2.20 53 3.50 3.47 3.42 14 2.22 2.22 2.22 54 3.57 3.53 3.47 15 2.24 2.23 2.23 55 3.64 3.60 3.53 16 2.25 2.25 2.25 56 3.72 3.67 3.60 17 2.27 2.26 2.26 57 3.80 3.74 3.66 18 2.28 2.28 2.28 58 3.88 3.82 3.72 19 2.30 2.30 2.29 59 3.97 3.90 3.79 20 2.32 2.31 2.31 60 4.06 3.98 3.86 21 2.33 2.33 2.33 61 4.16 4.07 3.92 22 2.35 2.35 2.35 62 4.26 4.16 3.99 23 2.37 2.37 2.37 63 4.37 4.25 4.06 24 2.39 2.39 2.39 64 4.49 4.34 4.13 25 2.41 2.41 2.41 65 4.61 4.44 4.20 26 2.43 2.43 2.43 66 4.73 4.54 4.27 27 2.45 2.45 2.45 67 4.86 4.64 4.34 28 2.48 2.47 2.47 68 5.00 4.75 4.40 29 2.50 2.50 2.49 69 5.14 4.85 4.47 30 2.52 2.52 2.52 70 5.29 4.95 4.53 31 2.55 2.55 2.54 71 5.44 5.06 4.59 32 2.58 2.57 2.57 72 5.60 5.16 4.64 33 2.60 2.60 2.60 73 5.76 5.27 4.69 34 2.63 2.63 2.62 74 5.92 5.37 4.74 35 2.66 2.66 2.65 75 6.09 5.47 4.78 36 2.69 2.69 2.68 76 6.27 5.56 4.82 37 2.73 2.72 2.72 77 6.44 5.66 4.86 38 2.76 2.76 2.75 78 6.62 5.74 4.89 39 2.80 2.79 2.78 79 6.80 5.82 4.92 40 2.84 2.83 2.82 80 6.98 5.90 4.94 41 2.87 2.87 2.86 81 7.16 5.97 4.96 42 2.92 2.91 2.89 82 7.34 6.04 4.98 43 2.96 2.95 2.93 83 7.51 6.10 5.00 44 3.00 2.99 2.97 84 7.67 6.15 5.01 45 3.05 3.04 3.02 85 7.83 6.20 5.02 46 3.10 3.08 3.06 86 7.98 6.24 5.02 47 3.15 3.13 3.11 87 8.12 6.27 5.03 48 3.20 3.18 3.15 88 8.26 6.30 5.03 49 3.25 3.23 3.20 89 8.38 6.33 5.04 90 8.50 6.35 5.04 Payments are based upon the age, nearest birthday, of the Payee on the date the first payment is due. If monthly installments for two or more specified periods for a given age are the same, the specified period of longer duration will apply. 07921 Page 33 TABLES OF MONTHLY INSTALLMENTS FOR EACH $1,000 OF PROCEEDS OPTION 1 TABLE INSTALLMENTS FOR A SPECIFIED PERIOD
NUMBER AMOUNT OF NUMBER AMOUNT OF NUMBER AMOUNT OF NUMBER AMOUNT OF OF YEARS MONTHLY OF YEARS MONTHLY OF YEARS MONTHLY OF YEARS MONTHLY PAYABLE INSTALLMENTS PAYABLE INSTALLMENTS PAYABLE INSTALLMENTS PAYABLE INSTALLMENTS -------- ------------ -------- ------------ -------- ------------ -------- ------------ 1 $84.09 11 $8.42 21 $4.85 31 $3.59 2 42.46 12 7.80 22 4.67 32 3.51 3 28.59 13 7.26 23 4.51 33 3.44 4 21.65 14 6.81 24 4.36 34 3.37 5 17.49 15 6.42 25 4.22 35 3.30 6 14.72 16 6.07 26 4.10 36 3.23 7 12.74 17 5.77 27 3.98 37 3.17 8 11.25 18 5.50 28 3.87 38 3.12 9 10.10 19 5.26 29 3.77 39 3.06 10 9.18 20 5.04 30 3.68 40 3.01
OPTION 3 TABLE INSTALLMENTS FOR LIFE WITH SPECIFIED MINIMUM PERIOD GUARANTEED PERIOD GUARANTEED PERIOD -------------------------- -------------------------- AGE OF AGE OF PAYEE 10 YEARS 15 YEARS 20 YEARS PAYEE 10 YEARS 15 YEARS 20 YEARS ------------ -------- -------- -------- ------ -------- -------- -------- 10 $2.14 $2.13 $2.13 50 $3.20 $3.18 $3.16 11 2.15 2.15 2.15 51 3.25 3.24 3.21 12 2.16 2.16 2.16 52 3.31 3.29 3.26 13 2.17 2.17 2.17 53 3.37 3.35 3.32 14 2.19 2.19 2.18 54 3.44 3.41 3.37 15 2.20 2.20 2.20 55 3.51 3.48 3.43 16 2.21 2.21 2.21 56 3.58 3.54 3.49 17 2.23 2.23 2.23 57 3.65 3.61 3.55 18 2.24 2.24 2.24 58 3.73 3.69 3.61 19 2.26 2.26 2.26 59 3.81 3.76 3.68 20 2.28 2.28 2.27 60 3.90 3.84 3.75 21 2.29 2.29 2.29 61 3.99 3.92 3.82 22 2.31 2.31 2.31 62 4.09 4.01 3.89 23 2.33 2.33 2.32 63 4.19 4.10 3.96 24 2.35 2.34 2.34 64 4.30 4.19 4.03 25 2.37 2.36 2.36 65 4.41 4.29 4.10 26 2.39 2.38 2.38 66 4.53 4.39 4.18 27 2.41 2.40 2.40 67 4.65 4.49 4.25 28 2.43 2.43 2.42 68 4.78 4.60 4.32 29 2.45 2.45 2.44 69 4.92 4.70 4.39 30 2.47 2.47 2.47 70 5.07 4.81 4.46 31 2.50 2.49 2.49 71 5.22 4.92 4.52 32 2.52 2.52 2.52 72 5.37 5.03 4.58 33 2.56 2.54 2.54 73 5.54 5.14 4.64 34 2.57 2.57 2.57 74 5.71 5.26 4.70 35 2.60 2.60 2.59 75 5.88 5.36 4.75 36 2.63 2.63 2.62 76 6.06 5.47 4.79 37 2.66 2.66 2.65 77 6.25 5.57 4.83 38 2.69 2.69 2.68 78 6.44 5.67 4.87 39 2.73 2.72 2.71 79 6.63 5.76 4.90 40 2.76 2.76 2.75 80 6.82 5.85 4.93 41 2.80 2.79 2.78 81 7.02 5.93 4.95 42 2.83 2.83 2.82 82 7.21 6.00 4.97 43 2.87 2.87 2.86 83 7.39 6.06 4.99 44 2.91 2.91 2.89 84 7.57 6.12 5.00 45 2.96 2.95 2.93 85 7.74 6.17 5.01 46 3.00 2.99 2.98 86 7.90 6.22 5.02 47 3.05 3.04 3.02 87 8.06 6.26 5.03 48 3.10 3.08 3.06 88 8.20 6.29 5.03 49 3.15 3.13 3.11 89 8.33 6.32 5.04 90 8.45 6.35 5.04 Payments are based upon the age, nearest birthday, of the Payee on the date the first payment is due. If monthly installments for two or more specified periods for a given age are the same, the specified period of longer duration will apply. 07921 Page 32 U AMERICAN GENERAL LIFE INSURANCE COMPANY A STOCK COMPANY This is a FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE INSURANCE POLICY. An adjustable Death Benefit is payable upon the Insured's death prior to the Maturity Date and while this policy is in force. Investment results are reflected in policy benefits. ACCUMULATION VALUES and CASH VALUES are flexible and will be based on the amount and frequency of premiums paid and the investment results of the Separate Account. NON-PARTICIPATING - NOT ELIGIBLE FOR DIVIDENDS. For Information, Service or to make a Complaint Contact Your Servicing Agent, or Our VUL Administrative Center 2727-A ALLEN PARKWAY P. O. BOX 4880 HOUSTON, TEXAS 77019-2191 1-800-340-2765 07921