EX-26.D.I.C 3 dex26dic.htm REVISED CVAT SCHEDULE PAGES (VL07) REVISED CVAT SCHEDULE PAGES (VL07)

Exhibit 26(d)(i)(c)

CVAT Schedule Pages (VL07)


Western Reserve Life Assurance Co. of Ohio

Office: Clearwater, Florida

Policy Schedule

 

 

Policy Number:    [0112345678]      
Primary Insured:    [JOHN DOE]      
Issue Age And Sex:    [35 – Male]      
Specified Amount:    $[250,000.00]    Policy Date:    [December 01, 2007]
Option Type:    [A]    Record Date:    [December 01, 2007]
Planned Premium:    $[5,000.00]    No Lapse Date:    [December 01, 2017]
Payment Frequency:    [Annually]    Reallocation Date:    [December 16, 2007]
Initial Premium:    $[5,000.00]    Minimum Monthly   
      Guarantee Premium:    $[130.14]
Rate Class:    [Preferred Elite (Non- Tobacco)]      
Rate Band:    [Band 1]      
Life Insurance Compliance Test:    [Cash Value Accumulation Test]
Minimum Specified Amount      

Band 1:

      $50,000.00   

Band 2:

      $500,000.00   

Band 3:

      $1,000,000.00   
Separate Account Provisions      

Separate Account:

   [WRL Series Life Account]   

Mortality and Expense Risk Charge

     

Policy Years 1-15:

   .75% (Annually)   

Policy Years 16+

     

Current:

   [.00% (Annually)]   

Guaranteed:

   .30% (Annually)   

Reallocation Account:

   Fixed Account   
Policy Value Provisions      

Net Premium Factor

     

Policy Year 1:

   [97.00% - 100.00%]   

Policy Years 2+:

   97.00%   

Monthly Policy Charge

     

Initial (Guaranteed for the First Policy Year):

   [$10.00]   

Guaranteed:

   $12.00   

Per Unit Charge per $1000 of Specified Amount:

     

Band 1:

      [$.27]   

Band 2:

      [$.25]   

Band 3:

      [$.24]   

Duration of Per Unit Charge

     

Current:

   [8]   

Guaranteed:

   20   
Fixed Account Value Limit:    [$5,000.00-$250,000.00]   

 

VL07    Page 3   


Western Reserve Life Assurance Co. of Ohio

Office: Clearwater, Florida

Policy Schedule (Continued)

 

 

Policy Number: [0112345678]

Limitation Percentage

The Limitation Percentage is a percentage based on the Primary Insured’s sex, Rate Class, Rate Band, and Attained Age at the beginning of the policy year, and is used in calculating the death benefit as shown in the Option Type section of the Death Benefit Provisions.

For the Cash Value Accumulation Test, the Limitation Percentages are as follows:

 

Primary Insured’s Attained Age

   Limitation Percentage

35

   489.8

36

   471.2

37

   453.3

38

   436.2

39

   421.3

40

   406.9

41

   393.0

42

   379.7

43

   366.9

44

   354.6

45

   342.8

46

   331.6

47

   320.7

48

   310.3

49

   300.2

50

   290.5

51

   281.1

52

   272.1

53

   263.4

54

   255.2

55

   247.3

56

   239.8

57

   232.6

58

   225.7

59

   219.1

60

   212.7

61

   206.7

62

   200.9

63

   195.4

64

   190.2

65

   185.3

66

   180.5

67

   176.0

68

   171.7

69

   167.5

70

   163.5

71

   159.7

72

   156.0

73

   152.5

74

   149.3

75

   146.1

76

   143.2

77

   140.3

78

   137.7

79

   135.1

80

   132.8

81

   130.6

82

   128.5

83

   126.6

84

   124.8

85

   123.1

86

   121.5

87

   120.1

88

   118.8

89

   117.5

90

   116.4

91

   115.3

92

   114.2

93

   113.1

94

   112.0

95

   110.8

96

   109.5

97

   107.9

98

   106.0

99

   103.4

100

   101.0

 

VL07    Page 3A   


Western Reserve Life Assurance Co. of Ohio

Office: Clearwater, Florida

Policy Schedule (Continued)

 

 

Policy Number: [0112345678]

Table of Surrender Charges

(Per $1000 of Initial Specified Amount as of the Policy Date)

The Table of Surrender Charges is applicable only to the Initial Specified Amount. Upon any increase to the Specified Amount, an additional Surrender Charge will be incurred.

 

Specified Amount:    $[250,000.00]
Policy Date:    [December 01, 2007]

 

End of Year*

   Surrender Charge

AT ISSUE

   $ 19.82

1

   $ 19.82

2

   $ 17.24

3

   $ 13.87

4

   $ 11.89

5

   $ 7.93

6

   $ 5.95

7

   $ 3.96

8

   $ 0.00

 

* The Surrender Charge on any date other than an end of year will be pro-rated between the two end of year charges.

 

VL07    Page 3B   


Western Reserve Life Assurance Co. of Ohio

Office: Clearwater, Florida

Rider Information

Policy Number: [0112345678]

 

          Monthly Deduction  

Primary Insured Rider Plus

      $ [1.02 ]

Number:

   [50X0003949]   

Insured:

   [John Doe]   

Face Amount:

   $[50,000.00]   

Rate Class:

   [Preferred Elite (Non Tobacco)]   

Per Unit Charge per $1,000 of Face Amount:

   $[.01]   

Other Insured Rider

      $ [3.23 ]

Number:

   [50X0003873]   

Insured:

   [Jane Doe]   

Issue Age:

   [26]   

Sex:

   [Female]   

Face Amount:

   $[100,001.00]   

Rate Class:

   [Preferred Elite (Non Tobacco)]   

Per Unit Charge per $1,000 of Face Amount:

   $[.03]   

The Monthly Deductions shown above are applicable for the first policy month. For Monthly Deductions after the first policy month, refer to the Rider form.

 

VL07    Page 4   


Western Reserve Life Assurance Co. of Ohio

Office: Clearwater, Florida

Policy Schedule

 

Policy Number: [0112345678]

Table of Guaranteed Maximum Life Insurance Rates

Guaranteed Rate Basis for Initial Specified Amount on Primary Insured

Commissioners 2001 Standard Ordinary Tobacco or Non-Tobacco Mortality Table

[John Doe]

[Male Lives]

[Non Tobacco User Classification]

Current Cost of Insurance Rates are less than or equal to the Guaranteed Rates. We guarantee that for the first [3] years from issue the current Cost of Insurance Rates will not change.

Current Monthly Cost of Insurance Rates per $1,000

 

Attained Age

   Monthly Rate

35

   .01165

36

   .01416

37

   .01847

Guaranteed Monthly Cost of Insurance Rates Per $ 1,000

 

Attained Age

   Monthly Rate

38

   .11083

39

   .11750

40

   .12666

41

   .13750

42

   .15083

43

   .16666

44

   .18416

45

   .20333

46

   .22250

47

   .23833

48

   .25083

49

   .26666

50

   .28750

51

   .31416

52

   .34666

53

   .38416

54

   .43166

55

   .48500

56

   .54000

57

   .59333

58

   .64666

59

   .70916

60

   .78500

61

   .87750

62

   .98500

63

   1.10250

64

   1.22500

65

   1.35250

66

   1.48166

67

   1.61666

68

   1.75916

69

   1.91916

70

   2.10583

71

   2.33250

72

   2.59750

73

   2.87666

74

   3.17666

75

   3.50333

76

   3.87166

77

   4.30000

78

   4.79750

79

   5.35500

80

   5.97666

81

   6.65250

82

   7.36833

83

   8.15000

84

   9.01916

85

   9.98583

86

   11.04916

87

   12.19833

88

   13.42000

89

   14.70166

90

   15.97833

91

   17.23500

92

   18.55166

93

   19.94000

94

   21.40250

95

   22.85083

96

   24.26500

97

   25.77166

98

   27.37833

99

   29.09250

 

VL07    Page 4A   


Western Reserve Life Assurance Co. of Ohio

Office: [Clearwater, Florida]

Policy Schedule

 

Policy Number: [0123456789]

Table of Guaranteed

Maximum Life Insurance Rates

Guaranteed Rate Basis for Initial Specified Amount on Primary Insured Rider Plus

Commissioners 2001 Standard Ordinary Tobacco or Non-Tobacco Mortality Table

[John Doe]

[Male Lives]

[Non Tobacco User Classification]

Monthly Cost of Insurance Rates per $1,000

 

Attained Age

   Monthly Rate

35

   0.09333

36

   0.09750

37

   0.10333

38

   0.11083

39

   0.11750

40

   0.12666

41

   0.13750

42

   0.15083

43

   0.16666

44

   0.18416

45

   0.20333

46

   0.22250

47

   0.23833

48

   0.25083

49

   0.26666

50

   0.28750

51

   0.31416

52

   0.34666

53

   0.38416

54

   0.43166

55

   0.48500

56

   0.54000

57

   0.59333

58

   0.64666

59

   0.70916

60

   0.78500

61

   0.87750

62

   0.98500

63

   1.10250

64

   1.22500

65

   1.35250

66

   1.48166

67

   1.61666

68

   1.75916

69

   1.91916

70

   2.10583

71

   2.33250

72

   2.59750

73

   2.87666

74

   3.17666

75

   3.50333

76

   3.87166

77

   4.30000

78

   4.79750

79

   5.35500

80

   5.97666

81

   6.65250

82

   7.36833

83

   8.15000

84

   9.01916

85

   9.98583

86

   11.04916

87

   12.19833

88

   13.42000

89

   14.70166

90

   15.97833

91

   17.23500

92

   18.55166

93

   19.94000

94

   21.40250

95

   22.85083

96

   24.26500

97

   25.77166

98

   27.37833

99

   29.09250

 

VL07    Page 4B   


Western Reserve Life Assurance Co. of Ohio

Office: [Clearwater, Florida]

Policy Schedule

 

Policy Number: [0123456789]

Table of Guaranteed

Maximum Life Insurance Rates

Guaranteed Rate Basis for Initial Specified Amount on Other Insured Rider

Commissioners 2001 Standard Ordinary Tobacco or Non-Tobacco Mortality Table

[Jane Doe]

[Female Lives]

[Non Tobacco User Classification]

Monthly Cost of Insurance Rates per $1,000

 

Attained Age

   Monthly Rate

26

   0.04583

27

   0.04750

28

   0.05000

29

   0.05250

30

   0.05500

31

   0.05833

32

   0.06166

33

   0.06583

34

   0.07083

35

   0.07666

36

   0.08250

37

   0.08750

38

   0.09166

39

   0.09666

40

   0.10250

41

   0.10916

42

   0.11666

43

   0.12583

44

   0.13666

45

   0.14916

46

   0.16416

47

   0.18166

48

   0.20083

49

   0.22250

50

   0.24666

51

   0.27416

52

   0.30500

53

   0.33750

54

   0.37166

55

   0.41083

56

   0.45333

57

   0.49833

58

   0.54500

59

   0.59250

60

   0.64250

61

   0.69750

62

   0.75583

63

   0.81750

64

   0.88500

65

   0.96000

66

   1.04166

67

   1.13250

68

   1.23333

69

   1.34333

70

   1.46750

71

   1.60916

72

   1.76416

73

   1.93333

74

   2.12083

75

   2.32666

76

   2.55250

77

   2.80250

78

   3.07500

79

   3.37416

80

   3.74583

81

   4.20250

82

   4.68583

83

   5.19333

84

   5.75916

85

   6.33250

86

   7.01000

87

   7.84666

88

   8.72916

89

   9.60750

90

   10.25416

91

   10.87250

92

   11.89750

93

   13.28666

94

   15.01666

95

   16.89916

96

   18.75333

97

   19.95666

98

   20.61000

99

   21.96583

 

VL07    Page 4C