Exhibit 4(g)(1)

POLICY NUMBER: [VF99999990]

POLICY SPECIFICATIONS

Summary of Coverages Effective on the Policy Date

R21CHR  S21CHR	Accelerated Death Benefit Rider For Chronic Conditions
	Eligible Insured:	[John Doe]
	Sex and Age	[Male, 35]
	[Couples Discount:]	[YES]
	[Rider Effective Date:	[May 1, 2022]]

[ICC21 S21PRO] Page [ X ]

POLICY NUMBER: [VF99999990]

POLICY SPECIFICATIONS

ACCELERATED DEATH BENEFIT RIDER FOR CHRONIC CONDITIONS

Chronic Illness Benefit Information

Elimination Period:	[90] consecutive days
Initial Lifetime Benefit Amount:	$[100,000]
Lifetime Benefit Amount Percentage:	[50]%
Minimum Chronic Illness Coverage Amount:	$[50,000]
Minimum Monthly Benefit Payment Amount	$[500]
Maximum Monthly Benefit Percentage:	[2]%
Maximum Per Diem Limitation Percentage:	[100]%
Days in Month Factor:	[30]

ICC21 S21CHR Page [ X ]

POLICY NUMBER: [VF99999990]

POLICY SPECIFICATIONS

MAXIMUM MONTHLY RIDER CHARGE RATES PER $1,000 RIDER NET AMOUNT AT RISK (NAR)

POLICY YEAR	RIDER CHARGE RATE	POLICY YEAR	RIDER CHARGE RATE
[1	0.1565	44	0.1565
2	0.1565	45	0.1565
3	0.1565	46	0.1565
4	0.1565	47	0.1565
5	0.1565	48	0.1565
6	0.1565	49	0.1565
7	0.1565	50	0.1565
8	0.1565	51	0.1565
9	0.1565	52	0.1565
10	0.1565	53	0.1565
11	0.1565	54	0.1565
12	0.1565	55	0.1565
13	0.1565	56	0.1565
14	0.1565	57	0.1565
15	0.1565	58	0.1565
16	0.1565	59	0.1565
17	0.1565	60	0.1565
18	0.1565	61	0.1565
19	0.1565	62	0.1565
20	0.1565	63	0.1565
21	0.1565	64	0.1565
22	0.1565	65	0.1565
23	0.1565	66	0.1565
24	0.1565	67	0.1565
25	0.1565	68	0.1565
26	0.1565	69	0.1565
27	0.1565	70	0.1565
28	0.1565	71	0.1565
29	0.1565	72	0.1565
30	0.1565	73	0.1565
31	0.1565	74	0.1565
32	0.1565	75	0.1565
33	0.1565	76	0.1565
34	0.1565	77	0.1565
35	0.1565	78	0.1565
36	0.1565	79	0.1565
37	0.1565	80	0.1565
38	0.1565	81	0.1565
39	0.1565	82	0.1565
40	0.1565	83	0.1565
41	0.1565	84	0.1565
42	0.1565	85	0.1565
43	0.1565	86	0.1565
		87+	0.0000]

[The rates shown above also represent the No-Lapse Guarantee Optional Benefit Charge Maximum Monthly Rider Charge Rates per $1,000 of No-Lapse Rider NAR for any No-Lapse Guarantee Value.]

ICC21 S21CHR Page [ X ]

POLICY NUMBER: [VF99999990]

POLICY SPECIFICATIONS

[NO-LAPSE GUARANTEE
OPTIONAL BENEFIT CHARGE
MAXIMUM MONTHLY RIDER CHARGE RATES PER $1,000 NO-LAPSE RIDER NAR

POLICY YEAR	RIDER CHARGE RATE	POLICY YEAR	RIDER CHARGE RATE
[1	0.0502	44	0.0502
2	0.0502	45	0.0502
3	0.0502	46	0.0502
4	0.0502	47	0.0502
5	0.0502	48	0.0502
6	0.0502	49	0.0502
7	0.0502	50	0.0502
8	0.0502	51	0.0502
9	0.0502	52	0.0502
10	0.0502	53	0.0502
11	0.0502	54	0.0502
12	0.0502	55	0.0502
13	0.0502	56	0.0502
14	0.0502	57	0.0502
15	0.0502	58	0.0502
16	0.0502	59	0.0502
17	0.0502	60	0.0502
18	0.0502	61	0.0502
19	0.0502	62	0.0502
20	0.0502	63	0.0502
21	0.0502	64	0.0502
22	0.0502	65	0.0502
23	0.0502	66+	0.0000]]
24	0.0502
25	0.0502
26	0.0502
27	0.0502
28	0.0502
29	0.0502
30	0.0502
31	0.0502
32	0.0502
33	0.0502
34	0.0502
35	0.0502
36	0.0502
37	0.0502
38	0.0502
39	0.0502
40	0.0502
41	0.0502
42	0.0502
43	0.0502

ICC21 S21CHR Page [ X ]