EX-99.(D)(I)1 2 d100939dex99di1.txt INSURANCE POLICY INDIVIDUAL FLEXIBLE PREMIUM VARIABLE METROPOLITAN LIFE UNIVERSAL LIFE INSURANCE POLICY INSURANCE COMPANY METLIFE BRIEF DESCRIPTION OF YOUR POLICY YOUR METLIFE POLICY This is an individual flexible premium variable universal life insurance policy where premiums can be paid until Attained Age 121. It does not pay Insured dividends. THIS POLICY DOES NOT HAVE SURRENDER [JOHN MIDDLE DOE] CHARGES. You may continue the coverage provided by the Policy beyond Attained Age 121. See the Benefits on or Policy Number after Attained Age 121 provision. If the Insured dies [SPECIMEN] while the Policy is in force, we will pay the Policy Proceeds to the Beneficiary. The Policy Proceeds are Issue Age of Insured described in the Payment to Your Beneficiary [35] provision. We must receive due proof of the Insured's death. The Policy Proceeds are described in the Sex of Insured Payment to Your Beneficiary provision. Any payment [MALE] will be subject to all of the provisions of the Policy. Policy Start Date THE AMOUNT AND/OR DURATION OF YOUR POLICY'S DEATH [SEPTEMBER 1, 2015] BENEFIT MAY BE VARIABLE OR FIXED AND MAY INCREASE OR DECREASE UNDER THE CONDITIONS DESCRIBED IN THE Policy Issue Date BENEFITS PROVIDED BY YOUR POLICY SECTION. YOUR [SEPTEMBER 1, 2015] POLICY'S CASH VALUE CAN VARY FROM DAY TO DAY. IT MAY INCREASE OR DECREASE, DEPENDING ON THE SEPARATE ACCOUNT INVESTMENT EXPERIENCE AND THE INTEREST CREDITED TO THE FIXED ACCOUNT. SEE THE SEPARATE ACCOUNT CASH VALUE AND FIXED ACCOUNT CASH VALUE PROVISIONS FOR DETAILS. RIGHT TO EXAMINE YOUR POLICY PLEASE READ THE POLICY TO BE SURE IT MEETS YOUR NEEDS. YOU MAY RETURN THE POLICY TO OUR DESIGNATED OFFICE OR TO OUR REPRESENTATIVE WITHIN [10] DAYS FROM THE DATE YOU RECEIVE IT. IF YOU RETURN IT WITHIN THIS PERIOD, WE WILL REFUND ANY PAYMENTS MADE AND VOID THE POLICY FROM THE START. The Policy is a legal contract between the Owner and Metropolitan Life Insurance Company. PLEASE READ YOUR CONTRACT CAREFULLY. Metropolitan Life Insurance Company Home Office, [200 Park Avenue, New York, NY 10166] /s/ Steven A. Kandarian /s/ Timothy J. Ring PRESIDENT SECRETARY 1E-47-15-NY Page 1 TABLE OF CONTENTS
PAGE Policy Specifications.................................................... 3 Schedule of Benefits............................................. 3 Planned Premium Payments......................................... 3 Schedule of Charges.............................................. 4 Table of Guaranteed Maximum Monthly Cost of Insurance Rates...... 6 Minimum Death Benefit Factors.................................... 7 Definitions.............................................................. 9 Premium Payments for Your Policy......................................... 11 Premiums, Grace Period and Reinstatement......................... 11 Conversion Right......................................................... 13 Your Policy's Value...................................................... 13 Cash Value....................................................... 13 Accessing Your Policy's Value............................................ 16 Cash Surrender Value of Your Policy.............................. 16 Loans............................................................ 16 Withdrawals...................................................... 17 Fixed Account Withdrawals and Transfers.......................... 18 Transfers........................................................ 18 Surrenders....................................................... 19 Postponement of Payments and Transfers........................... 19 Changing Your Policy..................................................... 20 Policy Changes................................................... 20 Benefits Provided by Your Policy......................................... 21 Death Benefit.................................................... 21 Benefits on or after Attained Age 121............................ 22 Payment of the Policy Benefits................................... 22 Available Payment Options................................................ 23 Payment Options.................................................. 23 Life Income Tables............................................... 24 Charges Applied to Your Policy........................................... 25 Charges Included in the Monthly Deduction........................ 25 Other Charges.................................................... 26 General Provisions of Your Policy........................................ 27 Separate Account and Investment Divisions........................ 27 General Provisions............................................... 28 Owner and Beneficiary............................................ 30
Riders, Endorsements and Amendments, if any, and a copy of the Application are a part of the Policy and follow the Owner and Beneficiary Section. 1E-47-15-NY Page 2 POLICY SPECIFICATIONS SCHEDULE OF BENEFITS YOUR METLIFE POLICY Face Amount/ Insured Policy Plan/Benefit Benefit Amount Risk Class [JOHN MIDDLE DOE] ------------------- ---------------- ---------- INDIVIDUAL FLEXIBLE PREMIUM [$50,000] [STANDARD Policy Number UNIVERSAL VARIABLE LIFE SMOKER] [SPECIMEN] INSURANCE [WAIVER OF SPECIFIED [MONTHLY PREMIUM [CLASS: 1] INITIAL FACE AMOUNT PREMIUM RIDER] WAIVED:] [$50,000] [$ 139.58] [WAIVER OF MONTHLY [CLASS: 1] Issue Age of Insured DEDUCTION RIDER] [35] [ACCELERATION OF DEATH Sex of Insured BENEFIT RIDER] [MALE] [AVIATION LIMITATION RIDER] [MILITARY AND NAVAL AVIATION LIMITATION RIDER] Date of Coverage [SPECIAL HAZARD EXCLUSION PROVISIONS RIDER] [SEPTEMBER 1, 2015] [WAIVER EXCLUSION RIDER] [NEW YORK JUVENILE INSURED LIMITATION] Death Benefit Option [A] PLANNED PREMIUM PAYMENTS* Minimum Fixed Account PLANNED FIRST YEAR LUMP SUM [$0] Cash Value Guaranteed Interest Rate PLANNED [ANNUAL] PREMIUM PAYMENTS 2.0% PAYMENTS FOR YEAR 1 [$1000.00] PAYMENTS FOR YEARS 2 - 20 [$1000.00] Minimum Loan Interest PAYMENTS FOR YEARS 21 & LATER [$1000.00] Rate Credited [2.0%] WITHDRAWING MONEY FROM YOUR POLICY Separate Account MAXIMUM NUMBER OF WITHDRAWALS YEARLY [12] METROPOLITAN MINIMUM WITHDRAWAL AMOUNT [$100.00] LIFE SEPARATE PERCENTAGE USED TO CALCULATE MAXIMUM [90.0%] ACCOUNT UL WITHDRAWAL AMOUNT OTHER LIMITS THAT APPLY TO YOUR POLICY MINIMUM FACE AMOUNT [$50,000.00] MINIMUM FACE AMOUNT DECREASE [$5,000.00] MINIMUM FACE AMOUNT INCREASE [$5,000.00] MINIMUM PREMIUM PAYMENT AMOUNT [$50.00] MINIMUM LOAN AMOUNT [$100.00] MAXIMUM FIXED ACCOUNT ALLOCATION [100.0%] PERCENT MAXIMUM FIXED ACCOUNT WITHDRAWAL [25.0%] PERCENT
1E-47-15-NY Page 3 POLICY SPECIFICATIONS * It is possible that insurance coverage may not continue to Attained Age 121 even if your Planned Premium Payments are paid in a timely manner. You may change your Planned Premium Payments; however, new Policy Specifications pages will not be sent to you for such a change. 1E-47-15-NY Page 3.1 POLICY SPECIFICATIONS SCHEDULE OF CHARGES YOUR METLIFE POLICY MAXIMUM PERCENT OF PREMIUM CHARGE # Insured For Premium Payments For Premium [JOHN MIDDLE DOE] up to and including Payments in excess of [$271.99]## each policy [$271.99]## each policy Policy Number year year [SPECIMEN] YEAR 1 4.00% 4.00% YEARS 2-10 6.00% 6.00% Initial Face Amount YEARS 11-20 6.00% 6.00% [$50,000] YEARS 21 & LATER 6.00% 6.00% Issue Age of Insured MAXIMUM MONTHLY POLICY CHARGE # [35] YEARS 1 - 20 $20.00 YEARS 21 & LATER $20.00 Sex of Insured [MALE] MAXIMUM MONTHLY COVERAGE EXPENSE CHARGE # YEAR 1 1.2693 per $1,000 Date of Coverage YEARS 2 - 20 0.1813 per $1,000 [SEPTEMBER 1, 2015] YEARS 21 & LATER 0.0000 per $1,000 Death Benefit Option MAXIMUM MONTHLY MORTALITY AND EXPENSE RISK CHARGE # [A] Percent of Cash Value in Separate Account YEARS 1 - 10 0.125% YEARS 11 - 20 0.021% YEARS 21 - 30 0.021% YEARS 31+ 0.021% MAXIMUM FIXED LOAN INTEREST RATE YEARS 1- 10 5.00% YEARS 11 & LATER 2.25% MAXIMUM TRANSFER PROCESSING CHARGE ALL YEARS [$25.00]
# If the Policy is reinstated, any time that the Policy was not in force will not be counted when we determine the charges. ## This premium (called "Target Premium") will be recalculated if: any Requested Increase or decrease in Face Amount is made; any riders are changed, added or removed; there is a change in the Insured's risk class; a Withdrawal that decreases the Face Amount is made; or there was a misstatement of the Insured's age or sex. We will send you a new Policy Specifications page reflecting the new premiums upon any of these changes. 1E-47-15-NY Page 4 POLICY SPECIFICATIONS Coverage may not be in force until Attained Age 121 since: you can change the amount, timing, and frequency of premium payments; the current charges (including the Cost of Insurance Rates) are not guaranteed; you can take Loans and Withdrawals; you can change the Death Benefit Option; the Face Amount may be changed; your Policy's Cash Value may increase or decrease depending on the Separate Account investment experience and the interest credited to the Fixed Account; and the cost of additional benefits may change due to the addition or deletion of riders. Coverage may cease prior to the Attained Age 121 unless additional premium is received. The Planned Premium Payment may need to be increased to keep the Policy in force. The Policy will stay in effect after Attained Age 121 as long as the Cash Surrender Value remains greater than or equal to zero. No charges will be taken on or after Attained Age 121. However, Loan Interest will be charged on any Policy Loan. We have the right to change the rates of interest credited to the Fixed Account Cash Value of your Policy, but the rates will not be less than the Minimum Fixed Account Cash Value Guaranteed Interest Rate and the Minimum Loan Interest Rate Credited, as applicable. The interest we credit on any loan amount will be at least equal to the fixed loan interest rate charged less 2%. We have the right to change the Cost of Insurance Rates, but the rates will not be greater than those shown in the Table of Guaranteed Maximum Monthly Cost of Insurance Rates. We also have the right to change the cost of the other expense charges, but the charges will not be more than the maximum charges shown on the Policy Specifications pages. The result of any changes to the Cost of Insurance Rates and charges shown above will not exceed the maximums shown. Credited interest rates may be changed at any time. Factors may only be changed based on changes in our future expectations as to: mortality; investment earnings; taxes; expenses; capital and reserve requirements; and persistency. Changes will be made only according to procedures and standards filed, if required, with the insurance supervisory official of the state which governs the Policy. Changes will be made on a future basis only (and will not recoup past losses or distribute past gains) and will not be unfairly discriminatory. Actual Cash Value may be less than that illustrated. Actual premiums required to keep the Policy in force may be greater than those illustrated. ALL CHARGES ARE FULLY DESCRIBED IN YOUR POLICY IN THE CHARGES APPLIED TO YOUR POLICY SECTION. 1E-47-15-NY Page 5 POLICY SPECIFICATIONS TABLE OF GUARANTEED MAXIMUM MONTHLY COST OF YOUR METLIFE POLICY INSURANCE RATES (PER $1,000 OF NET AMOUNT AT RISK) Insured ATTAINED ATTAINED ATTAINED [JOHN MIDDLE DOE] AGE RATE AGE RATE AGE RATE [35 0.1669 65 2.2468 95 28.2573 Policy Number 36 0.1761 66 2.4306 96 30.0201 [SPECIMEN] 37 0.1861 67 2.6097 97 31.9177 38 0.2003 68 2.7986 98 33.9667 Initial Face Amount 39 0.2145 69 2.9861 99 36.1845 [$50,000] 40 0.2312 70 3.2137 100 38.5896 41 0.2529 71 3.4636 101 40.4556 Issue Age of Insured 42 0.2780 72 3.8045 102 42.4671 [35] 43 0.3081 73 4.1484 103 44.6307 44 0.3440 74 4.4971 104 46.9670 Sex of Insured 45 0.3817 75 4.9044 105 50.0748 [MALE] 46 0.4168 76 5.3400 106 53.5075 47 0.4562 77 5.8461 107 57.3154 Date of Coverage 48 0.4780 78 6.4346 108 61.5548 [SEPTEMBER 1, 2015] 49 0.5031 79 7.1090 109 66.3061 50 0.5391 80 7.8348 110 71.6577 Basis of Computation of 51 0.5819 81 8.6545 111 77.7405 Minimum Cash Value 52 0.6406 82 9.4891 112 83.3334 2001 CSO MORTALITY 53 0.7070 83 10.3726 113 83.3334 TABLE [FOR A MALE 54 0.7901 84 11.3433 114 83.3334 SMOKER], AGE NEAREST 55 0.8843 85 12.4986 115 83.3334 BIRTHDAY 56 0.9803 86 13.7805 116 83.3334 57 1.0823 87 15.1795 117 83.3334 Monthly Cost of 58 1.1625 88 16.6739 118 83.3334 Insurance Factor 59 1.2553 89 18.2468 119 83.3334 1.00165158 60 1.3678 90 19.8801 120 83.3334 61 1.5075 91 21.3789 121+ 0.0000] 62 1.6763 92 22.9345 63 1.8640 93 24.5715 64 2.0565 94 26.3019
1E-47-15-NY Page 6 POLICY SPECIFICATIONS MINIMUM DEATH BENEFIT FACTORS YOUR METLIFE POLICY ATTAINED ATTAINED ATTAINED Insured AGE FACTOR AGE FACTOR AGE FACTOR [JOHN MIDDLE DOE] [35 2.50 65 1.20 95 1.01 Policy Number 36 2.50 66 1.19 96 1.01 [SPECIMEN] 37 2.50 67 1.18 97 1.01 38 2.50 68 1.17 98 1.01 Date of Coverage 39 2.50 69 1.16 99 1.01 [SEPTEMBER 1, 2015] 40 2.50 70 1.15 100 1.01 41 2.43 71 1.13 101 1.01 Death Benefit 42 2.36 72 1.11 102 1.01 Calculation Test* 43 2.29 73 1.09 103 1.01 [GUIDELINE PREMIUM 44 2.22 74 1.07 104 1.01 TEST] 45 2.15 75 1.05 105 1.01 46 2.09 76 1.05 106 1.01 47 2.03 77 1.05 107 1.01 48 1.97 78 1.05 108 1.01 49 1.91 79 1.05 109 1.01 50 1.85 80 1.05 110 1.01 51 1.78 81 1.05 111 1.01 52 1.71 82 1.05 112 1.01 53 1.64 83 1.05 113 1.01 54 1.57 84 1.05 114 1.01 55 1.50 85 1.05 115 1.01 56 1.46 86 1.05 116 1.01 57 1.42 87 1.05 117 1.01 58 1.38 88 1.05 118 1.01 59 1.34 89 1.05 119 1.01 60 1.30 90 1.05 120 1.01 61 1.28 91 1.04 121+ 1.01] 62 1.26 92 1.03 63 1.24 93 1.02 64 1.22 94 1.01
* This test is used to determine whether this Policy qualifies as life insurance under applicable tax law. You may not change the test, which was chosen on the Application, after the Policy has been issued. 1E-47-15-NY Page 7 SEE NEXT PAGE. 1E-47-15-NY Page 8 DEFINITIONS DEFINITIONS APPLICATION INITIAL FACE AMOUNT Application means the application, The Initial Face Amount of the Policy including any amendments, for: your is the Face Amount of the Policy on Policy; any Reinstatement of your the Policy Start Date. The Initial Policy; any application concerning the Face Amount can be decreased as Insured's smoking habits; any riders described in the Decreasing Your that are made a part of your Policy; Policy's Face Amount provision. Each and any policy changes. A copy of your piece of coverage will have its own Application is attached to and is part Initial Face Amount. of the Policy. INSURED ATTAINED AGE The Insured is the person whose life The Attained Age is equal to the Issue is covered by the Policy. Age plus the number of completed policy years. This includes any period INVESTMENT DIVISION during which the Policy was lapsed. An Investment Division is a sub account of the Separate Account that CASH VALUE invests in shares of an open-end The Cash Value is equal to the total management investment company or other of: the cash value in the Fixed pools of investment assets. Account; plus the cash value in the Investment Divisions; plus the cash INVESTMENT START DATE value in the Loan Account. See the The Investment Start Date is the date Cash Value Section for details. the first Net Premium is applied to your Policy. It is the later of: the DATE OF COVERAGE date we receive your first premium; The Date of Coverage is the effective and the Policy Issue Date. date of each piece of the Policy's Face Amount. The Date of Coverage for IN WRITING the Initial Face Amount is the same as In Writing means in a written or other the Policy Start Date. The Date of form satisfactory to us and received Coverage for each increase in Face at our Designated Office. Amount will be shown on the Policy Specifications page for that piece of ISSUE AGE coverage. The contestable and suicide The Issue Age is the age of the periods for each increase in Face Insured. It is determined by using his Amount are measured from that or her birthday nearest to the Policy coverage's Date of Coverage. Start Date. DESIGNATED OFFICE LOAN ACCOUNT The Designated Office is our Home The Loan Account is the account to Office or any other office we which we will transfer the amount of designate. any Loan from the Fixed Account and the Investment Divisions. EXCESS LOAN An Excess Loan occurs when the Policy MONTHLY ANNIVERSARY Loan Balance exceeds the Cash Value of The Monthly Anniversary date of your the Policy. Policy is the same date in each month as the Policy Start Date. However, FACE AMOUNT when the Monthly Anniversary falls on The Face Amount of the Policy is shown a date other than a Valuation Date, on the Policy Specifications page. The the Monthly Anniversary will be deemed Face Amount may be increased or the next Valuation Date. decreased as described in the Changing Your Policy's Face Amount provision. FIXED ACCOUNT The Fixed Account is a part of our general account. You may allocate your Net Premiums and transfer amounts to the Fixed Account. It provides guarantees of principal and interest. 1E-47-15-NY Page 9 DEFINITIONS (CONTINUED) NET AMOUNT AT RISK PAYEE The Net Amount at Risk is used to A Payee is a person, corporation, determine the Monthly Cost of partnership, trust or charity entitled Insurance for your Policy. to receive the Policy Proceeds, surrender proceeds or Withdrawal For Death Benefit Option A, the Net amount in one sum or under a Payment Amount at Risk is equal to: the Option. greatest of the Face Amount divided by the Monthly Cost of Insurance Factor, If the Payee is not a natural person, the Cash Value times the applicable the choice of a Payment Option will be Minimum Death Benefit Factor, and the subject to our consent. minimum death benefit required by applicable tax law; less the Cash PLANNED FIRST YEAR LUMP SUM Value. The Planned First Year Lump Sum is the amount of premium stated in the For Death Benefit Option B, the Net Application that is intended to be Amount at Risk is equal to: the paid as a lump sum by the first policy greatest of the Face Amount divided by anniversary. This amount is shown on the Monthly Cost of Insurance Factor the Policy Specifications page. plus the Cash Value, the Cash Value times the applicable Minimum Death PLANNED PREMIUM PAYMENT Benefit Factor, and the minimum death The Planned Premium Payment is the benefit required by applicable tax amount stated in the Application that law; less the Cash Value. is intended to be paid as a premium on the Planned Premium Payment Due Dates. The Cash Value used in the Net Amount This amount is shown on the Policy at Risk calculation is the Cash Value Specifications page 3. You may change at the start of the policy month this amount by making a request In before the deduction of the Total Writing. Monthly Cost of Insurance. PLANNED PREMIUM PAYMENT DUE DATE The Monthly Cost of Insurance Factor The Planned Premium Payment Due Date is shown on the Policy Specifications is based on the Policy Start Date and page. The applicable Minimum Death the mode in which you choose to pay Benefit Factor is based on the premiums. If premiums are paid on an Insured's Attained Age. It is shown on annual mode, it is the policy the Minimum Death Benefit Factors page. anniversary each year. If premiums are paid on other than an annual mode, it If the Face Amount or Death Benefit of is the policy anniversary and each a rider is to be included for the semi-annual, quarterly or Monthly purposes of calculating the Net Amount Anniversary, as applicable. at Risk under the Death Benefit Options, it will be indicated in the POLICY ISSUE DATE rider. The Policy Issue Date is used to measure the contestable and suicide The Cash Value used in the Net Amount periods for the initial coverage. at Risk calculation will not be less than zero. POLICY LOAN BALANCE The Policy Loan Balance at any time is The Net Amount at Risk will be equal to the outstanding Loan plus allocated to the pieces of coverage in Loan Interest accrued to date. the following order: 1. Each increase in Face Amount in POLICY PROCEEDS succession, starting with the most The Policy Proceeds is the amount paid recent increase; and then to the Beneficiary upon receipt of due 2. To the coverage provided by the proof of the Insured's death. remaining Initial Face Amount (which includes any increase in POLICY START DATE Face Amount resulting from a Death The Policy Start Date is used to Benefit Option change). measure policy years, months and anniversaries. It may be referred to NET PREMIUM as Policy Date on the Application. The Net Premium is the part of the premium that will be applied to your Policy's Cash Value. It is equal to: the premium paid; less the premium paid times the applicable Percent of Premium Charge for the current policy year. 1E-47-15-NY Page 10 DEFINITIONS PREMIUM PAYMENTS FOR YOUR (CONTINUED) POLICY PREMIUMS, GRACE PERIOD AND REINSTATEMENT REQUESTED INCREASE PAYING PREMIUMS FOR YOUR POLICY A Requested Increase is an increase in The first premium is due as of the Face Amount that you applied for after Policy Start Date. The Policy will not the Policy Issue Date. be in force until the first premium is paid. If you have the Policy and the SEC first premium has not been paid, we "SEC" stands for the United States will consider that you have the Policy Securities and Exchange Commission. for inspection only. Premiums after the first premium must be paid at our SEPARATE ACCOUNT Designated Office. The Separate Account is a separate investment account created by us to Premiums may be paid in any amount and receive and invest your Net Premiums. at any interval subject to the The Separate Account is divided into following conditions: subaccounts that correspond to the 1. There is a minimum amount for Investment Divisions. premium payments. Except with our consent, any premium payment must VALUATION DATE be at least the Minimum Payment A Valuation Date is each day that the Amount shown on the Policy New York Stock Exchange is open for Specifications page. trading and the SEC has not restricted 2. Total premiums paid in any policy trading or declared an emergency. Each year may not be equal to or exceed Valuation Date ends at the close of an amount that would cause the regular trading on the New York Stock Policy to fail to qualify as life Exchange. insurance under applicable tax law. We will refund any amount paid that VALUATION PERIOD exceeds this limit. A Valuation Period is the period 3. Premium payments cannot be made between the ends of two successive after Attained Age 121, unless they Valuation Dates. Net Premium are required under a Grace Period. allocations, requests for transfers, 4. If we receive a premium that causes future allocation changes, Loans, the Death Benefit to increase by an Withdrawals, and surrenders will take amount that exceeds that Net effect as of the end of the Valuation Premium, we have the right to Period in which we receive the premium refuse that premium payment. We may payment or the request In Writing. require additional evidence of insurability before we accept that WE, US AND OUR premium payment. Metropolitan Life Insurance Company. You may request a change to your YOU AND YOUR Planned Premium Payments. However, we The Owner of the Policy. will not process an increase to the Planned Premium Payment if payment of the increased planned premium would cause the Policy to fail to qualify as life insurance under applicable tax law. If we receive a payment, we will treat it as a premium payment, unless you request otherwise In Writing. ALLOCATING NET PREMIUMS You may allocate the Net Premiums among the Fixed Account and the Investment Divisions. Percentages must be in whole numbers. Also, your total allocation must equal 100%. There is a limit to the amount of cash value you may have in the Fixed Account. The cash value in the Fixed Account immediately after payment of the premium may not exceed: the Fixed Account cash value plus the Separate Account cash value; times the Maximum Fixed Account Allocation Percent. We reserve the right to change the amount you may allocate to the Fixed Account. 1E-47-15-NY Page 11 PREMIUM PAYMENTS FOR YOUR POLICY (CONTINUED) GRACE PERIOD FOR SUBMITTING ANY AMOUNT We reserve the right to change the DUE amount you may allocate to the Fixed If, on a Monthly Anniversary date, the Account. Cash Surrender Value is less than the next Monthly Deduction, we will give The initial allocation is shown on the you a 62-day period called the "Grace Application. Period" to allow you to pay a premium large enough to keep your Policy from Until 20 days after the Investment lapsing. The required premium is Start Date, your Net Premiums will be called the "Amount Due". At the start applied to the Fixed Account. During of the Grace Period, we will send a this time, values and benefits of your notice of the Amount Due. We will send Policy depend on the interest credited this notice to your last known address to the Fixed Account. Twenty days and to that of any assignee on record. after the Investment Start Date: the If we do not receive the Amount Due by Cash Value will be allocated to the the end of the Grace Period: the Fixed Account and the Investment Policy will lapse; and it will Divisions according to the allocations terminate without Cash Surrender Value. in effect on the date of the transfer; and future Net Premiums will be If the Insured dies during the Grace allocated to the Fixed Account and the Period, any Amount Due will be Investment Divisions according to the deducted from the Policy Proceeds. allocations in effect on the date we receive the premium at our Designated REINSTATING YOUR POLICY AFTER LAPSE Office. If the Policy has lapsed, you may reinstate your Policy (excluding YOU MAY CHANGE THE ALLOCATION riders) prior to Attained Age 121 and While your Policy is in force, you may within three years after the date of change the allocation of Net Premiums lapse. This is called a among the Fixed Account and the "Reinstatement". Riders can be Investment Divisions. The rules that reinstated if stated in the rider or apply to any allocation are outlined with our consent. To reinstate your in the Allocating Net Premiums Policy, you must submit a request In provision. Any change in allocation Writing and the following: percentages will take effect when we 1. Proof that the Insured is insurable receive your request In Writing. by our standards. 2. Payment of the Monthly Deductions CONTINUATION OF INSURANCE AFTER that were due and not paid at the PREMIUM PAYMENTS STOP time of lapse. If you stop making premium payments, 3. Payment of an amount large enough the insurance provided under the to keep the Policy in force for at Policy, including benefits provided by least three months. any rider made a part of the Policy, will continue under the provisions of Any Loan in effect at the time of the Policy for as long as the Cash lapse may be paid or reinstated. If Surrender Value is large enough to the Loan is reinstated, the reinstated cover the Monthly Deductions. See the Cash Value will be reduced by any Loan Grace Period for Submitting Any Amount Interest due at the time of lapse. If Due provision. the Loan is not reinstated, the reinstated Cash Value will be reduced PAID-UP INSURANCE OPTION by any Policy Loan Balance at the time You can exchange your Policy while it of lapse. is in force, on any policy anniversary before Attained Age 121, for a new If the Insured is alive on the date we policy that provides Paid-Up approve the request for Reinstatement, Insurance. Your request for the the Policy will be in force from the exchange must be In Writing on or date we approve the Reinstatement before the policy anniversary on which application. We will deduct a full the exchange is to be effective. This Monthly Deduction for the policy month Policy will be void as of the date of in which we approve the Reinstatement the exchange. Paid-Up Insurance will application. be provided by using: the Cash Surrender Value of the Policy as a net If the Insured is not alive on the single premium at the then current age date we approve the request for of the Insured as calculated by the Reinstatement, such approval is void. issuing company for that plan of insurance; the 2001 CSO Mortality The Maximum Monthly Mortality and Table; and an interest rate of 4%. The Expense Risk Charge, Maximum Monthly cash value of the paid-up insurance Coverage Expense Charge, Maximum will be based on an interest rate of Monthly Policy Charge and Maximum 4% a year. Paid-Up Insurance is Percent of Premium Charge at the time permanent life insurance with no of Reinstatement will be those in further premiums due. The Paid-Up effect at the time of lapse. See the Insurance will be issued: on a plan of Charges Applied to Your Policy Section. insurance offered by us or one of our affiliates; and with a start date as of the date this Policy ends. 1E-47-15-NY Page 12 CONVERSION RIGHT YOUR POLICY'S VALUE CASH VALUE CONVERSION RIGHT CASH VALUE OF YOUR POLICY While the Policy is in force during The Cash Value of your Policy is equal the first 24 policy months, or if to the total of the values in the there is a material change in the Fixed Account, the Separate Account investment policy of the Separate and the Loan Account. See the Cash Account, you have a one-time right to Surrender Value of Your Policy exchange the Policy to a new permanent provision for information on the value fixed benefit life policy on the life available to you. of the Insured, without proof of insurability. We, or an affiliate, FIXED ACCOUNT CASH VALUE will issue the new policy on the The cash value in the Fixed Account on following basis: the Investment Start Date is equal to: 1. The new policy will have the same the Net Premiums received; less the Policy Start Date and Policy Issue portion of the Monthly Deductions due Date as this Policy; from the Policy Start Date through the 2. The Face Amount of the new policy Investment Start Date, if any, charged may not be greater than the Face to the Fixed Account. Amount, not including riders, of this Policy on the exchange date; The cash value in the Fixed Account on 3. The cost of insurance rates for the any day after the Investment Start new policy will be based on the Date is equal to: Insured's age, smoker status, sex, 1. The cash value in the Fixed Account and risk class in use on the Policy on the prior day, with interest on Issue Date of this Policy. If the such value at the current rate; less risk class of this Policy is not 2. Any Withdrawal made on that day; offered on the new policy, we will less use the risk class closest to it; 3. Any amount transferred from the 4. The new policy will be a permanent Fixed Account to the Investment fixed benefit plan agreed to by the Divisions on that day (including issuing company, to the extent any part of a Transfer Processing available for sale by that company Charge taken from the Fixed on the exchange date and subject to Account); plus any limits under applicable tax law 4. Any part of a Net Premium received and other applicable rules; and allocated to the Fixed Account 5. The Cash Value of this Policy will on that day; plus be transferred to the new policy as 5. Any amounts transferred to the of the exchange date; Fixed Account on that day; plus 6. Any premium from this Policy that 6. Any loan repayments received and is in excess of any premium due for allocated to the Fixed Account on the new policy may be applied as an that day; plus advance premium. If the conversion 7. Any amount transferred from the results in an increase in cash Loan Account to the Fixed Account value on the new policy, the on that day; less increase must be paid by you. If a 8. Any amount transferred from the decrease in cash value results, we Fixed Account to the Loan Account will return such amount to you; on that day; less 7. Any Loan and loan interest due on 9. If that day is a Monthly the exchange date must be paid Anniversary, the part of the prior to the issue of the new Monthly Deduction charged to the policy; Fixed Account to cover the policy 8. Any riders attached to this Policy month that starts on that day. will be attached to the new policy only if available for such policy; 9. The new policy will be subject to any assignments and limitations to which this Policy is subject. 1E-47-15-NY Page 13 YOUR POLICY'S VALUE (CONTINUED) SEPARATE ACCOUNT CASH VALUE VARIABLE ACCUMULATION UNITS There is no cash value in the Separate At the end of a Valuation Date, the Account on the Investment Start Date. current market value of an Investment The Separate Account Cash Value is Division is determined by multiplying equal to the sum of the cash value in that Investment Division's each Investment Division. The cash accumulation unit value by the number value in each Investment Division on of Investment Division accumulation the twentieth day after the Investment units held under the Policy. Start Date is equal to the amount transferred from the Fixed Account to The number of Investment Division the Investment Division. accumulation units will increase when: any part of a Net Premium is received The cash value in each Investment and allocated to that Investment Division on any day starting 21 days Division; amounts are transferred to after the Investment Start Date is that Investment Division; or Loans are equal to: repaid and credited to that Investment 1. The cash value in the Investment Division. Division on the last Valuation Date times that Investment Division's The number of Investment Division Net Investment Factor for the accumulation units will decrease when: current Valuation Period; less 1. Any part of the Monthly Deduction 2. Any Withdrawal from the Investment is taken from that Investment Division during the current Division; Valuation Period ; less 2. A Loan is taken from that 3. Any amounts transferred from the Investment Division; Investment Division during the 3. An amount is transferred from that current Valuation Period (including Investment Division; any part of a Transfer Processing 4. A Transfer Processing Charge is Charge taken from the Investment taken from that Investment Division); plus Division; or 4. Any part of a Net Premium received 5. A Withdrawal is taken from that and allocated to the Investment Investment Division. Division during the current Valuation Period; plus VALUE OF EACH ACCUMULATION UNIT 5. Any amounts transferred to the The value of an accumulation unit may Investment Division from the Fixed increase or decrease from one Account or from another Investment Valuation Period to the next. For any Division during the current Valuation Period, the value is equal Valuation Period; plus to the value of an accumulation unit 6. Any loan repayments received and for the prior Valuation Period times allocated to the Investment the Net Investment Factor for that Division during the current Investment Division for the current Valuation Period; plus Valuation Period. 7. Any amount transferred from the Loan Account to the Investment Division during the current Valuation Period; less 8. Any amount transferred from the Investment Division to the Loan Account during the current Valuation Period; less 9. If a Monthly Anniversary occurs during the current Valuation Period, the part of the Monthly Deduction charged to the Investment Division during the current Valuation Period to cover the policy month that starts during that Valuation Period. 1E-47-15-NY Page 14 YOUR POLICY'S VALUE (CONTINUED) NET INVESTMENT FACTOR CASH VALUE OF YOUR POLICY ON AND AFTER The Net Investment Factor measures the ATTAINED AGE 121 investment performance of an If the Policy is continued beyond Investment Division during a Valuation Attained Age 121, the Cash Value on Period. The Net Investment Factor for and after Attained Age 121 will be each Investment Division for a determined in the same way described Valuation Period is equal to: above, except: 1. The value of the assets at the end 1. There will be no Monthly Deductions of the last Valuation Period; plus taken; and 2. The investment income and capital 2. Premium Payments cannot be made on gains, realized or unrealized, or after Attained Age 121, except credited to the assets during the for payments required under a Grace Valuation Period for which the Net Period. Investment Factor is being determined; less THE INTEREST WE CREDIT TO YOUR 3. The capital losses, realized or POLICY'S CASH VALUE IN THE FIXED unrealized, charged against the ACCOUNT assets during the Valuation Period; Interest is credited to the amount of less your Policy's cash value in the Fixed 4. Any amount charged against the Account. The effective annual interest Investment Division for taxes, rate credited will never be less than including any tax or other economic the Minimum Fixed Account Cash Value burden resulting from the Guaranteed Interest Rate shown on the application of tax laws that we Policy Specifications page. determine to be properly attributable to the Investment BASIS OF COMPUTATION Division, or any amount we set The minimum cash values in the Fixed aside during the Valuation Period Account and guaranteed cost of as a reserve for taxes attributable insurance rates are based on the to the operation or maintenance of mortality table and the Fixed Account the Investment Division; divided by Minimum Cash Value Guaranteed Interest 5. The value of the assets at the end Rate as shown on the Policy of the last Valuation Period. Specifications page. LOAN ACCOUNT CASH VALUE All values and benefits are at least The cash value in the Loan Account as equal to those required by the law of of the Investment Start Date is equal the state in which the Policy is to the amount transferred into the delivered. We have filed a detailed Loan Account on that day. statement showing the method of calculating cash values and reserves The cash value in the Loan Account on with the insurance supervisory any day after the Investment Start official of that state. Cash Values Date is equal to: are computed according to the Standard 1. The cash value in the Loan Account Nonforfeiture Law of life insurance. on the preceding Valuation Date, with interest at an amount no less than the Minimum Loan Interest Rate Credited shown on the Policy Specifications page (the interest we credit on any loan will be at least equal to the fixed loan interest rate charged less 2%); plus 2. Any amount transferred to the Loan Account from the Fixed Account on that day; plus 3. Any amount transferred to the Loan Account from the Investment Divisions on that day; plus 4. If that day is a policy anniversary, any amount due to cover unpaid Loan Interest; less 5. Any amount transferred from the Loan Account to the Fixed Account on that day; less 6. Any amount transferred from the Loan Account to the Investment Divisions on that day. 1E-47-15-NY Page 15 ACCESSING YOUR POLICY'S VALUE CASH SURRENDER VALUE OF YOUR POLICY CASH SURRENDER VALUE Cash value equal to the Loan allocated The Cash Surrender Value of the Policy to the Fixed Account and each is the amount we use to determine what Investment Division will be is available to you for Loans, transferred to the Loan Account. It Withdrawals and Surrenders. It is will earn interest at an annual equal to the Cash Value at the time of effective rate not less than the surrender, less any Policy Loan Minimum Loan Interest Rate Credited. Balance. The interest we credit on any loan amount will be at least equal to the LOANS fixed loan interest rate charged less 2%. Interest earned on the cash value BORROWING MONEY FROM YOUR POLICY in the Loan Account will remain in the While your Policy is in force and if Loan Account until: we receive a loan your Policy has Loan Value, you can repayment; a new Loan is made; the borrow money from your Policy by Policy enters the Grace Period; or the making a request In Writing. The next policy anniversary. Upon any of maximum amount you may borrow is the these events, the interest earned on greater of: the Loan Value defined the Loan Account will be transferred below; and 75% of the Cash Surrender to the Fixed Account and the Value on the date the loan is made. Investment Divisions in proportion to The Loan Value on the date the loan is the cash value in each. made is equal to: 1. The Cash Value; plus REPAYING YOUR LOAN AND LOAN INTEREST 2. Interest at the Minimum Fixed Your Policy Loan Balance can be repaid Account Cash Value Guaranteed in whole or in part at any time before Interest Rate to the next policy the death of the Insured and while the anniversary; less Policy is in force. When a loan 3. Any Policy Loan Balance; less repayment is made, an amount equal to 4. Loan Interest at the Maximum Fixed the loan repayment will be transferred Loan Interest Rate to the next from the Loan Account to the Fixed policy anniversary (including any Account and the Investment Divisions Loan Interest that would be due on in the same proportion that the cash the new loan); less value in each bears to the total Cash 5. The most recent Monthly Deduction Value less the cash value in the Loan charged, times the number of policy Account. months to the next policy anniversary. Any payment we receive will be applied The Policy will be the sole security as a premium payment unless it is for such Loan. clearly marked as a Loan or Loan Interest repayment. The amount of each loan request must be at least equal to the Minimum Loan The Policy Proceeds and Cash Surrender Amount shown on the Policy Value reflect the deduction of any Specification page. outstanding Policy Loan Balance. The Loan will be allocated among the If your Policy has an Excess Loan, we Fixed Account and the Investment will send a notice to your last known Divisions in the same proportion that address and that of any assignee of the respective cash value in each record. We will allow you a Grace bears to the total Cash Value less the Period for payment of the excess due. cash value in the Loan Account on the If the excess due remains unpaid at date of the Loan. the end of the Grace Period, the Policy will lapse without value. The Grace Period will end 62 days from the date the notice is sent. 1E-47-15-NY Page 16 ACCESSING YOUR POLICY'S VALUE (CONTINUED) WITHDRAWALS WITHDRAWING MONEY FROM YOUR POLICY After the first policy year, you may The Face Amount will be decreased in make a request In Writing for a the following order, unless any rider Withdrawal from the Cash Surrender made a part of the Policy states Value. A Withdrawal is subject to the otherwise: conditions below. 1. Each Requested Increase in succession, starting with the most CONDITIONS FOR WITHDRAWING MONEY recent Requested Increase; and then We have the right to limit the total 2. The remaining Initial Face Amount; amount you may withdraw. The total and then amount you may withdraw will never be 3. Any increase in Face Amount less than the Cash Surrender Value resulting from a change in Death times the Percentage Used to Calculate Benefit Option. Maximum Withdrawal Amount shown on the Policy Specifications page. A decrease in Face Amount may require a decrease in the amounts provided by Also no Withdrawal will be processed any riders made a part of the Policy. unless: 1. The Cash Surrender Value after the The Death Benefit of the Policy will Withdrawal is large enough to cover be based on the Face Amount after the two Monthly Deductions; Withdrawal and the reduced Cash Value. 2. The Face Amount after the The Face Amount of the Policy will be Withdrawal, excluding riders, is at decreased, if necessary, such that the least the Minimum Face Amount shown Net Amount at Risk after the on the Policy Specifications page; Withdrawal is not greater than the Net and Amount at Risk before the Withdrawal. 3. The Policy continues to qualify as life insurance under applicable tax Unless otherwise requested, the law after the Withdrawal. proceeds will be paid to you in a single lump sum. We may make other There is a minimum amount you can options available in addition to the withdraw from your Policy at any one single lump sum option. You may choose time. The minimum amount is shown on In Writing to apply all or part of the the Policy Specifications page as the amount to a Payment Option. See the Minimum Withdrawal Amount. Payment Options Section. There is a limit on how many ALLOCATION OF WITHDRAWALS Withdrawals from your Policy you can Subject to the Conditions for make in any policy year. This limit is Withdrawing Money, Withdrawals will be shown on the Policy Specifications allocated among the Fixed Account and page as the Maximum Number of the Investment Divisions in the same Withdrawals Yearly. We may charge a proportion that the respective cash fee for a Withdrawal. If we do, it value in each bears to the total Cash will not be more than [$25.00]. Value less the cash value in the Loan Account on the date of the Withdrawal. The maximum amount of a Withdrawal If the Fixed Account conditions will from any one of the Investment not allow this proportionate Divisions is the lesser of: allocation, we will contact you so 1. [90%] of the part of the Cash that you may specify an acceptable Surrender Value in that Investment allocation. Division at the start of that policy year; and 2. The amount required to keep the Face Amount, excluding riders, from being less than the Minimum Face Amount. The Face Amount of the Policy will be decreased, if necessary, after the Withdrawal so that the Net Amount at Risk is not greater than it was prior to the Withdrawal. 1E-47-15-NY Page 17 ACCESSING YOUR POLICY'S VALUE (CONTINUED) FIXED ACCOUNT WITHDRAWALS AND TRANSFERS TRANSFERS TRANSFERRING MONEY BETWEEN THE FIXED LIMITS ON WITHDRAWALS AND TRANSFERS ACCOUNT AND INVESTMENT DIVISIONS FROM THE FIXED ACCOUNT If the Policy is in force and you have There are limits on Withdrawals and not exercised your Conversion Right, transfers from the Fixed Account. The starting 20 days after the first Net limits are described below. Premium is applied to the Policy, you may transfer amounts: between the Withdrawals and transfers from the Fixed Account and the Investment Fixed Account can be made only once Divisions; and among the Investment each policy year and only within 30 Divisions. days after each policy anniversary. Transfers are subject to the following The maximum amount of all Withdrawals conditions: and transfers from the Fixed Account 1. We must receive the request In in a policy year is the greater of: Writing; 1. The part of the Cash Surrender 2. The request must be expressed as a Value in the Fixed Account at the dollar amount or as a percentage in start of that policy year times whole numbers; Maximum Fixed Account Withdrawal 3. The minimum amount of the transfer Percent; and must be equal to the lesser of 2. The last policy year's Fixed [$50] and the total amount in the Account maximum withdrawal amount. Fixed Account or Investment Division from which the transfer is However, if less than $[50] would being made; remain in the Fixed Account after 4. We may charge a fee for a transfer. the Withdrawal, you can withdraw If we do, it will not be more than all of the Cash Surrender Value in the Maximum Transfer Processing the Fixed Account. Charge shown on the Policy Specifications page; and LIMITS ON TRANSFERS AND ALLOCATIONS TO 5. We reserve the right to limit the THE FIXED ACCOUNT number of transfers in each policy There are limits on transfers and year to [4]. allocations to the Fixed Account. The limits are described below. We will consider all transfers that occur on the same day as one transfer The Fixed Account cash value for the purpose of determining: any immediately after any transfer to the charge under item 4 above; and the Fixed Account cannot exceed: the Fixed number of transfers made in a policy Account cash value plus the Separate year under item 5 above. Account cash value; times the Maximum Fixed Account Allocation Percent. Your right to make transfers is subject to restrictions imposed by us. We reserve the right to limit new We will only restrict your right if we amounts being transferred or allocated determine, in our sole opinion, that to the Fixed Account. We will only the exercise of the right by one or limit new amounts if the rate of more owners with interests in the interest that would be used for the Investment Division is, or would be, new amount is equal to the Minimum to the disadvantage of other owners. Fixed Account Cash Value Guaranteed Restrictions may be applied in any Interest Rate. manner reasonably designed to prevent any use of the transfer right that we consider to be to the disadvantage of other owners. A restriction could be applied to transfers to and from one or more of the Investment Divisions and could include: 1. The requirement of a minimum time period between each transfer; 2. Not accepting a transfer request from a third party acting under authorization on behalf of more than one owner; or 3. Limiting the dollar amount that may be transferred by an owner between the Investment Divisions at any one time.
1E-47-15-NY Page 18 ACCESSING YOUR POLICY'S VALUE (CONTINUED) SURRENDERS POSTPONEMENT OF PAYMENTS AND TRANSFERS SURRENDERING YOUR POLICY You may surrender the Policy for its OUR RIGHT TO POSTPONE PAYMENTS AND Cash Surrender Value during the TRANSFERS lifetime of the Insured. We will We will usually pay any amounts for determine the Cash Surrender Value as Loans, surrenders and Withdrawals of the date we receive your request In allocated to the Investment Divisions Writing. within seven days after we receive the request In Writing. We will usually If the surrender occurs on a Monthly pay any Death Benefit proceeds within Anniversary, the Policy will terminate seven days after we receive due proof on that date. Further, the Cash of claim. Payment of any amount from Surrender Value will not be reduced by the Investment Divisions on Loans and the Monthly Deduction due on that date Withdrawals (except when used to pay for a subsequent policy month. If the premiums on policies issued by us), surrender occurs on any date other surrenders and death (except the Face than a Monthly Anniversary, the Policy Amount) may be postponed whenever: will terminate on the next Monthly 1. The New York Stock Exchange is Anniversary date. closed (other than customary weekend and holiday closing) or If the Insured dies on or after the trading on the New York Stock date of surrender and before the Exchange is restricted as Policy terminates: the surrender will determined by the SEC; or be reversed; the Cash Surrender Value 2. An emergency exists as determined paid to you will be converted to a by the SEC, as a result of which Loan; and the Policy Proceeds will be disposal of securities is not paid. This means the Cash Surrender reasonably practicable or it is not Value paid to you will be deducted reasonably practicable to determine from the Policy Proceeds. See the the value of the net assets of the Payment to Your Beneficiary provision. Separate Account. Unless otherwise requested, the We have the right to postpone proceeds will be paid to you in a Transfers under the conditions listed single lump sum. We may make other above. options available in addition to the single lump sum option. You may choose We have the right to defer payment of In Writing to apply all or part of the the part of any amount paid from the amount to a Payment Option. See the Fixed Account on surrender and Payment Options Section. Withdrawals for not more than six months. We have the right to defer payment of the part of any Loan from the Fixed Account for not more than six months, except for payment of premiums to us. 1E-47-15-NY Page 19 CHANGING YOUR POLICY POLICY CHANGES POLICY CHANGES INCREASING YOUR FACE AMOUNT After the first policy anniversary and Each Requested Increase will be prior to Attained Age 121, you can subject to the following: request policy changes at any time 1. We must receive proof satisfactory unless we have stated otherwise in the to us that the Insured is insurable Policy. We may allow only one change by our standards on the date of the per policy year. No change will be Requested Increase. made that would result in the Policy 2. The charges for the increase will failing to qualify as life insurance be based on the risk class the under applicable tax law. Insured qualifies for on the Date of Coverage for the Requested Following are the types of changes Increase. that are allowed. 3. New insurance must be available under our underwriting rules on the CHANGING YOUR POLICY'S FACE AMOUNT same plan at the Attained Age of You can ask us to decrease or increase the Insured on the date of the the Face Amount of your Policy. The Requested Increase. request must be In Writing. 4. The increase must be at least equal to the Minimum Face Amount Increase DECREASING YOUR POLICY'S FACE AMOUNT shown on the Policy Specifications Each requested decrease in Face Amount page. will be subject to the following: 5. The total Face Amount after the 1. The decrease will reduce the Face increase cannot be greater than our Amount in the following order, published maximums. The total Face unless any rider made a part of the Amount is equal to the Face Amount Policy states otherwise: before the Requested Increase plus a. Each Requested Increase in the Requested Increase. succession, starting with the most recent Requested Increase; We will send new Policy Specifications and then pages to show the Date of Coverage for b. The remaining Initial Face and charges applicable to the increase Amount; and then in Face Amount. The increase will take c. Any increase in Face Amount effect on the date we approve the resulting from a change in Requested Increase. Death Benefit Option. 2. The Face Amount after the requested ADDITION OF RIDERS decrease may not be less than the You can ask us to add a rider to the Minimum Face Amount shown on the Policy. The request must be In Policy Specifications page. Writing. Proof of insurability may be 3. The decrease must be at least equal required. If we approve your request, to the Minimum Face Amount Decrease the addition of the rider will take shown on the Policy Specifications effect on the Issue Date of the Rider. page. 4. Decreasing the Face Amount could CHANGE IN RISK CLASS result in a decrease in amounts You can apply for a better risk class. provided by any riders made a part The request must be In Writing. Proof of the Policy. of insurability will be required. If we approve your request, the change We will send new Policy Specifications will take effect on the date we pages to show the decreased Face approve your request. Amount. The decrease will take effect on the date we receive your request. CHANGE FROM A SMOKER TO NONSMOKER RISK CLASS See the riders attached to your If any coverage under your Policy was Policy, if any, for information about issued at a smoker risk class, you may how a decrease in Face Amount may be able to apply for a change to a cause a decrease in the amount nonsmoker risk class. Application can provided by such riders. be made if the Insured has not used tobacco/nicotine products in the last 12 months and the Policy has been in force for at least one year. A change to a nonsmoker risk class will be subject to: application to change the risk class; evidence of insurability; and our general underwriting rules in effect at that time. 1E-47-15-NY Page 20 CHANGING YOUR POLICY BENEFITS PROVIDED BY YOUR POLICY (CONTINUED) Those rules: may involve criteria DEATH BENEFIT other than tobacco/nicotine use; and may involve a definition of PAYMENT TO YOUR BENEFICIARY tobacco/nicotine use different from We will pay the Policy Proceeds to the the definition used on the Policy Beneficiary upon receipt of due proof Issue Date. If the risk class is of the Insured's death. The Policy changed to a nonsmoker risk class: Proceeds are equal to: 1. The application will be attached to 1. The Death Benefit; plus and made a part of your Policy; and 2. Any insurance on the life of the 2. The application will be contestable Insured provided by riders (unless for two years from the effective the rider's Face Amount or Death date of the change in risk class. Benefit is reflected in the Death The contest will be limited to the Benefit of the Policy); plus difference between the premiums, 3. The Total Monthly Cost of Insurance rates and charges based on the for the part of the policy month smoker risk class and the premiums, from the date of the Insured's rates and charges based on the death to the end of that policy nonsmoker risk class. month; plus 4. Any premium received after the date CHANGING YOUR POLICY'S DEATH BENEFIT of the Insured's death; less OPTION 5. Any Amount Due under a Grace Period You can ask us to change the Death provision as of the date of the Benefit Option. The request must be In Insured's death; less Writing. We may require proof that the 6. Any Policy Loan Balance. Insured is insurable by our standards on the date of the change. The In no event will the amount payable effective date of the change will be upon the death of the Insured be less the date we approve your request if than the minimum amount required to the change would result in an increase permit the Policy to qualify as life in the Net Amount at Risk. The Death insurance under the applicable tax law. Benefit payable will not change as a result of this change, but the Face DEATH BENEFIT OPTIONS Amount may change. Changes are allowed Your Policy allows you to choose as follows: between two Death Benefit Options. The 1. Change from Death Benefit Option A amount of the Death Benefit depends to Death Benefit Option B. upon the Death Benefit Option in effect on the date of the Insured's The Face Amount of the Policy will death. The Death Benefit Option in be decreased, if necessary, to effect is shown on the most recent equal the Death Benefit less the Policy Specifications page. Cash Value on the effective date of the change. This change will not be DEATH BENEFIT OPTION A allowed if it would result in a The Death Benefit prior to Attained Face Amount for the Policy that is Age 121 is equal to the greater of: less than the Minimum Face Amount 1. The Face Amount; and shown on the Policy Specifications 2. The Policy's Cash Value times the page. The decrease will reduce the applicable Minimum Death Benefit Face Amount in the following order, Factor for the Insured's Attained unless any rider made a part of the Age as shown on the Minimum Death Policy states otherwise: Benefit Factors page. a. Each Requested Increase in succession, starting with the DEATH BENEFIT OPTION B most recent increase; and then The Death Benefit prior to Attained b. The remaining Initial Face Age 121 is equal to the greater of: Amount; and then 1. The Face Amount plus the Cash Value c. Any increase in Face Amount on the date of death; and resulting from a change in 2. The Policy's Cash Value times the Death Benefit Option. applicable Minimum Death Benefit Factor for the Insured's Attained See the riders attached to your Age as shown on the Minimum Death Policy, if any, for information Benefit Factors page. about how a decrease in Face Amount may cause a decrease in the amount provided by such riders. 2. Change from Death Benefit Option B to Death Benefit Option A. The Face Amount of the Policy will be increased, if necessary, to equal the Death Benefit on the effective date of the change.
1E-47-15-NY Page 21 BENEFITS PROVIDED BY YOUR POLICY (CONTINUED) In no case will the Death Benefit be DEATH BENEFIT OPTION B less than the minimum amount required The Death Benefit on or after Attained to meet the definition of life Age 121 will be: the Face Amount of insurance under applicable tax law. the Policy on the date of the Insured's death; plus the Cash Value If the Face Amount or Death Benefit of on the date of the Insured's death. a rider is to be included for the purposes of calculating the Death If the Face Amount or Death Benefit of Benefit under the above Options, it a rider made a part of the Policy is will be indicated in the rider. to be included for the purposes of calculating the Death Benefit under Any time the Death Benefit less the the above Options, it will be Cash Value is greater than the then indicated in the rider. current Face Amount, we have the right to distribute a part of the Cash Value The Policy will stay in effect after to you. The amount of the distribution Attained Age 121 as long as the Cash will be the amount required to make Surrender Value remains greater than the Death Benefit less the Cash Value or equal to zero. after the distribution equal to the then current Face Amount. If the Policy is in force on or after Attained Age 121: loans may be taken; BENEFITS ON OR AFTER ATTAINED AGE 121 and loan repayments, Withdrawals, transfers and surrenders may be made. BENEFITS PAYABLE ON OR AFTER ATTAINED AGE 121 PLEASE NOTE: THE POLICY MAY NOT If the Insured is living and the QUALIFY AS A LIFE INSURANCE CONTRACT Policy is in force at Attained Age UNDER APPLICABLE TAX LAW ON OR AFTER 121, you may choose to terminate the ATTAINED AGE 121 AND MAY BE SUBJECT TO Policy and receive the Cash Surrender TAX CONSEQUENCES. PLEASE CONSULT A TAX Value, if it is greater than zero, as ADVISOR PRIOR TO CONTINUING THE POLICY a Maturity Benefit. BEYOND ATTAINED AGE 121. CONTINUATION OF THE POLICY BEYOND PAYMENT OF THE POLICY BENEFITS ATTAINED AGE 121 You may continue the Policy beyond PAYMENT OF THE POLICY PROCEEDS Attained Age 121 until the death of Unless otherwise requested, when the the Insured. Insured dies we will pay the Policy Proceeds to the Payee in a single lump If the Policy is in force on or after sum option. We may make other options Attained Age 121, the amount of the available in addition to the single Death Benefit depends on the Death lump sum option. Benefit Option in effect on the date of the Insured's death. The Death The Payee can choose to apply all or Benefit Option is shown on the most part of the Policy Proceeds to a recent Policy Specifications page. Payment Option. Further, with our consent, any Payee who is entitled to Premiums cannot be paid on or after receive proceeds in one sum when a Attained Age 121 unless they are Payment Option ends, or at the death required under a Grace Period of a prior Payee, or when the proceeds provision. are withdrawn, can choose to apply the proceeds to a Payment Option. There will be no Monthly Deductions taken on or after Attained Age 121. DEATH BENEFIT OPTION A The Death Benefit on or after Attained Age 121 will be the greater of: 1. The Face Amount on the date of the Insured's death plus any rider death benefits determined as of the day prior to Attained Age 121 (unless otherwise indicated in the rider); and 2. 101 percent of the Cash Value on the date of the Insured's death. 1E-47-15-NY Page 22 AVAILABLE PAYMENT OPTIONS PAYMENT OPTIONS CHOICES OF PAYMENT OPTIONS; OPTION DATE OTHER PAYMENT OPTIONS AND FREQUENCIES The choice of a Payment Option and the Other Payment Options and payment naming of the Payee must be In frequencies may be arranged with us. Writing. You can make, change or revoke the choice before the death of LIMITATIONS the Insured. The Option Date is the If installments under an Option would effective date of the Payment Option, be less than [$50.00], proceeds can be as chosen. applied to a Payment Option only with our consent. When a Payment Option starts, a contract will be issued by us or by an AFTER A PAYEE DIES affiliate that will describe the terms Amounts to be paid after the death of of the Option. a Payee under a Payment Option will be paid as due to the successor Payee. If If your Policy has a collateral there is no successor Payee, amounts assignment, it will change a prior will be paid in one sum to the estate choice of a Payment Option. In this of the last Payee to die. If a Payee case, the amount due any assignee will under a Life Income Option dies within be paid to the assignee in one sum and 30 days after the Option Date, the the balance will be applied under the amount applied to the Option, less any Payment Option. payments made, will be paid in one sum, unless a Payment Option is chosen. LIFE INCOME OPTIONS Guaranteed Life Income Options are based on the age of the Payee on the Option Date. We will require proof of age. The Life Income payments will be based on the rates shown in the Life Income Tables; or, if they are greater, our Payment Option rates on the Option Date. If the rates at a given age are the same for different periods certain, the longest period certain will be deemed to have been chosen. SINGLE LIFE INCOME OPTION If this Option is chosen, we will make monthly payments during the lifetime of the Payee. SINGLE LIFE INCOME - 10 YEAR GUARANTEED PAYMENT PERIOD OPTION If this Option is chosen, we will make monthly payments during the life of the Payee with a guaranteed payment period of 10 years. JOINT AND SURVIVOR LIFE INCOME OPTION If this Option is chosen, monthly payments will be made: 1. While either of two Payees is living, called "Joint and Survivor Life Income", or 2. While either of two Payees is living, but for at least 10 years, called "Joint and Survivor Life Income, 10 Years Certain". 1E-47-15-NY Page 23 AVAILABLE PAYMENT OPTIONS (CONTINUED) LIFE INCOME TABLES MINIMUM PAYMENTS UNDER PAYMENT OPTIONS JOINT AND SURVIVOR LIFE INCOME Monthly payments for each $1,000 applied will not Joint and Survivor be less than the amounts shown in the following ------------------------------------ Tables. On request, we will provide additional Age of Both One Male and information about amounts of minimum payments. Payees One Female The amounts shown below are based on an ------------------------------------------------- interest rate of 1/2 percent a year and the 2000 50 $1.95 Annuity Mortality Table. 55 2.14 60 2.39 65 2.69 SINGLE LIFE INCOME 70 3.10 LIFE INCOME 75 3.64 Payee's ----------------------- 80 4.39 Age Male Female 85 5.45 -------------------------------------------------- 90 & over 6.96 50 $2.32 $2.15 55 2.60 2.39 60 2.96 2.69 JOINT AND SURVIVOR, 10 YEARS CERTAIN 65 3.41 3.08 ------------------------------------ 70 4.02 3.60 Age of Both One Male and 75 4.86 4.31 Payees One Female 80 6.01 5.33 ------------------------------------------------- 85 7.62 6.82 50 $1.95 90 & over 9.87 9.04 55 2.14 60 2.39 65 2.69 10 YEAR GUARANTEED 70 3.10 PAYMENT PERIODS 75 3.63 Payee's ----------------------- 80 4.35 Age Male Female 85 5.28 -------------------------------------------------- 90 & over 6.37 50 $2.32 $2.15 55 2.59 2.38 60 2.93 2.68 65 3.36 3.06 70 3.92 3.55 75 4.63 4.20 80 5.47 5.03 85 6.39 6.04 90 & over 7.26 7.06
1E-47-15-NY Page 24 CHARGES APPLIED TO YOUR POLICY CHARGES INCLUDED IN THE MONTHLY DEDUCTION MONTHLY DEDUCTION On each Monthly Anniversary date, we If the Policy is reinstated, any time deduct charges from your Policy's Cash that the Policy was not in force will Value. The sum of these charges is not be counted when we determine the called the "Monthly Deduction". The applicable Monthly Mortality and Monthly Deduction for the next month Expense Risk Charge. is deducted on the Monthly Anniversary date and is equal to: MONTHLY COVERAGE EXPENSE CHARGE 1. The Monthly Mortality and Expense A Monthly Coverage Expense Charge will Risk Charge; plus be assessed for each piece of 2. The Monthly Coverage Expense coverage, except coverage amounts Charge; plus resulting from a change in Death 3. The Monthly Policy Charge; plus Benefit Option. The Charge for each 4. The monthly costs for any riders piece of coverage is equal to: the made a part of the Policy, unless Initial Face Amount for each piece of otherwise indicated in a rider; plus coverage; times its applicable Monthly 5. The Total Monthly Cost of Insurance Coverage Expense Charge rate for the (described in the Total Monthly year; divided by 1,000. Cost of Insurance provision). The Maximum Monthly Coverage Expense The Monthly Deduction for a policy Charge for each piece of coverage is month will be taken from the Fixed shown on that coverage's Policy Account and the Investment Divisions Specifications page. The Monthly in the same proportion that the Coverage Expense Charge for each piece respective cash value in each bears to of coverage will never exceed the the total Cash Value less the cash maximum rate shown on that coverage's value in the Loan Account on the Policy Specifications page. Monthly Anniversary. However, at any time you can choose In Writing to have The Monthly Coverage Expense Charge Monthly Deductions allocated to: for any piece of coverage will 1. The Fixed Account or to a specific continue to be assessed based on the Investment Division until the cash Initial Face Amount of that piece of value in the Fixed Account or that coverage regardless of any subsequent Investment Division is equal to decrease in the Face Amount including zero; and then a reduction to zero. 2. To the Fixed Account and the remaining Investment Divisions in If the Policy is reinstated, any time the same proportion that the that the Policy was not in force will respective cash value in each bears not be counted when we determine the to the total Cash Value less the applicable Monthly Coverage Expense cash value in the Loan Account on Charge. the Monthly Anniversary. MONTHLY POLICY CHARGE You can change the Monthly Deduction A Monthly Policy Charge will be allocation by making a request In assessed on your Policy. The Writing. applicable Monthly Policy Charge will never exceed the Maximum shown on the We will not take any Monthly Policy Specifications page. Deductions from your Policy's Cash Value on or after Attained Age 121. If the Policy is reinstated, any time that the Policy was not in force will MONTHLY MORTALITY AND EXPENSE RISK not be counted when we determine the CHARGE applicable Monthly Policy Charge. A Monthly Mortality and Expense Risk Charge will be assessed for your Policy on each Monthly Anniversary. It will not exceed the applicable Maximum Monthly Mortality and Expense Risk Charge shown on the Policy Specifications page times the cash value in the Separate Account at the start of the current Monthly Anniversary. If the cash value in the Separate Account is negative, the Monthly Mortality and Expense Risk Charge will not be deducted for that month. 1E-47-15-NY Page 25 CHARGES APPLIED YOUR POLICY (CONTINUED) OTHER CHARGES TOTAL MONTHLY COST OF INSURANCE CHARGE APPLIED TO YOUR PREMIUM PAYMENTS A Monthly Cost of Insurance Charge We will deduct a "Percent of Premium will be assessed for each piece of Charge" from each premium we receive. coverage. The Charge covers the cost This Charge covers premiums received of providing insurance coverage for for the Initial Face Amount and each the next month. It is included in the Requested Increase. The Charge for Total Monthly Cost of Insurance. each piece of coverage is equal to: the amount of premium allocated to the The Total Monthly Cost of Insurance is piece of coverage; times the Percent equal to: of Premium Charge for that piece of 1. The Net Amount at Risk that is coverage. The Maximum Percent of allocated to the remaining Initial Premium Charge for each piece of Face Amount plus any increase in coverage is shown on that coverage's Face Amount resulting from a change Policy Specifications page. in Death Benefit Option multiplied by the Monthly Cost of Insurance Premiums will be allocated to each Rate for the Initial Face Amount, piece of coverage in the following divided by 1,000; plus order: 2. The Net Amount at Risk that is allocated to each Requested 1. To the coverage provided by the Increase multiplied by the Monthly Initial Face Amount up to and Cost of Insurance Rate for each including its Target Premium Requested Increase, divided by amount; and then 1,000. 2. In succession starting with the first Requested Increase up to and MONTHLY COST OF INSURANCE RATES including its Target Premium At the start of each policy year, we amount; and then will set the "Monthly Cost of 3. Any remaining premium will be Insurance Rate" used to calculate the allocated to each piece of coverage Monthly Cost of Insurance charge for based on the percentage allocated your Policy. Separate Monthly Cost of to it in items 1. and 2. above. Insurance Rates are determined for: the Initial Face Amount plus any If the Policy is reinstated, any time increase in Face Amount resulting from that the Policy was not in force will a Death Benefit Option change; and for not be counted when we determine the each Requested Increase. The Monthly applicable Percent of Premium Charge. Cost of Insurance Rate for each piece of coverage is based on the Attained Age, risk class and sex of the Insured. If the Death Benefit is equal to the Policy's Cash Value times the applicable Minimum Death Benefit Factor, any increase in Cash Value will cause an automatic increase in the Death Benefit. The Monthly Cost of Insurance Rate for such an increase is based on the Attained Age, the risk class used for the most recent Requested Increase and sex of the Insured. The Monthly Cost of Insurance Rates for each piece of coverage will never exceed the rates shown on the Table of Guaranteed Maximum Monthly Cost of Insurance Rates page for that coverage. Any change in the cost of insurance rates will apply to all persons of the same Attained Age, sex, and risk class whose coverage has been in force for the same length of time. 1E-47-15-NY Page 26 CHARGES APPLIED TO YOUR POLICY GENERAL PROVISIONS OF YOUR POLICY (CONTINUED) SEPARATE ACCOUNT AND INVESTMENT DIVISIONS INTEREST WE CHARGE ON POLICY LOANS SEPARATE ACCOUNT We charge interest on any loans. The The variable benefits under your rate we charge will not exceed the Policy are provided through Maximum Fixed Loan Interest Rate based investments in the Separate Account. on the policy year as shown on the This account is used for flexible Policy Specifications page. The premium variable life insurance difference between the fixed loan policies and, if permitted by law, may interest rate we charge on any loan be used for other policies or and the interest credited by us on any contracts as well. loan will not be greater than 2%. The Loan Interest is due each year on the We hold the assets of the Separate policy anniversary. Account. These assets are held separately from the assets held in our If you do not pay the loan interest general account (which includes the when it is due, an amount of cash Fixed Account). Income, gains and value equal to the loan interest will losses, whether or not realized, from be added to the existing loan, assets allocated to the Separate interest will be charged on it and it Account will be credited to or charged will be allocated to the Loan Account. against the Separate Account without The amount transferred will be regard to our other income, gains or deducted from the Fixed Account and losses. the Investment Divisions in the same proportion that the cash value in each The part of the assets held in the bears to the total Cash Value less the Separate Account equal to the reserves cash value in the Loan Account. and other policy liabilities with respect to the Separate Account will ILLUSTRATION OF BENEFITS not be charged with liabilities that You may request In Writing that we arise from any other business we may send you an illustration of benefits. conduct. We have the right to transfer We may charge a small fee for any any assets of the Separate Account requested illustration after the first that exceed the reserves and other in each policy year. This fee will not policy liabilities of the Separate exceed [$25.00]. Account to our general account. The Separate Account is registered with the Securities and Exchange Commission as a unit investment trust under the Investment Company Act of 1940. The Separate Account is also subject to the laws of the state of New York. To the extent required by law, the investment policy of the Separate Account will not be changed without the approval of the superintendent of the Insurance Department for the state of New York. We have filed a statement of the approval process with the superintendent of the Insurance Department for the state of New York. If the investment policy of the Separate Account is changed, we will give you written notice of the change. You can then choose to convert this Policy to fixed benefit coverage. The conversion will be on the basis described in the Conversion Rights provision. Your request to convert this Policy must be made within 60 days of the later of: (a) the effective date of the investment policy change; or (b) the date you receive the notice of the change. 1E-47-15-NY Page 27 GENERAL PROVISIONS OF YOUR POLICY (CONTINUED) GENERAL PROVISIONS INVESTMENT DIVISIONS THE CONTRACT The Separate Account has multiple We have issued the Policy in Investment Divisions. The Investment consideration of the Application and Divisions invest in shares of payment of premiums. The Policy registered investment companies or includes the attached Application, any other pools of investment assets. riders, and any endorsements. Together they comprise the entire contract and Income, gains and losses, whether or are made a part of the Policy when the not realized, from the assets of each insurance applied for is accepted. The Investment Division are credited to or Policy may be changed by mutual charged against that Investment agreement. Any change must be In Division without regard to income, Writing and approved by our President, gains or losses in other Investment Vice President or Secretary. Our Divisions or in the Fixed Account. representatives have no authority to alter or change any terms, conditions, We value the assets of each Investment or agreements of the Policy, or to Division at the end of each Valuation waive any of its provisions. Period. STATEMENTS MADE IN THE APPLICATION FOR The values and benefits of the Policy THE POLICY depend on: the investment performance All statements made in the Application of the Investment Divisions; and the for the Policy will be deemed interest credited to the Fixed representations and not warranties. Account. We do not guarantee the Material misrepresentations will not investment performance of the be used to void the Policy or any Investment Divisions. You bear the rider or to deny a claim unless made investment risk for amounts invested in the Application for the Policy. in the Investment Divisions for your Policy. CLAIMS OF CREDITORS To the extent permitted by law, ADDITION, DELETION OR SUBSTITUTION OF neither the Policy nor any payment INVESTMENT DIVISIONS under it will be subject to the claim As permitted by law, we can add or of creditors or to any legal process. remove shares of a fund that are held by the Separate Account or that the MISSTATEMENT OF AGE OR SEX Separate Account may buy. When a If we determine while the Insured is change is made, we will send you: a living that there was a misstatement prospectus supplement or a revised of age or sex reflected in the Policy, prospectus for the Separate Account the policy values will be recalculated which will describe all of the funds from the Policy Start Date based on then available for your Policy in the the correct information. Separate Account or its successor or any other investment company in which If we determine after the Insured's the Separate Account is invested; and death that there was a misstatement of any notice required by law. age or sex reflected in the Policy, the amount of the Death Benefit will When shares of a fund are removed, we be that which would be bought by the have the right to substitute a most recent Monthly Cost of Insurance different fund in which the Investment at the correct age and sex. Division will then invest: 1. The value of the removed shares of the fund; and 2. Future net premiums applied to that Investment Division. The investment policy of the Separate Account will not be changed unless the change has been approved by the superintendent of the Insurance Department for the State of New York. We have filed a statement of the approval process with the superintendent of the Insurance Department for the state of New York. 1E-47-15-NY Page 28 GENERAL PROVISIONS OF YOUR POLICY (CONTINUED) INCONTESTABILITY PERIOD TAX WITHHOLDING The insurance issued under the Policy We will deduct any withholding taxes will not be contestable after it has required by applicable law upon Policy been in force during the lifetime of surrender, withdrawal of proceeds, or the Insured: upon payment of the Policy Proceeds. 1. With respect to the initial coverage, for two years from the TAX REGULATION OF LIFE INSURANCE Policy Issue Date. This Policy is intended to qualify as 2. With respect to a Requested a life insurance contract under Increase, for two years from the applicable tax law. In order to have Date of Coverage of the Requested the Policy continue to qualify, we Increase. have the right to: 3. With respect to a Death Benefit 1. Restrict certain changes to the increase caused by a premium Policy, such as Death Benefit payment that required evidence of increases; insurability, for two years from 2. Make changes to the Policy; the date we received the premium 3. Require the issuance of a new payment. policy in connection with such 4. With respect to a Death Benefit changes; and increase caused by a change in 4. Refuse a premium payment. Death Benefit Option that required evidence of insurability, for two We will give you written notice of any years from the Date of Coverage of of the above actions. the Death Benefit increase. 5. With respect to an application for ANNUAL REPORT reinstatement, for two years from Each year, or more often if required the date of Reinstatement. by law or regulation, we will send you a report that shows: the Death This provision will not apply to any Benefit; current policy values; rider that contains its own surrenders; premiums paid and incontestability clause. deductions made since the last report; any Policy Loan Balance; and any other If the Policy was issued as the result information required by law or of the exercise of an option given in regulation. another policy and proof of insurability was not required, the contestable period applicable to the coverage resulting from the option exercise will end at the same time that it would have ended under the original policy. SUICIDE EXCLUSION If the Insured dies by suicide within two years from the Policy Issue Date, the amount payable will be limited to the amount of premiums paid (without interest) less any Withdrawals and any Policy Loan Balance on the date of death. If the Insured dies by suicide more than two years after the Policy Issue Date and within two years from the Date of Coverage of any Requested Increase: the increase will not be in effect; and the portion of each Monthly Deduction taken since the effective date of the increase that is attributable to the increase will be added directly to the Policy Proceeds. If the Policy was issued as the result of the exercise of an option given in another policy and proof of insurability was not required, the suicide period applicable to the coverage resulting from the option exercise will end at the same time that it would have ended under the original policy. 1E-47-15-NY Page 29 GENERAL PROVISIONS OF YOUR POLICY (CONTINUED) OWNER AND BENEFICIARY OWNER OF THE POLICY PROCEDURE FOR CHANGING THE OWNER OR The Owner can be a person, BENEFICIARY corporation, partnership, trust or You must make a request In Writing charity. The initial Owner of the during the Insured's lifetime to Policy is named in the Application. change the Beneficiary or Owner. Once Before the death of the Insured, you the request is received, the change can change the Owner. The new Owner will take effect as of the date you will have all of the rights of the signed the request, whether or not the Owner, including the right to make a Insured is living when we receive your further change of Owner. request. The change will be subject to any legal restrictions. It will also A change of Owner will void any prior be subject to any payment we made or Beneficiary designation unless there action we took before we received the is an irrevocable Beneficiary. change. Irrevocable Beneficiaries must give written consent to any change of INTERPRETATION OF OWNER AND Beneficiary. BENEFICIARY DESIGNATIONS A numbered sequence can be used to If there is more than one Owner, all name successive Owners or Owners must exercise the rights of Beneficiaries. Co-beneficiaries will ownership by joint action. At the receive equal shares unless otherwise death of an Owner who is a natural stated. person, his or her estate will be the Owner, unless a successor Owner has In naming (designating) Owners or been named. The rights of the Owner Beneficiaries, unless otherwise will end at the death of the Insured, stated, if you use the terms below, except as provided in the Beneficiary they will be interpreted as stated in of Your Policy provision. this provision: 1. A general designation of unnamed BENEFICIARY OF YOUR POLICY children as a group of Your Beneficiary can be a person, Beneficiaries includes all future corporation, partnership, trust or children born to or adopted by the charity. The initial Beneficiary is Insured after the date of the named in the Application. After the designation. Policy Issue Date but before the death 2. "Provision for issue" means that if of the Insured, you can change the a Beneficiary does not survive the Beneficiary; however, an irrevocable Insured, the share of the Policy Beneficiary cannot be changed without Proceeds for that Beneficiary will his or her written consent. The go to his or her living issue by Beneficiary has no interest in the right of representation. Policy until the death of the Insured. 3. A designation that specifies a A person must survive the Insured to family relationship such as "wife", qualify as Beneficiary. If no "husband" or "child" refers to Beneficiary survives, the proceeds their relationship to the Insured. will be paid to the Owner. At the time of payment of benefits, we can rely on an affidavit of any Owner or other responsible person to determine family relations or members of a class. ASSIGNMENTS If you make an absolute assignment of the Policy, the assignee will be the new Owner and Beneficiary. If you make a collateral assignment of the Policy, there is no change of Owner or Beneficiary. However, the rights of the Owner and Beneficiary will be subject to the terms of the collateral assignment. Assignments will be subject to all payments made and actions taken by us before a signed copy of the assignment form is received by us at our Designated Office. We will not be responsible for determining whether or not an assignment is valid. 1E-47-15-NY Page 30 SEE NEXT PAGE. INDIVIDUAL FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE INSURANCE POLICY This is an individual flexible premium variable universal life insurance policy where premiums can be paid until Attained Age 121. It does not pay dividends. THIS POLICY DOES NOT HAVE SURRENDER CHARGES. You may continue the coverage provided by the Policy beyond Attained Age 121. See the Benefits on or after Attained Age 121 provision. If the Insured dies while the Policy is in force, we will pay the Policy Proceeds to the Beneficiary. The Policy Proceeds are described in the Payment to Your Beneficiary provision. We must receive due proof of the Insured's death. The Policy Proceeds are described in the Payment to Your Beneficiary provision. Any payment will be subject to all of the provisions of the Policy. 1E-47-15-NY Page 32