EXHIBIT 5
THE UNITED STATES LIFE INSURANCE COMPANY
IN THE CITY OF NEW YORK
Home Office:
New York, New York
390 Park Avenue POLICY NUMBER:
New York, NY 10022-4684
1-800-251-3720
WE WILL PAY THE DEATH BENEFIT PROCEEDS to the designated Beneficiary if the last
surviving Contingent Insured named on the Policy Schedule dies prior to the
Maturity Date and while this policy is in force. Payment will be made after We
receive due proof of the deaths of both Contingent Insureds, and will be subject
to the terms of this policy. The method for determining the amount payable is
stated in the Death Benefit Proceeds provision.
WE WILL PAY THE CASH SURRENDER VALUE of this policy to the Owner on the Maturity
Date if one or both Contingent Insureds are living on that date. No benefits
will be paid upon the death of the first Contingent Insured.
THE DEATH BENEFIT WILL BE DETERMINED IN ACCORDANCE WITH THE DEATH BENEFIT AND
DEATH BENEFIT OPTIONS PROVISION. THE AMOUNT OR DURATION OF THE DEATH BENEFIT
PROCEEDS AND THE ACCUMULATION VALUES PROVIDED BY THIS POLICY WHEN BASED ON THE
INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND NOT GUARANTEED AS
TO FIXED DOLLAR AMOUNT. ACCUMULATION VALUES MAY INCREASE OR DECREASE.
The consideration for this policy is the application and payment of the first
premium. The first premium must be paid on or before delivery of this policy.
This is a JOINT AND LAST SURVIVOR FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE
POLICY. An adjustable Death Benefit is payable upon the LAST SURVIVING
Contingent Insured's death prior to the Maturity Date. Investment results are
reflected in policy benefits. ACCUMULATION VALUES are flexible and will be
based on the amount and frequency of premiums paid and the investment results of
the Separate Account. NONPARTICIPATING - NOT ELIGIBLE FOR DIVIDENDS.
NOTICE OF TEN DAY RIGHT TO EXAMINE POLICY
YOU MAY RETURN THIS POLICY WITHIN 10 DAYS AFTER DELIVERY IF YOU ARE NOT
SATISFIED WITH IT FOR ANY REASON. THE POLICY MAY BE RETURNED TO US OR TO THE
REGISTERED REPRESENTATIVE THROUGH WHOM IT WAS PURCHASED. UPON SURRENDER OF THIS
POLICY WITHIN THE 10 DAY PERIOD, IT WILL BE DEEMED VOID FROM THE DATE OF ISSUE,
AND WE WILL REFUND THE GREATER OF: (1) ANY PREMIUMS RECEIVED BY US; OR (2) YOUR
ACCUMULATION VALUE ON THE DATE OF SURRENDER PLUS ANY CHARGES THAT HAVE BEEN
DEDUCTED.
SIGNED AT THE HOME OFFICE ON THE DATE OF ISSUE.
/s/ Pauletta P. Cohn /s/ Donald W. Britton
- ----------------------------- ----------------------------------
Pauletta P. Cohn Donald W. Britton
Secretary President
JOINT AND LAST SURVIVOR FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY
INDEX
Annual Report 23 Last Surviving Contingent Insured 5
Automatic Rebalancing 17 Maturity Date 3
Beneficiary and Proceeds 19 Monthly Administration Fee 13
Cash Surrender Value 12 Owner 5
Changing Your Insurance Policy 8 Payment Options 20-22
Change of Ownership or Beneficiary 20 Policy Loans 18-19
Changing the Death Benefit Option 8 Policy Values 11-16
Changing the Specified Amount 8 Premium Class 3
Contract 5 Premium Expense Charge 6
Cost of Insurance Rate Table 4A Premium Payments 5
Date of Issue 3, 5 Reinstatement 23
Death Benefit and Death Benefit Options 7 Separate Account 9
Dollar Cost Averaging 16 Specified Amount 8
Exchange Option 23 Suicide 22
First Death, Notification of 5 Surrender Charges 25
General Account 11 Surrender, Full and Partial 15
General Provisions 22 Suspension and Deferral of
Grace Period 14 Payments Provision 17
Guaranteed Minimum Death Benefit 14 Transfer Provision 16
Incontestability 22 Valuation of Assets 9
Investment Advisor or Valuation Dates 10
Investment Objective, Change of 10 Valuation Units 9
Investments of the Separate Account 9 When This Policy Terminates 23
COMPANY REFERENCE. We, Our, Us, or Company means The United States Life
Insurance Company In the City of New York.
YOU, YOUR. The words You or Your mean the Owner of this policy.
HOME OFFICE. Our office at 390 Park Avenue, New York, New York, 10022-4684.
ADMINISTRATIVE CENTER. Our service center to which You should direct all
request, instructions and other communications. Our Administrative Center is
located at 2727-A Allen Parkway, Houston, Texas 77019-2191. The mailing address
for services is P.O. Box 4880, Houston, Texas 77210-4880. The mailing address
for any premium payments not accompanied by a billing statement is P.O.
Box 4728, Dept. L, Houston, TX 77210-4728.
WRITTEN, IN WRITING. A written request or notice in acceptable form and
content, which is signed and dated, and received at Our Administrative Center.
PREMIUM CLASS. One or a combination of the following terms will be used to
describe the Premium Class of this policy:
PREFERRED. The term "Preferred" means the cost of insurance is based on the
Contingent Insured being a better than average mortality risk.
STANDARD. The term "Standard" means the cost of insurance is based on the
Contingent Insured being an average mortality risk.
SPECIAL. The term "Special" means an extra amount is being charged due to the
health, occupation or avocation of a Contingent Insured.
UNINSURABLE. The term "Uninsurable" means the Contingent Insured would not
pass the Underwriting requirements for a single life policy.
TOBACCO. The term "Tobacco" means the cost of insurance is based on the
Contingent Insured being a user of tobacco.
NON-TOBACCO. The term "Non-Tobacco" means the cost of insurance is based on the
Contingent Insured being a non-user of tobacco.
NOTICE
This Policy Is A Legal Contract Between
The Policyowner and The Company
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POLICY SCHEDULE
BASIC POLICY YEARS PAYABLE MONTHLY COST
LAST SURVIVOR VARIABLE LIFE 65 SEE PAGE 4B
ADDITIONAL BENEFITS PROVIDED BY RIDERS
NONE
SCHEDULE OF PREMIUMS
INITIAL PREMIUM: $988.04
PLANNED PERIODIC PREMIUM: $988.04 PAYABLE ANNUALLY
MONTHLY DEDUCTION DAY: 15TH DAY OF EACH MONTH
GUARANTED MINIMUM DEATH BENEFIT
MONTHLY PREMIUM: $82.23
MINIMUM PARITAL SURRENDER: $500
MINIMUM VALUE THAT MAY BE RETAINED IN A
DIVISION AFTER A PARTIAL SURRENDER
OR TRANSFER: $500
MINIMUM DEATH BENEFIT AMOUNT (AFTER A
DECREASE IN SPECIFIED AMOUNT): $100,000
DEATH BENEFIT COMPLIANCE TEST: CASH VALUE ACCUMULATION
ANY CHANGES IN THE AMOUNT, TIMING OR FREQUENCY OF PREMIUM PAYMENTS, ADJUSTMENTS
IN THE CREDITING OF ADDITIONAL INTEREST, ADJUSTMENTS IN MORTALITY OR EXPENSE
CHARGES, LOANS OR PARTIAL SURRENDERS TAKEN, COST OF SUPPLEMENTARY RIDERS, OR
ADJUSTMENTS TO THE DEATH BENEFIT MAY VARY THE ACCUMULATION OF CASH VALUES AND
MAY REQUIRE MORE PREMIUM TO BE PAID THAN WAS ILLUSTRATED OR MAY CAUSE THE POLICY
TO LAPSE PRIOR TO THE MATURITY DATE.
POLICY DATA
CONTINGENT INSURANCE PREMIUM JOINT EQUAL
INSUREDS AGES CLASSES AGE
JOHN DOE 35 PREFERRED 35
JIM DOE 35 PREFERRED
INITIAL SPECIFIED AMOUNT: $100,000 DEATH BENEFIT OPTION: 1
DATE OF ISSUE: FEBRUARY 15, 2000
POLICY NUMBER: 0000000000 MATURITY DATE: FEBRUARY 15, 2065
THIS IS A (STATE NAME) POLICY
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POLICY SCHEDULE CONTINUED - POLICY NUMBER 0000000000
INTEREST RATE CURRENT ANNUAL RATE GUARANTEED ANNUAL RATE
GENERAL ACCOUNT [4.00%] [4.00%]
CHARGES DEDUCTED FROM THE SEPARATE ACCOUNT
MORTALITY AND EXPENSE CHARGES:
DEDUCTIONS FROM THE SEPARATE ACCOUNT WILL BE MADE AT AN ANNUAL RATE NOT TO
EXCEED THE RATES STATED BELOW. THE ACTUAL DEDUCTION WILL BE MADE ON A
DAILY BASIS.
POLICY YEARS CURRENT ANNUAL RATE GUARANTEED ANNUAL RATE
1-10 [0.40%] [0.40%]
11-30 [0.20%] [0.20%]
THEREAFTER [0.10%] [0.10%]
EXPENSE CHARGES:
PREMIUM TAX (IF APPLICABLE). DEPENDING ON THE LAWS OF THE JURISDICTION IN
WHICH THIS POLICY WAS ISSUED, AND SUBJECT TO FUTURE CHANGES IN RESIDENCE, A
PERCENTAGE OF EACH PREMIUM MAY BE DEDUCTED FOR PREMIUM TAX. PREMIUM TAX
RATES ARE SUBJECT TO CHANGE. THE PREMIUM TAX RATE FOR THIS POLICY ON THE
DATE OF ISSUE IS [0%].
PREMIUM EXPENSE CHARGE:
POLICY YEARS PERCENT OF PREMIUM (AFTER DEDUCTION
OF ANY STATE PREMIUM TAX)
1-10 6.5%
THEREAFTER 1.0%
MONTHLY ADMINISTRATION FEE:
POLICY YEARS CURRENT GUARANTEED
1-10 $21 $21
THEREAFTER $6 $6
BASIC POLICY CHARGES AND FEES:
COST OF INSURANCE CHARGES. GUARANTEED MAXIMUM COST OF INSURANCE RATE PER
$1,000 OF NET AMOUNT AT RISK ARE SHOWN ON PAGE 4B.
SURRENDER CHARGES. SURRENDER CHARGES WILL APPLY IF THIS POLICY IS
SURRENDERED OR THE SPECIFIED AMOUNT IS REDUCED DURING THE SURRENDER CHARGE
PERIOD FOLLOWING THE DATE OF ISSUE. SURRENDER CHARGES WILL ALSO APPLY
DURING THE SURRENDER CHARGE PERIOD FOLLOWING AN INCREASE IN THE SPECIFIED
AMOUNT. SURRENDER CHARGES APPLICABLE TO THIS POLICY APPEAR ON PAGES 25 AND
26. FOR EACH PARTIAL SURRENDER THERE WILL BE AN ADDITIONAL CHARGE THAT
WILL BE THE LESSER OF 2% OF THE AMOUNT WITHDRAWN OR $25.00.
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DEATH BENEFIT CORRIDOR RATES
BASED ON CASH VALUE ACCUMULATION TEST
POLICY POLICY
YEAR RATE YEAR RATE
1 6.0982 36 1.6787
2 5.8637 37 1.6303
3 5.6385 38 1.5851
4 5.4220 39 1.5425
5 5.2140 40 1.5028
6 5.0142 41 1.4659
7 4.8222 42 1.4317
8 4.6378 43 1.4000
9 4.4607 44 1.3706
10 4.2906 45 1.3434
11 4.1272 46 1.3180
12 3.9703 47 1.2944
13 3.8197 48 1.2726
14 3.6751 49 1.2525
15 3.5363 50 1.2341
16 3.4031 51 1.2174
17 3.2753 52 1.2023
18 3.1527 53 1.1885
19 3.0351 54 1.1759
20 2.9225 55 1.1642
21 2.8146 56 1.1530
22 2.7113 57 1.1423
23 2.6125 58 1.1315
24 2.5179 59 1.1206
25 2.4276 60 1.1089
26 2.3412 61 1.0963
27 2.2588 62 1.0828
28 2.1803 63 1.0684
29 2.1054 64 1.0539
30 2.0342 65 1.0400
31 1.9666
32 1.9026
33 1.8418
34 1.7844
35 1.7301
The Death Benefit Corridor rates between Policy Anniversaries will be calculated
monthly by interpolating (straight line) between the Policy Year values shown
above.
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DEATH BENEFIT CORRIDOR RATES
BASED ON GUIDELINE PREMIUM TEST
ATTAINED ATTAINED
AGE OF AGE OF
YOUNGER YOUNGER
CONTINGENT CONTINGENT
INSURED RATE INSURED RATE
0-40 2.50 60 1.30
41 2.43 61 1.28
42 2.36 62 1.26
43 2.29 63 1.24
44 2.22 64 1.22
45 2.15 65 1.20
46 2.09 66 1.19
47 2.03 67 1.18
48 1.97 68 1.17
49 1.91 69 1.16
50 1.85 70 1.15
51 1.78 71 1.13
52 1.71 72 1.11
53 1.64 73 1.09
54 1.57 74 1.07
55 1.50 75-90 1.05
56 1.46 91 1.04
57 1.42 92 1.03
58 1.38 93 1.02
59 1.34 94 1.01
95+ 1.00
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TABLE OF GUARANTEED MONTHLY COST OF INSURANCE RATES
PER $1,000 OF NET AMOUNT AT RISK
POLICY POLICY
YEAR RATE YEAR RATE
1 0.0002 36 1.3248
2 0.0008 37 1.5889
3 0.0014 38 1.8500
4 0.0021 39 2.1893
5 0.0030 40 2.5869
6 0.0040 41 3.0365
7 0.0053 42 3.5386
8 0.0067 43 4.0905
9 0.0085 44 4.6870
10 0.0106 45 5.3370
11 0.0131 46 6.0583
12 0.0161 47 6.8656
13 0.0196 48 7.7784
14 0.0237 49 8.8077
15 0.0287 50 9.9390
16 0.0345 51 11.1494
17 0.0416 52 12.4146
18 0.0503 53 13.7194
19 0.0608 54 15.0353
20 0.0737 55 16.3716
21 0.0892 56 17.7404
22 0.1080 57 19.1597
23 0.1300 58 20.6702
24 0.1560 59 22.3307
25 0.1874 60 24.4047
26 0.2249 61 27.3233
27 0.2698 62 31.9219
28 0.3241 63 39.9364
29 0.3900 64 54.7941
30 0.4695 65 83.3333
31 0.5641
32 0.6744
33 0.8030
34 0.9511
35 1.1227
IF THIS POLICY HAS BEEN ISSUED IN A SPECIAL (RATED) PREMIUM CLASS, THE
GUARANTEED MONTHLY COST WILL BE CALCULATED USING THE RATES SHOWN ABOVE UNLESS A
FORMULA FOR ADJUSTING THE RATES APPEARS ON PAGE 3.
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INVESTMENT OBJECTIVES OF THE SEPARATE ACCOUNT PORTFOLIOS
A brief description of each Separate Account Portfolio's investment objective
follows. However, no investment allocation should be made without referring to
the appropriate prospectus which describes each Portfolio in detail.
AIM VARIABLE INSURANCE FUNDS
The AIM Variable Insurance Funds is an open-end investment management investment
company which will offer shares in two separate funds. AIM Advisors, Inc.
serves as the investment adviser for the two funds.
1. AIM V.I. INTERNATIONAL EQUITY FUND. The Fund seeks to provide long-term
growth of capital by investing in a diversified portfolio of international
equity securities, the issuers of which are considered by the Adviser to
have strong earnings momentum.
2. AIM V.I. VALUE FUND. The Fund seeks to achieve long-term growth of capital
by investing primarily in equity securities judged by the Adviser to be
undervalued relative to the current or projected earnings of the companies
issuing the securities, or relative to current market values of assets owned
by the companies issuing the securities or relative to the equity market
generally.
AMERICAN CENTURY VARIABLE PORTFOLIOS, INC.
The American Century Variable Portfolios, Inc. is an open-end investment
management company which will offer one separate fund. American Century
Investment Management, Inc. serves as the fund's investment adviser.
VIP VALUE FUND. This Fund seeks long-term capital growth. Income is a
secondary objective. In selecting stocks for VP Value, the Fund managers look
for stocks of companies that they believe are undervalued at the time of
purchase.
AYCO SERIES TRUST
The AYCO Series Trust is an open-end investment management company which will
offer shares in one separate fund. AYCO Asset Management serves as the
investment adviser for the fund.
THE AYCO LARGE CAP GROWTH FUND. The Fund seeks long-term growth of capital. In
seeking to achieve its objective, the Fund normally invests at least 65% of
total assets in common stocks of large capitalization companies, both foreign
and domestic, that Ayco Asset Management believes will provide superior long-
term investment results. For these purposes, large capitalization companies are
those with market capitalizations of $5 billion or more at the time of the
Fund's investment.
DREYFUS INVESTMENT PORTFOLIOS
The Dreyfus Investment Portfolios is an open-end investment management company
which will offer shares in one separate fund. The Dreyfus Corporation serves as
the investment adviser for the fund.
MIDCAP STOCK PORTFOLIO. The Portfolio seeks investment results that are greater
than the total return performance of publicly traded common stocks of medium-
size domestic companies in the aggregate, as represented by the Standard &
Poor's MidCap 400(R) Index ("S&P 400").
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DREYFUS VARIABLE INVESTMENT FUND
The Dreyfus Variable Investment Fund is an open-end investment management
company which will offer shares in two separate funds. The Dreyfus Corporation
serves as the investment adviser for each of the two funds.
1. QUALITY BOND PORTFOLIO. The Portfolio seeks to provide maximum amount
current income to the extent consistent with the preservation of capital and
the maintenance of liquidity. The Portfolio invests primarily in debt
obligations of corporations, the U.S. government and its agencies and
instrumentalities, and major U.S. banking institutions.
2. SMALL CAP PORTFOLIO. The Portfolio seeks to maximize capital appreciation.
The Portfolio seeks out companies that the Adviser believes have the
potential for significant growth. During periods the Adviser judges to be of
market strength, the Portfolio will act aggressively to increase
shareholders' capital by investing principally in common stocks of domestic
and foreign issuers.
FIDELITY VARIABLE INSURANCE PRODUCTS FUND
The Fidelity Variable Insurance Products Fund is an open-end investment
management company which will offer shares in four separate funds. Fidelity
Management & Research Company ("FMR") serves as the investment adviser of the
funds.
1. VIP ASSET MANAGER PORTFOLIO. The Portfolio seeks to obtain high total return
with reduced risk over the long term by allocating its assets among stocks,
bonds, and short-term instruments.
2. VIP CONTRAFUND PORTFOLIO. The Portfolio seeks long-term capital
appreciation.
3. VIP EQUITY-INCOME PORTFOLIO. The Portfolio seeks a reasonable income. The
Portfolio will also consider the potential for capital appreciation. The
Portfolio's goal is to achieve a yield which exceeds the composite yield on
the securities comprising the Standard & Poor's 500(R) Index ("S&P 500").
4. VIP GROWTH PORTFOLIO. The Portfolio seeks to achieve capital appreciation.
J. P. MORGAN SERIES TRUST II.
The J.P. Morgan Series Trust II is an open-end investment management company
which will offer shares in one separate fund. J.P. Morgan Investment Management
Inc. serves as the investment adviser for the fund.
J. P. MORGAN SMALL COMPANY PORTFOLIO. The Portfolio's goal is to provide high
total return from a portfolio of small company stocks. This goal can be changed
only with shareholder approval. The Portfolio invests primarily in small and
medium sized U.S. companies whose market capitalizations are greater than $100
million and less than $2 billion, typically represented by the Russell 2000
Index. The Portfolio can moderately underweight or overweight industries
against the Russell 2000 Index's industry weightings when it believes it will
benefit performance.
JANUS ASPEN SERIES
The Janus Aspen Series is an open-end investment management company which will
offer shares in three separate funds. Janus Capital serves as the investment
adviser for the three funds.
1. AGGRESSIVE GROWTH PORTFOLIO. The Aggressive Growth Portfolio seeks long-term
growth of capital. It pursues its objective by investing primarily in common
stocks selected for their growth potential, and
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Page 4C
normally invests at least 50% of its assets in medium-sized companies.
Medium-sized are those whose market capitalization falls within the range of
companies in the S&P 400. Market capitalization is a commonly used measure
of the size and value of a company. The market capitalizations within the
index will vary, but as of December 31, 1999, they ranged from approximately
$170 million to $37 billion.
2. INTERNATIONAL GROWTH PORTFOLIO. The International Growth Portfolio seeks
long-term growth of capital. Normally, the Portfolio pursues its objective
by investing at least 65% of its total assets in securities of issuers from
at least five different countries, excluding the United States. Although the
Portfolio intends to invest substantially all of its assets in issuers
located outside the United States, it may at times invest in U.S. issuers
and it may at times invest all of its assets in fewer than five countries or
even a single country.
3. WORLDWIDE GROWTH PORTFOLIO. This Portfolio seeks long-term growth of capital
in a manner consistent with the preservation of capital. It pursues its
objective by investing primarily in common stocks of companies of any size
throughout the world. The Portfolio normally invests in issuers from at
least five different countries, including the United States. The Portfolio
may at times invest in fewer than five countries or even a single country.
MASSACHUSETTS FINANCIAL SERVICES (MFS) VARIABLE INSURANCE TRUST
The MFS Variable Insurance Trust is an open-end investment management company
which will offer shares in four separate funds. Massachusetts Financial
Services Company serves as the investment adviser for the fund.
1. MFS EMERGING GROWTH SERIES. The Fund seeks to provide long-term growth of
capital. The Fund's policy is to invest at least 80 percent of its net
assets under normal circumstances in common stocks of companies that the
Adviser believes are early in their life cycle but which have the potential
to become major enterprises (emerging growth companies).
2. MFS RESEARCH SERIES. The Fund's investment objective is long-term growth of
capital and future income. The Fund's objective may be changed without
shareholder approval. The Fund invests, under normal market conditions, at
least 80% of its total assets in common stocks and related securities, such
as preferred stocks, convertible securities and depositary receipts.
3. MFS NEW DISCOVERY SERIES. The Fund's investment objective is capital
appreciation. The Fund's objective may be changed without shareholder
approval. Principal Investment Policies. The Fund invests, under normal
market conditions, at least 65% of its total assets in equity securities of
emerging growth companies.
4. MFS CAPITAL OPPORTUNITIES SERIES. The Fund's investment objective is capital
appreciation. The Fund's objective may be changed without shareholder
approval. The Fund invests, under normal market conditions, at least 65% of
its total assets in common stocks and related securities, such as preferred
stocks, convertible securities and depositary receipts for those securities.
NEUBERGER BERMAN ADVISERS MANAGEMENT TRUST
The Neuberger Berman Advisers Management Trust is an open-end investment
management company which will offer shares in one separate fund. Neuberger
Berman Management Inc. serves as the investment adviser for the fund.
MID-CAP GROWTH PORTFOLIO. The Portfolio seeks growth of capital. To pursue
this goal, the Portfolio invests mainly in common stocks of mid-capitalization
companies. The Portfolio seeks to reduce risk by diversifying among many
companies, industries and sectors.
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NORTH AMERICAN FUNDS VARIABLE PRODUCT SERIES I
(FORMERLY KNOWN AS AMERICAN GENERAL SERIES PORTFOLIO COMPANY)
The North American Funds Variable Product Series I is an open-end investment
management company which will offer shares in seven separate funds. The
Variable Annuity Life Insurance Company (VALIC) serves as the investment adviser
for the seven funds. T. Rowe Price serves as the investment sub-adviser for the
Science Technology Fund.
1. INTERNATIONAL EQUITIES FUND. The Fund seeks to provide long-term growth of
capital through investments primarily in a diversified portfolio of equity
and equity related securities of foreign issuers that, as a group, are
expected to provide investment results closely corresponding to the
performance of the Morgan Stanley Capital International, Europe, Australasia
and the Far East Index (the "EAFE Index").
2. MIDCAP INDEX FUND. The Fund seeks to provide growth of capital through
investments primarily in a diversified portfolio of common stocks that, as a
group, are expected to provide investment results closely corresponding to
the performance of the S&P MidCap 400.
3. MONEY MARKET FUND. The Fund seeks liquidity, protection of capital and
current income through investments in short term money market securities.
The Fund uses 95% of its assets to buy short-term securities that are rated
within the highest rating category for short-term debt obligations by at
least two nationally recognized rating services or unrated securities of
comparable investment quality.
4. NASDAQ-100 INDEX FUND. The Fund seeks long-term capital growth through
investment in the stocks that are included in the Nasdaq-100 Index. This
investment objective can be changed by the Board of Trustees, without the
approval of Fund's shareholders.
5. SCIENCE & TECHNOLOGY FUND. The Fund seeks long-term growth of capital
through investment primarily in the common stocks and equity-related
securities of companies that are expected to benefit from the development,
advancement and use of science and technology.
6. SMALL CAP INDEX FUND. The Fund seeks to provide growth of capital through
investment primarily in a diversified portfolio of common stocks that, as a
group, are expected to provide investment results closely corresponding to
the performance of the Russell 2000 Index.
7. STOCK INDEX. The Fund seeks long-term capital growth through investment in
common stocks. That, as a group, are expected to provide investment results
closely corresponding to the performance of the S&P 500.
PIMCO VARIABLE INSURANCE TRUST.
The PIMCO Variable Insurance Trust is an open-end investment management company
which will offer shares in three separate funds. Pacific Investment Management
Company ("PIMCO") serves as the investment adviser for each of the three funds.
1. PIMCO REAL RETURN BOND PORTFOLIO. This Portfolio seeks maximum real return,
consistent with preservation of real capital and prudent investment
management.
2. PIMCO SHORT-TERM PORTFOLIO. This Portfolio seeks maximum current income,
consistent with preservation of capital and daily liquidity.
3. PIMCO TOTAL RETURN PORTFOLIO. This Portfolio seeks maximum total return,
consistent with preservation of capital and prudent investment management.
99206N
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PUTNAM VARIABLE TRUST
The Putnam Variable Trust is an open-end investment management company which
will offer shares in three separate funds. Putnam Investment Management, Inc.
Serves as the investment adviser for each of the three funds.
1. PUTNAM VT DIVERSIFIED INCOME FUND. The Fund seeks high current income
consistent with capital preservation. The Fund pursues its investment
objective by allocating its investments among the following three sectors of
the fixed income securities markets: (a) a U.S. Government Sector consisting
primarily of debt obligations of the U.S. Government; (b) a High Yield
Sector consisting of high-yielding, lower-rated, higher-risk U.S. and
foreign fixed-income securities; and (c) an International Sector, consisting
of obligations of foreign governments
2. PUTNAM VT GROWTH AND INCOME FUND. The Fund seeks capital growth and current
income as its investment objectives. It invests primarily in common stocks
that offer potential for capital growth, current income or both.
3. PUTNAM VT INTERNATIONAL GROWTH AND INCOME FUND. The Fund seeks capital
growth. Current income is a secondary objective. The Fund will invest
primarily in common stocks that offer potential for capital growth, and may
invest in stocks that offer potential for current income.
SAFECO RESOURCE SERIES TRUST
The SAFECO Resource Series Trust is an open-end investment management company
which will offer shares in two separate funds. SAFECO Asset Management Company
serves as the investment adviser for each of the two funds.
1. EQUITY PORTFOLIO. The Portfolio seeks long term growth of capital and
reasonable current income. The Portfolio does not seek to achieve both
growth and income with every portfolio security investment. It attempts to
achieve a reasonable balance between growth and income on an overall basis.
2. GROWTH OPPORTUNITIES PORTFOLIO. The Portfolio seeks growth of capital and
the increased income that ordinarily follows from such growth. The Portfolio
ordinarily invests most of its assets in common stock selected for potential
appreciation.
THE UNIVERSAL INSTITUTIONAL FUNDS, INC.
(FORMERLY KNOWN AS MORGAN STANLEY DEAN WITTER UNIVERSAL FUNDS, INC.)
The Universal Institutional Funds, Inc. is an open-end investment management
company which will offer shares in two separate funds. Morgan Stanley Dean
Witter Asset Management Inc. is the investment adviser for the Equity Growth
Portfolio. Miller Anderson & Sherrerd is the investment adviser for the High
Yield Portfolio.
1. EQUITY GROWTH PORTFOLIO. The Portfolio seeks long-term capital appreciation
by investing primarily in common and preferred stocks, convertible
securities, rights and warrants to purchase common stocks, depository
receipts and other equity securities. Under normal circumstances, the
Portfolio will invest at least 65% of its total assets in equity securities.
99206N
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2. HIGH YIELD PORTFOLIO. The Portfolio seeks above average return over a market
cycle of three to five years by investing at least 65 percent of its total
assets in high yield securities of U.S. and foreign issuers including
corporate bonds and other fixed income securities.
VAN KAMPEN LIFE INVESTMENT TRUST
The Van Kampen Life Investment Trust is an open-end investment management
company which will offer shares in one separate fund. Van Kampen Asset
Management Inc. serves as the investment adviser for the fund.
STRATEGIC STOCK PORTFOLIO. The Portfolio seeks an above average total return
through a combination of potential capital appreciation and dividend income,
consistent with the preservation of invested capital. The Portfolio invests
primarily in dividend paying equity securities of companies included in the Dow
Jones Industrial Average or in the Morgan Stanley Capital International Index.
VANGUARD VARIABLE INSURANCE FUND
The Vanguard Variable Insurance Fund is an open-end investment management
company which will offer shares in two separate funds. Wellington Management
Company, LLP is the adviser for the High Yield Bond Portfolio and The Vanguard
Group is the adviser for the REIT Index Portfolio.
1. HIGH YIELD BOND PORTFOLIO. The Portfolio seeks to provide a high level of
income. The Portfolio invests primarily in a diversified group of high-
yielding, higher-risk corporate bonds with medium- and lower-range credit-
quality ratings, commonly known as "junk bonds."
2. REIT INDEX PORTFOLIO. The Portfolio seeks to provide a high level of income
and moderate long-term growth of capital. The Portfolio invests in stocks of
real estate investment trusts (REITs), which own office buildings, hotels,
shopping centers, and other properties.
WARBURG PINCUS TRUST
The Warburg Pincus Trust is an open-end investment management company which will
offer shares in one separate fund. Credit Suisse Asset Management, LLC serves
as the investment adviser for the fund.
SMALL COMPANY GROWTH PORTFOLIO. The Portfolio seeks capital growth. The
Portfolio invests in equity securities of small U.S. companies.
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CONTRACT. Your policy is a legal contract that You have entered into with Us.
You have paid the first premium and have submitted an application, a copy of
which is attached. In return, We promise to provide the insurance coverage
described in this policy.
The entire contract consists of:
1. The basic policy;
2. The riders that add benefits to the basic policy, if any;
3. Endorsements, if any; and
4. The attached copies of the applications, and any amendments or supplemental
applications.
DATE OF ISSUE. The Date of Issue of this policy is the date from which the
first policy charges are due. The Date of Issue is also the date from which all
policy years, anniversaries, and monthly deduction dates are determined.
OWNER. The Owner is as stated in the application unless later changed. During
the last surviving Contingent Insured's lifetime, the Owner may exercise every
right the policy confers or We allow (subject to the rights of any assignee of
record, and to any endorsement on this policy limiting such rights). You may
have multiple Owners of the policy. In that case, the authorizations of all
Owners are required for all policy changes except for transfers, premium
allocations and deduction allocations. We will accept the authorization of one
Owner for transfers and changes in premium and deduction allocations. The Owner
or Owners may be the same as one or both Contingent Insureds, but this is not
required. If an Owner dies while the policy is in force and a Contingent
Insured is living, ownership rights pass on to a successor owner, if any, or to
the estate of the Owner.
JOINT EQUAL AGE. This policy has been issued on the basis of a Joint Equal Age
which is determined from the individual age nearest birthday of each of the two
Contingent Insureds with an adjustment which is the function of:
1. The age of each Contingent Insured; and
2. The gender of each Contingent Insured; and
3. The premium class of each Contingent Insured.
The Joint Equal Age as of the Date of Issue is shown on the Policy Schedule.
The attained Joint Equal Age will increase by one year on each policy
anniversary. The attained Joint Equal Age will continue to increase after the
first death of a Contingent Insured.
LAST SURVIVING CONTINGENT INSURED. Payment of a death benefit under this policy
will be made upon the death of the last survivor of the Contingent Insureds
named on the Policy Schedule. As used in this policy, the terms "last
survivor," "second to die" or "second death" mean "last surviving Contingent
Insured."
NOTIFICATION OF FIRST DEATH. While Death Benefit Proceeds will be payable upon
the death of the second to die, We must receive proof of the death of both
Contingent Insureds before payment will be made. Therefore, it is important
that Written proof of the first death be furnished to the Company at the time of
such death.
PREMIUM PAYMENTS
All premiums after the first are payable in advance. Premium payments are
flexible. This means You may choose the amount and frequency of payments.
The actual amount and frequency of premium payments will affect the Accumulation
Value and the amount and duration of insurance. Please refer to the Policy
Values Provision for a detailed explanation.
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PLANNED PERIODIC PREMIUMS. The amount and frequency of the Planned Periodic
Premiums You selected are shown on the Policy Schedule. You may request a change
in the amount and frequency. We may limit the amount of any increase. (See
"Maximum Premium").
UNSCHEDULED ADDITIONAL PREMIUMS. You may pay additional premiums at any time
before the Maturity Date shown on the Policy Schedule. We may limit the number
and amount of additional premium if such additional premium would cause the sum
of premiums paid to exceed the guideline premium limitation as defined by
Section 7702, Internal Revenue Code of 1986 (or as later amended). We will not
accept an additional premium that would cause an immediate increase in the net
amount at risk until we receive evidence of insurability satisfactory to us.
(See "Maximum Premium" and Maximum Net Amount at Risk")
Maximum Premium. We reserve the right to refund any premium that would cause
this policy to fail to qualify as life insurance under the Death Benefit
Compliance Test selected, and under applicable tax laws. The test selected is
shown on the Policy Schedule.
MAXIMUM NET AMOUNT AT RISK. The Company may automatically effect a partial
surrender or reduce the Death Benefit, both of which may have federal tax
consequences, if the Net Amount at Risk exceeds Company limitations. Net Amount
at Risk is the excess of the Death Benefit over the Accumulation Value of the
policy.
PREMIUM EXPENSE CHARGE. The Premium Expense Charge is calculated by multiplying
the premium paid (after deduction of any state premium tax or other applicable
tax charges) by the Premium Expense Charge Percentage shown on the Policy
Schedule. Premium Expense Charge Percentages differ according to policy year.
NET PREMIUM. The term Net Premium as used in this policy means "The premium
paid, less any applicable state premium tax, or other applicable tax charges and
the Premium Expense Charge" except as follows: No Premium Expense Charge or
state premium tax will be deducted if the source of the premium is Cash
Surrender Values applied from another policy issued by the Company (We refer to
this as an internal rollover). Any changes to the premium tax charges must be
approved by the insurance official of the state in which this policy is
delivered.
ALLOCATION OF NET PREMIUMS. The initial allocation of Net Premiums is shown
in the application for this policy and will remain in effect until changed by
Written notice from the Owner. The percentage allocation for future Net Premiums
may be changed at any time by Written Notice.
The initial Net Premium will be allocated to the Money Market Division on the
later of the following dates:
1. The Date of Issue; or
2. The date all requirements needed to place the policy in force have been
satisfied, including underwriting approval and receipt in Our Administrative
Center of the necessary premium.
The initial Net Premium will remain in the Money Market Division until the first
Valuation Date following the 15th day after it was applied. Any additional
Net Premiums received prior to the first Valuation Date which follows the 15th
day after the initial Net Premium was applied will be allocated to the Money
Market Division until such Valuation Date. At that time, We will transfer the
Accumulation Value to the selected Investment Option(s). Each Net Premium
received after such Valuation Date will be applied directly to the elected
Investment Option(s) as of the Business Day received.
Changes in the allocation of Net Premiums will be effective on the date we
receive the Owner's notice. The allocation may be 100% to any available
Division or may be divided among these options in whole percentage points
totaling 100%. We reserve the right to limit the number of Divisions which You
may select.
WHERE TO PAY. You may make Your planned periodic premium payments to Us at the
address on the billing statement or to an authorized agent. The mailing address
for any premium payments not accompanied by a billing statement is shown in the
definition for Administrative Center. A receipt signed by an officer of the
Company will be furnished upon request.
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DEATH BENEFIT AND DEATH BENEFIT OPTIONS
DEATH BENEFIT PROCEEDS. If both Contingent Insureds die prior to the Maturity
Date and while this policy is in force, We will pay the Death Benefit Proceeds
to the Beneficiary. The Death Benefit Proceeds will be subject to:
1. The Death Benefit Option in effect on the date of the second death; and
2. Any increases or decreases made to the Specified Amount. The Initial
Specified Amount is shown on the Policy Schedule.
You can find guidelines for changing the Death Benefit Option or the Specified
Amount in the section entitled "Changing Your Insurance Policy."
Any premium received after the date of the second death will be refunded and
will not be included in the Accumulation Value for purposes of calculating the
Death Benefit Amount.
The Death Benefit Proceeds will be the Death Benefit Amount, after reversing any
premium received after the date of the second death, less any outstanding policy
loan and will be subject to the other provisions of the Beneficiary and Proceeds
section.
DEATH BENEFIT COMPLIANCE TEST. Death benefit compliance tests are used to
determine if a policy will qualify as life insurance under applicable tax laws.
We will automatically increase the Death Benefit of the Policy if necessary to
ensure that the Policy will continue to qualify as life insurance. There are
two compliance tests which may be used: The Guideline Premium Test and the Cash
Value Accumulation Test. The test which You selected when this Policy was
issued is shown on the Policy Schedule. You cannot change Your election of the
death benefit compliance test after the Date of Issue.
The Guideline Premium Test limits the amount of premiums paid under this Policy
at any time to a certain amount which depends on the Death Benefit and the age
and gender of the Contingent Insureds. Therefore, the maximum premiums you can
pay are generally more limited under this test than under the Cash Value
Accumulation Test.
The Cash Value Accumulation Test limits the Accumulation Value under this Policy
at any time to a certain amount which depends on the Death Benefit and the
insurance characteristics of the Contingent Insureds. Therefore, a substantial
Accumulation Value may cause an increase in the Policy's Death Benefit.
DEATH BENEFIT OPTION. The Death Benefit Option which You have chosen is shown
on the Policy Schedule as either Option 1 or Option 2.
OPTION 1. If You have chosen Option 1, the Death Benefit Amount will be the
greater of:
1. The Specified Amount on the date of the second death; or
2. The following amount calculated on the date of the second death:
a) The Accumulation Value; multiplied by
b) The applicable Death Benefit Corridor Rate.
OPTION 2. If You have chosen Option 2, the Death Benefit Amount will be the
greater of:
1. The Specified Amount plus the Accumulation Value on the date of the second
death; or
2. The following amount calculated on the date of the second death:
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a) The Accumulation Value; multiplied by
b) The applicable Death Benefit Corridor Rate.
Death Benefit Corridor Rates are shown in the table for the Death Benefit
Compliance Test which You selected.
SPECIFIED AMOUNT. The Specified Amount is shown on the Policy Schedule. It may
be increased or decreased as described in the Changing Your Insurance Policy
provision.
CHANGING YOUR INSURANCE POLICY
You may request a change in the Specified Amount or Death Benefit Option at any
time except that:
1. A decrease in the Specified Amount may not become effective prior to the end
of the first policy year; and
2. Increases in the Specified Amount will be considered only while both
Contingent Insureds are living.
Your request must be submitted to Our Administrative Center In Writing.
INCREASING THE SPECIFIED AMOUNT. You may apply for an increase in Specified
Amount by submitting for each Contingent Insured:
1. A supplemental application; and
2. Evidence of insurability satisfactory to Us.
An increase will be effective on the Monthly Deduction Day on or next following
the date the applications for increase are approved by Us. The effective date
will appear in an endorsement to this policy.
DECREASING THE SPECIFIED AMOUNT. Any decrease will go into effect on the
Monthly Deduction Day following the Business Day We receive the request. The
Death Benefit Amount remaining in effect after any decrease cannot be less than
the greater of:
1. The Minimum Death Benefit Amount shown on the Policy Schedule; and
2. Any Death Benefit Amount required to qualify this policy as life insurance
under applicable tax laws.
Any such decrease will be applied proportionately against the Specified Amount
provided under the original application and any Specified Amount increases.
Any reduction in Specified Amount will be subject to any applicable surrender
charges on a pro-rata basis with the Surrender Charge prior to the reduction in
Specified Amount being reduced proportionately. However, if such charge is
greater than the Accumulation Value, the Specified Amount decrease will not be
allowed.
CHANGING THE DEATH BENEFIT OPTION. You may request a change in the Death
Benefit Option You have chosen.
1. If You request a change from Option 1 to Option 2: The new Specified Amount
will be the Specified Amount, prior to change, less the Accumulation Value
as of the effective date of the change, but not less than zero. The change
will go into effect on the Monthly Deduction Day following the date We
receive Your request for change.
2. If You request a change from Option 2 to Option 1: The new Specified Amount
will be the Death Benefit Amount as of the effective date of the change. The
change will go into effect on the Monthly Deduction Day following the date
We receive Your request for change.
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CHANGING THE TERMS OF YOUR POLICY. Any change in Your policy must be approved
by one of Our senior officers. No agent has the authority to make any changes
or waive any of the terms of Your policy.
SEPARATE ACCOUNT PROVISIONS
SEPARATE ACCOUNT. Separate Account USL VL-R is a segregated investment account
established by the Company under New York law to separate the assets funding the
variable benefits for the class of policies to which this policy belongs from
the other assets of the Company. That portion of the assets of the Separate
Account equal to the reserves and other policy liabilities with respect to the
Separate Account shall not be chargeable with liabilities arising out of any
other business We may conduct. Income, gains and losses, whether or not
realized from assets allocable to the Separate Account, are credited to or
charged against such Account without regard to Our other income, gains or
losses.
INVESTMENTS OF THE SEPARATE ACCOUNT. The Separate Account is segmented into
Divisions. Each Division invests in a single Investment Option. Net Premiums
will be applied to the Separate Account and allocated to one or more Divisions.
A brief description of each Division will be found starting on page X. The
assets of the Separate Account are invested in the Investment Option(s) listed
on the application for this policy. From time to time, We may add additional
Divisions. We may also discontinue offering one or more Divisions as provided
in the Rights Reserved by Us provision. You may make a change in investment
selections by filing a Written change form with Our Administrative Center. You
may make transfers to the additional Divisions subject to the rules stated in
the Transfer Provision section and any new rules or limitations which may apply
to such additional Divisions.
If shares of any of the Investment Options become unavailable for investment by
the Separate Account, or the Company's Board of Directors deems further
investment in these shares is inappropriate, the Company may limit further
investment in the shares or may substitute shares of another Investment Option
for shares already purchased under this policy as provided in the Rights
Reserved by Us provision.
VALUATION OF ASSETS. The assets of the Separate Account are valued as of each
Valuation Date at their fair market value in accordance with Our established
procedures. The Separate Account Value as of any Valuation Date prior to the
Maturity Date is the sum of Your account values in each Division of the Separate
Account as of that date.
VALUATION UNITS. In order to determine policy values in the Divisions, We use
Valuation Units which are calculated separately for each Division. The
Valuation Unit value for each Division will vary to reflect the investment
experience of the applicable Investment Option. The Valuation Unit for a
Division will be determined on each Valuation Date for the Division by
multiplying the Valuation Unit value for the Division on the preceding Valuation
Date by the Net Investment Factor for that Division for the current Valuation
Date.
NET INVESTMENT FACTOR. The Net Investment Factor for each Division is
determined by dividing (1) by (2) and subtracting (3), where:
1. Is the net asset value per share of the applicable Investment Option as of
the current Valuation Date (plus any per share amount of any dividend or
capital gains distribution paid by the Investment Option since the last
Valuation Date); and
2. Is the net asset value per share of the shares held in the Division as
determined as of the previous Valuation Date; and
3. Is a factor representing the Mortality and Expense Charge.
The net asset value of an Investment Option's shares held in each Division shall
be the value reported to Us by that Investment Option.
VALUATION DATES. Valuation of the various Divisions will occur on each Business
Day during each month. If the underlying Investment Option is unable to value
or determine the Division's investment in an Investment Option due to any of the
reasons stated in the Suspension and Deferral of Payments Provision, the
Valuation
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Date for the Division with respect to the unvalued portion shall be the first
Business Day that the assets can be valued or determined.
BUSINESS DAY. A Business Day is each day during which the New York Stock
Exchange is open for business. We will treat any information or Written
communications We receive after the close of a Business Day to have been
received as of the next Business Day. For the purpose of collecting daily
charges, a Business Day immediately preceded by one or more non-business
calendar days will include those non-business days as a part of that Business
Day. For example, a Business Day which falls on a Monday will consist of a
Monday and the immediately preceding Saturday and Sunday.
MINIMUM BALANCE. The minimum value that may be retained in a Division after a
partial surrender or transfer is shown on the Policy Schedule. If a partial
surrender causes the balance in any Division to drop below such minimum amount,
the Company reserves the right to transfer the remaining balance to the Money
Market Division. If a transfer causes the balance in any Division to drop below
the minimum amount, the Company reserves the right to transfer the remaining
balance in proportion to the transfer request.
CHANGE OF INVESTMENT ADVISOR OR INVESTMENT OBJECTIVE. Unless otherwise
required by law or regulation, the investment advisor or any investment
objective may not be changed without Our consent. If required, approval of or
change of any investment objective will be filed with the Insurance Department
of the state where the policy is being delivered.
RIGHTS RESERVED BY US. Upon notice to You, this policy may be modified by Us,
but only if such modification is necessary to:
1. Operate the Separate Account in any form permitted under the Investment
Company Act of 1940 or in any other form permitted by law;
2. Transfer any assets in any Division to another Division, or to one or more
other separate accounts;
3. Add, combine or remove Divisions in the Separate Account, or combine the
Separate Account with another separate account;
4. Make any new Division available to You on a basis to be determined by Us;
5. Substitute for the shares held by any Division the shares of another
Division or the shares of another investment company or any other investment
permitted by law;
6. Make any changes as required by the Internal Revenue Code, or by any other
applicable law, regulation or interpretation in order to continue treatment
of this policy as life insurance;
7. Make any changes required to comply with the requirements of any underlying
Investment Option; or
8. Make other changes in this policy that in Our judgement are necessary or
appropriate to ensure that this policy continues to qualify for tax
treatment as life insurance, or that do not reduce any Cash Surrender Value,
Death Benefit Amount, Accumulation Value or other accrued right or benefit.
When required by law, We will obtain Your approval of changes and We will gain
approval from any appropriate regulatory authority.
RIGHT TO CONVERT IN THE EVENT OF A MATERIAL CHANGE IN INVESTMENT POLICY. In the
event there is a material change in the investment policy of the Separate
Account which has been approved by the Superintendent of the New York Department
of Insurance, and You object to such change, You shall have the option to
convert, without evidence of insurability, to a general account fixed benefit
life insurance policy within 60 days after the later of: (1) the effective date
of such change in investment policy; or (2) the receipt of the notice of the
options available.
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GENERAL ACCOUNT
The General Account is a fixed account within Our general assets which We have
established for:
1. Any amounts transferred from the Divisions as a result of a loan; or
2. Any amounts the Owner allocated to such Account.
The guaranteed interest rate, compounded annually, used in calculating
Accumulation Values of amounts allocated to the General Account is shown on the
Policy Schedule and is not based on the investment experience of any Division of
the Separate Account. We can use interest rates greater than the guaranteed
rates to calculate Accumulation Values of amounts allocated to the General
Account. Once interest greater than 4.0% has been credited to the Accumulation
Value, it becomes non-forfeitable. We may apply a different rate of interest to
that portion of the Accumulation Value which equals the amount of the policy
loan. However, the annual rate applied will never be less than 4.0%.
POLICY VALUES PROVISION
ACCUMULATION VALUE. The Accumulation Value of Your policy is the total of all
values in the Divisions of the Separate Account and in the General Account.
The Accumulation Value reflects:
1. Net Premiums paid;
2. Monthly deductions;
3. The investment experience of the Divisions selected less the Mortality and
Expense Charge;
4. Amounts allocated to the General Account, including interest earned on
amounts in the General Account;
5. Deductions due to partial surrenders and any charges for partial surrenders;
and
6. Deductions, if any, resulting from decreases in Specified Amount.
Net premiums are allocated, in accordance with Your instructions, to the General
Account or allocated to the selected Divisions of the Separate Account and
converted to Valuation Units.
On each Monthly Deduction Day, a Monthly Deduction will be made by reducing the
unloaned portion of the General Account or redeeming Valuation Units from each
applicable Division in the same ratio as the allocation of policy deductions in
effect on the Monthly Deduction Day.
If the unloaned portion of the General Account or the balance in any Division of
the Separate Account is insufficient to make a Monthly Deduction in this
manner, We will cancel Valuation Units from each applicable Division and reduce
the unloaned portion of the General Account in the same ratio the Monthly
Deduction bears to the unloaned Accumulation Value of Your policy.
The Accumulation Value in any Division is determined by multiplying the value of
a Valuation Unit by the number of Valuation Units held under the policy in that
Division.
The value of the Valuation Units equal to the amount being borrowed from the
Separate Account will be transferred to the General Account as of the Business
Day that the loan request is received In Writing.
Valuation Units are surrendered to reflect a partial surrender as of the
Business Day that the request for partial surrender is received In Writing.
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ON THE DATE OF ISSUE. The Accumulation Value on the Date of Issue is:
1. The Net Premium received; less
2. The Monthly Deduction for the first policy month. (See "How We Calculate a
Monthly Deduction.")
The first deduction day is the Date of Issue. The Monthly Deduction Day is shown
on the Policy Schedule.
ON EACH MONTHLY DEDUCTION DAY. On each Monthly Deduction Day after the Date of
Issue, We will determine the Accumulation Value as follows:
1. We will take the Accumulation Value as of the last Monthly Deduction Day;
2. Add the interest earned for the month on the excess of the General Account
value on the last Monthly Deduction Day over any partial surrenders and
transfers made from the General Account since the last Monthly Deduction
Day;
3. Add all Net Premiums received since the last Monthly Deduction Day;
4. Add any investment gain (or subtract any investment loss) on the Divisions
of the Separate Account since the last Monthly Deduction Day as measured by
the change in the value of the Valuation Units;
5. Subtract any partial surrender made and any charges for partial surrenders
since the last Monthly Deduction Day; and
6. Subtract the Monthly Deduction for the policy month following the Monthly
Deduction Day. (See "How We Calculate a Monthly Deduction.")
ON ANY VALUATION DATE OTHER THAN A MONTHLY DEDUCTION DAY. The Accumulation
Value on any Valuation Date other than a Monthly Deduction Day will be the sum
of:
1. The value of the General Account as of the last Monthly Deduction Day;
2. Less any partial surrenders and any charges for partial surrenders since the
last Monthly Deduction Day;
3. Plus all Net Premiums received since the last Monthly Deduction Day; and
4. Plus the sum of the values of the Divisions of the Separate Account as of
the last Monthly Deduction Day, plus the amount of any investment gain (or
minus any investment loss) on the Divisions since the last Monthly Deduction
Day as measured by the change in the value of the Valuation Units.
CASH VALUE. The Cash Value of this policy will be equal to the Accumulation
Value less the Surrender Charge, if any.
CASH SURRENDER VALUE. The Cash Surrender Value of this policy will be equal to
the Cash Value less any indebtedness.
MONTHLY DEDUCTIONS MAY BE MADE ONLY IF THERE IS SUFFICIENT CASH SURRENDER VALUE
(UNLESS THE POLICY IS BEING CONTINUED UNDER THE GUARANTEED MINIMUM DEATH BENEFIT
PROVISION). Unless this policy is being continued in force under the
"Guaranteed Minimum Death Benefit" provision, a Monthly Deduction from the
Accumulation Value may be made only if the Cash Surrender Value is equal to or
greater than the Monthly Deduction. The Accumulation Value will be reduced by
the amount of each Monthly Deduction which will cause an equal reduction in the
Cash Surrender Value. If the Cash Surrender Value on a Monthly Deduction Day is
not sufficient to meet the Monthly Deduction for the current month, this policy
will be subject to the "Grace Period" and "Guaranteed Minimum Death Benefit"
provisions.
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SURRENDER CHARGES. Surrender Charges will apply if this policy is surrendered
or the Specified Amount is surrendered or reduced during the Surrender Charge
Period. Surrender Charges for any increases in Specified Amount will apply if
such increases are surrendered or reduced during the Surrender Charge Period of
each increase. Surrender Charges will vary according to the Joint Equal Age at
issue as shown in the Table of Surrender Charges per $1,000 of Specified Amount.
You may make a request for surrender or decrease in the Specified Amount at any
time during the last surviving Contingent Insured's lifetime before the Maturity
Date except that a decrease in the Specified Amount may not become effective
prior to the end of the first policy year.
The amount being surrendered or decreased will take affect on the Valuation Date
on or next following the date We receive a Written request for surrender or
decrease.
HOW WE CALCULATE A MONTHLY DEDUCTION. Each Monthly Deduction includes:
1. The cost of insurance provided by the basic policy;
2. The cost of insurance for benefits provided by riders, if any; and
3. The Monthly Administration Fee.
HOW WE CALCULATE THE COST OF INSURANCE FOR THE BASIC POLICY. We calculate the
cost of insurance at the beginning of each policy month on the Monthly Deduction
Day. The cost of insurance is determined as follows:
1. Reduce the Death Benefit Amount by the amount of Accumulation Value on the
Monthly Deduction Day before the cost of insurance deduction is taken, and
after the Monthly Administration Fee is deducted;
2. Multiply the difference by the cost of insurance rate per $1,000 of net risk
amount as provided in the "Cost of Insurance Rate" provision; and
3. Divide the result by 1,000.
COST OF INSURANCE FOR BENEFITS PROVIDED BY RIDERS. The cost of insurance for
benefits provided by riders, if any, will be as stated on the Policy Schedule or
in an endorsement to this policy.
MONTHLY ADMINISTRATION FEE. An administration fee will be deducted monthly. The
amount of the monthly fee may be adjusted, but will never be greater than the
amount shown on the Policy Schedule.
COST OF INSURANCE RATE. The cost of insurance rate for the Initial Specified
Amount, and for each Specified Amount increase, is based on each Contingent
Insured's:
1. Gender;
2. Age nearest birthday on each policy anniversary; and
3. Premium class associated with the Initial Specified Amount and each increase
in the Specified Amount. The premium class is shown on the Policy Schedule.
A portion of the cost of insurance rate is used to recover acquisition costs
associated with issuing the policy. Such acquisition costs are higher in the
early policy years.
A table of guaranteed monthly cost of insurance rates is included in this
policy. We can use cost of insurance rates that are lower than the guaranteed
rates. Any change in rates will apply to all policies in the same rate class as
this policy. The rate class of this policy is determined on its Date of Issue
according to:
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1. The calendar year of issue and policy year;
2. The plan of insurance;
3. The amount of insurance; and
4. The age, gender and premium class of each Contingent Insured.
CHANGES IN RATES, CHARGES AND FEES. This policy does not participate in Our
profits or surplus. Any redetermination of the cost of insurance rates, interest
rates, mortality and expense charges, Monthly Administration Fee or percentage
of premium charges will be based on Our expectations as to investment earnings,
mortality, persistency and expenses. (including but not limited to, reinsurance
costs and applicable tax charges.) Such changes in policy cost factors will be
determined in accordance with procedures and standards on file with the
Insurance Department and will be determined at least every five years. We will
not change these charges in order to recoup any prior losses.
TAX CHARGE. We reserve the right to impose additional charges or to establish
reserves for any federal or local taxes that may be incurred by Us, and that may
be deemed attributable to this policy. Any increase in the Tax Charge must be
approved by the Superintendent of Insurance.
GRACE PERIOD. If the Cash Surrender Value on a Monthly Deduction Day is not
enough to meet the Monthly Deduction for the current month, this policy will
remain in force during the 61-day period that follows. If the Cash Surrender
Value on a policy anniversary is not enough to pay any loan interest due, this
policy will remain in force during the 61-day period that follows. Such 61-day
period is referred to in this policy as the "Grace Period." There is no Grace
Period for the initial Monthly Deduction.
If the amount We require to keep Your policy in force is not paid by the end of
the Grace Period, this policy will terminate without value. However, We will
give You at least 31 days notice prior to termination that Your policy is in the
Grace Period and advise You of the amount required to keep Your policy in force.
Such notice will be sent to You at Your last known address, and to the assignee
of record, if any. If the last surviving Contingent Insured dies during the
Grace Period, Monthly Deductions through the policy month in which the death
occurred will be deducted from the proceeds.
If a surrender request is received within 31 days after the Grace Period
commences, the Cash Surrender Value payable will not be less than the Cash
Surrender Value on the Monthly Deduction Day the Grace Period commenced adjusted
for subsequent loans and partial surrenders. The Monthly Deduction for the
policy month following such Monthly Deduction Day will not be subtracted in the
calculation of such Cash Surrender Value.
GUARANTEED MINIMUM DEATH BENEFIT. A Guaranteed Minimum Death Benefit (GMDB)
monthly premium is shown on the Policy Schedule. The Option 1 death benefit
will remain payable while the GMDB is in force if, on each Monthly Deduction
Day:
1. The sum of premiums paid less any policy loans, is greater than:
2. The sum of monthly GMDB premiums accumulated from the Date of Issue
(including the monthly GMDB premium for the current month).
It is important to note that the benefit provided is the Option 1 death benefit,
even if Your policy's Cash Surrender Value has declined to zero, and even if You
have selected Option 2 as the death benefit for Your policy. The GMDB is a
minimum death benefit payable in lieu of (and not in addition to) benefits
otherwise payable under this policy.
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The GMDB premium shown on the Policy Schedule is for the Initial Specified
Amount and any benefit riders in force on the Date of Issue. If the Specified
Amount is increased, or if a benefit rider is added or increased, a new GMDB
premium will be calculated. If a benefit rider providing term life insurance
coverage is removed or decreased, a new GMDB premium will be calculated. If any
other benefit rider is removed or decreased, no change will be made in the GMDB
premium. If a decrease in the Specified Amount is requested by the Owner the
GMDB will terminate.
If the policy lapses and is later reinstated, the GMDB will not be reinstated.
SUSPENSION OR TERMINATION OF THE GMDB. You will not permanently lose the GMDB
when premium payments fall below the required premium amount, as long as the
policy remains in force. Your payment of sufficient premiums to pass the GMDB
test will restore the GMDB.
The GMDB will terminate if:
1. The policy terminates;
2. The Specified Amount is decreased at the request of the Owner;
3. A change is made in the Death Benefit Option; or
4. A partial surrender is made.
FULL SURRENDER. Subject to the Beneficiary and Proceeds section, You may return
Your policy to Us and request its Cash Surrender Value at any time during the
last surviving Contingent Insured's lifetime before the Maturity Date. The Cash
Surrender Value will be determined as of the Business Day the policy and the
Written request for surrender are received In Writing. If surrender takes place
within 31 days after a policy anniversary, the Cash Surrender Value will not be
less than on that anniversary. The Company may delay payment if the Suspension
and Deferral of Payments Provision is in effect.
PARTIAL SURRENDER. At any time after the first policy year, You may request a
portion of the Cash Surrender Value of the policy. Your request must be made In
Writing during the last surviving Contingent Insured's lifetime before the
Maturity Date. The minimum partial surrender is shown on the Policy Schedule.
Valuation Units are surrendered to reflect a partial surrender as of the
Business Day We receive the Written request for partial surrender.
A partial surrender will result in a reduction of the Cash Value, Accumulation
Value and the Death Benefit Amount. The Cash and Accumulation Values will be
reduced by the amount of the partial surrender. The reduced Death Benefit Amount
will be determined in accordance with the Death Benefit Option provision. If
Your Death Benefit Option is Option 1, the Specified Amount will be reduced by
the amount of the partial surrender. (The reduced amount will not be less than
$25,000.) The Death Benefit Amount remaining after this reduction must be no
less than the Minimum Death Benefit Amount after a Decrease in Specified Amount
shown on the Policy Schedule.
A partial surrender will result in the cancellation of Valuation Units from each
applicable Division and a reduction of the unloaned portion of the General
Account in the same ratio as the allocation of policy deductions in effect on
the date of each partial surrender. If the number of Valuation Units in any
Division or in the unloaned portion of the General Account is insufficient to
make a partial surrender in this manner, We will cancel Valuation Units from
each applicable Division and reduce the unloaned portion of the General Account
in the ratio the partial surrender request bears to the Cash Surrender Value of
Your policy. You must state In Writing in advance how partial surrenders should
be made if other than this method is to be used.
In addition to the amounts shown in the Table of Surrender Charges, there will
be a charge for each partial surrender not to exceed the lesser of 2% of the
amount withdrawn or $25.
The Company may delay payment if the Suspension and Deferral of Payments
Provision is in effect.
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PERIOD OF INSURANCE COVERAGE IF AMOUNT OR FREQUENCY OF PREMIUM PAYMENTS IS
REDUCED OR IF PREMIUM PAYMENTS ARE DISCONTINUED. If You reduce the amount or
frequency of premium payments, or if You discontinue payment of premiums, We
will continue making Monthly Deductions (as long as there is sufficient Cash
Surrender Value to make such deductions) until the Maturity Date. This policy
will remain in force until the earliest of the following dates:
1. The Maturity Date (if there is sufficient Cash Surrender Value to make
Monthly Deductions to that date);
2. Surrender of the policy;
3. The end of the Grace Period; or
4. Death of the last surviving Contingent Insured.
TRANSFER PROVISION
TRANSFER OF ACCUMULATION VALUE. Transfers will be made as of the Business Day
We receive the Written transfer request, subject to the restrictions that
follow. If You elect to use the transfer privilege, We will not be liable for a
transfer made in accordance with Your instructions. We may not unilaterally
terminate or discontinue the transfer privilege. However, we reserve the right
to charge a $25 fee for each transfer in excess of 12 in a policy year. Any
such charge will be administered in a nondiscriminatory manner. Transfers under
the Dollar Cost Averaging or Automatic Rebalancing programs will not count
toward the 12 free transfers.
TRANSFER OF ACCUMULATION VALUE (SEPARATE ACCOUNT). You may transfer all or part
of Your interest in a Division of the Separate Account subject to the following:
1. The minimum amount which may be transferred is $500.
2. If the entire amount in a Division of the Separate Account is not being
transferred, the minimum which must remain is $500.
Transfers between Separate Account Divisions result in the redemption of
Valuation Units in one Division and the purchase of Valuation Units in the
Division to which the transfer is made. We will not honor Your request for a
transfer if the Separate Account is unable to purchase shares of an Investment
Option for any reason.
TRANSFER OF ACCUMULATION VALUE (GENERAL ACCOUNT). A transfer from the General
Account to a Division of the Separate Account may be made during the 60 day
period following each policy anniversary. The amount that may be transferred
will be the greatest of the following amounts:
1. Twenty-five percent (25%) of the unloaned portion of the General Account as
of the policy anniversary;
2. The total dollar amount withdrawn from the General Account during the prior
policy year (whether the amount withdrawn was a partial surrender for cash
or was being transferred to the Separate Account);
3. $500.
DOLLAR COST AVERAGING. Dollar Cost Averaging (DCA) is an automatic transfer of
funds made periodically prior to the Maturity Date in accordance with
instructions from the Owner. Transfers will be made in accordance with the
Transfer provisions, except as provided below:
1. DCA transfers may be made:
(a) On any day of the month except the 29th, 30th or 31st;
(b) On a monthly, quarterly, semi-annual or annual basis; and
(c) From the Money Market Division to one or more of the other Separate
Account Divisions.
2. DCA may be elected only if the Accumulation Value at the time of election is
$5,000 or more.
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3. The minimum amount of each DCA transfer is $100, or the remaining amount in
the Money Market Division, if less.
4. DCA may not begin prior to the first Valuation Date following the 15th day
after the initial Net Premium is applied.
5. DCA will end when there is no longer any value in the Money Market Division,
or when You request that DCA end.
6. Amounts applied to the Money Market Division while DCA is active will be
available for future dollar cost averaging in accordance with the current
DCA request.
7. There is no charge for DCA.
8. DCA is not available if Automatic Rebalancing is active.
AUTOMATIC REBALANCING. Automatic Rebalancing occurs when funds are transferred
by the Company between the Separate Account Divisions so that the values in each
Division match the premium allocation percentages then in effect. You may choose
Automatic Rebalancing on a quarterly, semi-annual or annual basis if your
Accumulation Value is $5,000 or more. The date Automatic Rebalancing occurs will
be based on the Date of Issue of Your policy. For example, if Your policy is
dated January 17, and You have requested Automatic Rebalancing on a quarterly
basis, Automatic Rebalancing will start on April 17, and will occur quarterly
thereafter. After Automatic Rebalancing is elected, it will continue until We
are notified In Writing that it is to be discontinued. There is no charge for
Automatic Rebalancing. Automatic Rebalancing is not available if DCA is active.
SUSPENSION AND DEFERRAL OF PAYMENTS PROVISION
We reserve the right to defer payment of any Death Benefit Amount, loan or other
distribution that comes from that portion of Your Accumulation Value that is
allocated to Separate Account USL VL-R, if:
1. The New York Stock Exchange is closed other than customary weekend and
holiday closings, or trading on the New York Stock Exchange is restricted;
2. An emergency exists, as a result of which disposal of securities is not
reasonably practicable or it is not reasonably practicable to fairly
determine the Accumulation Value; or
3. The U.S. Securities and Exchange Commission by order permits the delay for
the protection of Owners.
As to amounts allocated to the General Account, We may defer payment of any Cash
Surrender Value withdrawal or loan amount for up to six months, or the period
allowed by law, whichever is less, after We receive the request In Writing. If
payment is deferred for more than 30 days We will pay interest at an annual
effective rate of not less than 3% per year from the date of the request.
Written notice of both the imposition and termination of any such suspension
will be given to the Owners, assignees of record and any irrevocable
Beneficiaries.
Payments which were due to have been made and which were deferred following the
suspension of the calculation of the Cash Surrender Value will be made within
thirty (30) days following the lifting of the suspension, and will be calculated
based on the Valuation Date which immediately follows termination of the
suspension.
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POLICY LOANS
You should consult Your tax advisor before You obtain a Policy Loan.
You may borrow from Us at any time while this policy is in force, an amount
which is equal to or less than the policy loan value. The policy loan value
will be the Cash Surrender Value, less interest on the amount to be borrowed
(including interest on any prior outstanding policy loan) to the next policy
anniversary.
The value of Valuation Units equal to the amount You borrow from the Separate
Account will be transferred to the General Account as of the Business Day that
We receive Your Written loan request.
OBTAINING A LOAN. You may obtain a policy loan by Written request and
assignment of the policy as sole security for the loan. The Company may delay
processing the loan requested if the Suspension and Deferral of Payments
Provision is in effect.
EFFECT OF A LOAN. When a loan is made, an amount equal to the amount being
borrowed from the Separate Account will be transferred to the General Account.
A loan will result in cancellation of units from each applicable Division and
reduction of the unloaned portion of the General Account according to the
allocation of policy deductions then in effect. The resulting amount will be
added to the loaned portion of the General Account. If the number of Valuation
Units in any Division or unloaned portion of the General Account is insufficient
for a loan to be made in this manner, We will cancel Valuation Units from each
applicable Division and reduce the unloaned portion of the General Account in
the same ratio the loan bears to the unloaned Accumulation Value of Your policy.
You must state In Writing in advance which Division units are to be canceled if
a different method is to be used.
Repayment of a loan will first be allocated to the General Account until You
have repaid any loaned amounts that were allocated to the General Account. You
may tell Us how to allocate repayments above that amount. If You do not tell
Us, an amount equal to the loan repayment will be transferred from the General
Account to the Divisions in the same ratio currently in effect for the
allocation of Net Premiums.
A loan, whether or not repaid, will have a permanent effect on the Cash
Surrender Values and on the death benefits. If not repaid, any indebtedness
will reduce the amount of Death Benefit Proceeds and the amount available upon
surrender of the policy.
LOAN INTEREST. Loan interest will accrue daily at an annual effective rate of
4.31% during the first 10 policy years, and 4.08% thereafter payable in advance.
(This is equivalent to an annual effective rate of 4.50% during the first 10
policy years and 4.25% thereafter paid in arrears.) On each policy anniversary,
loan interest for the next year is due in advance. Unpaid loan interest will be
deducted from the various accounts according to the Allocation of Policy
Deductions then in effect, and added to the loaned portion of the General
Account.
If the number of Valuation Units in any Division or unloaned portion of the
General Account is insufficient to deduct unpaid loan interest in this manner,
We will cancel Valuation Units from each applicable Division and reduce the
unloaned portion of the General Account in the same ratio the unpaid loan
interest bears to the unloaned Accumulation Value of Your policy. We will
credit interest monthly on the loaned portion of the General Account at an
annual effective rate of 4.0%.
PREFERRED LOANS. A "Preferred Loan" is a policy loan that is made at a net cost
to the Owner that is less than the net cost of other policy loans. Starting on
the tenth policy anniversary, this policy will be eligible for "Preferred Loans"
subject to the following guidelines:
1. The maximum amount eligible for Preferred Loans during a policy year is
restricted to the lesser of the following values on the first day of such
policy year:
a) The policy loan value; or
b) 10% of the Accumulation Value.
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2. When a Preferred Loan is made, interest to the next policy anniversary will
be charged at the rate shown in the Loan Interest provision.
3. Interest credited to the amount of the Accumulation Value offset by a
Preferred Loan:
a) Will be an annual effective rate that is equal to or less than the
Policy Loan annual effective interest rate; and
b) Will be at a higher rate than the rate used to credit interest to values
offset by any other policy loan and will never be less than an annual
effective rate of 4.25%.
HOW YOU MAY REPAY A POLICY LOAN. You may repay all or part of a policy loan at
any time, except that;
1. Repayment may be made only while this policy is in force and prior to the
death of the last surviving Contingent Insured;
2. A partial repayment must be at least $10; and
3. At the time You repay all or part of a policy loan, You must specify the
payment is to repay all or part of the policy loan.
At any time Your policy loan exceeds the Cash Value, this policy will lapse.
However, at least 31 days prior notice must be mailed by Us to Your last known
address and to the assignee of record, if any.
WE CAN DELAY PAYMENT. We can delay lending You money for up to 6 months, or the
period allowed by law, whichever is less. However, We cannot delay lending You
money if the amount is to be used to pay a premium to Us.
BENEFICIARY AND PROCEEDS
BENEFICIARY. The Beneficiary, with respect to each Contingent Insured, will be
as named in the application, or later changed by the Owner. Unless the Owner
provides otherwise, upon the death of the last surviving Contingent Insured We
will pay proceeds in equal shares to the named Beneficiaries that survive such
Contingent Insured. Unless otherwise provided by the beneficiary designation,
proceeds will be paid as follows:
1. If any Beneficiary of the last surviving Contingent Insured dies while the
last surviving Contingent Insured is living, that Beneficiary's interest
will pass to any other Beneficiaries of the last surviving Contingent
Insured according to their respective interests.
2. If there is no Beneficiary upon the death of the last surviving Contingent
Insured (and there is no provision to the contrary), proceeds will be paid
in one sum to the Owner, if living; otherwise, proceeds will be paid to the
Owner's estate.
COMMON DISASTER. If We cannot determine whether a Beneficiary or the last
surviving Contingent Insured died first in a common disaster, We will assume
that the Beneficiary died first. We will pay proceeds on this basis unless an
endorsement to this policy provides otherwise.
SIMULTANEOUS DEATH OF CONTINGENT INSUREDS. If We are unable to determine to Our
satisfaction that one of the Contingent Insureds predeceased the other, it will
be assumed that the Contingent Insureds died simultaneously. Thereupon, one-
half of the Death Benefit Proceeds will be payable with respect to each of the
Contingent Insureds.
PROCEEDS. Proceeds means the amount payable on:
1. The Maturity Date;
2. Exercise of the full surrender benefit; or
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3. The death of the last surviving Contingent Insured.
The Proceeds on the Maturity Date will be the Cash Surrender Value. The
Proceeds on the last surviving Contingent Insured's death will be the Death
Benefit Amount less any outstanding policy loan.
All Proceeds and partial surrender benefits are subject to the provisions of the
Payment Options section and the other provisions of this policy.
CHANGE OF OWNERSHIP OR BENEFICIARY
You may change the Owner or the Beneficiary at any time prior to the death of
the last surviving Contingent Insured unless the previous designation provides
otherwise. To do so, send a Written request to Our Administrative Center. The
change will go into effect when We have recorded the change.
However, after the change is recorded, it will be deemed effective as of the
date of Your Written request for change. The change will be subject to any
payment made or action We take before the request is recorded.
PAYMENT OPTIONS
Instead of being paid in one sum, all or part of the proceeds may be applied
under any of the Payment Options described in this provision. In addition to
these options other methods of payment may be chosen with Our consent.
PAYMENT CONTRACT. When proceeds become payable under a Payment Option, a
Payment Contract will be issued to each payee. The Payment Contract will state
the rights and benefits of the payee. It will also name those who are to
receive any balance unpaid at the death of the payee.
ELECTION OF OPTIONS. The Owner may elect or change any Payment Option prior to
the death of the last surviving Contingent Insured, subject to the provisions of
this policy. This election or change must be In Writing.
Within 60 days after We receive Written notification of the last surviving
Contingent Insured's death, a payee entitled to proceeds in one sum may elect to
receive proceeds under any option.
OPTION 1. PAYMENTS FOR A SPECIFIED PERIOD: Equal monthly payments will be made
for a specified period. The Option 1 Table in this policy shows the monthly
income for each $1,000 of proceeds applied.
OPTION 2. PAYMENTS OF A SELECTED AMOUNT: Equal monthly payments of a selected
amount will be made. Each payment must be at least $60 a year for each $1,000
of proceeds applied. Payments will continue until the amount applied, with
interest, has been paid in full.
OPTION 3. MONTHLY PAYMENTS FOR LIFE: Equal monthly payments will be made for a
specified period, and will continue after that period for as long as the payee
lives. The specified period may be 10, 15 or 20 years.
The Option 3 Table in this policy shows the monthly income for each $1,000 of
proceeds applied. The tables are based on the 1983a Male or Female Tables
adjusted by projection scale G for 9 years, with interest at the rate of 3% per
year and a 2% load.
At the time payments are to begin under this option, the payee may choose one of
the following:
1. Monthly payments based on the Option 3 Table; or
2. Monthly payments equal to a monthly annuity based on Our single premium
immediate annuity rates then in use.
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OPTION 4. PROCEEDS LEFT AT INTEREST: Proceeds may be left on deposit with Us for
any period up to 30 years. Interest earned on the proceeds may be:
1. Left on deposit to accumulate at the rate of 3% compounded annually; or
2. Paid in installments at the rate for each $1,000 of proceeds of $30
annually, $14.89 semiannually, $7.42 quarterly or $2.47 monthly.
Upon the death of the payee, or at the end of the specified period, any balance
left on deposit will be paid in a lump sum or under Payment Options 1, 2 or 3.
INTEREST RATES. The guaranteed rate of interest for proceeds held under Payment
Options 1, 2, 3 and 4 is 3% compounded annually. We may credit interest at a
higher rate. Any higher rate will be determined by Us.
PAYMENTS. The first payment under Options 1, 2 and 3 will be made when the
claim for payment of proceeds has been approved. Payments after the first will
be made according to the manner of payment chosen. Interest under Option 4 will
be credited from the date We receive Written notification of death and paid or
added to the proceeds as provided in the Payment Contract.
AVAILABILITY OF OPTIONS. If the proposed payee is not a natural person, payment
options may be chosen only with Our consent.
If this policy is assigned, We will have the right to pay the assignee in one
sum the amount to which the assignee is entitled. Any balance will be applied
according to the option chosen.
The amount to be applied under any one option must be at least $2,000. The
payment elected under any one option must be at least $25. If the total policy
proceeds are less than $2,000, payment will be made in one lump sum.
EVIDENCE THAT PAYEE IS ALIVE. Before making any payment under a Payment Option,
We may ask for proof that the payee is alive. If We request proof, no payment
will be made or considered due until We receive proof.
DEATH OF A PAYEE. If a payee dies, any unpaid balance will be paid as stated in
the Payment Contract. If there is no surviving payee named in the Payment
Contract, We will pay the estate of the payee:
1. Under Options 1 and 3, the value, as of the date We receive Written
notification of death, of the remaining payments for the specified period
discounted at the rate of interest, compounded annually, that was used in
determining the amount of the monthly payment;
2. Under Options 2 and 4, the balance of any proceeds remaining unpaid with
accrued interest, if any.
WITHDRAWAL OF PROCEEDS UNDER OPTIONS 1 OR 2. If provided in the Payment
Contract, a payee will have the right to withdraw the entire unpaid balance
under Options 1 or 2. Under Option 1, the amount will be the value of the
remaining payments for the specified period discounted at the rate of interest
used in determining monthly income. Under Option 2, the amount will be the
entire unpaid balance.
WITHDRAWAL OF PROCEEDS UNDER OPTION 4. A payee will have the right to withdraw
proceeds left under Option 4 subject to the following rules:
1. The amount to be withdrawn must be $500 or more; and
2. A partial withdrawal must leave a balance on deposit of $1,000 or more.
WITHDRAWALS MAY BE DEFERRED. We may defer payment of any withdrawal for up to 6
months from the date We receive a Written withdrawal request.
ASSIGNMENT. Payment Contracts may not be assigned.
99206N
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CHANGE IN PAYMENT. The right to make any change in payment is available only if
the Payment Contract provides for a change in payment.
CLAIMS OF CREDITORS. To the extent permitted by law, proceeds will not be
subject to any claims of a Beneficiary's creditors.
GENERAL PROVISIONS
ASSIGNING YOUR POLICY. Prior to the death of the last surviving Contingent
Insured, You may assign this policy as security for an obligation. We will not
be bound by an assignment unless it is received In Writing at Our Administrative
Center. Two copies of the assignment must be submitted. We will retain one
copy and return the other. We will not be responsible for the validity of any
assignment.
INCONTESTABILITY. We rely on the statements made in the application for the
policy and applications for any reinstatements or increases in Specified Amount.
These statements are considered representations and not warranties. No
statement may be used in defense of a claim under the policy unless it is in
such applications.
We cannot contest this policy after it has been in force during the last
surviving Contingent Insured's lifetime for 2 years from the Date of Issue.
However, We can contest an increase in Specified Amount before such increase has
been in effect during the last surviving Contingent Insured's lifetime for 2
years.
Additionally, if this policy is reinstated, We cannot contest the reinstated
policy after it has been in force during the last surviving Contingent Insured's
lifetime for 2 years from the date of reinstatement. However, We can contest a
reinstatement or an increase in Specified Amount based solely on the information
provided in the application for such reinstatement or increase.
These 2 year limitations do not apply to any Disability or Accidental Death
Benefit, or to the nonpayment of premium.
SUICIDE EXCLUSION. If the last surviving Contingent Insured takes his or her
own life within 2 years from the Date of Issue, We will refund all premiums
paid, less any policy loans, and less any partial cash surrenders paid, and this
policy will be terminated as of the Date of Issue.
If there are any increases in the Specified Amount that results from an
application by You subsequent to the Date of Issue (see the section entitled
"Changing Your Insurance Policy"), a new 2 year period shall apply to each
increase beginning on the date of each increase.
If the last surviving Contingent Insured takes his or her own life during the 2
year period following an increase, but after the policy has been in force for 2
years or more, We will refund the costs of insurance that were deducted for the
increase, and that increase will be terminated. The Initial Specified Amount,
and any increases in Specified Amount that have been in force for 2 years or
more, will remain in force on the life of the last surviving Contingent Insured.
When the laws of the state in which this policy is delivered require less than
these 2 year periods, the periods will be as stated in such laws.
AGE OR GENDER INCORRECTLY STATED. If the age or gender of a Contingent Insured
has been misstated to Us, We will adjust the excess of the Death Benefit Amount
over the Accumulation Value on the date of death to that which would have been
purchased by the Monthly Deduction for the policy month of death at the correct
cost of insurance rate. By age, We mean age nearest birthday as of the Date of
Issue.
STATUTORY BASIS OF POLICY VALUES. The Cash Values of the policy are not less
than the minimum values required by the law of the state where this policy is
delivered. The calculation of the Cash Values includes a charge for the cost of
insurance, as shown in the Table of Guaranteed Monthly Cost of Insurance Rates
and for the General Account interest at the annual effective rate shown on the
Policy Schedule.
99206N
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Calculation of minimum Cash Values, nonforfeiture benefits and Guaranteed Cost
of Insurance Rates are based on the 1980 Smoker or Nonsmoker Commissioners
Standard Ordinary Ultimate Mortality Table for the appropriate gender and age
nearest birthday.
A detailed statement of the method of computing values has been filed with the
state insurance department where required.
NO DIVIDENDS. This policy will not pay dividends. It will not participate in
any of Our surplus or earnings.
ANNUAL REPORT. We will send to You at least once a year, without charge, an
annual report which will show a summary of all transactions since the last
report, including:
1. Premiums paid;
2. Transfers;
3. Expense charges deducted;
4. The cost of insurance deducted;
5. Partial surrender benefits deducted including partial surrender fees;
6. The amount of any outstanding policy loan;
7. Separate Account Unit Values;
8. The current Cash Surrender Value and Accumulation Values;
9. The Death Benefit Amount; and
10. Any other information required by the Superintendent of Insurance.
WHEN THIS POLICY TERMINATES. This policy will terminate if:
1. You request that this policy be terminated;
2. The last surviving Contingent Insured dies;
3. Premiums are refunded due to suicide of either Contingent Insured;
4. The policy matures; or
5. The Grace Period ends and there is not sufficient Cash Surrender Value to
cover a Monthly Deduction.
REINSTATEMENT. "Reinstating" means placing Your policy in force after it has
terminated at the end of the Grace Period. We will reinstate this policy if We
receive:
1. Your Written request within 5 years after the end of the Grace Period and
before the Maturity Date;
2. Current evidence of insurability satisfactory to Us for each Contingent
Insured who was living on the date the policy terminated;
3. Payment of enough premiums to keep the policy in force for 2 months; and
4. Payment or reinstatement of any indebtedness.
99206N
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The reinstated policy will be in force from the Monthly Deduction Day on or
following the date We approve the reinstatement application.
The original surrender charge schedule will apply to a reinstated policy. The
Accumulation Value at the time of reinstatement will be:
1. The Surrender Charge deducted at the time of lapse (such charge not being
greater than the Accumulation Value at the time of lapse before the
Surrender Charge was applied); plus
2. The Net Premium allocated in accordance with the premium allocation
percentages at time of lapse unless the reinstatement application provides
otherwise, using Unit Values as of the date of reinstatement; plus
3. Any loan, repaid or reinstated; less
4. The Monthly Deduction for one month.
The dollar amount of any Surrender Charge reinstated will be the same as the
dollar amount of Surrender Charge at the time of lapse, and will be applied to
the funds from which the Surrender Charge was deducted at the time of lapse
using Unit Values as of the date of reinstatement.
OPTION TO EXCHANGE POLICY DURING FIRST 18 MONTHS. At any time during the first
18 months from the Date of issue of this policy, and while this policy is in
force on a premium paying basis, it may be exchanged for any general account
plan of life insurance offered by the Company for exchange on the Date of Issue
of this policy, subject to the following conditions.
1. The new policy will be issued with the same Date of Issue, insurance age,
and risk classification as this policy;
2. The amount of insurance will be the same as the initial amount of insurance
under this policy;
3. The new policy may include any additional benefit provided by rider included
in this policy if available for issue with the new policy;
4. The exchange will be subject to an equitable premium or cash value
adjustment that takes appropriate account of the premiums and cash values
under the original and new policies;
Evidence of insurability will not be required for the exchange.
99206N
Page 24
TABLE OF SURRENDER CHARGES PER $1,000 OF SPECIFIED AMOUNT
The following charges apply to each $1,000 of Initial Specified Amount
surrendered during the Surrender Charge Period following the Date of Issue. The
charges also apply to each $1,000 of increase in Specified Amount surrendered
during the Surrender Charge Period of each increase. The word "surrender" as
used in this provision means full surrender, or a reduction in Specified Amount
at the request of the Owner, or due to a partial surrender. The charge for the
surrender of all or any portion of the Specified Amount during the Surrender
Charge Period following the Date of Issue will be equal to the rate shown below
for the joint equal age at issue and the year of surrender, multiplied by the
number of thousands of Specified Amount being surrendered. The charges for
surrender of all or any portion of an increase in Specified Amount will be equal
to the rates shown below for the joint equal age at issue of such increase and
year of surrender, multiplied by the number of thousands of such increase being
surrendered. There will be an additional charge for each partial surrender that
will be the lesser of 2% of the amount withdrawn or $25.00.
JEA\DUR 1 2 3 4 5 6 7 8 9 10
16 0.78 0.68 0.59 0.49 0.39 0.31 0.23 0.16 0.08 0.00
17 0.78 0.68 0.59 0.49 0.39 0.31 0.23 0.16 0.08 0.00
18 0.84 0.74 0.63 0.53 0.42 0.34 0.25 0.17 0.08 0.00
19 0.90 0.79 0.68 0.56 0.45 0.36 0.27 0.18 0.09 0.00
20 0.96 0.84 0.72 0.60 0.48 0.38 0.29 0.19 0.10 0.00
21 1.02 0.89 0.77 0.64 0.51 0.41 0.31 0.20 0.10 0.00
22 1.08 0.95 0.81 0.68 0.54 0.43 0.32 0.22 0.11 0.00
23 1.14 1.00 0.86 0.71 0.57 0.46 0.34 0.23 0.11 0.00
24 1.20 1.05 0.90 0.75 0.60 0.48 0.36 0.24 0.12 0.00
25 1.25 1.09 0.94 0.78 0.62 0.50 0.37 0.25 0.13 0.00
26 1.31 1.15 0.98 0.82 0.65 0.52 0.39 0.26 0.13 0.00
27 1.37 1.20 1.03 0.86 0.68 0.55 0.41 0.28 0.14 0.00
28 1.43 1.25 1.07 0.89 0.71 0.57 0.43 0.29 0.14 0.00
29 1.51 1.32 1.13 0.94 0.76 0.60 0.45 0.30 0.15 0.00
30 1.60 1.40 1.20 1.00 0.80 0.64 0.48 0.32 0.16 0.00
31 1.72 1.50 1.29 1.07 0.86 0.68 0.52 0.34 0.17 0.00
32 1.83 1.60 1.37 1.15 0.92 0.73 0.55 0.37 0.19 0.00
33 1.95 1.70 1.46 1.22 0.98 0.78 0.59 0.39 0.20 0.00
34 2.10 1.84 1.58 1.31 1.05 0.84 0.63 0.42 0.21 0.00
35 2.23 1.95 1.67 1.39 1.12 0.89 0.67 0.44 0.22 0.00
36 2.40 2.10 1.80 1.50 1.20 0.96 0.72 0.48 0.24 0.00
37 2.57 2.25 1.93 1.61 1.28 1.03 0.77 0.52 0.26 0.00
38 2.74 2.40 2.06 1.72 1.37 1.10 0.82 0.55 0.28 0.00
39 2.95 2.59 2.21 1.85 1.48 1.18 0.89 0.59 0.29 0.00
40 3.13 2.74 2.35 1.96 1.57 1.25 0.94 0.62 0.31 0.00
41 3.35 2.93 2.51 2.09 1.68 1.34 1.01 0.67 0.34 0.00
42 3.58 3.13 2.69 2.24 1.79 1.43 1.07 0.71 0.36 0.00
43 3.81 3.34 2.86 2.38 1.91 1.52 1.15 0.76 0.38 0.00
44 4.10 3.59 3.07 2.56 2.05 1.64 1.23 0.82 0.41 0.00
45 4.29 3.76 3.22 2.68 2.15 1.72 1.29 0.86 0.43 0.00
46 4.55 3.98 3.41 2.84 2.28 1.82 1.37 0.91 0.46 0.00
47 4.81 4.21 3.61 3.01 2.41 1.93 1.45 0.96 0.48 0.00
48 5.08 4.44 3.81 3.17 2.54 2.03 1.52 1.01 0.51 0.00
49 5.40 4.73 4.05 3.38 2.70 2.16 1.62 1.08 0.54 0.00
50 5.67 4.96 4.25 3.55 2.84 2.27 1.70 1.13 0.57 0.00
99206N
Page 25
TABLE OF SURRENDER CHARGES PER $1,000 OF SPECIFIED AMOUNT
The following charges apply to each $1,000 of Initial Specified Amount
surrendered during the Surrender Charge Period following the Date of Issue. The
charges also apply to each $1,000 of increase in Specified Amount surrendered
during the Surrender Charge Period of each increase. The word "surrender" as
used in this provision means full surrender, or a reduction in Specified Amount
at the request of the Owner, or due to a partial surrender. The charge for the
surrender of all or any portion of the Specified Amount during the Surrender
Charge Period following the Date of Issue will be equal to the rate shown below
for the joint equal age at issue and the year of surrender, multiplied by the
number of thousands of Specified Amount being surrendered. The charges for
surrender of all or any portion of an increase in Specified Amount will be equal
to the rates shown below for the joint equal age at issue of such increase and
year of surrender, multiplied by the number of thousands of such increase being
surrendered. There will be an additional charge for each partial surrender that
will be the lesser of 2% of the amount withdrawn or $25.00.
JEA\DUR 1 2 3 4 5 6 7 8 9 10
51 10.05 8.79 7.54 6.28 5.03 4.02 3.02 2.01 1.01 0.00
52 10.65 9.32 7.99 6.66 5.33 4.26 3.20 2.13 1.07 0.00
53 11.25 9.84 8.44 7.03 5.63 4.50 3.38 2.25 1.13 0.00
54 12.01 10.51 9.01 7.51 6.01 4.80 3.60 2.40 1.20 0.00
55 12.72 11.13 9.54 7.95 6.36 5.09 3.82 2.54 1.27 0.00
56 13.67 11.96 10.25 8.54 6.84 5.47 4.10 2.73 1.37 0.00
57 14.63 12.80 10.97 9.14 7.32 5.85 4.39 2.93 1.46 0.00
58 15.58 13.63 11.69 9.74 7.79 6.23 4.67 3.12 1.56 0.00
59 16.77 14.67 12.58 10.48 8.39 6.71 5.03 3.35 1.68 0.00
60 17.79 15.57 13.34 11.12 8.90 7.12 5.34 3.56 1.78 0.00
61 19.16 16.77 14.37 11.98 9.58 7.66 5.75 3.83 1.92 0.00
62 20.52 17.96 15.39 12.83 10.26 8.21 6.16 4.10 2.05 0.00
63 21.89 19.15 16.42 13.68 10.95 8.76 6.57 4.38 2.19 0.00
64 23.59 20.64 17.69 14.74 11.80 9.44 7.08 4.72 2.36 0.00
65 25.20 22.05 18.90 15.75 12.60 10.08 7.56 5.04 2.52 0.00
66 27.35 23.93 20.51 17.09 13.68 10.94 8.21 5.47 2.74 0.00
67 29.49 25.80 22.12 18.43 14.75 11.80 8.85 5.90 2.95 0.00
68 31.64 27.69 23.73 19.78 15.82 12.66 9.49 6.33 3.16 0.00
69 34.32 30.03 25.74 21.45 17.16 13.73 10.30 6.86 3.43 0.00
70 36.46 31.90 27.35 22.79 18.23 14.58 10.94 7.29 3.65 0.00
71 39.31 34.40 29.48 24.57 19.66 15.72 11.79 7.86 3.93 0.00
72 40.90 35.79 30.68 25.56 20.45 16.36 12.27 8.18 4.09 0.00
73 42.55 37.23 31.91 26.59 21.28 17.02 12.77 8.51 4.26 0.00
74 43.70 38.24 32.78 27.31 21.85 17.48 13.11 8.74 4.37 0.00
75 47.45 41.52 35.59 29.66 23.73 18.98 14.24 9.49 4.75 0.00
76 49.08 42.95 36.81 30.68 24.54 19.63 14.72 9.82 4.91 0.00
77 49.36 43.19 37.02 30.85 24.68 19.74 14.81 9.87 4.94 0.00
78 49.65 43.44 37.24 31.03 24.83 19.86 14.90 9.93 4.97 0.00
79 50.00 43.75 37.50 31.25 25.00 20.00 15.00 10.00 5.00 0.00
80 50.00 43.75 37.50 31.25 25.00 20.00 15.00 10.00 5.00 0.00
81 50.00 43.75 37.50 31.25 25.00 20.00 15.00 10.00 5.00 0.00
82 50.00 43.75 37.50 31.25 25.00 20.00 15.00 10.00 5.00 0.00
83 50.00 43.75 37.50 31.25 25.00 20.00 15.00 10.00 5.00 0.00
84 49.95 43.71 37.46 31.22 24.98 19.98 14.99 9.99 5.00 0.00
85 49.65 43.44 37.24 31.03 24.83 19.86 14.90 9.93 4.97 0.00
86 49.35 42.93 37.01 31.09 24.68 18.75 12.34 6.42 0.00 0.00
87 49.00 41.65 34.79 27.93 21.07 14.21 6.86 0.00 0.00 0.00
88 48.50 40.26 32.50 24.25 16.01 8.25 0.00 0.00 0.00 0.00
89 48.10 38.48 28.86 19.24 9.62 0.00 0.00 0.00 0.00 0.00
90 47.75 35.81 23.88 11.94 0.00 0.00 0.00 0.00 0.00 0.00
99206N
Page 26
TABLES OF MONTHLY INSTALLMENTS FOR EACH $1,000 OF PROCEEDS
OPTION 1 TABLE
INSTALLMENTS FOR A SPECIFIED PERIOD
- ------------------------------------------------------------------------------------------------------------------------------------
Number Amount of Number Amount of Number Amount of Number Amount of
of Years Monthly of Years Monthly Of Years Monthly Of Years Monthly
Payable Installments Payable Installments Payable Installments Payable Installments
- ------------------------------------------------------------------------------------------------------------------------------------
5 $17.91 15 $6.87 25 $4.71 35 $3.82
6 15.14 16 6.53 26 4.59 36 3.76
7 13.16 17 6.23 27 4.47 37 3.70
8 11.68 18 5.96 28 4.37 38 3.65
9 10.53 19 5.73 29 4.27 39 3.60
10 9.61 20 5.51 30 4.18 40 3.55
11 8.86 21 5.32 31 4.10
12 8.24 22 5.15 32 4.02
13 7.71 23 4.99 33 3.95
14 7.26 24 4.84 34 3.88
- ------------------------------------------------------------------------------------------------------------------------------------
OPTION 3 TABLE
INSTALLMENTS FOR LIFE WITH SPECIFIED MINIMUM PERIOD
- -------------------------------------------------------------------------------------------------------------------------
AGE OF AGE OF
PAYEE GUARANTEED PERIOD PAYEE GUARANTEED PERIOD
- -------------------------------------------------------------------------------------------------------------------------
Female 10 Years 15 Years 20 Years Female 10 Years 15 Years 20 Years
- -------------------------------------------------------------------------------------------------------------------------
20* $2.85 $2.85 $2.85 50 $3.75 $3.73 $3.69
21 2.87 2.87 2.87 51 3.80 3.78 3.74
22 2.89 2.88 2.88 52 3.86 3.84 3.79
23 2.90 2.90 2.90 53 3.92 3.89 3.85
24 2.92 2.92 2.91 54 3.99 3.96 3.90
25 2.94 2.93 2.93 55 4.06 4.02 3.96
26 2.95 2.95 2.95 56 4.13 4.09 4.02
27 2.97 2.97 2.97 57 4.21 4.16 4.08
28 2.99 2.99 2.99 58 4.29 4.23 4.15
29 3.01 3.01 3.01 59 4.37 4.31 4.21
30 3.03 3.03 3.03 60 4.46 4.39 4.28
31 3.06 3.05 3.05 61 4.56 4.47 4.35
32 3.08 3.08 3.07 62 4.66 4.56 4.42
33 3.10 3.10 3.10 63 4.76 4.65 4.49
34 3.13 3.13 3.12 64 4.88 4.75 4.56
35 3.16 3.15 3.15 65 4.99 4.85 4.63
36 3.19 3.18 3.17 66 5.12 4.95 4.70
37 3.21 3.21 3.20 67 5.25 5.05 4.77
38 3.24 3.24 3.23 68 5.39 5.16 4.83
39 3.28 3.27 3.26 69 5.53 5.27 4.90
40 3.31 3.30 3.29 70 5.69 5.38 4.96
41 3.35 3.34 3.33 71 5.85 5.49 5.02
42 3.38 3.37 3.36 72 6.02 5.60 5.08
43 3.42 3.41 3.40 73 6.19 5.71 5.13
44 3.46 3.45 3.43 74 6.37 5.82 5.17
45 3.50 3.49 3.47 75 6.56 5.92 5.21
46 3.55 3.53 3.51 76 6.75 6.02 5.25
47 3.59 3.58 3.56 77 6.95 6.11 5.28
48 3.64 3.63 3.60 78 7.14 6.20 5.30
49 3.69 3.67 3.65 79 7.34 6.28 5.32
80** 7.54 6.35 5.34
- -------------------------------------------------------------------------------------------------------------------------
Payments are based upon the age, nearest birthday, of the Payee on the date the first payment is due. If monthly
installments for two or more specified periods for a given age are the same, the specified period of longer duration
will apply.
*Also applies to younger ages. **Also applies to older ages.
- -------------------------------------------------------------------------------------------------------------------------
99206N
Page 27
TABLES OF MONTHLY INSTALLMENTS FOR EACH $1,000 OF PROCEEDS
OPTION 1 TABLE
INSTALLMENTS FOR A SPECIFIED PERIOD
- ----------------------------------------------------------------------------------------------------------------------------
Number Amount of Number Amount of Number Amount of Number Amount of
Of Years Monthly of Years Monthly of Years Monthly of Years Monthly
Payable Installments Payable Installments Payable Installments Payable Installments
- ----------------------------------------------------------------------------------------------------------------------------
5 $17.91 15 $6.87 25 $4.71 35 $3.82
6 15.14 16 6.53 26 4.59 36 3.76
7 13.16 17 6.23 27 4.47 37 3.70
8 11.68 18 5.96 28 4.37 38 3.65
9 10.53 19 5.73 29 4.27 39 3.60
10 9.61 20 5.51 30 4.18 40 3.55
11 8.86 21 5.32 31 4.10
12 8.24 22 5.15 32 4.02
13 7.71 23 4.99 33 3.95
14 7.26 24 4.84 34 3.88
- ----------------------------------------------------------------------------------------------------------------------------
OPTION 3 TABLE
INSTALLMENTS FOR LIFE WITH SPECIFIED MINIMUM PERIOD
- ----------------------------------------------------------------------------------------------------------------------------
AGE OF AGE OF
PAYEE GUARANTEED PERIOD PAYEE GUARANTEED PERIOD
- ----------------------------------------------------------------------------------------------------------------------------
Male 10 Years 15 Years 20 Years Male 10 Years 15 Years 20 Years
- ----------------------------------------------------------------------------------------------------------------------------
20* $ 2.95 $2.94 $2.94 50 $4.05 $4.00 $3.93
21 2.97 2.96 2.96 51 4.11 4.06 3.99
22 2.98 2.98 2.98 52 4.18 4.13 4.04
23 3.00 3.00 3.00 53 4.26 4.19 4.10
24 3.02 3.02 3.02 54 4.34 4.27 4.16
25 3.05 3.04 3.04 55 4.42 4.34 4.22
26 3.07 3.06 3.06 56 4.51 4.42 4.28
27 3.09 3.09 3.08 57 4.60 4.50 4.35
28 3.12 3.11 3.11 58 4.69 4.58 4.41
29 3.14 3.14 3.13 59 4.79 4.66 4.47
30 3.17 3.16 3.16 60 4.90 4.75 4.54
31 3.20 3.19 3.18 61 5.01 4.84 4.60
32 3.22 3.22 3.21 62 5.13 4.94 4.67
33 3.25 3.25 3.24 63 5.26 5.03 4.73
34 3.29 3.28 3.27 64 5.39 5.13 4.79
35 3.32 3.31 3.00 65 5.52 5.23 4.85
36 3.35 3.35 3.33 66 5.66 5.33 4.91
37 3.39 3.38 3.36 67 5.81 5.43 4.97
38 3.43 3.42 3.40 68 5.96 5.53 5.02
39 3.47 3.46 3.44 69 6.12 5.63 5.07
40 3.51 3.50 3.47 70 6.28 5.73 5.11
41 3.55 3.54 3.51 71 6.44 5.82 5.15
42 3.60 3.58 3.55 72 6.61 5.91 5.19
43 3.65 3.63 3.59 73 6.78 6.00 5.23
44 3.70 3.67 3.64 74 6.96 6.08 5.26
45 3.75 3.72 3.68 75 7.13 6.16 5.28
46 3.80 3.77 3.73 76 7.30 6.24 5.31
47 3.86 3.83 3.78 77 7.47 6.31 5.33
48 3.92 3.88 3.83 78 7.64 6.37 5.34
49 3.98 3.94 3.88 79 7.81 6.42 5.36
80** 7.97 6.48 5.37
- ----------------------------------------------------------------------------------------------------------------------------
Payments are based upon the age, nearest birthday, of the Payee on the date the first payment is due. If monthly
installments for two or more specified periods for a given age are the same, the specified period of longer duration will
apply.
*Also applies to younger ages. **Also applies to older ages.
- ----------------------------------------------------------------------------------------------------------------------------
99206N
Page 28
THE UNITED STATES LIFE INSURANCE COMPANY
IN THE CITY OF NEW YORK
This is a JOINT AND LAST SURVIVOR FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE
POLICY. An Adjustable Death Benefit is payable upon the LAST SURVIVING
Contingent Insured's death prior to the Maturity Date. Investment results are
reflected in policy benefits. ACCUMULATION VALUES are flexible and will be based
on the amount and frequency of premiums paid and the investment results of the
Separate Account. NONPARTICIPATING - NOT ELIGIBLE FOR DIVIDENDS.
For Information, Service or to make a Complaint
Contact Your Registered Representative, or Our Administrative Center.
THE UNITED STATES LIFE INSURANCE COMPANY
IN THE CITY OF NEW YORK
2727-A Allen Parkway
P.O. BOX 4880
HOUSTON, TEXAS 77210-4880
1-800-251-3720
99206N