Policy Number SPECIMEN
Insured JOHN DOE
JANE DOE
Initial Specified Amount $500,000 Date of Issue MAY 1, 2000
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY
A Stock Company Home Office Location: Fort Wayne, Indiana
Administrator Mailing Address: The Lincoln National Life Insurance Company
350 Church Street
Hartford, CT 06103-1106
The Lincoln National Life Insurance Company ("Lincoln Life") agrees to pay the
Death Benefit Proceeds to the Beneficiary upon receipt of due proof of the death
of the second Insured to die. Such payment shall be made as provided under
GENERAL PROVISIONS, PAYMENT OF PROCEEDS. Lincoln Life further agrees to pay the
surrender value to the Owner upon surrender of the policy.
RIGHT TO EXAMINE THE POLICY. The policy may be returned to the insurance agent
through whom it was purchased or to Lincoln Life 10 days after receipt of the
policy (20 days after its receipt where required by law for policies issued in
replacement of other insurance). During this period (the "Right-to-Examine
Period"), any premium paid will be placed in the Money Market Fund and, if the
policy is so returned, it will be deemed void from the Date of Issue and Lincoln
Life will refund all premium paid. If the policy is not returned, the premium
payment will be processed as set forth in PREMIUM AND REINSTATEMENT PROVISIONS,
ALLOCATION OF NET PREMIUM PAYMENTS.
ANY BENEFITS AND VALUES PROVIDED BY THE POLICY BASED ON THE INVESTMENT
EXPERIENCE OF THE VARIABLE ACCOUNT ARE VARIABLE AND ARE NOT GUARANTEED AS TO
DOLLAR AMOUNT.
THE DEATH BENEFIT PROCEEDS ON THE DATE OF ISSUE EQUAL THE INITIAL SPECIFIED
AMOUNT OF THE POLICY. THEREAFTER, THE DEATH BENEFIT PROCEEDS MAY VARY UNDER THE
CONDITIONS DESCRIBED UNDER INSURANCE COVERAGE PROVISIONS.
The policy is issued and accepted subject to the terms set forth on the
following pages, which are made a part of the policy. In consideration of the
application and the payment of premiums as provided, the policy is executed by
Lincoln Life as of the Date of Issue.
Registrar
FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY ON THE LIVES OF TWO INSUREDS
Non-Participating Variable life insurance payable
upon death of the second Insured to die.
Adjustable Death Benefit.
Surrender Value payable upon surrender of the policy.
Flexible premiums payable to when the younger Insured reaches or would have
reached Age 100 or the death of the second Insured to die, whichever is earlier.
Investment results reflected in policy benefits.
Premium Payments and Supplementary Coverages as
shown in the Policy Specifications.
LN655
TABLE OF CONTENTS
PAGE*
Policy Specifications .........................................................3
Schedule 1: Surrender Charges.................................................5
Schedule 2: Expense Charges and Fees..........................................6
Schedule 3: Table of Guaranteed Maximum Cost of Insurance Rates Per $1,000.....7
Schedule 4: Corridor Percentages Table........................................8
Definitions....................................................................9
Premium and Reinstatement Provisions..........................................11
Ownership, Assignment and Beneficiary Provisions..............................12
Variable Account Provisions...................................................13
Policy Values Provisions......................................................14
Transfer Privilege Provision..................................................16
Nonforfeiture and Surrender Value Provisions..................................17
Loan Provisions...............................................................18
Insurance Coverage Provisions.................................................18
General Provisions............................................................20
Followed by Optional Methods of Settlement and Any Riders
*Page 4 is intentionally "blank."
LN655 2
POLICY SPECIFICATIONS
Policy Number SPECIMEN
Insured JOHN DOE
Issue Age 35 Premium Class STANDARD
Insured JANE DOE
Issue Age 32 Premium Class STANDARD
Initial Specified Amount $500,000 Date of Issue MAY 1, 2000
Minimum Specified Amount $250,000 Monthly Anniversary Day 01
LN655 FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE
BENEFIT AMOUNT: See Initial Specified Amount
DEATH BENEFIT OPTION: Death Benefit Option is 1. (See INSURANCE COVERAGE
PROVISIONS.)
PREMIUM PAYMENTS: Initial premium paid with application $10,000.00
Planned Premium $10,000.00
Additional premium payments may vary by frequency or
amount.
PAYMENT MODE: ANNUALLY
NO-LAPSE PREMIUM: A payment of at least $52.61 is due on
the Date of Issue and each Monthly Anniversary
Day thereafter to guarantee the policy will not
lapse. All or a portion of the remaining monthly
premiums can be paid in advance at any time. If
such cumulative premium payments are paid, it
will prevent the policy from lapsing. (SEE
PREMIUM AND REINSTATEMENT PROVISIONS, NO-LAPSE
PROVISION.)
NOTE: Unless the No-Lapse Provision is in effect, the
policy will terminate before the younger Insured
reaches or would have reached Age 100 if the actual
premiums paid and investment experience are
insufficient to continue coverage to such a date.
LIMITS ON ALLOCATION OF NET PREMIUM PAYMENTS: All allocations of Net Premium
Payments must be made in whole percentages and in aggregate must total 100%.
LIMITS ON TRANSFERS FROM THE FIXED ACCOUNT: Transfers from the Fixed Account
shall be made only within the 30 day period after an anniversary of the Date of
Issue. The amount of all such transfers in any such 30 day period shall not
exceed 20% of the Fixed Account Value as of the immediately preceding
anniversary of the Date of Issue. Lincoln Life may limit the dollar amount of
such transfers. (SEE TRANSFER PRIVILEGE PROVISION.)
GUARANTEED MINIMUM LOAN INTEREST RATES: The interest rate credited on the Loan
Account may vary, but will not be less than the interest rate charged on the
Loan Account, less 2% per year during Policy years 1 through 10 and less 1% per
year thereafter. (As of the Date of Issue, the annual rate at which interest is
credited on the Loan Account Value will be equal to the interest rate charged on
the Loan Account, less 1%, on and before the 10th Policy Anniversary, and the
interest rate charged on the Loan Account, less 0%, thereafter.)
LN655 3
POLICY SPECIFICATIONS
Policy Number SPECIMEN
Insured JOHN DOE
Issue Age 35 Premium Class STANDARD
Insured JANE DOE
Issue Age 32 Premium Class STANDARD
Initial Specified Amount $500,000 Date of Issue MAY 1, 2000
Minimum Specified Amount $250,000 Monthly Anniversary Day 01
OWNER
The Insureds
BENEFICIARY
Margaret Doe, Daughter, if surviving both Insureds
LN655 3A - 1 of 1
THIS PAGE INTENTIONALLY BLANK
SCHEDULE 1: SURRENDER CHARGES
The charge assessed upon full surrender of the policy will be the lesser of the
Surrender Charge shown or the then current Net Accumulation Value. Upon either a
partial surrender or a decrease in Specified Amount, no surrender charge is
applied. An additional surrender charge table will apply to each increase in
Specified Amount permitted by Lincoln Life.
SURRENDER CHARGE AS OF
POLICY YEAR BEGINNING OF POLICY YEAR
----------- ------------------------
1 $2,020.00
2 $2,020.00
3 $1,965.00
4 $1,885.00
5 $1,805.00
6 $1,725.00
7 $1,635.00
8 $1,450.00
9 $1,270.00
10 $1,090.00
11 $905.00
12 $725.00
13 $545.00
14 $365.00
15 180.00
16 and thereafter $0.00
The procedures for full and partial surrenders and the imposition of surrender
charges for full surrenders are described in greater detail in NONFORFEITURE AND
SURRENDER VALUE PROVISIONS.
A transaction fee of the lesser of $25 or 2% of the amount surrendered is
assessed for each partial surrender and will be processed as set forth in
NONFORFEITURE AND SURRENDER VALUE PROVISIONS, PARTIAL SURRENDER.
LN655 5
SCHEDULE 2: EXPENSE CHARGES AND FEES
PREMIUM LOAD. Lincoln Life will deduct a Premium Load of 8% from each premium
payment during the first 15 policy years and 5% thereafter.
MONTHLY ADMINISTRATIVE FEE. A Monthly Deduction is made on each Monthly
Anniversary Day from the Net Accumulation Value. (SEE POLICY VALUES PROVISIONS,
MONTHLY DEDUCTION.) It includes an administrative fee charge, Cost of Insurance
charges and any charges for supplemental riders or optional benefits.
The monthly administrative fee as of the Date of Issue of the policy consists
of:
(a) a fee of $10.00 per month; and
(b) a monthly charge of per $1,000 of initial Specified Amount for the first
120 months from the Date of Issue, and
(c) a monthly charge per $1,000 for any increase in Specified Amount for the
first 120 months following the date of increase.
The charge(s) described in (b) and (c) will be determined using the table below
and will be based on the older Insured's Age at the Date of Issue or date of any
increase in Specified Amount.
EXPENSE CHARGE EXPENSE CHARGE EXPENSE CHARGE
AGE PER $1,000 AGE PER $1,000 AGE PER $1,000
- ------------------ ------------------ ------------------ ---------------- ----------------- ----------------
0-40 0.0600 51 0.1080 62 0.1400
41 0.0640 52 0.1160 63 0.1400
42 0.0680 53 0.1240 64 0.1400
43 0.0720 54 0.1320 65 0.1450
44 0.0760 55 0.1400 66 0.1450
- ------------------ ------------------ ------------------ ---------------- ----------------- ----------------
45 0.0800 56 0.1400 67 0.1450
46 0.0840 57 0.1400 68 0.1450
47 0.0880 58 0.1400 69 0.1450
48 0.0920 59 0.1400 70+ 0.1500
49 0.0960 60 0.1400
50 0.1000 61 0.1400
- ------------------ ------------------ ------------------ ---------------- ----------------- ----------------
CHARGES AND FEES ASSOCIATED WITH THE VARIABLE SUB-ACCOUNTS. Lincoln Life imposes
a mortality and expense risk ("M&E") charge, which is calculated as a percentage
of the value of the Variable Sub-Accounts. The M&E charge is deducted from each
Variable Sub-Account at the end of each Valuation Period. This charge is made
daily at an equivalent annual rate of 0.80% of a Variable Sub-Account's Value.
Fund operating expenses may be deducted by each Fund as set forth in its
prospectus.
TRANSFER FEE. A transaction fee of $25 may be applied by Lincoln Life to each
transfer request in excess of 12 made during any Policy Year. A single transfer
request, either In Writing or by telephone, may consist of multiple
transactions.
LN655 6
SCHEDULE 3: TABLE OF GUARANTEED MAXIMUM COST OF INSURANCE RATES
(MONTHLY RATES PER $1,000 OF NET AMOUNT AT RISK)
SPECIAL NOTE: The Cost of Insurance Rate is the monthly rate charged under the
policy. The Cost of Insurance Rate varies based on the sex,
issue age (nearest birthday), duration and premium class of each
Insured. It is determined under an actuarial formula, on file
with the insurance supervisory official of the jurisdiction in
which the policy is delivered, that reflects one-alive and
both-alive probabilities. The rates set forth in the table below
reflect the amount of the Flat Extra or the Risk Factor
(substandard risk classification rates), if any, shown in the
POLICY SPECIFICATIONS, and are based on the 1980 CSO Tables. The
monthly Cost of Insurance Rate charged under the policy shall
not exceed the applicable rate set forth in the table below for
each respective duration (number of years from the Date of
Issue).
MONTHLY MONTHLY MONTHLY
DURATION RATE DURATION RATE DURATION RATE
- ------------------- ----------------- ----------------- ---------------- ---------------- -----------------
1 0.00006 2 0.00019 3 0.00034
4 0.00051 5 0.00072 6 0.00097
7 0.00125 8 0.00160 9 0.00199
10 0.00245 11 0.00379 12 0.00559
13 0.00695 14 0.00830 15 0.00951
16 0.01098 17 0.01295 18 0.01432
19 0.01573 20 0.01708 21 0.01852
22 0.01996 23 0.02232 24 0.02508
25 0.02870 26 0.03301 27 0.03830
28 0.04462 29 0.05212 30 0.06119
31 0.07169 32 0.08551 33 0.10171
34 0.12045 35 0.14291 36 0.16945
37 0.20182 38 0.24149 39 0.29087
40 0.35747 41 0.56891 42 0.77627
43 0.99394 44 1.32533 45 1.74827
46 2.19436 47 2.72027 48 3.28096
49 3.91144 50 4.63804 51 5.46308
52 6.38173 53 7.43672 54 8.40643
55 9.48003 56 9.85217 57 10.16255
58 10.43189 59 10.68160 60 10.91958
61 11.74364 62 12.61485 63 13.53432
64 13.63748 65 13.72362 66 13.79463
67 13.80948 68 13.81689 69 13.81850
LN655 7
SCHEDULE 4: CORRIDOR PERCENTAGES TABLE
The amount of the Death Benefit Proceeds must satisfy certain requirements under
the Internal Revenue Code if the policy is to qualify as insurance for Federal
income tax purposes. The amount of the Death Benefit Proceeds required to be
paid under the Internal Revenue Code to maintain the policy as life insurance
under each of the Death Benefit Options (SEE INSURANCE COVERAGE PROVISIONS,
DEATH BENEFIT OPTIONS) is equal to the product of the Accumulation Value and the
applicable Corridor Percentage set forth below.
ATTAINED AGE OF ATTAINED AGE OF THE
THE YOUNGER INSURED CORRIDOR YOUNGER INSURED CORRIDOR
(NEAREST BIRTHDAY) PERCENTAGE (NEAREST BIRTHDAY) PERCENTAGE
----------------------- -------------- ------------------------- -------------
0-40 250% 70 115%
41 243 71 113
42 236 72 111
43 229 73 109
44 222 74 107
------------- -------------- ------------- -------------
45 215 75 105
46 209 76 105
47 203 77 105
48 197 78 105
49 191 79 105
------------- -------------- ------------- -------------
50 185 80 105
51 178 81 105
52 171 82 105
53 164 83 105
54 157 84 105
------------- -------------- ------------- -------------
55 150 85 105
56 146 86 105
57 142 87 105
58 138 88 105
59 134 89 105
------------- -------------- ------------- -------------
60 130 90 105
61 128 91 104
62 126 92 103
63 124 93 102
64 122 94 101
------------- -------------- ------------- -------------
65 120 95 100
66 119 96 100
67 118 97 100
68 117 98 100
69 116 99 100
------------- -------------- ------------- -------------
LN655 8
DEFINITIONS
ACCUMULATION VALUE. The sum of (i) the Fixed Account value, (ii) the Variable
Account value, and (iii) the Loan Account value under the policy.
ADMINISTRATOR MAILING ADDRESS. The Administrator Mailing Address for the policy
is indicated on the front cover.
AGE. The age of the subject person at her or his nearest birthday.
COST OF INSURANCE. SEE POLICY VALUES PROVISIONS, COST OF INSURANCE.
COST OF INSURANCE RATES. This term is defined in SCHEDULE 3.
DATE OF ISSUE. The date from which Policy Years, Policy Anniversaries and Age
are determined. The Date of Issue is shown on the POLICY SPECIFICATIONS.
DEATH BENEFIT PROCEEDS. The amount payable to the Beneficiary upon the Second
Death (defined below) in accordance with the Death Benefit Option elected. The
two Death Benefit Options are described in INSURANCE COVERAGE PROVISIONS, DEATH
BENEFIT OPTIONS.
DUE PROOF OF DEATH. A certified copy of an official death certificate, a
certified copy of a decree of a court of competent jurisdiction as to the
finding of death, or any other proof of death satisfactory to Lincoln Life.
FIXED ACCOUNT. The account under which principal is guaranteed and interest is
credited at a rate of not less than 4% per year. (SEE POLICY VALUES PROVISION,
INTEREST CREDITED UNDER FIXED ACCOUNT.) Fixed Account assets are general assets
of Lincoln Life and are held in Lincoln Life's general account.
FUND(S). The Funds in the Variable Sub-Account portfolios to which the Owner may
allocate Net Premium Payments or transfers and in the shares of which such
allocations shall be invested. Each Fund is an open-end management investment
company registered under the 1940 Act.
GRACE PERIOD. SEE PREMIUM AND REINSTATEMENT PROVISIONS, POLICY LAPSE AND GRACE
PERIOD.
IN WRITING. With respect to any notice to Lincoln Life, this term means a
written form satisfactory to Lincoln Life and received by it at the
Administrator Mailing Address. With respect to any notice by Lincoln Life to the
Owner, any assignee or other person, this term means written notice by ordinary
mail to such person at the most recent address in Lincoln Life's records.
LOAN ACCOUNT. The account in which policy indebtedness (outstanding loans and
interest) accrues once it is transferred out of the Fixed and/or Variable
Sub-Accounts. The Loan Account is part of Lincoln Life's general account.
MONTHLY ANNIVERSARY DAY. The Day of the month, as shown in the POLICY
SPECIFICATIONS, when Lincoln Life makes the Monthly Deduction, or the next
Valuation Day if that day is not a Valuation Day or is nonexistent for that
month.
MONTHLY DEDUCTION. The Monthly Deduction is made from the Net Accumulation
Value; this deduction includes the Cost of Insurance, an administrative expense
charge and charges for supplemental riders or benefits, if applicable. (SEE
POLICY VALUES PROVISIONS, MONTHLY DEDUCTION). The first Monthly Deduction is
made as of the Date of Issue. Monthly Deductions occur thereafter on each
Monthly Anniversary Day.
LN655 9
DEFINITIONS (CONTINUED)
MORTALITY AND EXPENSE RISK (M&E) RATE. A daily rate assessed by Lincoln Life as
a percentage of the value of the Variable Sub-Accounts for its assumption of
mortality and expense risks. The M&E Rate is specified in SCHEDULE 2.
NET ACCUMULATION VALUE. The Accumulation Value less the Loan Account Value.
NET PREMIUM PAYMENT. The portion of a premium payment, after deduction of the
Premium Load as specified in SCHEDULE 2, available for allocation to the Fixed
and/or Variable Sub-Accounts.
1940 ACT. The Investment Company Act of 1940, as amended.
NO-LAPSE PREMIUM: The premium required to be paid on the Date of Issue and each
Monthly Anniversary Day on a cumulative basis to prevent the policy from
lapsing, if the No-Lapse Provision is elected. (SEE PREMIUM AND REINSTATEMENT
PROVISIONS, NO-LAPSE Provision.)
NYSE. New York Stock Exchange.
POLICY ANNIVERSARY. The day of the year the policy was issued, or the next
Valuation Day if that day is not a Valuation Day or is nonexistent for that
year.
POLICY YEAR. Each twelve-month period, beginning on the Date of Issue, during
which the policy is in effect.
RIGHT-TO-EXAMINE PERIOD. SEE RIGHT TO EXAMINE THE POLICY, on the Cover of the
Policy.
SEC. The Securities and Exchange Commission.
SECOND DEATH. The death of the second of the two Insureds to die.
SUB-ACCOUNT. The investment options available under this policy, including
Variable Sub-Accounts and the Fixed Account.
SURRENDER VALUE. See NONFORFEITURE AND SURRENDER VALUE PROVISIONS, SURRENDER
VALUE.
VALUATION DAY. Any day on which the NYSE is open for business, except a day
during which trading on the NYSE is restricted or on which an SEC-determined
emergency exists or on which the valuation or disposal of securities is not
reasonably practicable, as determined under applicable law.
VALUATION PERIOD. The period beginning immediately after the close of business
on a Valuation Day and ending at the close of business on the next Valuation
Day.
VARIABLE ACCOUNT. The Lincoln Life Flexible Premium Variable Life Account R,
which consists of all Variable Sub-Account(s) invested in shares of the Fund(s).
Variable Account assets are separate account assets of Lincoln Life, the
investment performance of which is kept separate from that of the general assets
of Lincoln Life. Variable Account assets are not chargeable with the general
liabilities of Lincoln Life.
VARIABLE ACCUMULATION UNIT. A unit of measure used to calculate the value of a
Variable Sub-Account.
LN655 10
PREMIUM AND REINSTATEMENT PROVISIONS
PREMIUMS. The first premium must be paid to commence coverage under this policy
(See INSURANCE PROVISIONS, DATE OF COVERAGE). Additional premium may be paid,
with the consent of Lincoln Life and subject to the requirements under
ADDITIONAL PREMIUMS, at any time before the younger Insured reaches or would
have reached Age 100. There is no minimum premium requirement. However, except
as provided under the NO-LAPSE PROVISION, the policy will lapse subject to the
terms set forth in the POLICY LAPSE AND GRACE PERIOD if the Net Accumulation
Value is insufficient to pay a Monthly Deduction.
PAYMENT OF PREMIUM. The initial premium is payable at the Administrator Mailing
Address or to an authorized representative of Lincoln Life. All subsequent
premium payments are payable at the Administrator Mailing Address.
PLANNED PREMIUM. If the Owner chooses to make periodic premium payments, Lincoln
Life shall send premium reminder notices In Writing for the amounts and with the
frequency elected by the Owner. Changes in the amounts or frequency of such
payments will be subject to consent of Lincoln Life.
ADDITIONAL PREMIUM. In addition to any planned premium, it is possible to make
additional premium payments of no less than $100 at any time before the younger
Insured reaches or would have reached Age 100. Lincoln Life reserves the right
to limit the amount or frequency of any such additional premium payments. If a
payment of any additional premium would increase the difference between the
Accumulation Value and the Specified Amount, Lincoln Life may reject the
additional premium payment unless evidence of insurability is furnished to
Lincoln Life and it agrees to accept the risk for both Insureds or any surviving
Insured. If a payment of additional premium would cause the policy to cease to
qualify as insurance for federal income tax purposes, Lincoln Life may reject
all or such excess portion of the additional premium. Any additional premium
payment received by Lincoln Life shall be applied as premium and not to repay
any outstanding loans, unless Lincoln Life is specifically instructed otherwise
In Writing by the Owner.
ALLOCATION OF NET PREMIUM PAYMENTS. Net Premium Payments may be allocated to the
Fixed and/or Variable Sub-Accounts under the policy subject to POLICY
SPECIFICATIONS, LIMITS ON ALLOCATION OF NET PREMIUM PAYMENTS. The Net Premium
Payment associated with the initial premium payment and any Net Premium Payments
received during the Right-to-Examine Period shall be allocated upon the
expiration of the Right-to-Examine Period in accordance with the allocation
percentages specified in the application. Subsequent Net Premium Payments shall
be allocated on the same basis as the most recent Net Premium Payment unless
Lincoln Life is otherwise instructed In Writing.
NO-LAPSE PROVISION. If the No-Lapse Provision has been selected, the Owner is
required to pay, on the Date of Issue and on or before each Monthly Anniversary
Day, the monthly No-Lapse Premium as specified in the POLICY SPECIFICATIONS. As
long as the sum of all premium payments less any indebtedness and partial
surrenders is at least equal to the sum of the No-Lapse Premiums due since the
Date of Issue, the policy will not lapse even if the Net Accumulation Value is
insufficient to meet the Monthly Deductions or the amount of indebtedness
exceeds the Accumulation Value, less Surrender Charges.
A period of 61 days will be granted for the No-Lapse Provision if on any Monthly
Anniversary Day it is determined that the No-Lapse Premium requirement has not
been met. At least 31 days before the end of that period, Lincoln Life will
notify the Owner of the amount of premium necessary to maintain the No-Lapse
Provision. The amount required shall be the difference between (a) the sum of
the No-Lapse Premiums due since the Date of Issue, and (b) the sum of all
premiums paid less indebtedness and partial surrenders.
The No-Lapse Provision will terminate if (a) the No-Lapse Premium requirements
are not met, (b) there is an increase in the Specified Amount, or (c) there is a
change in the Death Benefit Option. Once the No- Lapse Provision is terminated,
it cannot be reinstated.
LN655 11
PREMIUM AND REINSTATEMENT PROVISIONS (CONTINUED)
POLICY LAPSE AND GRACE PERIOD. Except as provided under the NO-LAPSE PROVISION,
if on any Monthly Anniversary Day the Net Accumulation Value is insufficient to
cover the current Monthly Deduction, or if the amount of indebtedness exceeds
Accumulation Value less Surrender Charges, Lincoln Life shall send a notice In
Writing to the Owner and any assignee of record. Such notice shall state the
amount which must be paid to avoid termination. The Net Premium Payment due will
be at least equal to (a) the amount by which the Monthly Deduction Amount
exceeds the Net Accumulation Value, or (b) the amount by which the indebtedness
exceeds the Accumulation Value, less Surrender Charges, and (c) enough
additional premium to maintain the policy in force for at least two months.
If the amounts set forth in the notice are not paid to Lincoln Life on or before
the day that is the later of (a) 31 days after the date of mailing of the
notice, and (b) 61 days after the Monthly Anniversary Day with respect to which
such notice applies (together, the "Grace Period"), then the policy shall
terminate. All coverage under the policy will then lapse without value.
REINSTATEMENT. After the policy has lapsed due to the failure to make a
necessary payment before the end of an applicable Grace Period, the policy may
be reinstated if both Insureds are living provided (a) the policy has not been
surrendered, (b) there is an application for reinstatement In Writing, (c)
evidence of insurability is furnished to Lincoln Life and it agrees to accept
the risk as to both Insureds, (d) enough premium is paid to keep the policy in
force for at least 2 months, and (e) any accrued loan interest is paid. The
reinstated policy shall be effective as of the Monthly Anniversary Day after the
date on which Lincoln Life approves the application for reinstatement. The
surrender charges set forth in SCHEDULE 1 will be reinstated as of the Policy
Year in which the policy lapsed.
OWNERSHIP, ASSIGNMENT AND BENEFICIARY PROVISIONS
OWNER. The Owner on the Date of Issue will be the person designated in the
POLICY SPECIFICATIONS. If no person is designated as Owner, the Insureds will be
the Owner.
RIGHTS OF OWNER. So long as one of the Insureds is alive and except as provided
below, the Owner may exercise all rights and privileges under the policy
including the right to: (a) release or surrender the policy to Lincoln Life, (b)
agree with Lincoln Life to any change in or amendment to the policy, (c)
transfer all rights and privileges to another person, (d) change the
Beneficiary, and (e) assign the policy.
The Owner may exercise any rights and privileges under the policy without the
consent of any designated Beneficiary if the Owner has reserved the right to
change the Beneficiary. If there is an assignment of the policy recorded with
Lincoln Life, the Owner may exercise the rights and privileges under the policy
only with the consent of the recorded assignee.
Unless provided otherwise, if the Owner is a person other than an Insured and
dies before the Second Death, all of the rights and privileges of the Owner
under the policy shall vest in the Owner's executors, administrators or assigns.
TRANSFER OF OWNERSHIP. The Owner may transfer all rights and privileges of the
Owner. On the date of transfer, the transferee shall become the Owner and shall
have all the rights and privileges of the Owner. The Owner may revoke any
transfer before the date of transfer.
LN655 12
OWNERSHIP, ASSIGNMENT AND BENEFICIARY PROVISIONS (CONTINUED)
A transfer, or a revocation of transfer, shall be In Writing and shall take
effect the later of the date of transfer specified by the Owner or the date it
is recorded by Lincoln Life, and any payment made or any action taken or allowed
by Lincoln Life before such time in reliance on the recorded ownership of the
policy shall be without prejudice to Lincoln Life.
Unless otherwise directed by the Owner, with the consent of any assignee
recorded with Lincoln Life, a transfer shall not affect the interest of any
Beneficiary designated before the date of transfer.
ASSIGNMENT. Assignment of the policy shall be In Writing and shall be effective
when Lincoln Life receives it. Lincoln Life shall not be responsible for the
validity or sufficiency of any assignment. An assignment of the policy shall
remain effective only so long as the assignment remains in force. If an
assignment so provides, it shall transfer the interest of any designated
transferee or of any Beneficiary if the Owner has reserved the right to change
the Beneficiary.
BENEFICIARY. The Beneficiary on the Date of Issue shall be the person designated
in the POLICY SPECIFICATIONS. Unless provided otherwise, the interest of any
Beneficiary who dies before the Second Death shall vest in the Owner or the
Owner's executors, administrators or assigns.
CHANGE OF BENEFICIARY. The Beneficiary may be changed from time to time. Unless
provided otherwise, the right to change the Beneficiary is reserved to the
Owner. A request for change of Beneficiary shall be In Writing, signed by the
Owner and, if the right to change the Beneficiary has not been reserved to the
Owner, signed by the existing Beneficiary. A change of Beneficiary shall be
effective, retroactive to the date of request, only when the change recorded by
Lincoln Life, and any payment made or any action taken or allowed by Lincoln
Life before such time in reliance on its records as to the identity of the
Beneficiary shall be without prejudice to Lincoln Life.
VARIABLE ACCOUNT PROVISIONS
VARIABLE ACCOUNT AND VARIABLE SUB-ACCOUNTS. Assets invested on a variable basis
are held in the separate account ("Variable Account") which is designated in the
DEFINITIONS of the policy. The separate account was established by a resolution
of Lincoln Life's Board of Directors as a "separate account" under the insurance
law of the State of Indiana, Lincoln Life's state of domicile and is registered
as a unit investment trust under the 1940 Act. The assets of the Variable
Account (except assets in excess of the reserves and other contract liabilities
of the Variable Account) shall not be chargeable with liabilities arising out of
any other business conducted by Lincoln Life and the income, gains or losses
from the Variable Account assets shall be credited or charged against the
Variable Account without regard to the income, gains or losses of Lincoln Life.
The Variable Account assets are owned and controlled exclusively by Lincoln
Life, and Lincoln Life is not a trustee with respect to such assets.
The Variable Account is divided into Variable Sub-Accounts. The assets of each
Variable Sub-Account shall be invested fully and exclusively in shares of the
appropriate Fund for such Variable Sub-Account. The investment performance of
each Variable Sub-Account shall reflect the investment performance of the
appropriate Fund. For each Variable Sub-Account, Lincoln Life shall maintain
Variable Accumulation Units as a measure of the investment performance of the
Fund shares held in such Variable Sub-Account.
Subject to any vote by persons entitled to vote thereon under the 1940 Act,
Lincoln Life may elect to operate the Variable Account as a management company
instead of a unit investment trust under the 1940 Act or, if registration under
the 1940 Act is no longer required, to deregister the Variable Account.
LN655 13
VARIABLE ACCOUNT PROVISIONS (CONTINUED)
In the event of such a change, Lincoln Life shall endorse the policy to reflect
the change and may take any other necessary or appropriate action required to
effect the change. Any changes in the investment policies of the Variable
Account shall first be approved by the Indiana Insurance Commissioner and
approved or filed, as required, in any other state or other jurisdiction where
the policy was issued.
INVESTMENTS OF THE VARIABLE SUB-ACCOUNTS. All amounts allocated or transferred
to a Variable Sub-Account will be used to purchase shares of the appropriate
Fund. Each Fund Group shall at all times be registered under the 1940 Act as an
open-end management investment company. The Funds available for investment and
for which Variable Sub-Accounts have been established as of the Date of Issue
are listed in the application. Lincoln Life, after due consideration of
appropriate factors, may add additional Funds and Fund Groups at any time or may
eliminate or substitute Funds or Fund Groups in accordance with FUND WITHDRAWAL
AND SUBSTITUTED Securities. Any and all distributions made by a Fund will be
reinvested in additional shares of that Fund at net asset value. Deductions by
Lincoln Life from a Variable Sub-Account will be made by redeeming a number of
Fund shares at net asset value equal in total value to the amount to be
deducted.
INVESTMENT RISK. Fund share values fluctuate, reflecting the risks of changing
economic conditions and the ability of a Fund Group's investment adviser or
sub-adviser to manage that Fund and anticipate changes in economic conditions.
As to the Variable Account assets, the Owner bears the entire investment risk of
gain or loss.
FUND WITHDRAWAL AND SUBSTITUTED SECURITIES. If a particular Fund ceases to be
available for investment, or Lincoln Life determines that further investment in
the particular Fund is not appropriate in view of the purposes of the Variable
Account (including without limitation that it is not appropriate in light of
legal, regulatory or federal income tax considerations), Lincoln Life may
withdraw the particular Fund as a possible investment in the Variable Account
and may substitute shares of a new or different Fund for shares of the withdrawn
Fund. Lincoln Life shall obtain any necessary regulatory or other approvals.
Lincoln Life may make appropriate endorsements to the policy to the extent
reasonably required to reflect any withdrawal or substitution.
POLICY VALUES PROVISIONS
ACCUMULATION VALUE. The Accumulation Value equals the sum of (i) the Fixed
Account value, (ii) the Variable Account value, and (iii) the Loan Account
value. At any point in time, therefore, the Accumulation Value reflects (a) Net
Premium Payments made, (b) the amount of any partial surrenders, (c) any
increases or decreases as a result of market performance in the Variable
Sub-Accounts, (d) interest credited under the Fixed Account, (e) interest
credited under the Loan Account, (f) monthly deductions, and (g) all expenses
and fees as specified under SCHEDULE 2.
FIXED ACCOUNT VALUE. The Fixed Account value, if any, with respect to the
policy, at any point in time, is equal to the sum of the Net Premium Payments
allocated or other amounts (net of any charges) transferred to the Fixed Account
plus interest credited to such account less the portion of the Monthly
Deductions applied to the Fixed Account and less any partial surrenders or
amounts transferred from the Fixed Account.
INTEREST CREDITED UNDER FIXED ACCOUNT. Lincoln Life will credit interest to the
Fixed Account daily. The interest rate applied to the Fixed Account will be the
greater of: (a) a compounded daily rate of 0.010746% (equivalent to a compounded
annual rate of 4%), or (b) a rate determined by Lincoln Life from time to time.
Such rate will be established on a prospective basis.
LOAN ACCOUNT VALUE. The Loan Account value, if any, with respect to the policy,
is the amount of any outstanding loan(s), including any interest charged on the
loan(s). (SEE LOAN PROVISIONS, LOAN ACCOUNT.)
LN655 14
POLICY VALUES PROVISIONS (CONTINUED)
INTEREST RATE CREDITED ON LOAN ACCOUNT. The interest rate credited on the Loan
Account may vary, but will not be less than the interest rate charged on the
loan account less 2% per year during Policy years 1 through 10 and less 1% per
year thereafter. (SEE the POLICY SPECIFICATIONS for the rate in effect as of the
Date of Issue.)
Such loan interest amount will be transferred into the Fixed and/or Variable
Sub-Accounts in proportion to the then current Net Accumulation Value, unless
the Owner and Lincoln Life agree otherwise.
VARIABLE ACCOUNT VALUE. The Variable Account value, if any, with respect to the
policy, for any Valuation Period is equal to the sum of the then stated values
of all Variable Sub-Accounts under the policy. The stated value of each Variable
Sub-Account is determined by multiplying the number of Variable Accumulation
Units, if any, credited or debited to such Variable Sub-Account with respect to
the policy by the Variable Accumulation Unit Value of the particular Variable
Sub-Account for such Valuation Period.
VARIABLE ACCUMULATION UNIT VALUE. Net Premium Payments, or portions thereof,
allocated, or amounts transferred, to each Variable Sub-Account are converted
into Variable Accumulation Units. The Variable Accumulation Unit value for a
Variable Sub-Account for any Valuation Period after the inception of the
Variable Sub-Account is determined as follows:
1. The total value of Fund shares held in the Variable Sub-Account is
calculated by multiplying the number of Fund shares owned by the
Variable Sub-Account at the beginning of the Valuation Period by the net
asset value per share of the Fund at the end of the Valuation Period and
adding any dividend or other distribution of the Fund earned during the
Valuation Period; minus
2. The liabilities of the Variable Sub-Account at the end of the Valuation
Period; such liabilities include daily charges imposed on the Variable
Sub-Account and may include a charge or credit with respect to any taxes
paid or reserved for by Lincoln Life that Lincoln Life determines result
from the operations of the Variable Account; and
3. The result of (2) is divided by the number of Variable Accumulation
Units for that Variable Sub-Account outstanding at the beginning of the
Valuation Period.
The daily charges imposed on a Variable Sub-Account for any Valuation Period are
equal to the M&E charge multiplied by the number of calendar days in the
Valuation Period.
The accumulation unit value may increase or decrease from Valuation Period to
Valuation Period.
COST OF INSURANCE. The Cost of Insurance is determined monthly. Such cost is
calculated as (1), multiplied by the result of (2) minus (3), where:
(1) is the Cost of Insurance Rate as described in COST OF INSURANCE RATES,
(2) is the Death Benefit at the beginning of the policy month, divided by
1.0032737, and
(3) is the Accumulation Value at the beginning of the policy month prior to
the deduction for the monthly Cost of Insurance.
COST OF INSURANCE RATES. The Cost of Insurance Rates are determined from time to
time by Lincoln Life based on its expectations of future mortality and vary as
set forth in SCHEDULE 3. The actuarial formula used to make such determination
has been filed with the insurance supervisory official of the jurisdiction in
which the policy is delivered. Any change in Cost of Insurance Rates will apply
to all individuals of the same class as the Insured. The Cost of Insurance Rates
shall not exceed the amounts described in SCHEDULE 3.
LN655 15
POLICY VALUES PROVISIONS (CONTINUED)
MONTHLY DEDUCTION. Each month, on the Monthly Anniversary Day, Lincoln Life will
deduct the Monthly Deduction by withdrawing the amount from the Fixed and
Variable Sub-Accounts in proportion to which the balances invested in such Fixed
and Variable Sub-Accounts bear to the Net Accumulation Value as of the date on
which the deduction is made. The Monthly Deduction for a policy month will be
calculated as Charge (1) plus Charge (2) where:
CHARGE (1) is the Cost of Insurance (as described in COST OF INSURANCE) and the
cost of any supplemental riders or optional benefits, and
CHARGE (2) is the Monthly Administrative Fee as described under SCHEDULE 2.
BASIS OF COMPUTATIONS. The Cost of Insurance Rates are guaranteed to be no
greater than that calculated based on the applicable 1980 Commissioners Standard
Ordinary Mortality Table (Age nearest birthday).
All policy values are at least equal to that required by the jurisdiction in
which the policy is delivered. A detailed statement of the method of computing
values has been filed with the insurance supervisory official of that
jurisdiction.
TRANSFER PRIVILEGE PROVISION
TRANSFER PRIVILEGE. At any time while the policy is in force, other than during
the Right-to-Examine Period, the Owner has the right to transfer amounts among
the Fixed and Variable Sub-Accounts then available under the policy. All such
transfers are subject to the following provisions. Transfers may be made In
Writing, or by telephone if telephone transfers have been previously authorized
In Writing. Transfer requests must be received at the Administrator Mailing
Address prior to the time of day set forth in the prospectus and provided the
NYSE is open for business, in order to be processed as of the close of business
on the date the request is received; otherwise, the transfer will be processed
on the next business day the NYSE is open for business. Lincoln Life shall not
be responsible for (a) any liability for acting in good faith upon any transfer
instructions given by telephone, or (b) the authenticity of such instructions. A
single transfer request, either In Writing or by telephone, may consist of
multiple transactions.
Transfers from the Fixed Sub-Account are subject to the POLICY SPECIFICATIONS,
LIMITS ON TRANSFERS. Transfers to the Fixed Sub-Account will earn interest as
specified under POLICY VALUES PROVISIONS, INTEREST CREDITED UNDER FIXED ACCOUNT.
Transfers involving Variable Sub-Accounts will reflect the purchase or
cancellation of Variable Accumulation Units having an aggregate value equal to
the dollar amount being transferred to or from a particular Variable
Sub-Account. The purchase or cancellation of such units shall be made using
Variable Accumulation Unit values of the applicable Variable Sub-Account for the
Valuation Period during which the transfer is effective.
Unless otherwise changed by Lincoln Life to be less restrictive, transfers shall
be subject to the following conditions: (a) Up to 12 transfer requests may be
made during any Policy Year without charge, however, for each transfer request
in excess of 12, a transfer fee as set forth in SCHEDULE 2 may be deducted on a
pro-rata basis from the Fixed and/or Variable Sub-Accounts from which the
transfer is being made; (b) The amount being transferred may not be less than
$100 unless the entire value of the Fixed or Variable Sub-Account is being
transferred; (c) The amount being transferred may not exceed Lincoln Life's
maximum amount limit then in effect; (d) Transfers among the Variable
Sub-Accounts or from a Variable
LN655 16
TRANSFER PRIVILEGE PROVISION (CONTINUED)
Sub-Account to the Fixed Account can be made at any time; (e) Transfers
involving Variable Sub-Account(s) shall be subject to such additional terms and
conditions as may be imposed by the Funds; and (f) Any value remaining in the
Fixed or a Variable Sub-Account following a transfer may not be less than $100.
NONFORFEITURE AND SURRENDER VALUE PROVISIONS
SURRENDER. Surrender of the policy is effective on the business day of receipt
by Lincoln Life of the policy and a request for surrender In Writing, provided
that at the time of such receipt the policy is in force.
SURRENDER VALUE. The amount payable on surrender of the policy (the "Surrender
Value") shall be the Net Accumulation Value less any accrued loan interest not
yet charged, and less any Surrender Charges as determined under the provision of
SCHEDULE 1.
The Surrender Value shall be paid by Lincoln Life in a lump sum or as provided
under the OPTIONAL METHODS OF SETTLEMENT rider. Any deferment of payments by
Lincoln Life will be subject to GENERAL PROVISIONS, DEFERMENT OF PAYMENTS.
CONTINUATION OF COVERAGE. Unless otherwise agreed to by the Owner and Lincoln
Life, if at least one Insured is still living when the younger Insured becomes
or would have become age 100 and the policy has not lapsed or been surrendered,
the Variable Account Value, if any, will be transferred to the Fixed Account on
the next Monthly Anniversary Day after the younger Insured becomes or would have
become age 100. No further Monthly Deductions will be made and the policy will
remain in force until it is surrendered or the Death Benefit Proceeds become
payable.
PARTIAL SURRENDER. A partial surrender may be made from the Policy on any
Valuation Day in accordance with the following as long as the policy is in
force. A partial surrender must be requested In Writing or, if previously
authorized, by telephone. A partial surrender may only be made if the amount of
the partial surrender, including the transaction fee, is (a) not less than $525;
(b) not more than 90% of the Surrender Value of the policy as of the end of the
Valuation Period ending on the Valuation Day on which the request is accepted by
Lincoln Life; and (c) would not cause the Specified Amount to decline below the
Minimum Specified Amount set forth in the POLICY SPECIFICATIONS. The amount of
the partial surrender and the $25 transaction fee (as indicated in Schedule 1:
Surrender Charges) shall be withdrawn from the Fixed and/or Variable
Sub-Accounts in proportion to the balances invested in such Sub-Accounts.
Any surrender results in a withdrawal of funds from all of the Fixed and/or
Variable Sub-Accounts. Any surrender from a Variable Sub-Account will result in
the cancellation of Variable Accumulation Units which have an aggregate value on
the date of the surrender equal to the total amount by which the Variable
Sub-Account is reduced. The cancellation of such units will be based on the
Variable Accumulation Unit value of the Variable Sub-Account determined at the
close of the Valuation Period during which the surrender is effective.
EFFECT OF PARTIAL SURRENDERS ON ACCUMULATION VALUE AND SPECIFIED AMOUNT. As of
the end of the Valuation Day on which there is a partial surrender, (a) the
Accumulation Value shall be reduced by the sum of (i) the amount of the partial
surrender, plus (ii) the transaction fee specified in SCHEDULE 1; and (b) if
DEATH BENEFIT OPTION 1 is in effect, the Specified Amount shall be reduced by
the amount of the partial surrender.
LN655 17
LOAN PROVISIONS
POLICY LOANS. If the policy has Surrender Value, Lincoln Life will grant a loan
against the policy provided: (a) a proper loan agreement is executed and (b) a
satisfactory assignment of the policy to Lincoln Life is made. The loan may be
for any amount up to 100% of the then current Surrender Value; however, Lincoln
Life reserves the right to limit the amount of such loan so that total
indebtedness will not exceed 90% of the then current Accumulation Value less the
Surrender Charge as set forth under SCHEDULE 1. The amount borrowed will be paid
within seven days of Lincoln Life's receipt of such request, except as Lincoln
Life may be permitted to defer the payment of amounts as specified under GENERAL
PROVISIONS, DEFERMENT OF PAYMENTS.
The minimum loan amount is $500. Lincoln Life reserves the right to modify this
amount in the future. Lincoln Life will withdraw such loan from the Fixed and/or
Variable Sub-Accounts in proportion to the then current account values, unless
the Owner instructs Lincoln Life otherwise.
LOAN ACCOUNT. The amount of any loan will be transferred out of the Fixed and/or
Variable Sub-Accounts as described above. Such amount will become part of the
Loan Account Value. The outstanding loan balance at any time includes accrued
interest on the loan.
LOAN REPAYMENT. The outstanding loan balance (i.e. indebtedness) may be repaid
at any time during the lifetime of either Insured, however, the minimum loan
repayment is $100 or the amount of the outstanding indebtedness, if less. The
Loan Account will be reduced by the amount of any loan repayment. Any repayment
of indebtedness, other than loan interest, will be allocated to the Fixed and/or
Variable Sub-Accounts in the same proportion in which Net Premium Payments are
currently allocated, unless the Owner and Lincoln Life agree otherwise In
Writing.
INTEREST RATE CHARGED ON LOAN ACCOUNT. Interest charged on the Loan Account will
be at a rate equivalent to 8% per year, payable in arrears.
Interest charged on the Loan Account is payable annually on each Policy
Anniversary or as otherwise agreed In Writing by the Owner and Lincoln Life.
Such loan interest amount, if not paid when due, will be transferred out of the
Fixed and/or Variable Sub-Accounts in proportion to the then current Net
Accumulation Value and into the Loan Account, unless both the Owner and Lincoln
Life agree otherwise.
INDEBTEDNESS. The term "indebtedness" means money which is owed on this policy
due to an outstanding loan and interest accrued thereon, but not yet charged. A
loan, whether or not repaid, will have a permanent effect on the Net
Accumulation Value and may have a permanent effect on the Death Benefit
Proceeds. Any indebtedness at time of settlement will reduce the proceeds
payable under the policy. A policy loan reduces the then current Net
Accumulation Value under the policy while repayment of a loan will cause an
increase in the then current Net Accumulation Value.
If at any time the total indebtedness against the policy, including interest
accrued but not due, equals or exceeds the then current Accumulation Value less
surrender charge, a notice will be sent at least 31 days before the end of the
grace period to the Owner and to assignees, if any, that this policy will
terminate unless the indebtedness is repaid. The policy will thereupon terminate
without value subject to the conditions in PREMIUM AND REINSTATEMENT PROVISIONS,
POLICY LAPSE AND GRACE PERIOD.
INSURANCE COVERAGE PROVISIONS
DATE OF COVERAGE. The date of coverage will be the Date of Issue provided the
initial premium has been paid and the policy has been accepted by the Owner (1)
while both Insureds are alive and (2) prior to any change in health and
insurability as represented in the application.
LN655 18
INSURANCE COVERAGE PROVISIONS (CONTINUED)
For any insurance that has been reinstated, the date of coverage will be the
Monthly Anniversary Day that coincides with or next follows the day the
application for reinstatement is approved by Lincoln Life, provided both of the
Insureds are alive on such day.
(SEE PREMIUM AND REINSTATEMENT PROVISIONS, REINSTATEMENT.)
TERMINATION OF COVERAGE. All coverage under the policy terminates on the first
to occur of the following:
1. Surrender of the policy;
2. Death of the second of the Insureds to die; and
3. Failure to pay the amount of premium necessary to avoid termination
before the end of any applicable Grace Period.
No action by Lincoln Life after such a termination of the policy, including any
Monthly Deduction made after termination of coverage, shall constitute a
reinstatement of the policy or waiver of the termination. Any such deduction
will be refunded.
DEATH BENEFIT PROCEEDS. If both Insureds die while the policy is in force,
Lincoln Life shall pay Death Benefit Proceeds equal to the greater of (i) the
amount determined under the Death Benefit Option in effect at the time of the
Second Death, or (ii) an amount determined by Lincoln Life equal to that
required by the Internal Revenue Code to maintain the contract as a life
insurance policy (SEE SCHEDULE 4.)
DEATH BENEFIT OPTIONS. Following are the Death Benefit Options available under
the policy:
DEATH BENEFIT OPTION 1:
THE SPECIFIED AMOUNT. The Specified Amount on the Second Death, less any
indebtedness and partial surrenders.
DEATH BENEFIT OPTION 2:
SUM OF THE SPECIFIED AMOUNT AND THE ACCUMULATION VALUE. The sum of the
Specified Amount plus the Net Accumulation Value as of the Valuation Day
immediately after the Second Death, less loan interest accrued but not
yet charged.
Unless DEATH BENEFIT OPTION 2 is elected, the Owner will be deemed to have
elected DEATH BENEFIT OPTION 1.
CHANGES IN SPECIFIED AMOUNT AND DEATH BENEFIT OPTION. Unless provided otherwise,
a change in Specified Amount or Death Benefit Option may be effected any time
while this policy is in force, subject to (a) the consent of Lincoln Life, b)
all such changes must be requested In Writing on a form satisfactory to Lincoln
Life and filed at the Administrator Mailing Address, and (c) the following
conditions:
CHANGES IN SPECIFIED AMOUNT:
1. If a decrease in the Specified Amount is requested, the decrease will
become effective on the Monthly Anniversary Day that coincides with or
next follows the receipt of the request provided any requirements, as
determined by Lincoln Life, are met.
In such event, Lincoln Life will reduce the existing Specified Amount
against the most recent increase first, then against the next most
recent increases successively, and finally, against insurance provided
under the original application; however, Lincoln Life reserves the right
to limit the amount of any decrease so that the Specified Amount will
not be less than the Minimum Specified Amount shown in the POLICY
SPECIFICATIONS.
LN655 19
INSURANCE COVERAGE PROVISIONS (CONTINUED)
2. If an increase in the Specified Amount is requested:
(a) a supplemental application must be submitted and evidence of
insurability of both Insureds satisfactory to Lincoln Life must
be furnished; and
(b) any other requirements as determined by Lincoln Life must be
met.
If Lincoln Life approves the request, the increase will become effective
upon (i) the Monthly Anniversary Day that coincides with or next follows
the date the request is approved by Lincoln Life and (ii) the deduction
from the Accumulation Value (in proportion to the then current account
values of the Fixed and/or Variable Sub-Accounts) of the first month's
Cost of Insurance for the increase, provided both Insureds are alive on
such day.
CHANGES IN DEATH BENEFIT OPTION:
1. On a change from DEATH BENEFIT OPTION 1 to DEATH BENEFIT OPTION 2:
The Specified Amount will be reduced by the Accumulation Value as of the
Monthly Anniversary Day that coincides with or next follows the date of
receipt of the request for change.
2. On a change from DEATH BENEFIT OPTION 2 to DEATH BENEFIT OPTION 1:
The Specified Amount will be increased by the Accumulation Value and the
date of the change will be the Monthly Anniversary Day that coincides
with or next follows the date of receipt of the request for change.
Lincoln Life will not allow a decrease in the amount of insurance below the
minimum amount required to maintain this contract as a life insurance policy
under the Internal Revenue Code.
GENERAL PROVISIONS
THE POLICY. The policy and the application for the policy constitute the entire
contract between the parties. All statements made in the application shall, in
the absence of fraud, be deemed representations and not warranties. No statement
may be used in defense of a claim under the policy unless it is contained in the
application and a copy of the application is attached to the policy when issued.
Only the President, a Vice President, an Assistant Vice President, a Secretary,
a Director or an Assistant Director of Lincoln Life may execute or modify the
policy.
The policy is executed at the Administrator Mailing Address located on the front
cover of the policy.
NON-PARTICIPATION. The policy is not entitled to share in surplus distribution.
NOTICE OF CLAIM. Due Proof of Death must be furnished to Lincoln Life as soon as
reasonably practicable after the death of each Insured. Such notice shall be
given to Lincoln Life In Writing by or on behalf of the Owner.
PAYMENT OF PROCEEDS. Proceeds, as used in this policy, means the amount payable
(a) upon the surrender of this policy, or (b) upon the Second Death.
The amount payable upon receipt of due proof of the Second Death will be the
Death Benefit Proceeds as of the date of death. (See INSURANCE COVERAGE
PROVISIONS, DEATH BENEFIT PROCEEDS.) Death Benefit Proceeds are payable at the
Administrator Mailing Address upon the Second Death subject to the receipt of
Due Proof of Death for both Insureds. If the Second Death occurs during the
GRACE PERIOD, Lincoln Life will pay the Death Benefit Proceeds for the Death
Benefit Option in effect immediately prior to the GRACE PERIOD reduced by any
overdue monthly deductions.
LN655 20
GENERAL PROVISIONS (CONTINUED)
If the policy is surrendered, the proceeds will be the Surrender Value described
in NONFORFEITURE AND SURRENDER VALUE PROVISIONS.
The proceeds are subject to the further adjustments described in the following
provisions:
1. Misstatement of Age or Sex;
2. Incontestability; and
3. Suicide.
When settlement is made, Lincoln Life may require return of the policy.
DEFERMENT OF PAYMENTS. Any amounts payable as a result of loans, surrender, or
partial surrenders will be paid within 7 days of Lincoln Life's receipt of such
request. However, payment of amounts from the Variable Sub-Accounts may be
postponed when the NYSE is closed or when the SEC declares an emergency.
Additionally, Lincoln Life reserves the right to defer the payment of such
amounts from the Fixed Account for a period not to exceed 6 months from the date
written request is received by Lincoln Life; during any such deferred period,
the amount payable will bear interest as required by law.
MISSTATEMENT OF AGE OR SEX. If the age or sex of either of the Insureds is
misstated, Lincoln Life will adjust all benefits to the amounts that would have
been purchased for the correct ages and sexes according to the basis specified
in the "Table of Guaranteed Maximum Life Insurance Rates.
SUICIDE. If the second of the Insureds to die commits suicide, while sane or
insane, within 2 years from the Date of Issue, the Death Benefit Proceeds will
be limited to a refund of premiums paid, less (a) any indebtedness against the
policy and (b) the amount of any partial surrenders. If the second of the
Insureds to die commits suicide, while sane or insane, within 2 years from the
date of any increase in the Specified Amount, the Death Benefit Proceeds with
respect to such increase will be limited to a refund of the monthly charges for
the cost of such additional insurance and the amount of insurance will be
limited to the amount of Death Benefit Proceeds applicable before such increase
was made provided that the increase became effective at least 2 years from the
Date of Issue of the policy.
INCONTESTABILITY. Except for nonpayment of Monthly Deductions, this policy will
be incontestable after it has been in force during the lifetime of both Insureds
for 2 years from its Date of Issue. This means that Lincoln Life will not use
any misstatement in the application to challenge a claim or avoid liability
after that time. Any increase in the Specified Amount effective after the Date
of Issue will be incontestable only after such increase has been in force for 2
years during the lifetime of both Insureds.
The basis for contesting an increase in Specified Amount will be limited to
material misrepresentations made in the supplemental application for the
increase. The basis for contesting after reinstatement will be (a) limited for a
period of 2 years from the date of reinstatement and (b) limited to material
misrepresentations made in the reinstatement application.
ANNUAL REPORT. Lincoln Life will send a report to the Owner at least once a year
without charge. The report will show the Accumulation Value as of the reporting
date and the amounts deducted from or added to the Accumulation Value since the
last report. The report will also show (a) the current Death Benefit Proceeds,
(b) the current policy values, (c) premiums paid and all deductions made since
the last report, and (d) outstanding policy loans.
PROJECTION OF BENEFITS AND VALUES. Lincoln Life will provide a projection of
illustrative future Death Benefit Proceeds and values to the Owner at any time
upon written request and payment of a service fee, if any.
LN655 21
GENERAL PROVISIONS (CONTINUED)
CHANGE OF PLAN. This policy may be exchanged for another policy only if the
Company consents to the exchange and all requirements for the exchange, as
determined by the Company, are met.
However, The Owner may exchange the policy for separate single life policies on
each of the Insureds under any of the following circumstances: 1) a change in
the Internal Revenue Code (IRC) that would result in a less favorable tax
treatment of the Insurance provided under the policy, 2) the Insureds are
legally divorced while the policy is inforce, or 3) the Insureds' business is
legally dissolved while the policy is inforce.
Such a policy split is subject to all of the following conditions: 1) both
Insureds are alive and the policy is inforce at the time of the change in
circumstances noted above, 2) evidence of insurability satisfactory to Lincoln
Life is furnished, unless a) the exchange is applied for within twelve months of
the enactment of the change in the IRC, or b) the exchange is applied for within
24 months of the date of legal divorce with the split to become effective after
24 months following the date of legal divorce, 3) the amount of insurance of
each new policy is not larger than one half of the Amount of Insurance then in
force under the policy unless agreed to by the Company, and 4) any other
requirements as determined by Lincoln Life are met.
The new policy will not take effect until the date all such requirements are
met. The premium for each new policy is determined according to Lincoln Life's
rates then in effect for that policy based on each Insured's then attained age
and sex.
POLICY CHANGES - APPLICABLE LAW. This policy must qualify initially and continue
to qualify as life insurance under the Internal Revenue Code in order for the
Owner to receive the tax treatment accorded to life insurance under Federal law.
Therefore, to maintain this qualification to the maximum extent permitted by
law, Lincoln Life reserves the right to return any premium payments that would
cause this policy to fail to qualify as life insurance under applicable tax law
as interpreted by Lincoln Life. Further, Lincoln Life reserves the right to make
changes in this policy or to make distributions from the policy to the extent it
deems necessary, in its sole discretion, to continue to qualify this policy as
life insurance. Any such changes will apply uniformly to all policies that are
affected. The Owner will be given advance written notice of such changes.
LN655 22
OPTIONAL METHODS OF SETTLEMENT
This rider is made part of the policy to which it is attached as of the Date of
Issue. Upon written request, the Company will agree to pay in accordance with
any one of the options shown below all or part of the net proceeds that may be
payable under the policy.
While an Insured is alive, the request, including the designation of the payee,
may be made by the Owner. At the time the Death Benefit Proceeds become payable
under the policy, the request, including the designation of the payee, may then
be made by the Beneficiary. Once Income Payments have begun, the policy cannot
be surrendered and the payee cannot be changed, nor can the settlement option be
changed.
PAYMENT DATES. The first Income Payment under the settlement option selected
will become payable on the date proceeds are settled under the option.
Subsequent payments will be made on the first day of each month in accordance
with the manner of payment selected.
MINIMUM PAYMENT AMOUNT. The settlement option elected must result in an Income
Payment at least equal to the minimum payment amount in accordance with the
Company's rules then in effect. If at any time payments are less than the
minimum payment amount, the Company has the right to change the frequency to an
interval that will provide the minimum payment amount. If any amount due is less
than the minimum per year, the Company may make other arrangements that are
equitable.
INCOME PAYMENTS. Income Payments will remain constant pursuant to the terms of
the settlement option(s) selected. The amount of each Income Payment shall be
determined in accordance with the terms of the settlement option and the
table(s) set forth in this rider, as applicable. The mortality table used is the
1983 Individual Annuitant Mortality (IAM) Table "a" and 3% interest. In
determining the settlement amount, the settlement age of the payee will be
reduced by one year when the first installment is payable during the 1990's,
reduced by two years when the first installment is payable during the decade
2000-2009, and so on.
FIRST OPTION: LIFE ANNUITY. An annuity payable monthly to the payee during the
lifetime of the payee, ceasing with the last payment due prior to the death of
the payee.
SECOND OPTION: LIFE ANNUITY WITH CERTAIN PERIOD. An annuity providing monthly
income to the payee for a fixed period of 60, 120, 180, or 240 months (as
selected), and for as long thereafter as the payee shall live.
THIRD OPTION: ANNUITY CERTAIN. An amount payable monthly for the number of years
selected which may be from 5 to 30 years.
FOURTH OPTION: AS A DEPOSIT AT INTEREST. The Company will retain the proceeds
while the payee is alive and will pay interest annually thereon at a rate of not
less than 3% per year. Upon the payee's death, the amount on deposit will be
paid.
EXCESS INTEREST. At the sole discretion of the Company, excess interest may be
paid or credited from time to time in addition to the payments guaranteed under
any Optional Method of Settlement.
ADDITIONAL OPTIONS. Any proceeds payable under the policy may also be settled
under any other method of settlement offered by the Company at the time of the
request.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY
LR650 Page 1
OPTIONAL METHODS OF SETTLEMENT (CONTINUED)
LIFE ANNUITY AND LIFE ANNUITY WITH CERTAIN PERIOD TABLE FOR EACH $1,000 APPLIED - MALE
- ----------------------------------------------------------- ---------------------------------------------------------
Settlement age of Number of instalments certain Settlement age of Number of instalments certain
payee nearest payee nearest
birthday 60 120 180 240 birthday 60 120 180 240
- ----------------------------------------------------------- ---------------------------------------------------------
Age Life Annuity Age Life Annuity
10 $2.87 $2.87 $2.87 $2.87 $2.87 35 $3.44 $3.44 $3.44 $3.43 $3.41
11 2.89 2.89 2.89 2.88 2.88 36 3.48 3.48 3.48 3.46 3.45
12 2.90 2.90 2.90 2.90 2.90 37 3.52 3.52 3.52 3.50 3.48
13 2.92 2.92 2.91 2.91 2.91 38 3.57 3.56 3.56 3.54 3.52
14 2.93 2.93 2.93 2.93 2.92 39 3.61 3.61 3.60 3.58 3.56
15 2.95 2.95 2.95 2.94 2.94 40 3.66 3.65 3.65 3.63 3.60
16 2.96 2.96 2.96 2.96 2.96 41 3.71 3.70 3.69 3.67 3.64
17 2.98 2.98 2.98 2.98 2.97 42 3.76 3.75 3.74 3.72 3.68
18 3.00 3.00 3.00 2.99 2.99 43 3.81 3.81 3.79 3.77 3.73
19 3.02 3.02 3.01 3.01 3.01 44 3.87 3.86 3.85 3.82 3.77
20 3.04 3.04 3.03 3.03 3.03 45 3.93 3.92 3.90 3.87 3.82
21 3.06 3.05 3.05 3.05 3.05 46 3.99 3.98 3.96 3.92 3.87
22 3.08 3.08 3.07 3.07 3.07 47 4.05 4.05 4.02 3.98 3.92
23 3.10 3.10 3.09 3.09 3.09 48 4.12 4.11 4.09 4.04 3.97
24 3.12 3.12 3.12 3.11 3.11 49 4.19 4.18 4.15 4.10 4.03
25 3.14 3.14 3.14 3.14 3.13 50 4.27 4.26 4.22 4.17 4.08
26 3.17 3.17 3.16 3.16 3.15 51 4.34 4.33 4.30 4.23 4.14
27 3.19 3.19 3.19 3.19 3.18 52 4.43 4.41 4.37 4.30 4.20
28 3.22 3.22 3.22 3.21 3.20 53 4.51 4.50 4.45 4.37 4.26
29 3.25 3.25 3.24 3.24 3.23 54 4.60 4.59 4.54 4.45 4.32
30 3.28 3.28 3.27 3.27 3.26 55 4.70 4.68 4.62 4.53 4.39
31 3.31 3.31 3.30 3.30 3.29 56 4.80 4.78 4.72 4.61 4.45
32 3.34 3.34 3.33 3.33 3.32 57 4.91 4.89 4.82 4.69 4.51
33 3.37 3.37 3.37 3.36 3.35 58 5.03 5.00 4.92 4.78 4.58
34 3.41 3.41 3.40 3.39 3.38 59 5.15 5.12 5.03 4.87 4.65
- ----------------------------------------------------------- ---------------------------------------------------------
OPTIONAL METHODS OF SETTLEMENT (CONTINUED)
LIFE ANNUITY AND LIFE ANNUITY WITH CERTAIN PERIOD TABLE FOR EACH $1,000 APPLIED - MALE
---------------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
---------------------------------------------------------
Age Life Annuity
60 $5.28 $5.25 $5.14 $4.96 $4.71
61 5.43 5.39 5.27 5.06 4.78
62 5.58 5.53 5.39 5.16 4.84
63 5.74 5.69 5.53 5.26 4.90
64 5.91 5.85 5.66 5.36 4.96
65 6.10 6.03 5.81 5.46 5.02
66 6.30 6.21 5.96 5.56 5.08
67 6.51 6.41 6.12 5.66 5.13
68 6.73 6.62 6.28 5.77 5.18
69 6.97 6.84 6.44 5.86 5.23
70 7.23 7.07 6.61 5.96 5.27
71 7.51 7.32 6.79 6.05 5.31
72 7.80 7.58 6.96 6.14 5.34
73 8.12 7.85 7.14 6.23 5.37
74 8.46 8.14 7.32 6.31 5.40
75 8.82 8.45 7.50 6.38 5.42
76 9.21 8.76 7.67 6.45 5.44
77 9.63 9.10 7.84 6.51 5.45
78 10.08 9.44 8.01 6.57 5.47
79 10.56 9.80 8.17 6.62 5.48
80 11.07 10.17 8.33 6.66 5.49
81 11.62 10.55 8.48 6.70 5.49
82 12.20 10.94 8.61 6.73 5.50
83 12.82 11.33 8.74 6.76 5.50
84 13.47 11.73 8.86 6.79 5.51
85 14.17 12.12 8.97 6.81 5.51
---------------------------------------------------------
LR650 Page 2
OPTIONAL METHODS OF SETTLEMENT (CONTINUED)
LIFE ANNUITY AND LIFE ANNUITY WITH CERTAIN PERIOD TABLE FOR EACH $1,000 APPLIED - FEMALE
- ----------------------------------------------------------- ---------------------------------------------------------
Settlement age of Number of instalments certain Settlement age of Number of instalments certain
payee nearest payee nearest
birthday 60 120 180 240 birthday 60 120 180 240
- ----------------------------------------------------------- ---------------------------------------------------------
Age Life Annuity Age Life Annuity
10 $2.80 $2.80 $2.80 $2.80 $2.80 35 $3.26 $3.26 $3.26 $3.25 $3.24
11 2.81 2.81 2.81 2.81 2.81 36 3.29 3.29 3.29 3.28 3.27
12 2.82 2.82 2.82 2.82 2.82 37 3.32 3.32 3.32 3.31 3.30
13 2.83 2.83 2.83 2.83 2.83 38 3.35 3.35 3.35 3.34 3.33
14 2.85 2.85 2.85 2.84 2.84 39 3.39 3.39 3.38 3.38 3.37
15 2.86 2.86 2.86 2.86 2.86 40 3.42 3.42 3.42 3.41 3.40
16 2.87 2.87 2.87 2.87 2.87 41 3.46 3.46 3.46 3.45 3.43
17 2.89 2.89 2.89 2.88 2.88 42 3.50 3.50 3.50 3.49 3.47
18 2.90 2.90 2.90 2.90 2.90 43 3.54 3.54 3.54 3.53 3.51
19 2.92 2.92 2.92 2.91 2.91 44 3.59 3.59 3.58 3.57 3.55
20 2.93 2.93 2.93 2.93 2.93 45 3.64 3.63 3.63 3.61 3.59
21 2.95 2.95 2.95 2.95 2.94 46 3.68 3.68 3.67 3.66 3.63
22 2.96 2.96 2.96 2.96 2.96 47 3.73 3.73 3.72 3.71 3.68
23 2.98 2.98 2.98 2.98 2.98 48 3.79 3.79 3.77 3.76 3.72
24 3.00 3.00 3.00 3.00 2.99 49 3.84 3.84 3.83 3.81 3.77
25 3.02 3.02 3.02 3.02 3.01 50 3.90 3.90 3.89 3.86 3.82
26 3.04 3.04 3.04 3.03 3.03 51 3.97 3.96 3.95 3.92 3.88
27 3.06 3.06 3.06 3.06 3.05 52 4.03 4.03 4.01 3.98 3.93
28 3.08 3.08 3.08 3.08 3.07 53 4.10 4.10 4.08 4.04 3.99
29 3.10 3.10 3.10 3.10 3.09 54 4.18 4.17 4.15 4.11 4.04
30 3.13 3.13 3.12 3.12 3.12 55 4.25 4.25 4.22 4.18 4.11
31 3.15 3.15 3.15 3.14 3.14 56 4.34 4.33 4.30 4.25 4.17
32 3.18 3.18 3.17 3.17 3.16 57 4.42 4.41 4.38 4.32 4.23
33 3.20 3.20 3.20 3.20 3.19 58 4.52 4.51 4.47 4.40 4.30
34 3.23 3.23 3.23 3.22 3.22 59 4.61 4.60 4.56 4.48 4.37
- ----------------------------------------------------------- ---------------------------------------------------------
LIFE ANNUITY AND LIFE ANNUITY WITH CERTAIN PERIOD TABLE FOR EACH $1,000 APPLIED - FEMALE
- ---------------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------------
Age Life Annuity
60 $4.72 $4.70 $4.66 $4.57 $4.44
61 4.83 4.81 4.76 4.66 4.51
62 4.95 4.93 4.87 4.75 4.58
63 5.08 5.05 4.98 4.85 4.65
64 5.21 5.18 5.10 4.95 4.72
65 5.36 5.32 5.22 5.05 4.79
66 5.51 5.47 5.36 5.16 4.86
67 5.67 5.63 5.50 5.26 4.93
68 5.85 5.80 5.65 5.37 5.00
69 6.04 5.98 5.80 5.49 5.06
70 6.25 6.18 5.97 5.60 5.12
71 6.47 6.39 6.14 5.71 5.18
72 6.71 6.62 6.32 5.83 5.23
73 6.98 6.86 6.50 5.94 5.28
74 7.26 7.12 6.69 6.04 5.32
75 7.57 7.40 6.89 6.14 5.35
76 7.90 7.69 7.09 6.24 5.39
77 8.26 8.01 7.29 6.33 5.41
78 8.65 8.34 7.49 6.41 5.43
79 9.08 8.70 7.69 6.49 5.45
80 9.54 9.07 7.89 6.55 5.47
81 10.03 9.47 8.08 6.61 5.48
82 10.58 9.88 8.26 6.66 5.49
83 11.16 10.31 8.43 6.70 5.49
84 11.80 10.75 8.59 6.74 5.50
85 12.48 11.20 8.74 6.77 5.50
- ---------------------------------------------------------
ANNUITY CERTAIN TABLE FOR EACH $1,000 APPLIED
- ----------------------------------------------------------- ---------------------------------------------------------
Number of years Amount of each instalment Number of years Amount of each instalment
during which during which
instalments will be instalments will be
paid Annual Monthly paid Annual Monthly
- ----------------------------------------------------------- ---------------------------------------------------------
5 $211.99 $17.91 12 $97.54 $8.24
6 179.22 15.14 13 91.29 7.71
7 155.83 13.16 14 85.95 7.26
8 138.31 11.68 15 81.33 6.87
9 124.69 10.53 16 77.29 6.53
10 113.82 9.61 17 73.74 6.23
11 104.93 8.86 18 70.59 5.96
- ----------------------------------------------------------- ---------------------------------------------------------
- ---------------------------------------------------------
Number of years Amount of each instalment
during which
instalments will be
paid Annual Monthly
- ---------------------------------------------------------
19 $67.78 $5.73
20 65.26 5.51
25 55.76 4.71
30 49.53 4.18
- ---------------------------------------------------------
LR650 Page 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY
FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY ON
THE LIVES OF TWO INSUREDS Non-Participating Variable life
insurance payable upon death of the second Insured to die.
Adjustable Death Benefit.
Surrender Value payable upon surrender of the policy.
Flexible premiums payable to when the younger Insured reaches
or would have reached Age 100 or the death of the second Insured to
die, whichever is earlier. Investment results reflected in policy benefits.
Premium Payments and Supplementary Coverages
as shown in the Policy Specifications.
LN655
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY VUL/SVUL ADDENDUM TO
APPLICATION
THIS VUL/SVUL ADDENDUM IS SUBMITTED AS A
SUPPLEMENT TO A LIFE INSURANCE APPLICATION
- ------------------------------------------------------------------------------------------------------------------------------------
NAME OF PROPOSED INSURED(A):
- ------------------------------------------------------------------------------
FIRST MIDDLE INITIAL LAST
NAME OF PROPOSED INSURED(B):
- ------------------------------------------------------------------------------
FIRST MIDDLE INITIAL LAST
NAME OF OWNER(S):
-----------------------------------------------------------------------------------------
PROVIDE FULL LEGAL NAME
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
1. BROKER/ Print Name of Broker/Dealer:
DEALER
INFORMATION ------------------------------------------------------------
Address:
------------------------------------------------------------------------------
Telephone: Field Office Code:
------------------------------- ----------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
2. INVESTMENT Overall Investment Objective for Sub-Account Selections: (SELECT ONE OBJECTIVE ONLY)
OBJECTIVE Aggressive Growth Growth Growth & Income Income
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
3. TELEPHONE I(We) acknowledge that neither the Company nor any person
authorized by the Company will be responsible for TRANSFER any claim, loss,
liability or expense in connection with a telephone transfer if the Company
or such other AUTHORIZA- person acted on telephone transfer instructions in
good faith in reliance on this authorization.
Check here if you DO NOT wish to authorize telephone transfer instructions.
Check here if you DO NOT wish to authorize your registered representative/agent to make telephone transfers.
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
4. NO LAPSE
PROVISION The No Lapse Provision will only be effective if
elected here and if the No Lapse Premium
requirement is met. (This provision may not be
available in all states for all products.)
YES NO
- ------------------------------------------------------------------------------------------------------------------------------------
5. AUTOMATIC Quarterly Semi-Annual Annual
REBALANCING
YES NOTE: THIS SERVICE IS NOT AVAILABLE IF DOLLAR COST AVERAGING IS SELECTED.
(IF BOX IS NOT CHECKED, AUTOMATIC REBALANCING WILL NOT BE PROVIDED AT POLICY ISSUE.)
- ------------------------------------------------------------------------------------------------------------------------------------
6. DOLLAR COST SELECT ONE TRANSFER OPTION (SEE THE PROSPECTUS FOR THE MINIMUM PER TRANSFER):
AVERAGING $_____________ monthly $_____________ quarterly
(FOLLOW Each amount transferred is to be applied to the Fund(s) listed on the following page in the percentages
INSTRUCTIONS IN noted (USE WHOLE PERCENTAGES ONLY. TOTAL MUST EQUAL 100%).
SECTION 7 BEFORE
COMPLETING THIS
SECTION) I(We) understand that these transfers will continue until the Fund is exhausted or I(we) terminate the
program, whichever occurs earlier. I(We) also understand that I(we) may add to such Fund at any time to
continue this program or may change the periodic amounts.
YES NOTE: IF DOLLAR COST AVERAGING IS SELECTED, ALLOCATIONS MUST BE MADE FROM
THE MONEY MARKET FUND.
(IF BOX IS NOT CHECKED, DOLLAR COST AVERAGING WILL NOT BE PROVIDED AT POLICY ISSUE.)
- ------------------------------------------------------------------------------------------------------------------------------------
7. INITIAL FIXED ACCOUNT ________% Transfer(s) from the Fixed Account may only be made during the 30-day period
PREMIUM following each Policy Anniversary and is (are) subject to a maximum annual limit of 20% of the Fixed Account
PAYMENT Value as of that Policy Anniversary. (SEE POLICY SPECIFICATION PAGE)
ALLOCATION
- ------------------------------------------------------------------------------------------------------------------------------------
B10409
- --------------------------------------------------------------------------------------------------------------------------
7. (CONT'D) VARIABLE ACCOUNT - INITIAL DOLLAR
INITIAL PREMIUM SUB-ACCOUNTS (FUNDS) PREMIUM COST
PAYMENT (REFER TO THE PROSPECTUS FOR FUND AVAILABILITY) ALLOCATION % AVERAGING %
ALLOCATION
- ---------------------------- --------------------------------------------------- --------------------- -------------------
--------------------------------------------------- --------------------- -------------------
(Allocation to any one AIM VARIABLE INSURANCE FUNDS, INC.
% line must be 1% --------------------------------------------------- --------------------- -------------------
or more. Use whole AIM V.I. Growth Fund
percentages only. --------------------------------------------------- --------------------- -------------------
Grand Total of all AIM V.I. International Equity Fund
allocations made in --------------------------------------------------- --------------------- -------------------
this section of the AIM V.I. Value Fund
application must equal --------------------------------------------------- --------------------- -------------------
100%)
--------------------------------------------------- --------------------- -------------------
AMERICAN VARIABLE INSURANCE SERIES
--------------------------------------------------- --------------------- -------------------
Global Small Capitalization Fund - Class 2
--------------------------------------------------- --------------------- -------------------
Growth Fund - Class 2
--------------------------------------------------- --------------------- -------------------
Growth-Income Fund - Class 2
--------------------------------------------------- --------------------- -------------------
--------------------------------------------------- --------------------- -------------------
BARON CAPITAL FUNDS TRUST
--------------------------------------------------- --------------------- -------------------
IF DOLLAR COST Baron Capital Asset Fund - Insurance Shares
AVERAGING --------------------------------------------------- --------------------- -------------------
is elected, an allocation
must be made to the --------------------------------------------------- --------------------- -------------------
Money Market Fund and BT INSURANCE FUNDS TRUST
the % allocated must --------------------------------------------------- --------------------- -------------------
result in an initial amount EAFE(R) Equity Index Fund
of at least $1,000 in such --------------------------------------------------- --------------------- -------------------
account. Please complete Equity 500 Index Fund
Section 6. --------------------------------------------------- --------------------- -------------------
Small Cap Index Fund
--------------------------------------------------- --------------------- -------------------
--------------------------------------------------- --------------------- -------------------
DELAWARE GROUP PREMIUM FUND, INC.
--------------------------------------------------- --------------------- -------------------
Delchester Series
--------------------------------------------------- --------------------- -------------------
Devon Series
--------------------------------------------------- --------------------- -------------------
Emerging Markets Series
--------------------------------------------------- --------------------- -------------------
REIT Series
--------------------------------------------------- --------------------- -------------------
Small Cap Value Series
--------------------------------------------------- --------------------- -------------------
Trend Series
--------------------------------------------------- --------------------- -------------------
--------------------------------------------------- --------------------- -------------------
FIDELITY VARIABLE INSURANCE PRODUCTS FUND
--------------------------------------------------- --------------------- -------------------
Growth Portfolio - Service Class
--------------------------------------------------- --------------------- -------------------
High Income Portfolio - Service Class
--------------------------------------------------- --------------------- -------------------
FIDELITY VARIABLE INSURANCE PRODUCTS FUND II
--------------------------------------------------- --------------------- -------------------
Contrafund Portfolio - Service Class
--------------------------------------------------- --------------------- -------------------
FIDELITY VARIABLE INSURANCE PRODUCTS FUND III
--------------------------------------------------- --------------------- -------------------
Growth Opportunities Portfolio - Service Class
--------------------------------------------------- --------------------- -------------------
--------------------------------------------------- --------------------- -------------------
JANUS ASPEN SERIES
--------------------------------------------------- --------------------- -------------------
Balanced Portfolio
--------------------------------------------------- --------------------- -------------------
Worldwide Growth Portfolio
--------------------------------------------------- --------------------- -------------------
Global Technology Portfolio
--------------------------------------------------- --------------------- -------------------
--------------------------------------------------- --------------------- -------------------
LINCOLN NATIONAL
--------------------------------------------------- --------------------- -------------------
LN Bond Fund Inc.
--------------------------------------------------- --------------------- -------------------
LN Capital Appreciation Fund, Inc.
--------------------------------------------------- --------------------- -------------------
LN Equity-Income Fund, Inc.
--------------------------------------------------- --------------------- -------------------
LN Global Asset Allocation Fund, Inc.
--------------------------------------------------- --------------------- -------------------
LN Money Market Fund, Inc.
--------------------------------------------------- --------------------- -------------------
LN Social Awareness Fund, Inc.
--------------------------------------------------- --------------------- -------------------
--------------------------------------------------- --------------------- -------------------
MFS(R)VARIABLE INSURANCE TRUst
--------------------------------------------------- --------------------- -------------------
MFS Emerging Growth Series
--------------------------------------------------- --------------------- -------------------
MFS Total Return Series
--------------------------------------------------- --------------------- -------------------
MFS Utilities Series
--------------------------------------------------- --------------------- -------------------
--------------------------------------------------- --------------------- -------------------
NEUBERGER & BERMAN ADVISERS MANAGEMENT TRUST
--------------------------------------------------- --------------------- -------------------
AMT Mid Cap Growth Portfolio
--------------------------------------------------- --------------------- -------------------
AMT Partners Portfolio
--------------------------------------------------- --------------------- -------------------
--------------------------------------------------- --------------------- -------------------
TEMPLETON VARIABLE PRODUCTS SERIES FUND
--------------------------------------------------- --------------------- -------------------
International Fund - Class 2
--------------------------------------------------- --------------------- -------------------
Stock Fund - Class 2
--------------------------------------------------- --------------------- -------------------
--------------------------------------------------- --------------------- -------------------
OTHER:
--------------------------------------------------- --------------------- -------------------
--------------------------------------------------- --------------------- -------------------
NOTE: ALL PAYMENTS AND VALUES PROVIDED BY THE LIFE INSURANCE POLICY WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE
VARIABLE ACCOUNT ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. THE DEATH BENEFIT PROCEEDS AND THE CASH
VALUES MAY INCREASE OR DECREASE IN ACCORDANCE WITH THE EXPERIENCE OF THE VARIABLE ACCOUNT. ALSO, THE DEATH BENEFIT
PROCEEDS MAY BE VARIABLE OR FIXED UNDER SPECIFIED CONDITIONS.
- --------------------------------------------------------------------------------------------------------------------------
B10409
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
CERTIFICATIONS AND SIGNATURES
I(We) have read the above questions and answers and declare that they are complete and true to the best of my (our) knowledge and
belief. I(We) agree, a) that this VUL/SVUL Addendum to Application and Life Insurance Application (Part I pages 1, 2, 3, 4 and 5,
and Part IIA, or Part II, if required) shall form a part of any policy/contract issued, and b) that no Agent/Representative of the
Company shall have the authority to waive a complete answer to any question in this Addendum to Application, make or alter any
contract, or waive any of the Company's other rights or requirements. I(We) further agree that no insurance shall take effect unless
and until the policy/contract has been delivered to and accepted by me(us) and the initial premium paid during the lifetime of the
Proposed Insured(s), and provided the Proposed Insured(s) remain in the state of health and insurability represented in Parts I and
II, or Part IIA if required, of this Application.
I(We) acknowledge receipt of the current prospectus(es).
_____________________
DATED AT (CITY AND STATE) ON (MONTH, DAY AND YEAR)
_____________________
SIGNATURE OF PROPOSED INSURED (A)
_____________________
SIGNATURE OF PROPOSED INSURED (B)
_____________________
SIGNATURE OF APPLICANT/OWNER/TRUSTEE/SUB-TRUSTEE IF OTHER THAN PROPOSED INSURED
_____________________
SIGNATURE OF APPLICANT/OWNER/TRUSTEE/SUB-TRUSTEE IF OTHER THAN PROPOSED INSURED
_____________________
SIGNATURE OF LICENSED AGENT/REPRESENTATIVE/BROKER (AS WITNESS)
_____________________
SIGNATURE OF WITNESS (IF OTHER THAN AGENT/REPRESENTATIVE)
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
B10409