- -------------------------======================================================= SUPPLEMENT TO THE APPLICATION [ ] The Prudential Insurance Company of America [ ] Pruco Life Insurance Company A Subsidiary of The Prudential Insurance Company of America | No. XX XXX XXXX ------------------------------------------------------- A Supplement to the Application for a variable contract in which John Doe --------------- is named as the proposed Insured. - ---------------------- =============================================================================== I BELIEVE THIS CONTRACT MEETS MY INSURANCE NEEDS AND FINANCIAL OBJECTIVES. I ACKNOWLEDGE RECEIPT OF A CURRENT PROSPECTUS FOR THE CONTRACT. I UNDERSTAND THAT THE CONTRACT'S VALUE AND DEATH BENEFIT MAY VARY DEPENDING ON THE CONTRACT'S INVESTMENT EXPERIENCE ........................................... YES [ ] NO [X] An illustration of values is available upon request. |Date |Signature of Applicant | | | July 1, 1999 | John Doe - -------------------------------------------------------------------------------- ============ ORD 86218-90 ============