EXHIBIT 1.A.(13)(d)(iii)
RIDER FOR LEVEL TERM INSURANCE BENEFIT ON
DEPENDENT CHILDREN
This benefit is a part of this contract only if it is listed on a
contract data page.
Benefit
We will pay the amount of term insurance under this benefit if we receive due
proof that a dependent child died while this contract is in force and not in
default past the last day of the grace period and before the term insurance
provided by the benefit on his or her life ends. But our payment is subject to
all the provisions of this rider and of the rest of this contract.
The phrase dependent child means the Insured's child, stepchild, or
legally adopted child who: (1) has reached the 14th day after his or her date of
birth; (2) has not reached the first contract anniversary after his or her 25th
birthday; and either (3) is named in the application for change, which is
attached to and made a part of this contract, and on the date of the request has
not reached his or her 18th birthday; or (4) becomes the child of the Insured by
birth, marriage or adoption after the date of the request but before the child's
18th birthday.
We show the amount of term insurance under this benefit on a contract
data page. The insurance on each dependent child's life will end on the earlier
of: (1) the end of the day before the first contract anniversary after the
child's 25th birthday; (2) the end of the day before the first contract
anniversary after the Insured's 75th birthday; and (3) the end of the last day
before the contract date of any other contract to which the insurance on the
dependent child is converted or changed.
Benefit Charges
The monthly charge for this benefit is deducted each month from the contract
fund. The amount of that charge is shown under Adjustments to the Contract Fund.
Monthly charges for this benefit stop on the earlier of the date of the
Insured's death and the first anniversary after the Insured's 75th birthday.
This benefit has no cash value, but it can affect the cash value
of the contract.
PAID-UP INSURANCE
Paid-up Insurance on a Dependent Child
If the Insured dies while this contract is in force and not in default past the
last day of the grace period, any term insurance provided by this benefit on a
dependent child's life will become paid-up term insurance. While this paid-up
insurance is in effect, the contract will remain in force. The paid-up insurance
will have cash values but no loan value.
If the Insured dies by suicide within the period which we state in the
Suicide Exclusion under Death Benefits provision of the contract and our
liability is limited as we state for suicide in that provision, any provision
for paid up insurance on a dependent child who was, until the Insured died,
insured under this contract will not apply. Instead, we will then offer to
insure a dependent child under a new contract of life insurance. The new
contract will be subject to conditions and charges that are then determined, in
accordance with regular rules in effect at the time. It's amount will not be
less than the greater of (1) the amount of insurance on that person's life under
this contract, and (2) the lowest amount offered for the plan of insurance to be
provided by the new contract. Proof that the dependent child is insurable will
not be required, unless the new contract is to provide either an increased
amount of insurance or a benefit that did not apply to the dependent child under
this contract.
If this benefit becomes paid-up, it may be surrendered for its net cash
value. This will be the net value on the date of surrender of the paid-up
insurance. But, within 30 days after a contract anniversary, the net cash value
will not be less than it was on that anniversary. To compute this net cash
value, we use the Commissioners 1980 Standard Ordinary Mortality Table. We use
continuous functions based on age last birthday. We use an effective interest
rate of 4% a year.
We will usually pay any cash value promptly. But we have the right to
postpone paying it for up to six months. If we do so for more than ten days, we
will pay interest at the rate that then applies to Option 3 (Interest Payment)
of the Settlement Options provision in this contract.
VL 185 B-98 NY
II-127
CONVERSION OF INSURANCE ON A DEPENDENT CHILD
Right to Convert
The insurance on each dependent child may be converted under this rider to a new
contract of life insurance. The insurance on each child's life may be converted
only once and once converted, all coverage under this rider on such child will
end. A conversion may be made only on (a) the day the insurance ends as
described in the last paragraph under Benefit above, and (b) each contract
anniversary immediately following his or her 18th and 22nd birthdays provided
that such anniversary occurs before the insurance ends. It will not be necessary
to prove that the child is insurable.
Conditions
The right to convert to a new contract is subject to these conditions: (1) The
insurance on the child must be converted while this contract is in force and not
in default past the last day of the grace period. (2) The amount of the new
contract must meet the minimum as we describe under Contract Specifications. (3)
We must receive a written application for the new contract no later than the
date the insurance on the child may be converted.
The new contract will not take effect unless the premium for it is paid
while the child is living and within 31 days after its contract date. If the
premium is paid as we state, it will be deemed that the insurance under the new
contract took effect on its contract date.
Premium Credit
When the insurance on a dependent child is converted, we will allow a premium
credit on the first premium for the new contract. The credit is equal to the
lesser of $1.00 for each full $1,000 of the term insurance under this benefit
and $1.00 for each full $1,000 of the new contract's basic amount of insurance.
Contract Date
The date of the new contract will be the day after the date the insurance on the
dependent child is converted. If a dependent child's coverage is converted, that
child's coverage will end at the end of the day before the contract date of the
new contract.
Contract Specifications
The new contract will be in the standard rating class. We will set the issue age
and the premiums for the new contract in accordance with our regular rules in
use on its contract date.
We will endorse the new contract to show that the period we state in its
Incontestability provision will start on the date coverage of the child began
under this benefit. But if this contract was reinstated after the date the
coverage began but before the date of the new contract, that period will start
on the date of the most recent reinstatement. We will have the right to use the
statements that were made to us as the basis for reinstatement to contest the
new contract. The period during which we will have that right will be the period
we state in the Incontestability provision of the new contract.
We will endorse the new contract to show that the period we state in its
Suicide Exclusion provision will start on the date coverage of the child began
under this benefit.
Except as we state in the next sentence, the new contract may be any
life or endowment policy we regularly issue on its contract date for the same
rating class, amount, issue age, and sex. It may not be; a single premium
contract; one that insures anyone in addition to the child; one that includes or
provides for term insurance, other than extended insurance; one with premiums
that increase after a stated time, if its first premium is less than 80% of any
later premium; or one with any benefit other than the basic insurance benefit
and the waiver benefit we refer to below. A waiver benefit may either waive or
pay premiums in the event of the Insured's total disability.
The basic amount of the new contract may be any amount you ask for as
long as it is at least $10,000 and not more than five times the amount of
insurance on the child's life under this benefit; but the total amount for the
child may not exceed the maximum amount allowed by law. If the amount you want
is smaller than the smallest amount we would regularly issue on the plan you
want, we will issue a new contract for as low as $10,000 on the Life Paid Up at
Age 85 (Life Paid Up at Age 65 plan if the issue age for the new contract is
less than 15 years) plan if you ask us to.
If the new contract provides for premium payment to at least age 85, or
age 65 if the issue age for it is less than 15 years, we will include a waiver
benefit in the event of the total disability of the person insured if we would
include a waiver benefit in other contracts like the new one.
VL 185 B-98 NY
II-128
We will not waive or pay any premium under the new contract unless the
total disability started on or after its contract date. And we will not waive or
pay any premium under the new contract unless it has a waiver benefit, even if
we have paid premiums into this contract due to the Insured's total disability.
Any waiver benefit in the new contract will be the same one, with the
same provisions, that we put in other contracts like it on its contract date. In
any of these paragraphs, when we refer to other contracts, we mean contracts we
would regularly issue on the same plan as the new contract and for the same
rating class, amount, issue age and sex.
MISCELLANEOUS PROVISIONS
Changes
The insurance on a dependent child may be changed to a new contract of life
insurance other than in accordance with the requirements we state in this form.
But this kind of change may be made only if we consent, and will be subject to
conditions and charges that are then determined.
Beneficiary
The word beneficiary where we use it in this contract without qualification
means the beneficiary for insurance payable upon the death of the Insured.
On the contract date, the following two statements apply, unless we
issue the contract with an endorsement that states otherwise: (1) The
beneficiary for insurance payable upon the death of a dependent child will be
the Insured if living, otherwise the beneficiary for this insurance named in the
application. (2) If no such beneficiary is living when insurance under this
benefit becomes payable, we will make the payment in one sum to the estate of
the later to die of the Insured and such beneficiary.
You may change a beneficiary for insurance payable upon the death of a
dependent child by sending us a request in a form that meets our needs. We may
ask you to send us the contract to be endorsed. If we receive your request, and
the contract if we ask for it, at our Home Office, we will file and record the
change and it will take effect as of the date you signed the request. But if we
make any payment(s) before we receive the request, we will not have to make the
payment(s) again. Any beneficiary's interest is subject to the rights of any
assignee we know of. When a beneficiary is designated, any relationship shown is
to the Insured, unless otherwise stated.
Reinstatement
If this contract is reinstated, it will not include the insurance that we
provide under this benefit on the dependent children unless you prove to us that
each child who is to be insured on or within 15 days after the date of
reinstatement is insurable for the benefit. If you do not submit such proof for
any child, the benefit may be reinstated if all the other conditions are met to
reinstate the contract, but any child for whom proof is not submitted will not
be insured under the reinstated benefit. In this case, you may be required to
send the contract to us for endorsement.
Incontestability
Except for non-payment of premium, we will not contest this benefit with respect
to the insurance on any dependent child's life after it has been in force during
the child's lifetime for two years from the issue date.
TERMINATION OF BENEFIT
This benefit will end on the earliest of:
1. the end the last day of the grace period if the contract is in
default;
2. the end of the day before the first contract anniversary after
the Insured's 75th birthday;
3. the date the contract is surrendered for its net cash value, if
it has any, or the paid-up insurance, if any, under the benefit
is surrendered; and
4. the date the contract ends for any other reason.
Further, if you ask us in a form that meets our needs, we will cancel
the benefit as of the first monthly date on or after we receive your request.
Monthly charges due then and later will be reduced accordingly.
VL 185 B-98 NY
II-129
MAXIMUM TOTAL AMOUNT OF INSURANCE ALLOWED BY LAW
A dependent child might die when his or her age is less than 14 years
and six months. And there might be other life insurance, with us or other
companies, payable on the child's life under a contract(s) that was issued and
dated before the insurance for the child took effect under this benefit. If so,
the most we could pay under this benefit for that death is the excess of: (1)
the maximum that is allowed to be paid in accordance with the Table below, over
(2) the amount of the insurance on the child's life under (all) the other
contract(s). If the amount of insurance on the child's life under this benefit
is greater than that excess, we will reduce it by the difference, with
appropriate adjustment of the premium as filed with the Superintendent of
Insurance of New York.
If the insurance under this benefit is more than we would be allowed to
pay upon a dependent child's death, you may wish to have us reduce it to what we
could pay, with appropriate adjustment of the premium as filed with the
Superintendent of Insurance of New York. To do so, you must ask us in writing
and in a form that meets our needs. You must also send the contract to us to be
endorsed.
When we compute insurance under this or other contracts we will not
include: (1) return premium benefits; (2) dividend additions; or (3) benefits
that are paid only for death by accident.
[DEPENDENT CHILD]
THIS SUPPLEMENTARY BENEFIT RIDER ATTACHED TO THIS CONTRACT ON THE
CONTRACT DATE
VL 185 B-98 NY
II-130
CONTRACT DATA
INSURED
[JOHN DOE] [Male], Issue Age [35]
================================================================================
RATING CLASS
[Standard]
================================================================================
BASIC CONTRACT INFORMATION
Policy Number [xx xxx xx]
Contract Date [January 1, 1998]
Premium Period Life
Beneficiary [See Beneficiary Provision attached]
================================================================================
NOTICE
The contract has no generally applicable guaranteed effective interest rate used
to determine contract values. The guaranteed interest rate credited on that
portion of the contract fund placed in the fixed interest rate investment option
is 4% a year. Excess interest credited on the fixed interest rate investment
option is not guaranteed and we have the right to change the interest rate from
time to time, but not less than the fixed interest rate investment option's
guaranteed interest rate.
Dividends are not guaranteed. We have the right to determine the amount of
dividends, if any, to be credited to the contract. This may result in total cash
values different from those illustrated.
================================================================================
TYPE OF DEATH BENEFIT (see Death Benefit Provisions)
[Type B]
================================================================================
LIFE INSURANCE ON THE INSURED (as of the Contract Date)
Basic Insurance Amount
$[50,000.00]
================================================================================
INSURANCE ON ALL OTHER INSUREDS (see appropriate form for details)
Rider VL 185 B on the life of each dependent child - Level Term Insurance
Benefit on Dependent Children.
Amount
$[10,000.00]
================================================================================
CONTRACT DATA CONTINUED ON NEXT PAGE
Page 3 (97)(NY)
II-131
POLICY NO. [XX XXX XXX]
CONTRACT DATA CONTINUED
MINIMUM INITIAL PREMIUM
The minimum initial premium due on the Contract Date is $[72.86].
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CONTRACT LIMITATIONS
The minimum premium we will accept is $[25.00].
The minimum basic insurance amount is $[50,000.00].
The minimum increase in basic insurance amount is $[10,000.00].
The minimum decrease in basic insurance amount is $[10,000.00].
The minimum amount you may withdraw is $[500.00].
The minimum amount you may borrow is $[200.00].
The Surrender Charge Threshold is $[50,000.00].
================================================================================
ADJUSTMENTS TO PREMIUM PAYMENTS
From each premium paid we will:
Subtract an administrative charge of up to 7.5% of the premium (s) paid.
---------
Subtract a charge for sales expenses at a rate of up to 4% of the premium(s)
---------
paid.
The remainder of the premium is the invested premium amount.
================================================================================
ADJUSTMENTS TO THE CONTRACT FUND
On the Contract Date the contract fund is equal to the invested premium amount
credited on that date, minus any of the charges described below which may be
-----
due on that date.
On each day after the contract date, we will adjust the contract fund by:
adding any invested premium amounts.
------
adding any increase due to investment results of the variable investment
------
options.
adding guaranteed interest at an effective annual rate of 4% (0.01074598% a
------
day) on that portion of
CONTRACT DATA CONTINUED ON NEXT PAGE
Page 3A (97)(NY)
II-132
POLICY NO. [XX XXX XXX]
CONTRACT DATA CONTINUED
the contract fund that is not in a variable investment option.
adding any excess interest on that portion of the contract fund that is in a
------
fixed interest rate investment option.
subtracting any decrease due to investment results of the variable investment
-----------
options.
subtracting a charge against the variable investment options at an effective
-----------
annual rate of not more than 0.90% (.00245475% a day) for mortality and
expense risks that we assume.
subtracting any withdrawals.
-----------
subtracting an administrative charge of up to $25.00 for any withdrawals.
-----------
subtracting an administrative charge of up to $25.00 for any change in basic
-----------
insurance amount.
subtracting an administrative charge of up to $25.00 for each transfer between
-----------
investment options exceeding twelve in any contract year.
subtracting any surrender charges that may result from a withdrawal,
-----------
surrender, or reduction in the basic insurance amount.
And on each monthly date, we will adjust the contract fund by:
subtracting a charge for the cost of insurance of up to the maximum monthly
-----------
rate (see Table of Maximum Monthly Insurance Rates) multiplied by the coverage
amount divided by $1000. The coverage amount is equal to the death benefit
(See Death Benefit) minus the value of the contract fund.
subtracting a charge for administrative expenses of up to $10.00 plus $0.07
-----------
per $1000 of the basic insurance amount within the first contract year.
subtracting a charge for administrative expenses of up to $10.00 plus $0.07
-----------
per $1000 of the basic insurance amount after the first contract year.
CONTRACT DATA CONTINUED ON NEXT PAGE
Page 3B (97)
II-133
POLICY NO. [XX XXX XXX]
CONTRACT DATA CONTINUED
subtracting a charge of up to $0.01 per $1000 of the basic insurance amount to
-----------
guarantee the minimum death benefit.
subtracting a maximum monthly charge for the following benefits:
-----------
the maximum monthly charge for Rider VL 185 B is:
starting on the Contract Date $[4.10]payable until
[JAN 1, 2038].
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SCHEDULE OF MAXIMUM SURRENDER CHARGES
For a full surrender at the beginning of the contract year indicated, the
maximum charge we will deduct from the contract fund is shown below. For a full
surrender at other times, the surrender charge will reflect the completed
contract months that have passed since the last anniversary.
For a Surrender Occurring
At the Start of The Maximum Surrender
Contract Year Charge is
-----------------------------------------------------------------
1 $[446.82]
2 $[446.82]
3 $[446.82]
4 $[446.82]
5 $[446.82]
6 $[446.82]
7 $[446.82]
8 $[335.12]
9 $[223.41]
10 $[111.71]
11 and later 0.00
-----------------------------------------------------------------
We may also deduct a surrender charge when you change the basic insurance
amount or the type of death benefit, and when you make a withdrawal. (See
Change In Basic Insurance Amount, Changing The Type Of Death Benefit, and
Withdrawals.)
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CONTRACT DATA CONTINUED ON NEXT PAGE
Page 3C (97)
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POLICY NO. XX XXX XXX
CONTRACT DATA CONTINUED
INVESTMENT OPTIONS
THE PRUDENTIAL VARIABLE APPRECIABLE ACCOUNT
This account is registered with the SEC under the Investment Company Act of
1940. Each investment option of this account invests in a specific portfolio of
The Prudential Series Fund, Inc., and such other funds as we may specify from
time to time. The Prudential Series Fund, Inc. and other funds identified below
are registered with the SEC under the Investment Company Act of 1940 as open-
end diversified management investment companies. We show below the available
investment options and the funds and fund portfolios they invest in.
These are Class One investments as described under Transfers.
VARIABLE INVESTMENT OPTIONS
Money Market
Diversified Bond
Conservative Balanced
Flexible Managed
High Yield Bond
Stock Index
Equity Income
Equity
Prudential Jennison
Global
FIXED INTEREST RATE INVESTMENT OPTION
The fixed interest rate investment option is funded by the general account of
the company. It is described in the Fixed Investments provision of this
contract. This is a Class Two investment as described under Transfers.
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INITIAL ALLOCATION OF INVESTED PREMIUM AMOUNTS
Fixed Interest Rate 40%
Money Market 60%
================================================================================
END OF CONTRACT DATA
Page 3D (97)(NY)
II-135
POLICY NO. XX XXX XX
TABLE(S)
TABLE OF DEATH BENEFIT GUARANTEE VALUES
These values are used to determine the death benefit guarantee as described
under Death Benefit Guarantee. The values on contract anniversaries are shown
below. On a date that falls between two anniversaries, the value will fall
between the values for those anniversaries considering the time that has passed
since the last anniversary.
The Limited Death Benefit Guarantee period is the first [32] contract years.
LIMITED LIFETIME
CONTRACT DEATH BENEFIT DEATH BENEFIT
ANNIVERSARY GUARANTEE VALUE GUARANTEE VALUE
- --------------------------------------------------------------------------
Contract Date $0 $0
1st $[841.88] $[3,111.68]
2nd $[1,717.44] $[6,347.83]
3rd $[2,628.02] $[9,713.42]
4th $[3,575.02] $[13,213.64]
5th $[4,559.90] $[16,853.87]
6th $[5,584.18] $[20,639.70]
7th $[6,649.43] $[24,576.97]
8th $[7,757.29] $[28,671.73]
9th $[8,909.46] $[32,930.28]
10th $[10,107.72] $[37,359.17]
11th $[11,353.91] $[41,965.22]
12th $[12,649.95] $[46,755.51]
13th $[13,997.83] $[51,737.41]
14th $[15,399.62] $[56,918.59]
15th $[16,857.48] $[62,307.01]
16th $[18,373.66] $[67,910.97]
17th $[19,950.49] $[73,739.09]
18th $[21,590.39] $[79,800.33]
19th $[23,295.89] $[86,104.02]
20th $[25,069.61] $[92,659.86]
21st $[26,914.27] $[99,477.93]
22nd $[28,832.72] $[106,568.73]
23rd $[30,827.91] $[113,943.16]
24th $[32,902.91] $[121,612.57]
25th $[35,060.91] $[129,588.75]
CONTRACT DATA CONTINUED ON NEXT PAGE
Page 4 (97)
II-136
POLICY NO. XX XXX XXX
LIMITED LIFETIME
CONTRACT DEATH BENEFIT DEATH BENEFIT
ANNIVERSARY GUARANTEE VALUE GUARANTEE VALUE
- --------------------------------------------------------------------------
26th $[37,305.23] $[137,883.98]
27th $[39,639.32] $[146,511.02]
28th $[42,066.77] $[155,483.14]
29th $[44,591.32] $[164,814.15]
30th $[47,216.85] $[174,518.40]
31st $[49,947.40] $[184,610.82]
32nd $[52,787.18] $[195,106.93]
33rd $[206,022.89]
34th $[217,375.49]
35th $[229,182.19]
36th $[241,461.16]
37th $[254,231.29]
38th $[267,512.22]
39th $[281,324.39]
40th $[295,689.05]
41st $[310,573.69]
42nd $[326,053.72]
43rd $[342,152.95]
44th $[358,896.15]
45th $[376,309.08]
46th $[394,418.52]
47th $[413,252.34]
48th $[432,839.51]
49th $[453,210.17]
50th $[474,395.66]
51st $[496,428.57]
52nd $[519,342.79]
53rd $[543,173.58]
54th $[567,957.60]
55th $[593,732.98]
56th $[620,539.38]
57th $[648,418.04]
58th $[677,411.84]
59th $[707,565.39]
60th $[738,925.09]
61st $[771,539.17]
62nd $[805,457.82]
63rd $[840,733.21]
64th $[877,419.62]
65th $[915,573.48]
- -------------------------------------------------------------------
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Page 4A (97)
II-137