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EXHIBIT 1A(5)(c)
PEOPLES BENEFIT LIFE INSURANCE COMPANY
Home Office located at: 4333 Edgewood Road N.E., Cedar Rapids, Iowa 52499
A Stock Company
(Hereafter called the Company, we, our or us)
LEVEL ONE YEAR TERM INSURANCE RIDER
This extra benefit rider, attached to and made part of the policy, provides as
described below, level term insurance on the Insured.
We agree to pay the death benefits to your beneficiary when we receive due proof
at our home office of the following:
1. That the Insured's death occurred while this rider was in force.
2. That the Insured's death occurred before the expiry date of this rider.
INSURED
The Insured is the person shown as the Insured on page 3.
EXPIRY DATE
The expiry date means the rider anniversary at the end of the period of coverage
for this rider shown on page 3.
AMOUNT OF DEATH BENEFIT
The amount of death benefit payable is shown on page 3. This amount is payable
in addition to the proceeds payable under the policy.
TERMINATION
This rider will terminate on the earliest of the following dates:
1. The expiry date of this rider.
2. The date the policy terminates.
3. The date the rider or policy lapses for failure to pay a premium.
4. The death of the Insured.
5. The date the conversion option is exercised.
6. The date a Nonforfeiture Option under the policy, if any, becomes effective.
You may terminate this rider by written request. Our acceptance of a premium for
any period after the date of termination of this rider shall create no liability
for us, nor will it constitute a waiver of the termination. Any premium which
has been accepted by us will be refunded.
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THE CONTRACT
In this rider "policy" means the policy in which you have requested that this
rider be included. "Page 3" means page 3 of the policy.
This rider is issued in consideration of the application and the payment of
premiums as provided.
The amount of insurance under this rider, the amount of premium and the
premium-paying period are shown on page 3.
If a waiver of premium rider is included in the policy, that rider will also
apply to this rider.
This rider is a part of the policy. All provisions of the policy which are not
inconsistent with the provisions of this rider apply to this rider.
RIDER DATE
Rider months, years and anniversaries are measured from the rider date. The
rider date is the policy date unless a different rider date is shown in an
endorsement attached to the policy. When used in the rider, "effective date"
means the rider date.
INCONTESTABILITY
This rider is subject to the Incontestability provisions of the policy. However,
the contestable period shall as far as this rider is concerned, be measured from
the date of issue of this rider.
NON-PARTICIPATION
This rider will not share in our surplus earnings.
BASIS OF COMPUTATION
We use the Male and Female1980 CSO, (S or NS), Age Last Birthday. Reserves are
not less than the required minimum reserves.
MONTHLY INSURANCE CHARGE FOR THIS RIDER
While this rider is in force, a Monthly Cost of Insurance Charge for this
coverage will be included in the Monthly Deduction to the Policy Value. The
Monthly Guaranteed Maximum Cost of Insurance Rates are shown in the Monthly
Guaranteed Maximum Cost of Insurance Rates Table as shown in the policy to which
this rider is attached. We may use Cost of Insurance Rates lower than the
guaranteed maximum rates but will never charge rates in excess of the guaranteed
maximum rates. Any change to the Cost of Insurance Rates will be applied
uniformly to all members of the same premium class. The Monthly Guaranteed
Maximum Cost of Insurance Rate is based on the Insured's:
-Sex
-Attained age, and
-Premium class shown on page 3 of the policy.
RENEWAL
If this rider is in force on any Expiry Date, and the Insured is age 99 or less,
it may be renewed on that date or within 31 days thereafter without evidence of
insurability. Renewal will be for one year.
Upon renewal, this rider will continue in force upon deduction of the Monthly
Cost of Insurance Charges, for the Insured's then attained age, until the next
Expiry Date, subject to the provisions of this rider and policy.
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CONVERSION
While in force this rider may be converted to a new policy without evidence of
insurability. This conversion option is available while no premium is in
default, and prior to the Insured's 75th birthday. The new policy will be issued
for an amount not exceeding the amount Insured by this rider.
A rider providing benefits in the event of total and permanent disability, or
additional benefits in the event of death by accident, will be included in the
new policy without evidence of insurability only if:
a) such a rider is in force under the terms of the policy to which this
rider is attached at the date of conversion,
b) the Insured is not totally and permanently disabled on the date of
conversion, and
c) only if on the date of conversion, we customarily issue such riders with
new policies at the then attained insurance age of the Insured.
Such conversion will be made only on your written request.
The date of issue of the policy will be the date of conversion. The plan of
insurance under the new policy will be a plan of level premium whole life or
endowment insurance which we issue on the policy date of the new policy, at our
then current rates.
INCONTESTABILITY AND SUICIDE
If the rider is converted in accordance with the Conversion Option, the
Incontestability and Suicide provisions in the new policy shall be void.
CONTINUATION
If the policy to which this rider is attached is converted prior to the Expiry
Date, then this rider may be continued on the new policy without evidence of
insurability at the same premium rate.
Signed for us at our home office.
/s/ [SIG] /s/ BART HERBERT JR.
SECRETARY PRESIDENT
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