1
EXHIBIT 1.A.(5)(a)
NEW ENGLAND LIFE
INSURANCE COMPANY
NEV-18
Variable Life Policy
PLAN OF INSURANCE
Flexible Premium Adjustable Variable Survivorship Life
NEW ENGLAND LIFE INSURANCE COMPANY Agrees to pay THE DEATH BENEFIT OF THIS
POLICY TO THE BENEFICIARY ON RECEIPT OF PROOF OF THE LAST DEATH AND to provide
THE OTHER RIGHTS AND BENEFITS OF THE POLICY.
These agreements are subject to all of the provisions of the Policy.
Signed on the Date of Issue
for the Company at its
Home Office,
501 Boylston Street
Boston, MA 02117
ABCD
President
ABCD
Secretary
FLEXIBLE PREMIUM
ADJUSTABLE VARIABLE
SURVIVORSHIP LIFE POLICY
- - The Death Proceeds are payable at the Last Death, if the Policy is in force.
- - The Policy can be adjusted by decreasing the Face Amount.
- - The amount and frequency of premium payments can be changed.
- - The Policy does not share in dividends.
THE DEATH BENEFIT ON THE POLICY DATE WILL BE EQUAL TO THE FACE AMOUNT SHOWN IN
SECTION 1. THEREAFTER, THE DEATH BENEFIT CAN VARY FROM DAY TO DAY. IT CAN
INCREASE OR DECREASE, DEPENDING ON SEPARATE INVESTMENT ACCOUNT PERFORMANCE AND
ON FIXED ACCOUNT INTEREST; BUT IT WILL NOT BE LESS THAN THE FACE AMOUNT. SEE
SECTION 9.
THE CASH VALUE OF THIS POLICY CAN VARY FROM DAY TO DAY. IT CAN INCREASE OR
DECREASE, DEPENDING ON SEPARATE INVESTMENT ACCOUNT PERFORMANCE AND ON FIXED
ACCOUNT INTEREST. SEE SECTION 13.
PLEASE READ YOUR POLICY CAREFULLY
This Policy is a legal Contract between you and the Company.
RIGHT TO RETURN THE POLICY WHEN THIS POLICY IS ISSUED, YOU SHOULD EXAMINE IT.
YOU CAN RETURN THE POLICY TO THE COMPANY OR ITS AGENT FOR ANY REASON WITHIN 10
DAYS AFTER YOU RECEIVE IT FROM THE COMPANY. IF YOU RETURN THE POLICY: AN AMOUNT
EQUAL TO THE SUM OF (a) THE DIFFERENCE, IF ANY, BETWEEN ANY PREMIUM PAID PLUS
ANY UNSCHEDULED PAYMENT MADE AND THE AMOUNTS ALLOCATED TO THE VARIABLE ACCOUNT
AND THE FIXED ACCOUNT AND (b) THE VALUE OF ANY AMOUNTS ALLOCATED TO THE VARIABLE
ACCOUNT AND THE FIXED ACCOUNT WILL BE REFUNDED TO YOU; AND THE POLICY WILL BE
CANCELLED FROM THE START.
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NEV-18
POLICY PROVISIONS
Section
1 Policy Schedule
2 Table of Guaranteed Insurance Factors Per
$1,000
3 Surrender Charge
4 Table of Corridor Factors
5 Accounts Available
6 Contract
7 The Variable Account
8 The Fixed Account
9 Death Benefit
10 Premiums
11 Monthly Deduction
12 Reinstatement After Lapse
13 Cash Value of the Policy
14 Policy Loans
15 Policy Changes
16 24 Months Conversion Right
17 Owner and Beneficiary
18 Payment of Benefits
19 Payment Options
20 Life Income Tables
- Riders, if any
- Amendments and Endorsements
- Copy of the Application
ALPHABETICAL GUIDE
Section
1,6 Age of Insured
11 Amount at Risk
17 Assignments
17 Beneficiary
18 Benefits, Payment of
13 Cash Value
6 Claims of Creditors
6 Contestable
6 Contract
1, 6 Date of Issue
1, 6 Date, Policy
9 Death Benefit
15 Decrease in Face Amount
1 Face Amount
8 Fixed Account
11 Grace Period
2 Insurance Factors
13 Investment Return
18, 19 Life Income Options
20 Life Income Tables
1 Loan Interest Rate
14 Loans, Policy
11 Monthly Deduction
13 Net Cash Value
17 Owner
15 Partial Surrender
19 Payment Options
6 Periodic Reports
15 Policy Changes
14 Policy Loan Balance
6 Postponement of Payments
10 Premiums
12 Reinstatement
1 Schedule, Policy
5, 7 Sub-Accounts
6 Suicide
3 Surrender Charge
3, 13 Surrender of the Policy
16 24 Months Conversion Right
7 Variable Account
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NEW ENGLAND LIFE
INSURANCE COMPANY
1. Policy Schedule
OWNER AND BENEFICIARY
As named in the Application or as later
changed. See the Owner and Beneficiary Section
of the Policy.
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POLICY NUMBER
Specimen
POLICY DATE DATE OF ISSUE
September 1, 1999 September 1, 1999
POLICY LOAN INTEREST RATE DEATH BENEFIT OPTION DEFINITION OF LIFE INSURANCE TEST
4.35% 1 Guideline Premium Test
THIS POLICY IS ADJUSTABLE. IF IT IS ADJUSTED, A NEW POLICY SCHEDULE WILL
SUPERSEDE THIS SCHEDULE.
SCHEDULE OF INSUREDS
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Insured 1: John Alden Age and Sex: 35 Male Policy Class: Smoker Standard
Insured 2: Myles Standish Age and Sex: 35 Male Policy Class: Smoker Standard
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SCHEDULE OF BENEFITS
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FACE AMOUNT*
Flexible Premium Adjustable Variable Survivorship Life $100,000
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SCHEDULE OF PREMIUMS
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Planned Annual Premium: $768.00**
Monthly Minimum Premium: $ 41.66
Maximum Monthly Policy Fee:
Years 1 - 3 $12.50
Thereafter $ 5.50
Maximum Monthly Mortality and Expense Risk Charge:
Years 1 - 10 $.009/12 times (Cash Value before the Monthly Deduction minus
the Policy's portion of the Fixed Account)
Thereafter $.0045/12 times (Cash Value before the Monthly Deduction minus
the Policy's portion of the Fixed Account)
Maximum Monthly Administrative Charge:
Years 1 - 3 $8.00
Thereafter $6.00
Maximum Premium Expense Charge:
Year 1 30% of the first $768.00 of premium plus 7.5% of the
remainder***
Years 2 - 10 15% of the first $768.00 of premium in each year plus
7.5% of the remainder***
Thereafter 7.5% of the premium
ABCD
Secretary
4
NEW ENGLAND LIFE
INSURANCE COMPANY
1. Policy Schedule (second page)
OWNER AND BENEFICIARY
As named in the Application or as later
changed. See the Owner and Beneficiary Section
of the Policy.
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POLICY NUMBER
Specimen
POLICY DATE DATE OF ISSUE
September 1, 1999 September 1, 1999
POLICY LOAN INTEREST RATE DEATH BENEFIT OPTION DEFINITION OF LIFE INSURANCE TEST
4.35% 1 Guideline Premium Test
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THIS POLICY IS ADJUSTABLE. IF IT IS ADJUSTED, A NEW POLICY SCHEDULE WILL
SUPERSEDE THIS SCHEDULE.
SCHEDULE OF PREMIUMS (CONTINUED)
* This coverage may expire if premiums paid are insufficient to continue the
coverage. There may be little or no Cash Value at that time.
** If the Planned Annual Premium is paid on the first day of each policy year,
and the Actual Investment Return is 4% and the guaranteed maximum charges
apply in all years, this Policy will terminate in policy year 40 unless
additional premium is paid.
*** Premiums paid within 20 days before a policy anniversary are assumed to be
paid in the following year.
ABCD
Secretary
5
NEW ENGLAND LIFE
INSURANCE COMPANY
2. Table of Guaranteed Insurance Factors per $1,000
Based on the 1980 CSO Smoker Table
POLICY NUMBER Specimen
POLICY YEAR MONTHLY FACTOR POLICY YEAR MONTHLY FACTOR
1 $.0006 34 $2.2448
2 .0019 35 2.5494
3 .0035 36 2.8913
4 .0055 37 3.2761
5 .0080 38 3.7166
6 .0111 39 4.2180
7 .0151 40 4.7750
8 .0199 41 5.3988
9 .0259 42 6.0596
10 .0331 43 6.7460
11 .0419 44 7.4456
12 .0522 45 8.1702
13 .0646 46 8.9418
14 .0790 47 9.7747
15 .0963 48 10.6882
16 .1165 49 11.6882
17 .1410 50 12.7422
18 .1702 51 13.8176
19 .2056 52 14.8807
20 .2482 53 15.9144
21 .2979 54 17.0246
22 .3560 55 18.1139
23 .4220 56 19.1958
24 .4978 57 20.2900
25 .5830 58 21.4397
26 .6817 59 22.8934
27 .7970 60 24.7464
28 .9320 61 27.4231
29 1.0905 62 31.9931
30 1.2737 63 39.9825
31 1.4824 64 54.8157
32 1.7133 65 83.3333
33 1.9683
ABCD
Secretary
6
NEW ENGLAND LIFE
INSURANCE COMPANY
3. Surrender Charge
POLICY NUMBER
Specimen
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THIS POLICY IS ADJUSTABLE. IF IT IS ADJUSTED, A NEW SECTION 3 SURRENDER CHARGE
WILL SUPERSEDE THIS SECTION.
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A Surrender Charge will be deducted from partial surrenders that reduce the Face
Amount, full surrender, decrease in Face Amount, and lapse transactions during
the first 15 policy years. The Maximum Surrender Charge for year 1 is shown
below. The Maximum Surrender Charges for the last policy month of each of years
2 through 15 are shown below; the Maximum Surrender Charges for other months
will reflect the number of completed policy months in the year of surrender,
lapse or decrease in Face Amount.
YEAR OF
SURRENDER, MAXIMUM
DECREASE OR SURRENDER
LAPSE CHARGE
1 $691.20
2 641.82
3 592.46
4 543.09
5 493.71
6 444.34
7 394.97
8 345.60
9 296.23
10 246.86
11 197.49
12 148.11
13 98.74
14 49.37
15 0.00
ABCD
Secretary
7
NEW ENGLAND LIFE
INSURANCE COMPANY
4. Table of Corridor Factors
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POLICY NUMBER
Specimen
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AGE* IRS ENHANCED AGE* IRS ENHANCED
35 2.50 2.50 68 1.17 1.17
36 2.50 2.50 69 1.16 1.16
37 2.50 2.50 70 1.15 1.15
38 2.50 2.50 71 1.13 1.13
39 2.50 2.50 72 1.11 1.11
40 2.50 2.50 73 1.09 1.09
41 2.43 2.43 74 1.07 1.07
42 2.36 2.36 75 1.05 1.05
43 2.29 2.29 76 1.05 1.05
44 2.22 2.22 77 1.05 1.05
45 2.15 2.15 78 1.05 1.05
46 2.09 2.09 79 1.05 1.05
47 2.03 2.03 80 1.05 1.05
48 1.97 1.97 81 1.05 1.10
49 1.91 1.91 82 1.05 1.15
50 1.85 1.85 83 1.05 1.20
51 1.78 1.78 84 1.05 1.25
52 1.71 1.71 85 1.05 1.30
53 1.64 1.64 86 1.05 1.35
54 1.57 1.57 87 1.05 1.40
55 1.50 1.50 88 1.05 1.45
56 1.46 1.46 89 1.05 1.50
57 1.42 1.42 90 1.05 1.50
58 1.38 1.38 91 1.04 1.50
59 1.34 1.34 92 1.03 1.50
60 1.30 1.30 93 1.02 1.50
61 1.28 1.28 94 1.01 1.50
62 1.26 1.26 95 1.01 1.50
63 1.24 1.24 96 1.01 1.40
64 1.22 1.22 97 1.01 1.30
65 1.20 1.20 98 1.01 1.20
66 1.19 1.19 99 1.01 1.10
67 1.18 1.18 100 1.00 1.00
* Based on age of younger Insured.
ABCD
Secretary
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5. Accounts Available on 9/1/99
- - Variable
Back Bay Advisors Money Market Sub-account
Back Bay Advisors Bond Income Sub-account
Fidelity VIP High Income Sub-account
Back Bay Advisors Managed Sub-account
Fidelity VIP II Asset Manager Sub-account
Loomis Sayles Balanced Sub-account
Alger Equity Growth Sub-account
Capital Growth Sub-account
Davis Venture Value Sub-account
Fidelity VIP Equity-Income Sub-account
Goldman Sachs Midcap Value Sub-account
Loomis Sayles Small Cap Sub-account
MFS Investors Sub-account
MFS Research Managers Sub-account
Westpeak Growth and Income Sub-account
Westpeak Stock Index Sub-account
Fidelity VIP Overseas Sub-account
Morgan Stanley International Magnum Equity Sub-account
- - Fixed
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NEV-18
6. Contract
THE CONTRACT
This Policy is a legal contract between the Owner of the Policy (called "you")
and New England Life Insurance Company, a Massachusetts corporation, (called
"the Company"). The Policy, which includes the attached Application and any
Application for adjustment of the Policy, is the entire contract between you and
the Company. All riders are listed in Section 1. No change in or waiver of the
provisions of the Policy is valid unless the change or waiver is signed by the
President or the Secretary of the Company.
PAYMENTS UNDER THE CONTRACT
All contract amounts are in dollars of the United States of America. Payments by
the Company under the contract will be made at the Home Office of the Company.
The obligations of the Company are subject to all payments made and actions
taken by the Company under the Policy before receipt by the Company at its Home
Office of proof of the Last Death.
DATES
Policy years, months and anniversaries are all measured from the Policy Date.
Contestable and suicide periods start on the Date of Issue. The Policy Date and
the Date of Issue are shown in Section 1.
LAST DEATH
The Last Death is the later of: the death of Insured 1; and the death of Insured
2.
NOT CONTESTABLE AFTER TWO YEARS
Insurance is issued by the Company in reliance on the statements made in the
Application for the insurance. Those statements are representations; they are
not warranties. No statement can be used to contest or rescind insurance on the
life of an Insured or to defend against a claim unless contained in the
Application for the insurance on that Insured. The insurance issued under this
Policy will not be contestable after it has been in force during the life of
each Insured:
- - With respect to the amount of Death Benefit which results from other than
payments for which proof of insurability is required, for two years from
the Date of Issue; and
- - With respect to any amount of Death Benefit which results from a payment
for which proof of insurability is required, for two years from the date
that payment is received.
SUICIDE WITHIN TWO YEARS
If either of the Insureds dies by suicide while sane or insane within two years
from the Date of Issue, the Death Benefit will be limited to: the amount of the
premiums paid; less any Policy Loan Balance; and less any partial surrenders.
The Policy will terminate as of the date of the first death by suicide.
Within 60 days after the first death by suicide, the Owner can purchase new life
insurance on an Eligible Insured without evidence of insurability. For purposes
of this provision, an Eligible Insured is a surviving Insured on whom the
Company would have issued a single life policy on the Policy Date of this
Policy. The new policy will be issued:
- - On the most recently approved plan of single life variable insurance issued
by the Company on the Policy Date of the new policy, if the issue age on
the new policy is age 75 or younger;
- - On a single life Ordinary Life insurance plan with a level face amount
issued by the Company on the Policy Date of the new policy, if the issue
age on the new policy is greater than 75;
- - On a policy form and at rates in use by the Company on the Policy Date;
- - Subject to any assignments and limitations to which this Policy is subject;
- - With a Policy Date and Date of Issue the same as the date of the first
death by suicide under this Policy;
- - Based on the underwriting class to which the Eligible Insured was assigned
by the Company on the Policy Date of this Policy;
- - At the insurance age of the Eligible Insured on the Policy Date of the new
policy; and
- - With a Face Amount equal to the Face Amount of this Policy plus the amount
of any single life term rider for the Eligible Insured under this Policy.
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NEV-18
Riders can be added to the new policy only with the consent of the Company.
Application for the new policy must be: in writing; signed by the Owner and by
the Eligible Insured; and received by the Company within 60 days after the date
of the first death by suicide. However, if that Insured dies within this 60 day
period; and before the application for a new policy is received by the Company;
a death benefit for the Eligible Insured's death will be paid as if the new
policy had been issued: as a variable life policy; assuming all premiums for the
new policy were allocated to the Fixed Account (see Section 8); and assuming the
Death Benefit Option chosen was equal to the face amount of the policy.
NOTIFICATION OF FIRST DEATH
The Company should be notified immediately when the first death occurs. Even if
premiums continue to be paid after the first death, the Company has the right:
to contest the Policy under the Not Contestable After Two Years provision; or to
limit benefits and terminate the Policy under the Suicide Within Two Years
provision.
AGE AND SEX OF INSURED
The age of an Insured on the Policy Date and on each policy anniversary means
the age at the nearest birthday of that Insured based on calendar months.
If the age or the sex of either Insured has not been correctly stated in the
Application, the Death Benefit will be the amount that the most recent Monthly
Deduction (see Section 11) which was made would have provided for the correct
age and sex.
CLAIMS OF CREDITORS
The Policy and payments under it are exempt from the claims of creditors to the
extent allowed by law.
BASIS OF VALUES
"1980 CSO" means Commissioners 1980 Standard Ordinary; it is used to describe
mortality tables. Minimum Cash Values, Reserves and Guaranteed Insurance Factors
are based on the mortality table shown in Section 2. Interest is compounded
daily at the effective rate of 4% per year. A detailed statement of the method
of computing values has been filed with the Insurance Department of the state in
which the Policy is delivered. All values are equal to or in excess of the
minimum values required by the law of that state.
PERIODIC REPORTS
The Company will send you all reports required by law and regulation. Such
reports will be sent once each year or more often if required by law or
regulation. The annual report will include, as of the date for which the report
is made: the Death Benefit; the Cash Value; any Policy Loan Balance; all
transactions in connection with the Policy since the most recent report; and any
other required information.
POLICY ILLUSTRATION OF BENEFITS AND VALUES
Upon written request the Company will send you a policy illustration which will
illustrate benefits and values under the Policy.
POSTPONEMENT OF VARIABLE BENEFITS
The Company can postpone the determination of and the payment or transfer of
amounts based on separate investment account performance if:
- - The New York Stock Exchange is closed for trading (except for normal
weekend and holiday closing) or when trading is restricted; or
- - The Securities and Exchange Commission determines that a state of emergency
exists which may make payment or transfer impractical; or
- - The Securities and Exchange Commission orders the New England Zenith Fund
or its successor or any other investment company in which the Variable
Account is invested to postpone payment or transfer of variable benefits.
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NEV-18
POSTPONEMENT OF SURRENDERS, TRANSFERS AND LOANS FROM THE FIXED ACCOUNT
The Company can postpone the payment of the portion of the Policy's Net Cash
Value which is in the Fixed Account for not more than six months after
surrender. If payment is postponed for more than 30 days, it will be credited
with interest from the date of surrender. The rate of interest will be set each
year by the Company; but the rate will not be less than 3% per year.
The Company can postpone transfers from the Fixed Account for not more than six
months from the date of the request. The effective date of the transfer is the
date on which values are transferred from the Fixed Account.
The Company can postpone the making of any Policy Loan from the Fixed Account
for not more than six months from the day you apply, except Loans to pay
premiums on policies issued by the Company.
7. The Variable Account
THE VARIABLE ACCOUNT
The Variable Account (called "the Account") is a separate investment account
established by the Company in accordance with Delaware law and is now operated
in accordance with Massachusetts law. The assets of the Account are owned by the
Company. The assets of the Account will be used to provide values and benefits
under this Policy and similar policies. The portion of the Account assets equal
to the reserves plus other policy liabilities of the Account is not chargeable
with liabilities arising out of any other business the Company may conduct. The
Company reserves the right to transfer to its general account Variable Account
assets which exceed the total of reserves and other liabilities of the Account.
Income and realized and unrealized capital gains and losses of the Account are
credited to the Account without regard to any of the Company's other income or
capital gains and losses.
SUB-ACCOUNTS
The Account consists of sub-accounts, each of which is invested in shares of one
portfolio of the New England Zenith fund or its successor or any other
investment company in which the Account is invested. Shares of a portfolio are
purchased for a sub-account at their net asset value.
The initial net premium is allocated to the Account and the Fixed Account based
on allocation instructions in the Application for insurance. The portion of the
initial net premium allocated to the Account will be credited with Money Market
sub-account net investment performance beginning on the latest of:
- - The Policy Date;
- - The date of the last Part II of the Application, if any is required;
- - The effective date of the choice of the Account; and
- - The date the first premium is received by the Company.
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NEV-18
The portion of the Policy's Cash Value allocated to the Account will be
deposited, based on your choice, in the sub-accounts on the day the Company
mails the Confirmation for the initial premium. Before this date, the values and
benefits of the Policy will depend on: the net investment performance of the
Money Market sub-account if any portion of the initial premium is allocated to
the Account; and the Policy's portion of the Fixed Account. After this date each
future net premium allocated to the Account and each future net unscheduled
payment allocated to the Account will be invested in the sub-accounts you chose
as of the date it is received by the Company at its Home Office.
Each distribution of income, dividends and capital gains from a portfolio to a
sub-account will be reinvested for the benefit of the owners of the policies in
that sub-account at net asset value in shares of the portfolio which made the
distribution.
The Cash Value of the Policy at any time cannot be allocated among more than 9
sub-accounts, except with the consent of the Company; and the Fixed Account will
be counted in the limit of 9.
The values and benefits of a policy depend on: the investment performance of the
portfolios in which the sub-accounts are invested; and the interest credited to
the Fixed Account. The Company does not guarantee the investment performance of
the portfolios of the sub-accounts. You bear the investment risk for amounts
invested in the sub-accounts for your Policy.
CHOICE OF SUB-ACCOUNTS
You choose the sub-accounts in which net premiums and net unscheduled payments
are to be invested. You can change the choice for future premiums and future
unscheduled payments at any time by notice to the Company. The portion of the
net premium and the net unscheduled payment to be applied to each sub-account
chosen must be a whole percent.
CHANGE IN PORTFOLIOS
The Company can add or remove portfolios as sub-account investments as permitted
by law. When a change is made, the Company will send you: a revised prospectus
for the Account which will describe all of the portfolios then available in the
New England Zenith Fund or its successor or any other investment company in
which the Account is invested; and any notice required by law.
When a portfolio is removed, the Company has the right to substitute a different
portfolio in which the sub-account will then invest:
- - The value of the removed portfolio; and
- - Future net premiums and future net unscheduled payments applied to that
sub-account.
TRANSFER OPTION
After the Company mails the Confirmation of the first premium, you can transfer
all or a portion of the Policy's existing share of a sub-account to another
sub-account or to the Fixed Account. (See Restriction of New Amounts Applied to
the Fixed Account provision.) Requests for transfers can be made in writing or
by telephone. The Company is not responsible for determining the authenticity of
transfer instructions received by telephone. Transfers will be subject to a
limit of 4 in each policy year, except with the consent of the Company. A
transfer out of the Fixed Account will not count against this limit. The Company
reserves the right to charge for each additional transfer.
CHANGE OF INVESTMENT POLICY
The investment policy of the Account will not be changed unless: (a) the change
has been approved by the Insurance Commissioner of the Commonwealth of
Massachusetts; and (b) a statement of the approval process has been filed with
the Insurance Department of the state in which this Policy is delivered. If the
investment policy of the Account is changed, the Company will give you written
notice of the change. You can then choose to convert this Policy to a fixed
benefit coverage. The conversion will be on the basis described in the 24 Months
Conversion Right section. (See Section 16.) Your request to convert this Policy
must be made within 60 days of the later of: (a) the effective date of the
investment policy change; or (b) the date you receive the notice of the change.
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NEV-18
RIGHTS RESERVED BY THE COMPANY
The Company reserves the right to take certain actions subject to compliance
with law including, if required, the approval of the owners of the policies.
These actions are: (a) to create new investment accounts; (b) to combine any two
or more separate investment accounts, including the Account; (c) to invest some
or all of the assets of the Account other than in the New England Zenith Fund;
(d) to invest some or all of the assets of the Account in any other investment
company chosen by New England Life Insurance Company; (e) to remove a portfolio
in which the sub-account is invested or to substitute a different portfolio; (f)
to operate the Account as a management investment company and to charge
investment advisory fees under the Investment Company Act of 1940 or to operate
the Account in any other form permitted by law; and (g) to deregister the
Account under the Investment Company Act of 1940 if registration is no longer
required.
8. THE FIXED ACCOUNT
THE FIXED ACCOUNT
The Fixed Account is a portion of the general account of the Company.
The initial net premium is allocated to the Account and the Fixed Account based
on allocation instructions in the Application for insurance. The portion of the
initial net premium allocated to the Fixed Account is first invested in the
Fixed Account as of the latest of:
- - The Policy Date;
- - The date of the last Part II of the Application, if any is required;
- - The effective date of the choice of the Fixed Account; and
- - The date the first premium is received by the Company.
Thereafter, each net premium allocated to the Fixed Account and each
net unscheduled payment allocated to the Fixed Account will be applied as of the
date it is received by the Company at its Home Office. Each transfer to the
Fixed Account will be applied as of the transfer date.
FIXED ACCOUNT INTEREST
The rate of interest for each amount applied to the Fixed Account: will be the
rate set by the Company in advance for the date the amount is applied to the
Fixed Account; and will not be less than a rate equivalent to an annual
effective rate of 4%. The effective interest rate used on the Policy will be the
weighted average of all such rates for the Policy.
After the Policy has been in force for a total of 10 years, if the Company sets
an interest rate for the Fixed Account which is greater than 4%, that rate will
be increased for the Policy by at least .45%. The increase in interest rate will
reflect a reduction in the Company's interest holdback margin for expenses.
Each year, on the policy anniversary, the Company will determine a portion, if
any, of the Policy's portion of the Fixed Account which will be reinvested at
the rate effective on that date.
Interest will be credited to the Fixed Account on a daily basis.
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NEV-18
RESTRICTION OF NEW AMOUNTS APPLIED TO THE FIXED ACCOUNT
The Company reserves the right to restrict new amounts applied to the Fixed
Account if the rate of interest that would be used for the new amount is a rate
equivalent to an annual effective rate of 4%.
TRANSFERS OUT OF THE FIXED ACCOUNT
You can transfer a limited amount of the Policy's portion of the Fixed Account
to the sub-accounts once within 30 days after each policy anniversary. Except
with consent of the Company, the transfer will be limited to the greater of: 25%
of the Policy's portion of the Fixed Account; and the amount of the Policy's
portion of the Fixed Account transferred to the sub-accounts the prior year.
Requests for transfers can be made in writing or by telephone. The Company is
not responsible for determining the authenticity of transfer instructions
received by telephone.
CHOICE OF THE FIXED ACCOUNT
You can choose to have net premiums and net unscheduled payments applied to the
Fixed Account. You can change the choice for future net premiums and future net
unscheduled payments at any time by notice to the Company in writing. (See the
Restriction of New Amounts Applied to the Fixed Account provision.) The portion
of the net premium and net unscheduled payment to be applied to the Fixed
Account must be a whole percent.
9. DEATH BENEFIT
DEATH BENEFIT
The Company will pay a Death Benefit to the Beneficiary upon receipt of proof of
the Last Death. The amount of the Death Benefit will depend on the Death Benefit
Option in effect on the date of the Last Death if the Last Death occurs prior to
age 100 of the younger Insured. If the Last Death occurs on or after age 100 of
the younger Insured, the Death Benefit will equal the greatest of:
- - The Cash Value on the date of the Last Death;
- - The Face Amount of the Policy if, at age 100 of the younger Insured, the
Policy has a Guaranteed Death Benefit Rider attached and the No Lapse
Guarantee Benefit is in effect; and
- - The smallest Face Amount that has been in effect since the younger
Insured's age 80 (or since the Policy Date if the younger Insured was older
than age 80 on that Date) if the Policy has an Expanded Death Benefit Rider
attached.
The amount payable in any event will be reduced by any Policy Loan Balance on
the date of the Last Death. If the Last Death occurs during the grace period,
the Amount Due (see the Grace Period Provision in the Monthly Deduction Section)
will be deducted from the policy proceeds to cover Monthly Deductions to the
date of death. The policy proceeds will be paid in one sum unless all or part of
the proceeds is applied to a Payment Option. (See Payment of Benefits, Section
18.)
CHOICE OF DEFINITION OF LIFE INSURANCE TEST
This Policy is intended to qualify as a flexible premium adjustable life
insurance contract under the Internal Revenue Code (called "the Code") and any
interpretive regulation or rulings by the Internal Revenue Service. The Code
provides two tests to determine whether the policy meets the definition of life
insurance: the Cash Value Accumulation Test; and the Guideline Premium Test. The
Test used for the life of this Policy will be the one chosen in the original
Application; that Test cannot be changed.
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NEV-18
CASH VALUE ACCUMULATION TEST
If you choose the Cash Value Accumulation Test, the Death Benefit will not be
less than: the Policy's Cash Value plus the pro rata portion of any Monthly
Deduction made for a period beyond the date of the Last Death; times the Net
Single Premium Corridor Factor for the age of the younger Insured at the
beginning of the policy year. If you choose the Cash Value Accumulation Test,
the Net Single Premium Corridor Factor will be shown in Section 4.
GUIDELINE PREMIUM TEST
If you choose the Guideline Premium Test, you must choose one of two Death
Benefit Corridors (the IRS Corridor or the Enhanced Corridor) in the original
application. Evidence that there has been no change in insurability of either
Insured since the Date of Issue may be required to change the Death Benefit
Corridor for the Policy at a later time (see below). If you choose the Guideline
Premium Test, the Corridor Factors will be shown in Section 4.
If you choose the IRS Corridor, the Death Benefit will not be less than: the
Policy's Cash Value plus the pro rata portion of any Monthly Deduction made for
a period beyond the date of the Last Death; times the IRS Corridor Factor for
the age of the younger Insured at the beginning of the policy year.
If you choose the Enhanced Corridor, the Death Benefit will not be less than:
the Policy's Cash Value plus the pro rata portion of any Monthly Deduction made
for a period beyond the date of the Last Death; times the Enhanced Corridor
Factor for the age of the younger Insured at the beginning of the policy year.
DEATH BENEFIT OPTIONS
This Policy provides five Death Benefit Options. The Death Benefit Option will
be as chosen in the Application or as later changed. The Death Benefit Option is
shown in Section 1.
OPTION 1
The Death Benefit equals the greater of:
- - The Face Amount shown in Section 1; and
- - The death benefit required by the Guideline Premium Test with the Enhanced
Corridor.
OPTION 2
The Death Benefit equals the greater of:
- - The Face Amount shown in Section 1; and
- - The death benefit required by the Guideline Premium Test with the IRS
Corridor.
OPTION 3
The Death Benefit equals the greater of:
- - The Face Amount shown in Section 1 plus the Cash Value; and
- - The death benefit required by the Guideline Premium Test with the Enhanced
Corridor.
OPTION 4
The Death Benefit equals the greater of:
- - The Face Amount shown in Section 1; and
- - The death benefit required by the Cash Value Accumulation Test with the Net
Single Premium Corridor.
OPTION 5
The Death Benefit equals the greater of:
- - The Face Amount shown in Section 1 plus the Cash Value; and
- - The death benefit required by the Cash Value Accumulation Test with the Net
Single Premium Corridor.
If you have a Survivorship Level Term Insurance Rider, you can choose to have
the Term Amount of the Rider added to the Face Amount of the Policy for purposes
of calculating the Death Benefit.
16
CHANGING THE DEATH BENEFIT OPTION
After the first policy year and before the younger Insured is age 100, you can
change the Death Benefit Option on the first day of any policy month by written
application to the Company. However, if the change would increase the amount at
risk (see Section 11), the change can be made: only if both Insureds are living
on the Adjustment Date; and only if there has been no change in the insurability
of both Insureds. A change in Death Benefit Option will be effective on the
Adjustment Date shown in the new Policy Schedule.
Except with the consent of the Company, a change from Option 1 or 2 to Option 3
or a change from Option 4 to Option 5 can be made only if the Face Amount after
the change is at least $100,000. A change from Option 2 to Option 3 will require
evidence that there has been no change in insurability of either Insured since
the Date of Issue. If you change from Option 1 or 2 to Option 3 or from Option 4
to Option 5: the Face Amount will be decreased such that the Death Benefit
immediately before and after the change is the same; and no Surrender Charge
will apply. A decrease in Face Amount may require a decrease in the amounts
provided by riders attached to this Policy. If you chose the Guideline Premium
Test for the Policy, a portion of the Cash Value will be paid to you if
necessary in order to allow the Policy to continue to qualify as life insurance.
If you change from Option 3 to Option 1 or 2 OR from Option 5 to Option 4, the
Face Amount will be increased such that the Death Benefit immediately before and
after the change is the same.
A change from Option 1 to Option 2 OR Option 2 to Option 1 is also allowed. A
change from Option 2 to Option 1 will require evidence that there has been no
change in insurability of either Insured since the Date of Issue.
10. PREMIUMS
PAYMENT
Premiums are payments made to the Company to pay for the Policy. The Policy will
not be in force until the first premium is paid. After the first premium is
paid, premiums can be paid: at any time; and in any amount, subject to the
Limits on Premiums below. Payments can be made at the Home Office of the Company
or at any Agency of the Company. A receipt for payment signed by the Secretary
of the Company will be given on request. Unless you request otherwise in writing
to the Company, any payment received by the Company in response to an
anniversary bill and within 45 days after a policy anniversary when a Policy
Loan exists on the Policy will be used: first, as a planned premium; and second,
as payment of loan interest; and third, as an unscheduled payment. Otherwise,
the payment will be used: first, as a planned premium; and second, as an
unscheduled payment.
AMOUNT AND FREQUENCY
Planned annual premiums are shown in Section 1. Payments and Planned Premium
Dates can be annual, semi-annual or quarterly or can be at any frequency agreed
to by the Company. (See Limits on Premiums below.)
Unscheduled payments can be made at any time. (See Limits on Premiums below.)
Cash Values and Death Benefits will be permanently affected by the amount and
frequency of planned and unscheduled payments.
LIMITS ON PREMIUMS
Payments are subject to these limits:
- - No payment can be made at and after age 100 of the younger Insured, except
as stated in the Grace Period provision (see Section 11); and
- - No payment can be less than $25; and
- - Total planned and unscheduled payments will be limited to the Company's
published maximum; and
- - No unscheduled payment can be made if it increases the Death Benefit by
more than it increases the Cash Value, except with the consent of the
Company; and
- - No planned premium can be increased except with the consent of the Company.
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If you have selected the Guideline Premium Test for the Policy (see Section 9,
Choice of Definition of Life Insurance Test), premiums on this Policy are also
limited to an amount no greater than that allowing the Policy to continue to
qualify as life insurance.
NET PREMIUM
The net premium is equal to: the premium payment; less no more than the Maximum
Premium Expense Charge at the rates shown in Section 1.
11. MONTHLY DEDUCTION
MONTHLY DEDUCTION
On the first day of each policy month until age 100 of the younger Insured, the
Company will make a Monthly Deduction for that policy month from the Cash Value
of this Policy. The amount of the Monthly Deduction for a policy month is equal
to:
- - The cost of insurance and the cost of any riders for the policy month;
PLUS
- - An amount not greater than the Maximum Monthly Policy Fee shown in Section
1;
PLUS
- - An amount not greater than the Maximum Monthly Mortality and Expense Risk
Charge shown in Section 1;
PLUS
- - An amount not greater than the Maximum Monthly Administrative Charge shown
in Section 1.
At and after age 100 of the younger Insured the Cash Value of the Policy will be
calculated as described in the Cash Value of the Policy Section, except that the
Monthly Deductions will be equal to zero.
If the Policy meets the Monthly Minimum Premium test (see below) or if a
Guaranteed Death Benefit Rider is attached and the No Lapse Guarantee Benefit is
in effect, the Monthly Deduction will be made, whether or not premiums are paid,
until the Cash Value equals zero. Otherwise, the Monthly Deduction will be made,
whether or not premiums are paid, as long as the Net Cash Value is sufficient to
cover the entire Monthly Deduction. This provision will not continue any rider
beyond the termination date as provided in the rider.
The Monthly Deduction will be deducted from the sub-accounts and the Fixed
Account in the same proportion as the Cash Value of the Policy is in the
sub-accounts and the Fixed Account unless you choose in writing to have Monthly
Deductions deducted: from a specific sub-account or the Fixed Account until the
Policy's portion of that sub-account or of the Fixed Account equals zero; and
then from the remaining sub-accounts and the Fixed Account in the same
proportion as the Cash Value of the Policy is in the sub-accounts and the Fixed
Account.
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18
COST OF INSURANCE
The monthly cost of insurance for the Policy is equal to: the amount at risk;
times the cost of insurance rate per $1,000 for that month divided by 1,000. The
amount at risk is equal to:
- - The Death Benefit on the first day of the policy month discounted at the
monthly equivalent of 4% per year;
LESS
- - The Cash Value on the first day of the policy month after the Monthly
Deduction has been processed.
COST OF INSURANCE RATES
The cost of insurance rates for each policy year are based on: the sexes of the
Insureds; the underwriting classes of the Insureds; and the ages of the Insureds
on the first day of the policy year. The rates will be set by the Company each
year on the policy anniversary, based on the expectations of the Company as to
future experience. The Table of Guaranteed Insurance Factors per $1,000 (see
Section 2) shows the maximum guaranteed factor for each policy month which
starts on the Policy Date or a policy anniversary. The factors between
anniversaries vary monthly based on uniform distribution of deaths throughout
the policy year.
MONTHLY DEDUCTION ADJUSTMENT AT DEATH
The portion of any Monthly Deduction made for a period beyond the date of the
Last Death will be added to the policy proceeds. If the Last Death occurs during
the grace period, the Amount Due (see Grace Period Provision below) will be
deducted from the policy proceeds to cover Monthly Deductions to the date of the
Last Death.
GRACE PERIOD
Unless the Policy meets the Monthly Minimum Premium test or unless a Guaranteed
Death Benefit Rider is attached and the No Lapse Guarantee Benefit is in effect,
if the Net Cash Value on the first day of a policy month is not enough to cover
the Monthly Deduction for that month, the Company will mail a premium notice to
you at your address on record with the Company. There is a grace period of 62
days from the date when the Monthly Deduction was due in which to pay the Amount
Due.
The Amount Due is the least of: a premium large enough to permit the Monthly
Deduction to be made; a premium large enough to permit the No Lapse Guarantee
Benefit to be in effect if a Guaranteed Death Benefit Rider is attached to the
Policy; and a premium large enough to meet the Monthly Minimum Premium test. The
insurance remains in force during the grace period. If the Amount Due remains
unpaid at the end of its 62-day grace period, the Policy will lapse without
value. Any riders will also lapse without value unless otherwise stated in the
rider.
MONTHLY MINIMUM PREMIUM
If certain criteria are met, this Policy will not lapse even if the Net Cash
Value on the first day of the policy month is not enough to cover the Monthly
Deduction due for that month. During the first three policy years, on the first
day of each policy month, the Company will test for this benefit unless this
Policy is the result of exercising a Change to a New Insured rider.
The test will compare (a) to (b), where:
- - (a) equals the total of the Monthly Minimum Premiums for the Policy from
the Policy Date to that policy month; and
- - (b) equals the total premiums paid to date less all partial surrenders less
any Cash Value paid to you to allow the Policy to continue to qualify as
life insurance and less any Policy Loan Balance at that time.
If (b) is greater than or equal to (a), the Policy will not lapse if the Net
Cash Value on the first day of the policy month is not enough to cover the
Monthly Deduction due for that month.
The Monthly Minimum Premium is shown in the Policy Schedule. (See Section 1.)
This Premium will be recalculated when: the Face Amount is decreased; the amount
provided by riders attached to this Policy is changed; a partial surrender is
made which results in a decrease in Face Amount; a correction in the insurance
age of either Insured; or the underwriting class of this Policy and its riders
is changed to a more favorable underwriting class.
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12. REINSTATEMENT AFTER LAPSE
REINSTATEMENT
If the Policy lapses, the Policy and riders can be reinstated. (See Limitations
on Reinstatement below.) Reinstatement is subject to:
- - Written application to reinstate; and
- - Proof that both Insureds are insurable; and
- - Payment or reinstatement of any Policy Loan Balance which existed on the
date when the Policy lapsed; and
- - Payment of the cost to reinstate described below.
The Monthly Minimum Premium Test will be reinstated if the Policy lapses and is
reinstated within the first three policy years.
The cost to reinstate in the first three policy years equals the least of:
- - An amount equal to: the difference between the premiums paid and premiums
required to allow the Policy to meet the Monthly Minimum Premium Test; plus
two additional Monthly Minimum Premiums;
- - An amount equal to: the difference between the premiums paid and premiums
required to allow the No Lapse Guarantee Benefit to be in effect if the
Guaranteed Death Benefit Rider is attached to the Policy; plus 2/12 of the
Guaranteed Death Benefit Premium shown in Section 1; and
- - An amount needed to keep the Policy and any riders in force for at least
two months.
The cost to reinstate after the first three policy years equals the lesser of:
- - An amount equal to: the difference between the premiums paid and premiums
required to allow the No Lapse Guarantee Benefit to be in effect if the
Guaranteed Death Benefit Rider is attached to the Policy; plus 2/12 of the
Guaranteed Death Benefit Premium shown in Section 1; and
- - An amount needed to keep the Policy and any riders in force for at least
two months.
LIMITATIONS ON REINSTATEMENT
The Policy and riders cannot be reinstated, except with the consent of the
Company, if more than seven years have passed since the date of lapse.
Any rider which provides life or disability insurance on a person other than one
of the Insureds can be reinstated only as stated in the rider.
EFFECTIVE DATE OF REINSTATEMENT
Reinstatement will take effect: only if the application for reinstatement is
approved by the Company; and only when the premium for reinstatement has been
paid, provided that at the time of payment there has been no change in
insurability as represented in the application for reinstatement.
MAXIMUM MONTHLY CHARGES AFTER REINSTATEMENT
For the purpose of determining the Maximum Monthly Policy Fee, Maximum Monthly
Mortality and Expense Risk Charge, Maximum Monthly Administrative Charge, and
Maximum Premium Expense Charge on any date after reinstatement, the period the
Policy was lapsed will not count.
FIXED ACCOUNT INTEREST RATE AFTER REINSTATEMENT
If the Policy lapses and is reinstated in the same policy year, the rate of
interest for the amount applied to the Fixed Account at reinstatement will be
the effective interest rate (see Fixed Account Interest) for the Policy at the
time of lapse. Otherwise, the rate of interest for the amount applied to the
Fixed Account at reinstatement will be the rate set by the Company in advance
for the date the Policy is reinstated.
SURRENDER CHARGE AT AND AFTER REINSTATEMENT
A Surrender Charge will be applied if the Policy lapses. If the Policy is
reinstated, the Charge will be credited to the Cash Value of the Policy. The
Surrender Charge on the date of reinstatement will be the same as it was on the
date of lapse. For the purpose of determining the Surrender Charge on any date
after reinstatement, the period the Policy was lapsed will not count.
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13. CASH VALUE OF THE POLICY
CASH VALUE
The first net premium will be credited to the Policy as of the latest of:
- - The Policy Date;
- - The date of the last Part II of the Application; and
- - The date the first premium is received by the Company.
Each future net premium will be credited to the Cash Value as of the date it is
received by the Company.
Until the day the Company mails the Confirmation of the initial premium, the
Cash Value of the Policy will depend on the net investment performance of the
Money Market sub-account and the Policy's portion of the Fixed Account (see the
Sub-Accounts provision of Section 7 and The Fixed Account provision of Section
8). Thereafter, the Cash Value of the Policy is equal to: the Policy's share of
the chosen sub-accounts; plus the Policy's portion of the Fixed Account; plus
the amount of any assets transferred to the general account of the Company
because of Policy Loans. (See Section 14.) The amount of the Cash Value depends
on: the frequency and amount of net planned premiums; the frequency and amount
of net unscheduled payments; investment performance of the chosen sub-accounts;
interest credited to the Policy's portion of the Fixed Account; Monthly
Deductions; all chosen Death Benefit Options; partial surrenders; transfers
among sub-accounts and the Fixed Account; and Policy Loans. The Cash Value can
increase or decrease on a daily basis, depending on: the actual investment
performance of the chosen sub-accounts; and the interest credited to the
Policy's portion of the Fixed Account. (See Actual Investment Return below.)
The Cash Value of the Policy is not increased by the cash value of any rider,
unless stated in the rider.
NET CASH VALUE
The Net Cash Value is equal to:
- - The Cash Value of the Policy;
LESS
- - Any Policy Loan Balance;
LESS
- - The Surrender Charge that would apply upon surrender, whether or not there
is a surrender. (See Section 3.)
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SURRENDER OF THE POLICY
You can surrender the Policy for its Net Cash Value at any time by notice to the
Company in writing. Upon surrender, the Policy will be cancelled. The Net Cash
Value will be paid to you in one sum, unless you choose in writing to apply all
or part to a Payment Option. (See Payment of Benefits, Section 18.) If you
surrender the Policy during the grace period, the Amount Due (see the Grace
Period provision in the Monthly Deduction Section) will be deducted from the Net
Cash Value to cover the Monthly Deduction to the date of surrender.
MONTHLY DEDUCTION ADJUSTMENT AT SURRENDER
The pro rata portion of any Monthly Deduction made for a period beyond the date
of surrender will be added to the policy proceeds.
ACTUAL INVESTMENT RETURN
The Policy has an Actual Investment Return for each Valuation Period for its
share of each chosen sub-account and for its portion of the Fixed Account. The
Policy's Actual Investment Return for each sub-account for each Valuation Period
is equal to (a) minus (b); where:
- - (a) is equal to the Policy's share of the sub-account as of the end of the
Valuation Period;
PLUS
the monthly charges deducted in the Valuation Period;
LESS
any net planned premium and net unscheduled payment credited during the
Valuation Period;
PLUS
the total of the partial surrenders made during the Valuation Period;
PLUS
the interest credited to the sub-account during the Valuation Period for
any borrowed portion of the Policy's Cash Value;
PLUS or LESS
a charge or credit for the Policy's share of any reserve for taxes which the
Company determines to apply to the sub-account; and
- - (b) is equal to the Policy's share of the sub-account as of the end of
the most recent Valuation Period;
PLUS or LESS
a charge or credit for the Policy's share of any reserve for taxes
which the Company determines to apply to the sub-account.
The Actual Investment Return for the Fixed Account for each Valuation Period is
equal to (a) minus (b); where:
- - (a) is equal to the Policy's portion of the Fixed Account as of the end of
the Valuation Period;
PLUS
the monthly charges deducted in the Valuation Period;
LESS
any net planned premium and net unscheduled payment credited during the
Valuation Period;
PLUS
the total of the partial surrenders made during the Valuation Period;
PLUS
the interest credited to the Fixed Account during the Valuation Period for any
borrowed portion of the Policy's Cash Value; and
- - (b) is equal to the Policy's portion of the Fixed Account as of the end of
the most recent Valuation Period.
VALUATION PERIODS AND VALUATION DATES
A Valuation Period for each sub-account is a period:
- - Which starts on a Valuation Date; and
- - Which ends on the next succeeding Valuation Date.
Each day the New York Stock Exchange is open for trading is a Valuation Date.
Each Valuation Date ends at the close of regular trading on the New York Stock
Exchange.
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14. POLICY LOANS
POLICY LOANS
You can borrow all or part of the Loan Value of the Policy by written request to
the Company. Unless the Company consents otherwise, no request can be made until
the Company mails the Confirmation for the first premium. Policy Loans are made
on the sole security of the Policy. The amount you can borrow at any time is
equal to the Loan Value less any Policy Loan Balance at that time.
Unless you request otherwise, Policy Loans will reduce first, the Policy's share
of the sub-accounts proportionately and second, if necessary, the Policy's
portion of the Fixed Account, except as noted below in the Interest on Loans;
Policy Loan Balance provision. Assets equal to the amount of the Loan:
- - Will be transferred to the general account of the Company; and
- - Will earn interest at the effective rate per year of not less than: the
Policy Loan interest rate; less .35%.
On each policy anniversary interest earned on the assets transferred to the
general account will be credited to the Policy's Cash Value in the sub-accounts
and the Fixed Account in the same proportion as the Policy's Cash Value is then
invested in the sub-accounts and the Fixed Account.
Policy Loans, whether or not repaid, can have a permanent effect on Cash Values
and Death Benefits.
LOAN VALUE
The Loan Value of the Policy on the date the Loan is made is equal to 90% of:
the Cash Value of the Policy minus the Surrender Charge that would apply upon
surrender (whether or not there will be a surrender).
INTEREST ON LOANS; POLICY LOAN BALANCE
Interest will be charged on Policy Loans at the rate shown in Section 1.
Interest accrues daily. The Policy Loan Balance at any time means Policy Loans
outstanding plus interest accrued to date. Loan interest is due on the policy
anniversary each year. Loan interest not paid when due will be added to the Loan
and interest will be charged on it; when loan interest is added to the Loan, the
Policy's share of the sub-accounts and the Policy's portion of the Fixed Account
will be reduced proportionately.
REPAYMENT OF LOANS
Policy Loans can be repaid to the Company at any time in whole or in part. Loan
repayments will be allocated: first, to repay the Loans made against the Fixed
Account; and second, unless you request otherwise, to repay the Loans made
against the sub-accounts in the same proportion as the Policy is invested in the
sub-accounts. The rate of interest for each loan repayment allocated to the
Fixed Account will equal the lesser of: the rate set by the Company in advance
for the date the loan repayment is allocated to the Fixed Account; and the
effective interest rate (see Fixed Account Interest) for the Policy on the date
of the repayment.
A Policy Loan is a charge against the Policy. The proceeds of the Policy will be
reduced by any Policy Loan Balance on the date proceeds become payable. If the
Policy Loan Balance at any time exceeds the Cash Value of the Policy less the
Surrender Charge on the next loan interest due date or, if greater, on the
current Valuation Date (called "excess Policy Loan"), the Company will mail a
notice to you and to any assignee. The notice will be mailed to the addresses on
record with the Company. If the excess amount is not paid to the Company within
62 days after the mailing of the notice, the Policy will lapse without value.
Unless you request otherwise in writing to the Company, any payment received by
the Company in response to an anniversary bill and within 45 days after a policy
anniversary when a Policy Loan exists on the Policy will be used: first, as a
planned premium; and second, as payment of loan interest; and third, as an
unscheduled payment. Otherwise, the payment will be used: first, as a planned
premium; and second, as an unscheduled payment.
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15. Policy Changes
DECREASE IN FACE AMOUNT
After the first policy year, the Face Amount may be decreased on the first day
of any policy month by written request to the Company; but only if the Face
Amount which will remain after a decrease is at least $100,000, except with the
consent of the Company. No portion of the Cash Value will be paid to you unless
you chose the Guideline Premium Test for the Policy and paying a portion of the
Cash Value to you is necessary in order to allow the Policy to continue to
qualify as life insurance. A Surrender Charge will apply to a decrease in Face
Amount in proportion to the decrease. (See Section 3.) The Cash Value after the
decrease in Face Amount will be equal to: the Cash Value just prior to the
decrease; less any Surrender Charge for the decrease. The Death Benefit will be
recalculated based on the new Face Amount and the Cash Value after the decrease.
A decrease in Face Amount may require a decrease in the amounts provided by
riders attached to this Policy.
PARTIAL SURRENDER
After the Company mails the Confirmation for the initial premium, you can make a
partial surrender at any time by written request to the Company. A portion of
the Cash Value will be paid to you. A Surrender Charge will apply if the Face
Amount is decreased as a result of a partial surrender. The Surrender Charge
will be in proportion to the decrease in Face Amount. (See Section 3.) In each
policy year, partial surrenders will be limited, except with the consent of the
Company, to: 20% of the Net Cash Value on the day the first partial surrender is
made for the policy year; or, if less, the Loan Value minus any Policy Loan
Balance. The amount of the partial surrender, including any Surrender Charge,
will be deducted from the Cash Value. The Death Benefit of the Policy will be
based on the reduced Cash Value. The Face Amount of the Policy will be reduced,
if necessary, so the amount at risk before and after the partial surrender is
the same. The Face Amount which will remain after the partial surrender must be
at least $100,000, except with the consent of the Company. A decrease in Face
Amount may require a decrease in the amounts provided by riders attached to this
Policy.
Unless you request otherwise, a partial surrender will reduce: first, the
Policy's portion of the sub-accounts proportionately; and second, the Policy's
portion of the Fixed Account.
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16. 24 MONTHS CONVERSION RIGHT
24 MONTHS CONVERSION RIGHT
The 24 Months Conversion Right allows you to convert all or a portion of this
Policy, subject to the terms of this Section, to fixed benefit coverage: by
transferring value to the Fixed Account; and by allocating future net premiums
and future net unscheduled payments to the Fixed Account.
A request to exercise the 24 Months Conversion Right must be in written form
satisfactory to the Company. The 24 Months Conversion Right can be exercised:
- - Once within 24 months after the Date of Issue of the Policy;
- - Even if the Company is restricting new amounts applied to the Fixed
Account. (See Restriction of New Amounts Applied to the Fixed Account
provision of Section 8.)
If the Company is not restricting amounts applied to the Fixed Account: you can
transfer to the Fixed Account all or part of the Policy's Cash Value in the
sub-accounts; and you can allocate all or part of future net premiums and net
unscheduled payments to the Fixed Account. However, at any time in the future if
the Company is restricting new amounts applied to the Fixed Account, the Company
reserves the right to limit the allocation of future net premiums and net
unscheduled payments to the Fixed Account to the Policy's lowest Fixed Account
allocation percentage since the most recent date when this Right was exercised.
The Policy's share of the sub-accounts will be reduced proportionately when Cash
Value is transferred under this Right.
If the Company is restricting amounts applied to the Fixed Account: you can
transfer to the Fixed Account the portion of the Policy's Cash Value in the
sub-accounts which is attributable to the coverage for which this Right is being
exercised; and you can allocate future net premiums and net unscheduled payments
to the Fixed Account based on the Company's published rules. The Policy's share
of the sub-accounts will be reduced proportionately when Cash Value is
transferred under this Right.
Transfers to the Fixed Account resulting from the exercise of the 24 Months
Conversion Right are not counted in the limit of 4. (See Transfer Option
provision of Section 7.)
17. OWNER AND BENEFICIARY
OWNER
The Owner of the Policy is named in the Application (see copy attached); but,
the Owner can be changed. The new Owner will succeed to all rights of the Owner,
including the right to make a further change of Owner. At the death of the
Owner, his or her estate will be the Owner, unless a successor Owner has been
named. In this Policy "you" means the Owner, whether the Owner is a person, a
partnership, a corporation, a fiduciary or any other legal entity. The rights of
the Owner will end at the Last Death, except for Payment of Benefits. (See
Section 18.)
BENEFICIARY
The Beneficiary is named in the Application (see copy attached); but, the
Beneficiary can be changed before the Last Death. The Beneficiary has no rights
in the Policy until the Last Death. The Beneficiary can be a person, a
corporation, a partnership, a fiduciary or any other legal entity. A person must
survive the last Insured to die to qualify as Beneficiary. If none survives, the
proceeds will be paid to the Owner.
CHANGE OF OWNER OR BENEFICIARY
A change of Owner or Beneficiary must be in written form satisfactory to the
Company, and must be dated and signed by the Owner who is making the change. The
change will be subject to all payments made and actions taken by the Company
under the Policy before the signed change form is received by the Company at its
Home Office.
ASSIGNMENTS
An absolute assignment of the Policy by the Owner is a change of Owner and
Beneficiary to the assignee. A collateral assignment of the Policy by the Owner
is not a change of Owner or Beneficiary; but their rights will be subject to the
terms of the assignment except that the rights of an irrevocable beneficiary
named before the assignment are superior to those of the assignee. Assignments
will be subject to all payments made and actions taken by the Company before a
signed copy of the assignment form is received by the Company at its Home
Office. The Company will not be responsible for determining whether or not an
assignment is valid.
NEV-18
25
DESIGNATION OF OWNER AND BENEFICIARY
A numbered sequence can be used to name successive Owners or Beneficiaries.
Co-Beneficiaries will receive equal shares unless otherwise stated.
In naming Owners or Beneficiaries, unless otherwise stated:
- - "Child" includes an adopted or posthumous child;
- - "Provision for issue" means that if a Beneficiary does not survive both
Insureds, the share of that Beneficiary will be taken by his or her living
issue by right of representation; and
- - A family relation such as "wife", "husband" or "child" means the
relation to Insured 1.
At the time for payment of benefits the Company can rely on an affidavit of any
Owner or other responsible person to determine family relations or members of a
class.
18. PAYMENT OF BENEFITS
PAYMENT
The policy proceeds will be paid in one sum, unless all or part of the proceeds
are applied to a Payment Option. (See Section 19.) The Company will pay interest
on death proceeds from the date the proceeds become payable to the date of
payment in one sum, or to the Option Date. The rate of interest will be set each
year by the Company. The rate will not be less than: that required by law; or 3%
per year. The interest payable on surrender proceeds is described in Section 6.
SELECTION OF PAYMENT OPTIONS; OPTION DATE
The selection of a Payment Option and the naming of the Payee must be in written
form satisfactory to the Company. You can make or change or revoke the selection
before the Last Death. The Option Date is the effective date of the Payment
Option, as stated in the selection form.
PAYEE
The Payee is a person, a corporation, a partnership, a fiduciary or any other
legal entity entitled to receive payment in one sum or under a Payment Option.
SELECTION BY PAYEES
Any proceeds payable in one sum at the Last Death, or upon surrender of the
Policy, can be applied to any Payment Option chosen by the Payee. Further, with
the consent of the Company, any Payee who is entitled to receive proceeds in one
sum when a Payment Option ends, or at the death of a prior Payee, or when
proceeds are withdrawn, can choose to apply the proceeds to a Payment Option.
RIGHTS OF PAYEES
In the selection of a Payment Option the right can be given to the Payee:
- - To withdraw principal and interest under the Fourth or Fifth Option; or
- - To withdraw the commuted value of payments certain under the First, Second,
or Sixth Option.
Under the Life Income Options only payments certain can be commuted. No Payee
can assign, commute or withdraw the payments under any Payment Option, unless
the right is reserved in the selection of the Option.
NEV-18
26
LIMITATIONS
If instalments under an Option would be less than $20, proceeds can be applied
to a Payment Option only with the consent of the Company.
LIFE INCOME OPTIONS
Guaranteed Life Income Options are based on the age of the Payee on the Payee's
birthday nearest the Option Date. The Company will require proof of age. The
Life Income payments will be based: on the rates shown in the Life Income Tables
(Section 20); or, if they are greater, on the Payment Option rates of the
Company on the Option Date. If the rates at a given age are the same for
different periods certain, the longest period certain will be used.
PURCHASE OF INCREASED PAYMENT OPTION BENEFITS
On the Option Date, a one sum purchase payment can be made to the Company to be
added to the proceeds being applied to any Payment Option. The portion of Life
Income payments purchased in this way will be based on the Payment Option rates
of the Company on the Option Date, which may not be the rates shown in the Life
Income Tables (Section 20). The purchase payment will be limited to the
Company's published maximum for single premium immediate annuities on the Option
Date. A portion of the purchase payment may be used by the Company to pay
premium taxes on the purchase payment.
DEATH OF PAYEE
If a Payee under a Life Income Option dies within 30 days after the Option Date,
the amount applied to the Option, less any payments made, will be paid in one
sum, unless a Payment Option is chosen by the successor Payee. Otherwise,
amounts to be paid after the death of a Payee under a Payment Option will be
paid as due to the successor Payee. If there is no successor Payee, amounts to
be paid in one sum, or the commuted value of any unpaid payments certain, will
be paid in one sum to the estate of the last Payee to die.
COMMUTATION RATE
The interest rate used to compute the commuted value of any unpaid payments
certain:
- - Under the First Option will be 3% per year; and
- - Under the Life Income Options will be the rate used by the Company in
computing the amount of the monthly payments.
NEV-18
27
19. Payment Options
PAYMENT OPTIONS
All or part of the policy proceeds can be applied to any one of the following
Options, subject to Section 18, Payment of Benefits:
FIRST OPTION: INCOME FOR A SPECIFIED NUMBER OF YEARS
The Company will make monthly payments which will include both principal and
interest. Payments will start on the Option Date and will continue for the
number of years chosen. The number of years chosen cannot be more than 30.
Interest is at the rate of 3% per year compounded yearly. Additional interest
paid by the Company for any year will be added to the monthly payments for that
year.
Guaranteed monthly payments per $1,000 of proceeds applied to the First Option
are shown below:
- ---------------------------------------------------------------------
Number Number Number
of Years of Years of Years
- ---------------------------------------------------------------------
1 $84.47 11 $8.86 21 $5.32
2 42.86 12 8.24 22 5.15
3 28.99 13 7.71 23 4.99
4 22.06 14 7.26 24 4.84
5 17.91 15 6.87 25 4.71
6 15.14 16 6.53 26 4.59
7 13.16 17 6.23 27 4.47
8 11.68 18 5.96 28 4.37
9 10.53 19 5.73 29 4.27
10 9.61 20 5.51 30 4.18
- ---------------------------------------------------------------------
SECOND OPTION: LIFE INCOME
The Company will make equal monthly payments. Payments will start on the Option
Date and will continue:
- - During the life of the Payee, with no payment after the death of the Payee,
called "Life Income, No Refund"; or
- - During the life of the Payee, but for at least 10 years, called "Life
Income, 10 Years Certain"; or
- - During the life of the Payee, but for at least 20 years, called "Life
Income, 20 Years Certain".
THIRD OPTION: LIFE INCOME WITH REFUND
The Company will make equal monthly payments. Payments will start on the Option
Date and will continue during the life of the Payee. At the death of the Payee,
if the total payments made are less than the total proceeds applied to the
Option, then:
- - The difference will be paid in one sum, called "Life Income, Cash Refund";
or
- - The equal monthly payments will continue until the total payments are equal
to the total proceeds applied to the Option, called "Life Income,
Instalment Refund".
FOURTH OPTION: INTEREST
The Company will hold the proceeds at interest during the life of the Payee or
for any other period agreed to by the Company. Interest on the proceeds:
- - Will be paid each month to the Payee starting one month after the Option
Date; or
- - Will be added to the principal amount each year and will earn interest.
At the death of the Payee, or at the end of the period agreed to, the balance of
principal and any accrued interest will be paid in one sum. The rate of interest
will be set each year by the Company; but the rate will not be less than 3% per
year.
FIFTH OPTION: SPECIFIED AMOUNT OF INCOME
The Company will make monthly payments which will include both principal and
interest. Payments will be in the amount chosen. Payments can be quarterly or at
any other frequency chosen, and payments can be for different amounts, all
subject to the consent of the Company. Payments will start on the Option Date
and will continue until the balance is fully paid out. At the death of the Payee
any unpaid balance and accrued interest will be paid in one sum. The rate of
interest will be set each year by the Company; but the rate will not be less
than 3% per year. Interest will be added each year to the principal and will
earn interest.
NEV-18
28
SIXTH OPTION: LIFE INCOME FOR TWO LIVES
The Company will make monthly payments. Payments will start on the Option Date
and will continue:
- - While either of two Payees is living, called "Joint and Survivor Life
Income"; or
- - While either of two Payees is living, but for at least 10 years, called
"Joint and Survivor Life Income, 10 Years Certain"; or
- - While two Payees are living, and after the death of one Payee, two-thirds
of the monthly amount while the other Payee is living, called "Joint and
2/3 to Survivor Life Income".
NEV-18
29
20. LIFE INCOME TABLES
LIFE INCOME TABLES
Guaranteed monthly payments per $1,000 of amounts applied to the Life Income
Options are shown below:
- --------------------------------------------------------------
SECOND AND THIRD OPTIONS: LIFE INCOME
- --------------------------------------------------------------
Age 10 20
of NO YEARS YEARS CASH INSTALMENT
Payee REFUND CERTAIN CERTAIN REFUND REFUND
- -------------------------------------------------------------
*15 2.83 2.82 2.82 2.82 2.82
16 2.84 2.34 2.83 2.83 2.83
17 2.85 2.85 2.85 2.84 2.84
18 2.86 2.86 2.86 2.85 2.86
19 2.88 2.88 2.87 2.87 2.87
20 2.89 2.89 2.89 2.88 2.88
21 2.91 2.90 2.90 2.89 2.90
22 2.92 2.92 2.92 2.91 2.91
23 2.94 2.94 2.93 2.92 2.93
24 2.95 2.95 2.95 2.94 2.94
25 2.97 2.97 2.96 2.96 2.96
26 2.99 2.99 2.98 2.97 2.98
27 3.01 3.00 3.00 2.99 2.99
28 3.03 3.02 3.02 3.01 3.01
29 3.04 3.04 3.04 3.03 3.03
30 3.07 3.06 3.06 3.05 3.05
31 3.09 3.09 3.08 3.07 3.07
32 3.11 3.11 3.10 3.09 3.09
33 3.13 3.13 3.13 3.11 3.12
34 3.16 3.16 3.15 3.14 3.14
35 3.18 3.18 3.18 3.16 3.17
36 3.21 3.21 3.20 3.19 3.19
37 3.24 3.24 3.23 3.21 3.22
38 3.27 3.27 3.26 3.24 3.24
39 3.30 3.30 3.29 3.27 3.27
40 3.33 3.33 3.32 3.30 3.30
41 3.37 3.36 3.35 3.33 3.34
42 3.40 3.40 3.38 3.36 3.37
43 3.44 3.44 3.42 3.39 3.40
44 3.48 3.48 3.45 3.43 3.44
45 3.52 3.52 3.49 3.47 3.48
46 3.57 3.56 3.53 3.50 3.51
47 3.61 3.60 3.57 3.54 3.55
48 3.66 3.65 3.62 3.58 3.60
49 3.71 3.70 3.66 3.63 3.64
50 3.76 3.75 3.71 3.67 3.69
51 3.82 3.80 3.75 3.72 3.74
52 3.88 3.86 3.81 3.77 3.79
53 3.94 3.92 3.86 3.82 3.84
54 4.00 3.98 3.91 3.88 3.90
55 4.07 4.05 3.97 3.93 3.95
56 4.14 4.12 4.03 3.99 4.02
57 4.22 4.19 4.09 4.06 4.08
58 4.30 4.27 4.15 4.12 4.15
59 4.39 4.35 4.21 4.19 4.22
60 4.48 4.44 4.28 4.26 4.29
61 4.58 4.53 4.35 4.34 4.37
62 4.68 4.63 4.41 4.42 4.45
63 4.79 4.73 4.48 4.50 4.54
64 4.91 4.84 4.55 4.58 4.63
65 5.04 4.95 4.62 4.68 4.73
66 5.17 5.07 4.69 4.77 4.83
67 5.32 5.20 4.76 4.87 4.93
68 5.48 5.33 4.83 4.98 5.04
69 5.64 5.47 4.89 5.09 5.16
- --------------------------------------------------------
- --------------------------------------------------------------
SECOND AND THIRD OPTIONS: LIFE INCOME
- --------------------------------------------------------------
Age 10 20
of NO YEARS YEARS CASH INSTALMENT
Payee REFUND CERTAIN CERTAIN REFUND REFUND
- --------------------------------------------------------------
70 5.82 5.62 4.96 5.20 5.28
71 6.01 5.77 5.02 5.32 5.41
72 6.22 5.92 5.08 5.45 5.55
73 6.44 6.09 5.13 5.59 5.69
74 6.67 6.26 5.18 5.72 5.84
75 6.92 6.43 5.23 5.87 6.00
76 7.19 6.61 5.27 6.02 6.17
77 7.48 6.79 5.31 6.18 6.34
78 7.79 6.97 5.34 6.35 6.53
79 8.12 7.15 5.37 6.53 6.72
80 8.48 7.34 5.40 6.71 6.93
81 8.85 7.52 5.42 6.90 7.14
82 9.25 7.69 5.44 7.11 7.36
83 9.67 7.87 5.46 7.31 7.59
84 10.13 8.04 5.47 7.53 7.84
**85 10.62 8.20 5.48 7.78 8.09
* and under **and over
- ----------------------------------------------------------------
SIXTH OPTION: LIFE INCOME FOR TWO LIVES
- ----------------------------------------------------------------
Age of One Age of Other Payee
Payee 55 60 65 70 75
- ----------------------------------------------------------------
JOINT AND SURVIVOR
55 $3.63 $3.75 $3.85 $3.93 $3.98
60 3.75 3.92 4.08 4.21 4.31
65 3.85 4.08 4.31 4.52 4.69
70 3.93 4.21 4.52 4.83 5.12
75 3.98 4.31 4.69 5.12 5.57
80 4.02 4.38 4.82 5.36 5.97
- ----------------------------------------------------------------
JOINT AND SURVIVOR, 10 YEARS CERTAIN
55 $3.63 $3.75 $3.85 $3.93 $3.98
60 3.75 3.92 4.08 4.20 4.30
65 3.85 4.08 4.30 4.51 4.68
70 3.93 4.20 4.51 4.82 5.10
75 3.98 4.30 4.68 5.10 5.51
80 4.01 4.37 4.80 5.32 5.87
- ----------------------------------------------------------------
JOINT AND 2/3 TO SURVIVOR
55 $3.91 $4.08 $4.26 $4.46 $4.68
60 4.08 4.28 4.50 4.74 5.00
65 4.26 4.50 4.77 5.07 5.40
70 4.46 4.74 5.07 5.45 5.87
75 4.68 5.00 5.40 5.87 6.40
80 4.90 5.27 5.73 6.30 6.98
- ----------------------------------------------------------------
Payments for other ages will be quoted by the Company on request.
The rates shown above are based on an interest rate of 3% per year; and on
mortality: using a 50/50 male/female weighting; based on the Individual
Annuitant Mortality Table for 1983; and with projection on Scale G to the year
2000 and then on Scale B Modified to year 2035.
NEV-18
30
AMENDMENTS AND ENDORSEMENTS (To be made only by the Company)
31
Please notify the Company of any change in your name or address. The Company
will communicate with you at your address on record with the Company.
New England Life
Insurance Company
501 Boylston Street
Boston, Massachusetts 02117
FLEXIBLE PREMIUM
ADJUSTABLE VARIABLE
SURVIVORSHIP LIFE POLICY
- - The Death Proceeds are payable at the Last Death, if the Policy is in
force.
- - The Policy can be adjusted by decreasing the Face Amount.
- - The amount and frequency of premium payments can be changed.
- - The Policy does not share in dividends.
NEV-18
32
NEV-18-E
NEW ENGLAND LIFE
INSURANCE COMPANY
- --------------------------------------------------------------------------------
Variable Life Policy
- --------------------------------------------------------------------------------
PLAN OF INSURANCE
Flexible Premium Adjustable Variable Survivorship Life
- --------------------------------------------------------------------------------
NEW ENGLAND LIFE INSURANCE COMPANY Agrees to pay THE DEATH BENEFIT OF THIS
POLICY TO THE BENEFICIARY ON RECEIPT OF PROOF OF THE LAST DEATH AND to provide
THE OTHER RIGHTS AND BENEFITS OF THE POLICY.
These agreements are subject to all of the provisions of the Policy.
Signed on the Date of Issue
for the Company at its
Home Office,
501 Boylston Street
Boston, MA 02117
ABCD
President
ABCD
Secretary
FLEXIBLE PREMIUM
ADJUSTABLE VARIABLE
SURVIVORSHIP LIFE POLICY
- - The Death Proceeds are payable at the Last Death, if the Policy is in
force.
- - The Policy can be adjusted by decreasing the Face Amount.
- - The amount and frequency of premium payments can be changed.
- - The Policy does not share in dividends.
THE DEATH BENEFIT ON THE POLICY DATE WILL BE EQUAL TO THE FACE AMOUNT SHOWN IN
SECTION 1. THEREAFTER, THE DEATH BENEFIT CAN VARY FROM DAY TO DAY. IT CAN
INCREASE OR DECREASE, DEPENDING ON SEPARATE INVESTMENT ACCOUNT PERFORMANCE AND
ON FIXED ACCOUNT INTEREST; BUT IT WILL NOT BE LESS THAN THE FACE AMOUNT. SEE
SECTION 9.
33
NEW ENGLAND LIFE
INSURANCE COMPANY
- --------------------------------------------------------------------------------
THE CASH VALUE OF THIS POLICY CAN VARY FROM DAY TO DAY. IT CAN
INCREASE OR DECREASE, DEPENDING ON SEPARATE INVESTMENT ACCOUNT PERFORMANCE AND
ON FIXED ACCOUNT INTEREST. SEE SECTION 13.
PLEASE READ YOUR POLICY CAREFULLY
This Policy is a legal Contract between you and the Company.
RIGHT TO RETURN THE POLICY
WHEN THIS POLICY IS ISSUED, YOU SHOULD EXAMINE IT. YOU CAN RETURN THE POLICY TO
THE COMPANY OR ITS AGENT FOR ANY REASON WITHIN 10 DAYS AFTER YOU RECEIVE IT FROM
THE COMPANY. IF YOU RETURN THE POLICY: AN AMOUNT EQUAL TO ANY PREMIUM PAID PLUS
ANY UNSCHEDULED PAYMENT MADE WILL BE REFUNDED TO YOU; AND THE POLICY WILL BE
CANCELLED FROM THE START.
- --------------------------------------------------------------------------------
NEV-18-E
34
NEW ENGLAND LIFE
INSURANCE COMPANY
- --------------------------------------------------------------------------------
Policy Provisions
Section
1 Policy Schedule
2 Table of Guaranteed Insurance Factors Per $1,000
3 Surrender Charge
4 Table of Corridor Factors
5 Accounts Available
6 Contract
7 The Variable Account
8 The Fixed Account
9 Death Benefit
10 Premiums
11 Monthly Deduction
12 Reinstatement After Lapse
13 Cash Value of the Policy
14 Policy Loans
15 Policy Changes
16 24 Months Conversion Right
17 Owner and Beneficiary
18 Payment of Benefits
19 Payment Options
20 Life Income Tables
- Riders, if any
- Amendments and Endorsements
- Copy of the Application
Alphabetical Guide
Section
1,6 Age of Insured
11 Amount at Risk
17 Assignments
17 Beneficiary
18 Benefits, Payment of
13 Cash Value
6 Claims of Creditors
6 Contestable
6 Contract
1,6 Date of Issue
1,6 Date, Policy
9 Death Benefit
15 Decrease in Face Amount
1 Face Amount
8 Fixed Account
11 Grace Period
2 Insurance Factors
13 Investment Return
18,19 Life Income Options
20 Life Income Tables
1 Loan Interest Rate
14 Loans, Policy
11 Monthly Deduction
13 Net Cash Value
17 Owner
15 Partial Surrender
19 Payment Options
6 Periodic Reports
15 Policy Changes
14 Policy Loan Balance
6 Postponement of Payments
10 Premiums
12 Reinstatement
1 Schedule, Policy
5,7 Sub-Accounts
6 Suicide
3 Surrender Charge
3,13 Surrender of the Policy
16 24 Months Conversion Right
7 Variable Account
- --------------------------------------------------------------------------------
NEV-18-E
35
NEW ENGLAND LIFE
INSURANCE COMPANY
- --------------------------------------------------------------------------------
1. Policy Schedule OWNER AND BENEFICIARY
As named in the Application or as later
changed. See the Owner and Beneficiary
Section of the Policy.
- --------------------------------------------------------------------------------
POLICY NUMBER
Specimen
POLICY DATE DATE OF ISSUE
September 1, 1999 September 1, 1999
POLICY LOAN INTEREST RATE DEATH BENEFIT OPTION DEFINITION OF LIFE INSURANCE TEST
4.35% 1 Guideline Premium Test
- --------------------------------------------------------------------------------
THIS POLICY IS ADJUSTABLE. IF IT IS ADJUSTED, A NEW POLICY SCHEDULE WILL
SUPERSEDE THIS SCHEDULE.
- --------------------------------------------------------------------------------
SCHEDULE OF INSUREDS
- --------------------------------------------------------------------------------
Insured 1: John Alden Age and Sex: 35 Male Policy Class: Smoker Standard
Insured 2: Myles Standish Age and Sex: 35 Male Policy Class: Smoker Standard
- --------------------------------------------------------------------------------
SCHEDULE OF BENEFITS
- --------------------------------------------------------------------------------
FACE AMOUNT*
Flexible Premium Adjustable Variable Survivorship Life $100,000
- --------------------------------------------------------------------------------
SCHEDULE OF PREMIUMS
- --------------------------------------------------------------------------------
Planned Annual Premium: $768.00**
Monthly Minimum Premium: $ 41.66
Maximum Monthly Policy Fee:
Years 1 - 3 $ 12.50
Thereafter $ 5.50
Maximum Monthly Mortality and Expense Risk Charge:
Years 1 - 10 $.009/12 times (Cash Value before the Monthly Deduction minus
the Policy's portion of the Fixed Account)
Thereafter $.0045/12 times (Cash Value before the Monthly Deduction minus
the Policy's portion of the Fixed Account)
Maximum Monthly Administrative Charge:
Years 1 - 3 $ 8.00
Thereafter $ 6.00
Maximum Premium Expense Charge:
Year 1 30% of the first $768.00 of premium plus 7.5% of the
remainder***
Years 2 - 10 15% of the first $768.00 of premium plus 7.5% of the
remainder***
Thereafter 7.5% of the premium
- --------------------------------------------------------------------------------
ABCD
Secretary
36
NEW ENGLAND LIFE
INSURANCE COMPANY
- --------------------------------------------------------------------------------
1. Policy Schedule (second page) OWNER AND BENEFICIARY
As named in the Application or as later
changed. See the Owner and Beneficiary
Section of the Policy.
- --------------------------------------------------------------------------------
POLICY NUMBER
Specimen
POLICY DATE DATE OF ISSUE
September 1, 1999 September 1, 1999
POLICY LOAN INTEREST RATE DEATH BENEFIT OPTION DEFINITION OF LIFE INSURANCE TEST
4.35% 1 Guideline Premium Test
- --------------------------------------------------------------------------------
THIS POLICY IS ADJUSTABLE. IF IT IS ADJUSTED, A NEW POLICY SCHEDULE WILL
SUPERSEDE THIS SCHEDULE.
- --------------------------------------------------------------------------------
SCHEDULE OF PREMIUMS (CONTINUED)
- --------------------------------------------------------------------------------
*This coverage may expire if premiums paid are insufficient to continue the
coverage. There may be little or no Cash Value at that time.
**If the Planned Annual Premium is paid on the first day of each policy
year, and the Actual Investment Return is 4% and the guaranteed maximum
charges apply in all years, this Policy will terminate in policy year
40 unless additional premium is paid.
***Premiums paid within 20 days before a policy anniversary are assumed to be
paid in the following year.
- --------------------------------------------------------------------------------
ABCD
Secretary
37
NEW ENGLAND LIFE
INSURANCE COMPANY
- --------------------------------------------------------------------------------
2. Table of Guaranteed Insurance Factors per $1,000
Based on the 1980 CSO Smoker Table
POLICY NUMBER Specimen
- --------------------------------------------------------------------------------
POLICY YEAR MONTHLY FACTOR POLICY YEAR MONTHLY FACTOR
1 $.0006 34 $2.2448
2 .0019 35 2.5494
3 .0035 36 2.8913
4 .0055 37 3.2761
5 .0080 38 3.7166
6 .0111 39 4.2180
7 .0151 40 4.7750
8 .0199 41 5.3988
9 .0259 42 6.0596
10 .0331 43 6.7460
11 .0419 44 7.4456
12 .0522 45 8.1702
13 .0646 46 8.9418
14 .0790 47 9.7747
15 .0963 48 10.6882
16 .1165 49 11.6882
17 .1410 50 12.7422
18 .1702 51 13.8176
19 .2056 52 14.8807
20 .2482 53 15.9144
21 .2979 54 17.0246
22 .3560 55 18.1139
23 .4220 56 19.1958
24 .4978 57 20.2900
25 .5830 58 21.4397
26 .6817 59 22.8934
27 .7970 60 24.7464
28 .9320 61 27.4231
29 1.0905 62 31.9931
30 1.2737 63 39.9825
31 1.4824 64 54.8157
32 1.7133 65 83.3333
33 1.9683
- --------------------------------------------------------------------------------
ABCD
Secretary
38
NEW ENGLAND LIFE
INSURANCE COMPANY
- --------------------------------------------------------------------------------
3. Surrender Charge
- --------------------------------------------------------------------------------
POLICY NUMBER
Specimen
- --------------------------------------------------------------------------------
THIS POLICY IS ADJUSTABLE. IF IT IS ADJUSTED, A NEW SECTION 3 SURRENDER CHARGE
WILL SUPERSEDE THIS SECTION.
- --------------------------------------------------------------------------------
A Surrender Charge will be deducted from partial surrenders that reduce the Face
Amount, full surrender, decrease in Face Amount, and lapse transactions during
the first 15 policy years. The Maximum Surrender Charge for year 1 is shown
below. The Maximum Surrender Charges for the last policy month of each of years
2 through 15 are shown below; the Maximum Surrender Charges for other months
will reflect the number of completed policy months in the year of surrender,
lapse or decrease in Face Amount.
YEAR OF
SURRENDER, MAXIMUM
DECREASE OR SURRENDER
LAPSE CHARGE
1 $691.20
2 641.82
3 592.46
4 543.09
5 493.71
6 444.34
7 394.97
8 345.60
9 296.23
10 246.86
11 197.49
12 148.11
13 98.74
14 49.37
15 0.00
- --------------------------------------------------------------------------------
ABCD
Secretary
39
NEW ENGLAND LIFE
INSURANCE COMPANY
- --------------------------------------------------------------------------------
4. Table of Corridor Factors
- --------------------------------------------------------------------------------
POLICY NUMBER
Specimen
- --------------------------------------------------------------------------------
AGE* IRS ENHANCED AGE* IRS ENHANCED
35 2.50 2.50 68 1.17 1.17
36 2.50 2.50 69 1.16 1.16
37 2.50 2.50 70 1.15 1.15
38 2.50 2.50 71 1.13 1.13
39 2.50 2.50 72 1.11 1.11
40 2.50 2.50 73 1.09 1.09
41 2.43 2.43 74 1.07 1.07
42 2.36 2.36 75 1.05 1.05
43 2.29 2.29 76 1.05 1.05
44 2.22 2.22 77 1.05 1.05
45 2.15 2.15 78 1.05 1.05
46 2.09 2.09 79 1.05 1.05
47 2.03 2.03 80 1.05 1.05
48 1.97 1.97 81 1.05 1.10
49 1.91 1.91 82 1.05 1.15
50 1.85 1.85 83 1.05 1.20
51 1.78 1.78 84 1.05 1.25
52 1.71 1.71 85 1.05 1.30
53 1.64 1.64 86 1.05 1.35
54 1.57 1.57 87 1.05 1.40
55 1.50 1.50 88 1.05 1.45
56 1.46 1.46 89 1.05 1.50
57 1.42 1.42 90 1.05 1.50
58 1.38 1.38 91 1.04 1.50
59 1.34 1.34 92 1.03 1.50
60 1.30 1.30 93 1.02 1.50
61 1.28 1.28 94 1.01 1.50
62 1.26 1.26 95 1.01 1.50
63 1.24 1.24 96 1.01 1.40
64 1.22 1.22 97 1.01 1.30
65 1.20 1.20 98 1.01 1.20
66 1.19 1.19 99 1.01 1.10
67 1.18 1.18 100 1.00 1.00
* Based on age of younger Insured.
- --------------------------------------------------------------------------------
ABCD
Secretary
40
NEW ENGLAND LIFE
INSURANCE COMPANY
- --------------------------------------------------------------------------------
5. Accounts Available on 9/1/99
- - Variable
Back Bay Advisors Money Market Sub-account
Back Bay Advisors Bond Income Sub-account
Fidelity VIP High Income Sub-account
Back Bay Advisors Managed Sub-account
Fidelity VIP II Asset Manager Sub-account
Loomis Sayles Balanced Sub-account
Alger Equity Growth Sub-account
Capital Growth Sub-account
Davis Venture Value Sub-account
Fidelity VIP Equity-Income Sub-account
Goldman Sachs Midcap Value Sub-account
Loomis Sayles Small Cap Sub-account
MFS Investors Sub-account
MFS Research Managers Sub-account
Westpeak Growth and Income Sub-account
Westpeak Stock Index Sub-account
Fidelity VIP Overseas Sub-account
Morgan Stanley International Magnum Equity Sub-account
- - Fixed
41
6. CONTRACT
THE CONTRACT
This Policy is a legal contract between the Owner of the Policy (called "you")
and New England Life Insurance Company, a Massachusetts corporation, (called
"the Company"). The Policy, which includes the attached Application and any
Application for adjustment of the Policy, is the entire contract between you and
the Company. All riders are listed in Section 1. No change in or waiver of the
provisions of the Policy is valid unless the change or waiver is signed by the
President or the Secretary of the Company.
PAYMENTS UNDER THE CONTRACT
All contract amounts are in dollars of the United States of America. Payments by
the Company under the contract will be made at the Home Office of the Company.
The obligations of the Company are subject to all payments made and actions
taken by the Company under the Policy before receipt by the Company at its Home
Office of proof of the Last Death.
DATES
Policy years, months and anniversaries are all measured from the Policy Date.
Contestable and suicide periods start on the Date of Issue. The Policy Date and
the Date of Issue are shown in Section 1.
LAST DEATH
The Last Death is the later of: the death of Insured 1; and the death of
Insured 2.
NOT CONTESTABLE AFTER TWO YEARS
Insurance is issued by the Company in reliance on the statements made in the
Application for the insurance. Those statements are representations; they are
not warranties. No statement can be used to contest or rescind insurance on the
life of an Insured or to defend against a claim unless contained in the
Application for the insurance on that Insured. The insurance issued under this
Policy will not be contestable after it has been in force during the life of
each Insured:
- - With respect to the amount of Death Benefit which results from other
than payments for which proof of insurability is required, for two
years from the Date of Issue; and
- - With respect to any amount of Death Benefit which results from a
payment for which proof of insurability is required, for two years from
the date that payment is received.
SUICIDE WITHIN TWO YEARS
If either of the Insureds dies by suicide while sane or insane within two years
from the Date of Issue, the Death Benefit will be limited to: the amount of the
premiums paid; less any Policy Loan Balance; and less any partial surrenders.
The Policy will terminate as of the date of the first death by suicide.
Within 60 days after the first death by suicide, the Owner can purchase new life
insurance on an Eligible Insured without evidence of insurability. For purposes
of this provision, an Eligible Insured is a surviving Insured on whom the
Company would have issued a single life policy on the Policy Date of this
Policy. The new policy will be issued:
- - On the most recently approved plan of single life variable insurance
issued by the Company on the Policy Date of the new policy, if the
issue age on the new policy is age 75 or younger;
- - On a single life Ordinary Life insurance plan with a level face amount
issued by the Company on the Policy Date of the new policy, if the
issue age on the new policy is greater than 75;
- - On a policy form and at rates in use by the Company on the Policy Date;
- - Subject to any assignments and limitations to which this Policy is
subject;
- - With a Policy Date and Date of Issue the same as the date of the first
death by suicide under this Policy;
- - Based on the underwriting class to which the Eligible Insured was
assigned by the Company on the Policy Date of this Policy;
- - At the insurance age of the Eligible Insured on the Policy Date of the
new policy; and
- - With a Face Amount equal to the Face Amount of this Policy plus the
amount of any single life term rider for the Eligible Insured under
this Policy.
NEV-18-E
42
Riders can be added to the new policy only with the consent of the Company.
Application for the new policy must be: in writing; signed by the Owner and by
the Eligible Insured; and received by the Company within 60 days after the date
of the first death by suicide. However, if that Insured dies within this 60 day
period; and before the application for a new policy is received by the Company;
a death benefit for the Eligible Insured's death will be paid as if the new
policy had been issued: as a variable life policy; assuming all premiums for the
new policy were allocated to the Fixed Account (see Section 8); and assuming the
Death Benefit Option chosen was equal to the face amount of the policy.
NOTIFICATION OF FIRST DEATH
The Company should be notified immediately when the first death occurs. Even if
premiums continue to be paid after the first death, the Company has the right:
to contest the Policy under the Not Contestable After Two Years provision; or to
limit benefits and terminate the Policy under the Suicide Within Two Years
provision.
AGE AND SEX OF INSURED
The age of an Insured on the Policy Date and on each policy anniversary means
the age at the nearest birthday of that Insured based on calendar months.
If the age or the sex of either Insured has not been correctly stated in the
Application, the Death Benefit will be the amount that the most recent Monthly
Deduction (see Section 11) which was made would have provided for the correct
age and sex.
CLAIMS OF CREDITORS
The Policy and payments under it are exempt from the claims of creditors to the
extent allowed by law.
BASIS OF VALUES
"1980 CSO" means Commissioners 1980 Standard Ordinary; it is used to describe
mortality tables. Minimum Cash Values, Reserves and Guaranteed Insurance Factors
are based on the mortality table shown in Section 2. Interest is compounded
daily at the effective rate of 4% per year. A detailed statement of the method
of computing values has been filed with the Insurance Department of the state in
which the Policy is delivered. All values are equal to or in excess of the
minimum values required by the law of that state.
PERIODIC REPORTS
The Company will send you all reports required by law and regulation. Such
reports will be sent once each year or more often if required by law or
regulation. The annual report will include, as of the date for which the report
is made: the Death Benefit; the Cash Value; any Policy Loan Balance; all
transactions in connection with the Policy since the most recent report; and any
other required information.
POLICY ILLUSTRATION OF BENEFITS AND VALUES
Upon written request the Company will send you a policy illustration which will
illustrate benefits and values under the Policy.
POSTPONEMENT OF VARIABLE BENEFITS
The Company can postpone the determination of and the payment or transfer of
amounts based on separate investment account performance if:
- - The New York Stock Exchange is closed for trading (except for normal
weekend and holiday closing) or when trading is restricted; or
- - The Securities and Exchange Commission determines that a state of
emergency exists which may make payment or transfer impractical; or
- - The Securities and Exchange Commission orders the New England Zenith
Fund or its successor or any other investment company in which the
Variable Account is invested to postpone payment or transfer of
variable benefits.
NEV-18-E
43
POSTPONEMENT OF SURRENDERS, TRANSFERS AND LOANS FROM THE FIXED ACCOUNT
The Company can postpone the payment of the portion of the Policy's Net Cash
Value which is in the Fixed Account for not more than six months after
surrender. If payment is postponed for more than 30 days, it will be credited
with interest from the date of surrender. The rate of interest will be set each
year by the Company; but the rate will not be less than 3% per year.
The Company can postpone transfers from the Fixed Account for not more than six
months from the date of the request. The effective date of the transfer is the
date on which values are transferred from the Fixed Account.
The Company can postpone the making of any Policy Loan from the Fixed Account
for not more than six months from the day you apply, except Loans to pay
premiums on policies issued by the Company.
7. THE VARIABLE ACCOUNT
THE VARIABLE ACCOUNT
The Variable Account (called "the Account") is a separate investment account
established by the Company in accordance with Delaware law and is now operated
in accordance with Massachusetts law. The assets of the Account are owned by the
Company. The assets of the Account will be used to provide values and benefits
under this Policy and similar policies. The portion of the Account assets equal
to the reserves plus other policy liabilities of the Account is not chargeable
with liabilities arising out of any other business the Company may conduct. The
Company reserves the right to transfer to its general account Variable Account
assets which exceed the total of reserves and other liabilities of the Account.
Income and realized and unrealized capital gains and losses of the Account are
credited to the Account without regard to any of the Company's other income or
capital gains and losses.
SUB-ACCOUNTS
The Account consists of sub-accounts, each of which is invested in shares of one
portfolio of the New England Zenith fund or its successor or any other
investment company in which the Account is invested. Shares of a portfolio are
purchased for a sub-account at their net asset value.
The initial net premium is allocated to the Account and the Fixed Account based
on allocation instructions in the Application for insurance. The portion of the
initial net premium allocated to the Account will be credited with Money Market
sub-account net investment performance beginning on the latest of:
- - The Policy Date;
- - The date of the last Part II of the Application, if any is required;
- - The effective date of the choice of the Account; and
- - The date the first premium is received by the Company.
NEV-18-E
44
The portion of the Policy's Cash Value allocated to the Account will be
deposited in the Money Market sub-account on the day the Company mails the
Confirmation for the initial premium. Fifteen days after the Company mails the
Confirmation for the initial premium, the portion of the Policy's Cash Value
allocated to the Account will be transferred, based on your choice, to the
sub-accounts. Before this date, the values and benefits of the Policy will
depend on: the net investment performance of the Money Market sub-account if any
portion of the initial premium is allocated to the Account; and the Policy's
portion of the Fixed Account. After this date each future net premium allocated
to the Account and each future net unscheduled payment allocated to the Account
will be invested in the sub-accounts you chose as of the date it is received by
the Company at its Home Office.
Each distribution of income, dividends and capital gains from a portfolio to a
sub-account will be reinvested for the benefit of the owners of the policies in
that sub-account at net asset value in shares of the portfolio which made the
distribution.
The Cash Value of the Policy at any time cannot be allocated among more than 9
sub-accounts, except with the consent of the Company; and the Fixed Account will
be counted in the limit of 9.
The values and benefits of a policy depend on: the investment performance of the
portfolios in which the sub-accounts are invested; and the interest credited to
the Fixed Account. The Company does not guarantee the investment performance of
the portfolios of the sub-accounts. You bear the investment risk for amounts
invested in the sub-accounts for your Policy.
CHOICE OF SUB-ACCOUNTS
You choose the sub-accounts in which net premiums and net unscheduled payments
are to be invested. You can change the choice for future premiums and future
unscheduled payments at any time by notice to the Company. The portion of the
net premium and the net unscheduled payment to be applied to each sub-account
chosen must be a whole percent.
CHANGE IN PORTFOLIOS
The Company can add or remove portfolios as sub-account investments as permitted
by law. When a change is made, the Company will send you: a revised prospectus
for the Account which will describe all of the portfolios then available in the
New England Zenith Fund or its successor or any other investment company in
which the Account is invested; and any notice required by law.
When a portfolio is removed, the Company has the right to substitute a different
portfolio in which the sub-account will then invest:
- - The value of the removed portfolio; and
- - Future net premiums and future net unscheduled payments applied to that
sub-account.
TRANSFER OPTION
After 15 days from the date the Company mails the Confirmation of the first
premium, you can transfer all or a portion of the Policy's existing share of a
sub-account to another sub-account or to the Fixed Account. (See Restriction of
New Amounts Applied to the Fixed Account provision.) Requests for transfers can
be made in writing or by telephone. The Company is not responsible for
determining the authenticity of transfer instructions received by telephone.
Transfers will be subject to a limit of 4 in each policy year, except with the
consent of the Company. A transfer out of the Fixed Account will not count
against this limit. The Company reserves the right to charge for each additional
transfer.
CHANGE OF INVESTMENT POLICY
The investment policy of the Account will not be changed unless: (a) the change
has been approved by the Insurance Commissioner of the Commonwealth of
Massachusetts; and (b) a statement of the approval process has been filed with
the Insurance Department of the state in which this Policy is delivered. If the
investment policy of the Account is changed, the Company will give you written
notice of the change. You can then choose to convert this Policy to a fixed
benefit coverage. The conversion will be on the basis described in the 24 Months
Conversion Right section. (See Section 16.) Your request to convert this Policy
must be made within 60 days of the later of: (a) the effective date of the
investment policy change; or (b) the date you receive the notice of the change.
NEV-18-E
45
RIGHTS RESERVED BY THE COMPANY
The Company reserves the right to take certain actions subject to compliance
with law including, if required, the approval of the owners of the policies.
These actions are: (a) to create new investment accounts; (b) to combine any two
or more separate investment accounts, including the Account; (c) to invest some
or all of the assets of the Account other than in the New England Zenith Fund;
(d) to invest some or all of the assets of the Account in any other investment
company chosen by New England Life Insurance Company; (e) to remove a portfolio
in which the sub-account is invested or to substitute a different portfolio; (f)
to operate the Account as a management investment company and to charge
investment advisory fees under the Investment Company Act of 1940 or to operate
the Account in any other form permitted by law; and (g) to deregister the
Account under the Investment Company Act of 1940 if registration is no longer
required.
8. THE FIXED ACCOUNT
THE FIXED ACCOUNT
The Fixed Account is a portion of the general account of the Company.
The initial net premium is allocated to the Account and the Fixed Account based
on allocation instructions in the Application for insurance. The portion of the
initial net premium allocated to the Fixed Account is first invested in the
Fixed Account as of the latest of:
- - The Policy Date;
- - The date of the last Part II of the Application, if any is required;
- - The effective date of the choice of the Fixed Account; and
- - The date the first premium is received by the Company.
Thereafter, each net premium allocated to the Fixed Account and each net
unscheduled payment allocated to the Fixed Account will be applied as of the
date it is received by the Company at its Home Office. Each transfer to the
Fixed Account will be applied as of the transfer date.
FIXED ACCOUNT INTEREST
The rate of interest for each amount applied to the Fixed Account: will be the
rate set by the Company in advance for the date the amount is applied to the
Fixed Account; and will not be less than a rate equivalent to an annual
effective rate of 4%. The effective interest rate used on the Policy will be the
weighted average of all such rates for the Policy.
After the Policy has been in force for a total of 10 years, if the Company sets
an interest rate for the Fixed Account which is greater than 4%, that rate will
be increased for the Policy by at least .45%. The increase in interest rate will
reflect a reduction in the Company's interest holdback margin for expenses.
Each year, on the policy anniversary, the Company will determine a portion, if
any, of the Policy's portion of the Fixed Account which will be reinvested at
the rate effective on that date.
Interest will be credited to the Fixed Account on a daily basis.
NEV-18-E
46
NEV-18-E
RESTRICTION OF NEW AMOUNTS APPLIED TO THE FIXED ACCOUNT
The Company reserves the right to restrict new amounts applied to the Fixed
Account if the rate of interest that would be used for the new amount is a rate
equivalent to an annual effective rate of 4%.
TRANSFERS OUT OF THE FIXED ACCOUNT
You can transfer a limited amount of the Policy's portion of the Fixed Account
to the sub-accounts once within 30 days after each policy anniversary. Except
with consent of the Company, the transfer will be limited to the greater of: 25%
of the Policy's portion of the Fixed Account; and the amount of the Policy's
portion of the Fixed Account transferred to the sub-accounts the prior year.
Requests for transfers can be made in writing or by telephone. The Company is
not responsible for determining the authenticity of transfer instructions
received by telephone.
CHOICE OF THE FIXED ACCOUNT
You can choose to have net premiums and net unscheduled payments applied to the
Fixed Account. You can change the choice for future net premiums and future net
unscheduled payments at any time by notice to the Company in writing. (See the
Restriction of New Amounts Applied to the Fixed Account provision.) The portion
of the net premium and net unscheduled payment to be applied to the Fixed
Account must be a whole percent.
9. Death Benefit
DEATH BENEFIT
The Company will pay a Death Benefit to the Beneficiary upon receipt of proof of
the Last Death. The amount of the Death Benefit will depend on the Death Benefit
Option in effect on the date of the Last Death if the Last Death occurs prior to
age 100 of the younger Insured. If the Last Death occurs on or after age 100 of
the younger Insured, the Death Benefit will equal the greatest of:
- - The Cash Value on the date of the Last Death;
- - The Face Amount of the Policy if, at age 100 of the younger Insured,
the Policy has a Guaranteed Death Benefit Rider attached and the No
Lapse Guarantee Benefit is in effect; and
- - The smallest Face Amount that has been in effect since the younger
Insured's age 80 (or since the Policy Date if the younger Insured was
older than age 80 on that Date) if the Policy has an Expanded Death
Benefit Rider attached.
The amount payable in any event will be reduced by any Policy Loan Balance on
the date of the Last Death. If the Last Death occurs during the grace period,
the Amount Due (see the Grace Period Provision in the Monthly Deduction Section)
will be deducted from the policy proceeds to cover Monthly Deductions to the
date of death. The policy proceeds will be paid in one sum unless all or part of
the proceeds is applied to a Payment Option. (See Payment of Benefits, Section
18.)
CHOICE OF DEFINITION OF LIFE INSURANCE TEST
This Policy is intended to qualify as a flexible premium adjustable life
insurance contract under the Internal Revenue Code (called {the Code") and any
interpretive regulation or rulings by the Internal Revenue Service. The Code
provides two tests to determine whether the policy meets the definition of life
insurance: the Cash Value Accumulation Test; and the Guideline Premium Test. The
Test used for the life of this Policy will be the one chosen in the original
Application; that Test cannot be changed.
47
NEV-18-E
CASH VALUE ACCUMULATION TEST
If you choose the Cash Value Accumulation Test, the Death Benefit will not be
less than: the Policy's Cash Value plus the pro rata portion of any Monthly
Deduction made for a period beyond the date of the Last Death; times the Net
Single Premium Corridor Factor for the age of the younger Insured at the
beginning of the policy year. If you choose the Cash Value Accumulation Test,
the Net Single Premium Corridor Factor will be shown in Section 4.
GUIDELINE PREMIUM TEST
If you choose the Guideline Premium Test, you must choose one of two Death
Benefit Corridors (the IRS Corridor or the Enhanced Corridor) in the original
application. Evidence that there has been no change in insurability of either
Insured since the Date of Issue may be required to change the Death Benefit
Corridor for the Policy at a later time (see below). If you choose the Guideline
Premium Test, the Corridor Factors will be shown in Section 4.
If you choose the IRS Corridor, the Death Benefit will not be less than: the
Policy's Cash Value plus the pro rata portion of any Monthly Deduction made for
a period beyond the date of the Last Death; times the IRS Corridor Factor for
the age of the younger Insured at the beginning of the policy year.
If you choose the Enhanced Corridor, the Death Benefit will not be less than:
the Policy's Cash Value plus the pro rata portion of any Monthly Deduction made
for a period beyond the date of the Last Death; times the Enhanced Corridor
Factor for the age of the younger Insured at the beginning of the policy year.
DEATH BENEFIT OPTIONS
This Policy provides five Death Benefit Options. The Death Benefit Option will
be as chosen in the Application or as later changed. The Death Benefit Option is
shown in Section 1.
OPTION 1
The Death Benefit equals the greater of:
- - The Face Amount shown in Section 1; and
- - The death benefit required by the Guideline Premium Test with the
Enhanced Corridor.
OPTION 2
The Death Benefit equals the greater of:
- - The Face Amount shown in Section 1; and
- - The death benefit required by the Guideline Premium Test with the IRS
Corridor.
OPTION 3
The Death Benefit equals the greater of:
- - The Face Amount shown in Section 1 plus the Cash Value; and
- - The death benefit required by the Guideline Premium Test with the
Enhanced Corridor.
OPTION 4
The Death Benefit equals the greater of:
- - The Face Amount shown in Section 1; and
- - The death benefit required by the Cash Value Accumulation Test with the
Net Single Premium Corridor.
OPTION 5
The Death Benefit equals the greater of:
- - The Face Amount shown in Section 1 plus the Cash Value; and
- - The death benefit required by the Cash Value Accumulation Test with the
Net Single Premium Corridor.
If you have a Survivorship Level Term Insurance Rider, you can choose to have
the Term Amount of the Rider added to the Face Amount of the Policy for purposes
of calculating the Death Benefit.
48
NEV-18-E
CHANGING THE DEATH BENEFIT OPTION
After the first policy year and before the younger Insured is age 100, you can
change the Death Benefit Option on the first day of any policy month by written
application to the Company. However, if the change would increase the amount at
risk (see Section 11), the change can be made: only if both Insureds are living
on the Adjustment Date; and only if there has been no change in the insurability
of both Insureds. A change in Death Benefit Option will be effective on the
Adjustment Date shown in the new Policy Schedule.
Except with the consent of the Company, a change from Option 1 or 2 to Option 3
or a change from Option 4 to Option 5 can be made only if the Face Amount after
the change is at least $100,000. A change from Option 2 to Option 3 will require
evidence that there has been no change in insurability of either Insured since
the Date of Issue. If you change from Option 1 or 2 to Option 3 or from Option 4
to Option 5: the Face Amount will be decreased such that the Death Benefit
immediately before and after the change is the same; and no Surrender Charge
will apply. A decrease in Face Amount may require a decrease in the amounts
provided by riders attached to this Policy. If you chose the Guideline Premium
Test for the Policy, a portion of the Cash Value will be paid to you if
necessary in order to allow the Policy to continue to qualify as life insurance.
If you change from Option 3 to Option 1 or 2 OR from Option 5 to Option 4, the
Face Amount will be increased such that the Death Benefit immediately before and
after the change is the same.
A change from Option 1 to Option 2 OR Option 2 to Option 1 is also allowed. A
change from Option 2 to Option 1 will require evidence that there has been no
change in insurability of either Insured since the Date of Issue.
10. Premiums
PAYMENT
Premiums are payments made to the Company to pay for the Policy. The Policy will
not be in force until the first premium is paid. After the first premium is
paid, premiums can be paid: at any time; and in any amount, subject to the
Limits on Premiums below. Payments can be made at the Home Office of the Company
or at any Agency of the Company. A receipt for payment signed by the Secretary
of the Company will be given on request. Unless you request otherwise in writing
to the Company, any payment received by the Company in response to an
anniversary bill and within 45 days after a policy anniversary when a Policy
Loan exists on the Policy will be used: first, as a planned premium; and second,
as payment of loan interest; and third, as an unscheduled payment. Otherwise,
the payment will be used: first, as a planned premium; and second, as an
unscheduled payment.
AMOUNT AND FREQUENCY
Planned annual premiums are shown in Section 1. Payments and Planned Premium
Dates can be annual, semi-annual or quarterly or can be at any frequency agreed
to by the Company. (See Limits on Premiums below.)
Unscheduled payments can be made at any time. (See Limits on Premiums below.)
Cash Values and Death Benefits will be permanently affected by the amount and
frequency of planned and unscheduled payments.
LIMITS ON PREMIUMS
Payments are subject to these limits:
- - No payment can be made at and after age 100 of the younger Insured,
except as stated in the Grace Period provision (see Section 11); and
- - No payment can be less than $25; and
- - Total planned and unscheduled payments will be limited to the Company's
published maximum; and
- - No unscheduled payment can be made if it increases the Death Benefit by
more than it increases the Cash Value, except with the consent of the
Company; and
- - No planned premium can be increased except with the consent of the
Company.
49
NEV-18-E
If you have selected the Guideline Premium Test for the Policy (see Section 9,
Choice of Definition of Life Insurance Test), premiums on this Policy are also
limited to an amount no greater than that allowing the Policy to continue to
qualify as life insurance.
NET PREMIUM
The net premium is equal to: the premium payment; less no more than the Maximum
Premium Expense Charge at the rates shown in Section 1.
11. Monthly Deduction
MONTHLY DEDUCTION
On the first day of each policy month until age 100 of the younger Insured, the
Company will make a Monthly Deduction for that policy month from the Cash Value
of this Policy. The amount of the Monthly Deduction for a policy month is equal
to:
- - The cost of insurance and the cost of any riders for the policy month;
PLUS
- - An amount not greater than the Maximum Monthly Policy Fee shown in
Section 1;
PLUS
- - An amount not greater than the Maximum Monthly Mortality and Expense
Risk Charge shown in Section 1; PLUS
- - An amount not greater than the Maximum Monthly Administrative Charge
shown in Section 1.
At and after age 100 of the younger Insured the Cash Value of the Policy will be
calculated as described in the Cash Value of the Policy Section, except that the
Monthly Deductions will be equal to zero.
If the Policy meets the Monthly Minimum Premium test (see below) or if a
Guaranteed Death Benefit Rider is attached and the No Lapse Guarantee Benefit is
in effect, the Monthly Deduction will be made, whether or not premiums are paid,
until the Cash Value equals zero. Otherwise, the Monthly Deduction will be made,
whether or not premiums are paid, as long as the Net Cash Value is sufficient to
cover the entire Monthly Deduction. This provision will not continue any rider
beyond the termination date as provided in the rider.
The Monthly Deduction will be deducted from the sub-accounts and the Fixed
Account in the same proportion as the Cash Value of the Policy is in the
sub-accounts and the Fixed Account unless you choose in writing to have Monthly
Deductions deducted: from a specific sub-account or the Fixed Account until the
Policy's portion of that sub-account or of the Fixed Account equals zero; and
then from the remaining sub-accounts and the Fixed Account in the same
proportion as the Cash Value of the Policy is in the sub-accounts and the Fixed
Account.
50
NEV-18-E
COST OF INSURANCE
The monthly cost of insurance for the Policy is equal to: the amount at risk;
times the cost of insurance rate per $1,000 for that month divided by 1,000. The
amount at risk is equal to:
- - The Death Benefit on the first day of the policy month discounted at
the monthly equivalent of 4% per year;
LESS
- - The Cash Value on the first day of the policy month after the Monthly
Deduction has been processed.
COST OF INSURANCE RATES
The cost of insurance rates for each policy year are based on: the sexes of the
Insureds; the underwriting classes of the Insureds; and the ages of the Insureds
on the first day of the policy year. The rates will be set by the Company each
year on the policy anniversary, based on the expectations of the Company as to
future experience. The Table of Guaranteed Insurance Factors per $1,000 (see
Section 2) shows the maximum guaranteed factor for each policy month which
starts on the Policy Date or a policy anniversary. The factors between
anniversaries vary monthly based on uniform distribution of deaths throughout
the policy year.
MONTHLY DEDUCTION ADJUSTMENT AT DEATH
The portion of any Monthly Deduction made for a period beyond the date of the
Last Death will be added to the policy proceeds. If the Last Death occurs during
the grace period, the Amount Due (see Grace Period Provision below) will be
deducted from the policy proceeds to cover Monthly Deductions to the date of the
Last Death.
GRACE PERIOD
Unless the Policy meets the Monthly Minimum Premium test or unless a Guaranteed
Death Benefit Rider is attached and the No Lapse Guarantee Benefit is in effect,
if the Net Cash Value on the first day of a policy month is not enough to cover
the Monthly Deduction for that month, the Company will mail a premium notice to
you at your address on record with the Company. There is a grace period of 62
days from the date when the Monthly Deduction was due in which to pay the Amount
Due.
The Amount Due is the least of: a premium large enough to permit the Monthly
Deduction to be made; a premium large enough to permit the No Lapse Guarantee
Benefit to be in effect if a Guaranteed Death Benefit Rider is attached to the
Policy; and a premium large enough to meet the Monthly Minimum Premium test. The
insurance remains in force during the grace period. If the Amount Due remains
unpaid at the end of its 62-day grace period, the Policy will lapse without
value. Any riders will also lapse without value unless otherwise stated in the
rider.
MONTHLY MINIMUM PREMIUM
If certain criteria are met, this Policy will not lapse even if the Net Cash
Value on the first day of the policy month is not enough to cover the Monthly
Deduction due for that month. During the first three policy years, on the first
day of each policy month, the Company will test for this benefit unless this
Policy is the result of exercising a Change to a New Insured rider.
The test will compare (a) to (b), where:
- - (a) equals the total of the Monthly Minimum Premiums for the Policy
from the Policy Date to that policy month; and
- - (b) equals the total premiums paid to date less all partial surrenders
less any Cash Value paid to you to allow the Policy to continue to
qualify as life insurance and less any Policy Loan Balance at that
time.
If (b) is greater than or equal to (a), the Policy will not lapse if the Net
Cash Value on the first day of the policy month is not enough to cover the
Monthly Deduction due for that month.
The Monthly Minimum Premium is shown in the Policy Schedule. (See Section 1.)
This Premium will be recalculated when: the Face Amount is decreased; the amount
provided by riders attached to this Policy is changed; a partial surrender is
made which results in a decrease in Face Amount; a correction in the insurance
age of either Insured; or the underwriting class of this Policy and its riders
is changed to a more favorable underwriting class.
51
NEV-18-E
12. Reinstatement After Lapse
REINSTATEMENT
If the Policy lapses, the Policy and riders can be reinstated. (See Limitations
on Reinstatement below.) Reinstatement is subject to:
- - Written application to reinstate; and
- - Proof that both Insureds are insurable; and
- - Payment or reinstatement of any Policy Loan Balance which existed on
the date when the Policy lapsed; and
- - Payment of the cost to reinstate described below.
The Monthly Minimum Premium Test will be reinstated if the Policy lapses and is
reinstated within the first three policy years.
The cost to reinstate in the first three policy years equals the least of:
- - An amount equal to: the difference between the premiums paid and
premiums required to allow the Policy to meet the Monthly Minimum
Premium Test; plus two additional Monthly Minimum Premiums;
- - An amount equal to: the difference between the premiums paid and
premiums required to allow the No Lapse Guarantee Benefit to be in
effect if the Guaranteed Death Benefit Rider is attached to the Policy;
plus 2/12 of the Guaranteed Death Benefit Premium shown in Section 1;
and
- - An amount needed to keep the Policy and any riders in force for at
least two months.
The cost to reinstate after the first three policy years equals the lesser of:
- - An amount equal to: the difference between the premiums paid and
premiums required to allow the No Lapse Guarantee Benefit to be in
effect if the Guaranteed Death Benefit Rider is attached to the Policy;
plus 2/12 of the Guaranteed Death Benefit Premium shown in Section 1;
and
- - An amount needed to keep the Policy and any riders in force for at
least two months.
LIMITATIONS ON REINSTATEMENT
The Policy and riders cannot be reinstated, except with the consent of the
Company, if more than seven years have passed since the date of lapse.
Any rider which provides life or disability insurance on a person other than one
of the Insureds can be reinstated only as stated in the rider.
EFFECTIVE DATE OF REINSTATEMENT
Reinstatement will take effect: only if the application for reinstatement is
approved by the Company; and only when the premium for reinstatement has been
paid, provided that at the time of payment there has been no change in
insurability as represented in the application for reinstatement.
MAXIMUM MONTHLY CHARGES AFTER REINSTATEMENT
For the purpose of determining the Maximum Monthly Policy Fee, Maximum Monthly
Mortality and Expense Risk Charge, Maximum Monthly Administrative Charge, and
Maximum Premium Expense Charge on any date after reinstatement, the period the
Policy was lapsed will not count.
FIXED ACCOUNT INTEREST RATE AFTER REINSTATEMENT
If the Policy lapses and is reinstated in the same policy year, the rate of
interest for the amount applied to the Fixed Account at reinstatement will be
the effective interest rate (see Fixed Account Interest) for the Policy at the
time of lapse. Otherwise, the rate of interest for the amount applied to the
Fixed Account at reinstatement will be the rate set by the Company in advance
for the date the Policy is reinstated.
SURRENDER CHARGE AT AND AFTER REINSTATEMENT
A Surrender Charge will be applied if the Policy lapses. If the Policy is
reinstated, the Charge will be credited to the Cash Value of the Policy. The
Surrender Charge on the date of reinstatement will be the same as it was on the
date of lapse. For the purpose of determining the Surrender Charge on any date
after reinstatement, the period the Policy was lapsed will not count.
52
NEV-18-E
13. Cash Value of the Policy
CASH VALUE
The first net premium will be credited to the Policy as of the latest of:
- - The Policy Date;
- - The date of the last Part II of the Application; and
- - The date the first premium is received by the Company.
Each future net premium will be credited to the Cash Value as of the date it is
received by the Company.
Until 15 days after the Company mails the Confirmation of the initial premium,
the Cash Value of the Policy will depend on the net investment performance of
the Money Market sub-account and the Policy's portion of the Fixed Account (see
the Sub-Accounts provision of Section 7 and The Fixed Account provision of
Section 8). Thereafter, the Cash Value of the Policy is equal to: the Policy's
share of the chosen sub-accounts; plus the Policy's portion of the Fixed
Account; plus the amount of any assets transferred to the general account of the
Company because of Policy Loans. (See Section 14.) The amount of the Cash Value
depends on: the frequency and amount of net planned premiums; the frequency and
amount of net unscheduled payments; investment performance of the chosen
sub-accounts; interest credited to the Policy's portion of the Fixed Account;
Monthly Deductions; all chosen Death Benefit Options; partial surrenders;
transfers among sub-accounts and the Fixed Account; and Policy Loans. The Cash
Value can increase or decrease on a daily basis, depending on: the actual
investment performance of the chosen sub-accounts; and the interest credited to
the Policy's portion of the Fixed Account. (See Actual Investment Return below.)
The Cash Value of the Policy is not increased by the cash value of any rider,
unless stated in the rider.
NET CASH VALUE
The Net Cash Value is equal to:
- - The Cash Value of the Policy;
LESS
- - Any Policy Loan Balance;
LESS
- - The Surrender Charge that would apply upon surrender, whether or not
there is a surrender. (See Section 3.)
53
NEV-18-E
SURRENDER OF THE POLICY
You can surrender the Policy for its Net Cash Value at any time by notice to the
Company in writing. Upon surrender, the Policy will be cancelled. The Net Cash
Value will be paid to you in one sum, unless you choose in writing to apply all
or part to a Payment Option. (See Payment of Benefits, Section 18.) If you
surrender the Policy during the grace period, the Amount Due (see the Grace
Period provision in the Monthly Deduction Section) will be deducted from the Net
Cash Value to cover the Monthly Deduction to the date of surrender.
MONTHLY DEDUCTION ADJUSTMENT AT SURRENDER
The pro rata portion of any Monthly Deduction made for a period beyond the date
of surrender will be added to the policy proceeds.
ACTUAL INVESTMENT RETURN
The Policy has an Actual Investment Return for each Valuation Period for its
share of each chosen sub-account and for its portion of the Fixed Account. The
Policy's Actual Investment Return for each sub-account for each Valuation Period
is equal to (a) minus (b); where:
- - (a) is equal to the Policy's share of the sub-account as of the end of
the Valuation Period;
PLUS
the monthly charges deducted in the Valuation Period;
LESS
any net planned premium and net unscheduled payment credited during the
Valuation Period;
PLUS
the total of the partial surrenders made during the Valuation Period;
PLUS
the interest credited to the sub-account during the Valuation Period
for any borrowed portion of the Policy's Cash Value;
PLUS or LESS
a charge or credit for the Policy's share of any reserve for taxes
which the Company determines to apply to the sub-account; and
- - (b) is equal to the Policy's share of the sub-account as of the end of
the most recent Valuation Period;
PLUS or LESS
a charge or credit for the Policy's share of any reserve for taxes
which the Company determines to apply to the sub-account.
The Actual Investment Return for the Fixed Account for each Valuation Period is
equal to (a) minus (b); where:
- - (a) is equal to the Policy's portion of the Fixed Account as of the end
of the Valuation Period;
PLUS
the monthly charges deducted in the Valuation Period;
LESS
any net planned premium and net unscheduled payment credited during the
Valuation Period;
PLUS
the total of the partial surrenders made during the Valuation Period;
PLUS
the interest credited to the Fixed Account during the Valuation Period
for any borrowed portion of the Policy's Cash Value; and
- - (b) is equal to the Policy's portion of the Fixed Account as of the end
of the most recent Valuation Period.
VALUATION PERIODS AND VALUATION DATES
A Valuation Period for each sub-account is a period:
- - Which starts on a Valuation Date; and
- - Which ends on the next succeeding Valuation Date.
Each day the New York Stock Exchange is open for trading is a Valuation Date.
Each Valuation Date ends at the close of regular trading on the New York Stock
Exchange.
54
NEV-18-E
14. Policy Loans
POLICY LOANS
You can borrow all or part of the Loan Value of the Policy by written request to
the Company. Unless the Company consents otherwise, no request can be made until
the Company mails the Confirmation for the first premium. Policy Loans are made
on the sole security of the Policy. The amount you can borrow at any time is
equal to the Loan Value less any Policy Loan Balance at that time.
Unless you request otherwise, Policy Loans will reduce first, the Policy's share
of the sub-accounts proportionately and second, if necessary, the Policy's
portion of the Fixed Account, except as noted below in the Interest on Loans;
Policy Loan Balance provision. Assets equal to the amount of the Loan:
- - Will be transferred to the general account of the Company; and
- - Will earn interest at the effective rate per year of not less than: the
Policy Loan interest rate; less .35%.
On each policy anniversary interest earned on the assets transferred to the
general account will be credited to the Policy's Cash Value in the sub-accounts
and the Fixed Account in the same proportion as the Policy's Cash Value is then
invested in the sub-accounts and the Fixed Account.
Policy Loans, whether or not repaid, can have a permanent effect on Cash Values
and Death Benefits.
LOAN VALUE
The Loan Value of the Policy on the date the Loan is made is equal to 90% of:
the Cash Value of the Policy minus the Surrender Charge that would apply upon
surrender (whether or not there will be a surrender).
INTEREST ON LOANS; POLICY LOAN BALANCE
Interest will be charged on Policy Loans at the rate shown in Section 1.
Interest accrues daily. The Policy Loan Balance at any time means Policy Loans
outstanding plus interest accrued to date. Loan interest is due on the policy
anniversary each year. Loan interest not paid when due will be added to the Loan
and interest will be charged on it; when loan interest is added to the Loan, the
Policy's share of the sub-accounts and the Policy's portion of the Fixed Account
will be reduced proportionately.
REPAYMENT OF LOANS
Policy Loans can be repaid to the Company at any time in whole or in part. Loan
repayments will be allocated: first, to repay the Loans made against the Fixed
Account; and second, unless you request otherwise, to repay the Loans made
against the sub-accounts in the same proportion as the Policy is invested in the
sub-accounts. The rate of interest for each loan repayment allocated to the
Fixed Account will equal the lesser of: the rate set by the Company in advance
for the date the loan repayment is allocated to the Fixed Account; and the
effective interest rate (see Fixed Account Interest) for the Policy on the date
of the repayment.
A Policy Loan is a charge against the Policy. The proceeds of the Policy will be
reduced by any Policy Loan Balance on the date proceeds become payable. If the
Policy Loan Balance at any time exceeds the Cash Value of the Policy less the
Surrender Charge on the next loan interest due date or, if greater, on the
current Valuation Date (called "excess Policy Loan"), the Company will mail a
notice to you and to any assignee. The notice will be mailed to the addresses on
record with the Company. If the excess amount is not paid to the Company within
62 days after the mailing of the notice, the Policy will lapse without value.
Unless you request otherwise in writing to the Company, any payment received by
the Company in response to an anniversary bill and within 45 days after a policy
anniversary when a Policy Loan exists on the Policy will be used: first, as a
planned premium; and second, as payment of loan interest; and third, as an
unscheduled payment. Otherwise, the payment will be used: first, as a planned
premium; and second, as an unscheduled payment.
55
NEV-18-E
15. Policy Changes
DECREASE IN FACE AMOUNT
After the first policy year, the Face Amount may be decreased on the first day
of any policy month by written request to the Company; but only if the Face
Amount which will remain after a decrease is at least $100,000, except with the
consent of the Company. No portion of the Cash Value will be paid to you unless
you chose the Guideline Premium Test for the Policy and paying a portion of the
Cash Value to you is necessary in order to allow the Policy to continue to
qualify as life insurance. A Surrender Charge will apply to a decrease in Face
Amount in proportion to the decrease. (See Section 3.) The Cash Value after the
decrease in Face Amount will be equal to: the Cash Value just prior to the
decrease; less any Surrender Charge for the decrease. The Death Benefit will be
recalculated based on the new Face Amount and the Cash Value after the decrease.
A decrease in Face Amount may require a decrease in the amounts provided by
riders attached to this Policy.
PARTIAL SURRENDER
After the Company mails the Confirmation for the initial premium, you can make a
partial surrender at any time by written request to the Company. A portion of
the Cash Value will be paid to you. A Surrender Charge will apply if the Face
Amount is decreased as a result of a partial surrender. The Surrender Charge
will be in proportion to the decrease in Face Amount. (See Section 3.) In each
policy year, partial surrenders will be limited, except with the consent of the
Company, to: 20% of the Net Cash Value on the day the first partial surrender is
made for the policy year; or, if less, the Loan Value minus any Policy Loan
Balance. The amount of the partial surrender, including any Surrender Charge,
will be deducted from the Cash Value. The Death Benefit of the Policy will be
based on the reduced Cash Value. The Face Amount of the Policy will be reduced,
if necessary, so the amount at risk before and after the partial surrender is
the same. The Face Amount which will remain after the partial surrender must be
at least $100,000, except with the consent of the Company. A decrease in Face
Amount may require a decrease in the amounts provided by riders attached to this
Policy.
Unless you request otherwise, a partial surrender will reduce: first, the
Policy's portion of the sub-accounts proportionately; and second, the Policy's
portion of the Fixed Account.
56
NEV-18-E
16. 24 Months Conversion Right
24 MONTHS CONVERSION RIGHT
The 24 Months Conversion Right allows you to convert all or a portion of this
Policy, subject to the terms of this Section, to fixed benefit coverage: by
transferring value to the Fixed Account; and by allocating future net premiums
and future net unscheduled payments to the Fixed Account.
A request to exercise the 24 Months Conversion Right must be in written form
satisfactory to the Company. The 24 Months Conversion Right can be exercised:
- - Once within 24 months after the Date of Issue of the Policy;
- - Even if the Company is restricting new amounts applied to the Fixed
Account. (See Restriction of New Amounts Applied to the Fixed Account
provision of Section 8.)
If the Company is not restricting amounts applied to the Fixed Account: you can
transfer to the Fixed Account all or part of the Policy's Cash Value in the
sub-accounts; and you can allocate all or part of future net premiums and net
unscheduled payments to the Fixed Account. However, at any time in the future if
the Company is restricting new amounts applied to the Fixed Account, the Company
reserves the right to limit the allocation of future net premiums and net
unscheduled payments to the Fixed Account to the Policy's lowest Fixed Account
allocation percentage since the most recent date when this Right was exercised.
The Policy's share of the sub-accounts will be reduced proportionately when Cash
Value is transferred under this Right.
If the Company is restricting amounts applied to the Fixed Account: you can
transfer to the Fixed Account the portion of the Policy's Cash Value in the
sub-accounts which is attributable to the coverage for which this Right is being
exercised; and you can allocate future net premiums and net unscheduled payments
to the Fixed Account based on the Company's published rules. The Policy's share
of the sub-accounts will be reduced proportionately when Cash Value is
transferred under this Right.
Transfers to the Fixed Account resulting from the exercise of the 24 Months
Conversion Right are not counted in the limit of 4. (See Transfer Option
provision of Section 7.)
17. Owner and Beneficiary
OWNER
The Owner of the Policy is named in the Application (see copy attached); but,
the Owner can be changed. The new Owner will succeed to all rights of the Owner,
including the right to make a further change of Owner. At the death of the
Owner, his or her estate will be the Owner, unless a successor Owner has been
named. In this Policy "you" means the Owner, whether the Owner is a person, a
partnership, a corporation, a fiduciary or any other legal entity. The rights of
the Owner will end at the Last Death, except for Payment of Benefits. (See
Section 18.)
BENEFICIARY
The Beneficiary is named in the Application (see copy attached); but, the
Beneficiary can be changed before the Last Death. The Beneficiary has no rights
in the Policy until the Last Death. The Beneficiary can be a person, a
corporation, a partnership, a fiduciary or any other legal entity. A person must
survive the last Insured to die to qualify as Beneficiary. If none survives, the
proceeds will be paid to the Owner.
CHANGE OF OWNER OR BENEFICIARY
A change of Owner or Beneficiary must be in written form satisfactory to the
Company, and must be dated and signed by the Owner who is making the change. The
change will be subject to all payments made and actions taken by the Company
under the Policy before the signed change form is received by the Company at its
Home Office.
ASSIGNMENTS
An absolute assignment of the Policy by the Owner is a change of Owner and
Beneficiary to the assignee. A collateral assignment of the Policy by the Owner
is not a change of Owner or Beneficiary; but their rights will be subject to the
terms of the assignment except that the rights of an irrevocable beneficiary
named before the assignment are superior to those of the assignee. Assignments
will be subject to all payments made and actions taken by the Company before a
signed copy of the assignment form is received by the Company at its Home
Office. The Company will not be responsible for determining whether or not an
assignment is valid.
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NEV-18-E
DESIGNATION OF OWNER AND BENEFICIARY
A numbered sequence can be used to name successive Owners or Beneficiaries.
Co-Beneficiaries will receive equal shares unless otherwise stated.
In naming Owners or Beneficiaries, unless otherwise stated:
- - "Child" includes an adopted or posthumous child;
- - "Provision for issue" means that if a Beneficiary does not survive both
Insureds, the share of that Beneficiary will be taken by his or her living
issue by right of representation; and
- - A family relation such as "wife", "husband" or "child" means the relation
to Insured 1.
At the time for payment of benefits the Company can rely on an affidavit of any
Owner or other responsible person to determine family relations or members of a
class.
18. Payment of Benefits
PAYMENT
The policy proceeds will be paid in one sum, unless all or part of the proceeds
are applied to a Payment Option. (See Section 19.) The Company will pay interest
on death proceeds from the date the proceeds become payable to the date of
payment in one sum, or to the Option Date. The rate of interest will be set each
year by the Company. The rate will not be less than: that required by law; or 3%
per year. The interest payable on surrender proceeds is described in Section 6.
SELECTION OF PAYMENT OPTIONS; OPTION DATE
The selection of a Payment Option and the naming of the Payee must be in written
form satisfactory to the Company. You can make or change or revoke the selection
before the Last Death. The Option Date is the effective date of the Payment
Option, as stated in the selection form.
PAYEE
The Payee is a person, a corporation, a partnership, a fiduciary or any other
legal entity entitled to receive payment in one sum or under a Payment Option.
SELECTION BY PAYEES
Any proceeds payable in one sum at the Last Death, or upon surrender of the
Policy, can be applied to any Payment Option chosen by the Payee. Further, with
the consent of the Company, any Payee who is entitled to receive proceeds in one
sum when a Payment Option ends, or at the death of a prior Payee, or when
proceeds are withdrawn, can choose to apply the proceeds to a Payment Option.
RIGHTS OF PAYEES
In the selection of a Payment Option the right can be given to the Payee:
- - To withdraw principal and interest under the Fourth or Fifth Option; or
- - To withdraw the commuted value of payments certain under the First, Second,
or Sixth Option.
Under the Life Income Options only payments certain can be commuted. No Payee
can assign, commute or withdraw the payments under any Payment Option, unless
the right is reserved in the selection of the Option.
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NEV-18-E
LIMITATIONS
If instalments under an Option would be less than $20, proceeds can be applied
to a Payment Option only with the consent of the Company.
LIFE INCOME OPTIONS
Guaranteed Life Income Options are based on the age of the Payee on the Payee's
birthday nearest the Option Date. The Company will require proof of age. The
Life Income payments will be based: on the rates shown in the Life Income Tables
(Section 20); or, if they are greater, on the Payment Option rates of the
Company on the Option Date. If the rates at a given age are the same for
different periods certain, the longest period certain will be used.
PURCHASE OF INCREASED PAYMENT OPTION BENEFITS
On the Option Date, a one sum purchase payment can be made to the Company to be
added to the proceeds being applied to any Payment Option. The portion of Life
Income payments purchased in this way will be based on the Payment Option rates
of the Company on the Option Date, which may not be the rates shown in the Life
Income Tables (Section 20). The purchase payment will be limited to the
Company's published maximum for single premium immediate annuities on the Option
Date. A portion of the purchase payment may be used by the Company to pay
premium taxes on the purchase payment.
DEATH OF PAYEE
If a Payee under a Life Income Option dies within 30 days after the Option Date,
the amount applied to the Option, less any payments made, will be paid in one
sum, unless a Payment Option is chosen by the successor Payee. Otherwise,
amounts to be paid after the death of a Payee under a Payment Option will be
paid as due to the successor Payee. If there is no successor Payee, amounts to
be paid in one sum, or the commuted value of any unpaid payments certain, will
be paid in one sum to the estate of the last Payee to die.
COMMUTATION RATE
The interest rate used to compute the commuted value of any unpaid payments
certain:
- - Under the First Option will be 3% per year; and
- - Under the Life Income Options will be the rate used by the Company in
computing the amount of the monthly payments.
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NEV-18-E
19. Payment Options
PAYMENT OPTIONS
All or part of the policy proceeds can be applied to any one of the following
Options, subject to Section 18, Payment of Benefits:
FIRST OPTION: INCOME FOR A SPECIFIED NUMBER OF YEARS
The Company will make monthly payments which will include both principal and
interest. Payments will start on the Option Date and will continue for the
number of years chosen. The number of years chosen cannot be more than 30.
Interest is at the rate of 3% per year compounded yearly. Additional interest
paid by the Company for any year will be added to the monthly payments for that
year.
Guaranteed monthly payments per $1,000 of proceeds applied to the First Option
are shown below:
- -------------------------------------------------------------------------------
Number Number Number
of Years of Years of Years
- -------------------------------------------------------------------------------
1 $84.47 11 $8.86 21 $5.32
2 42.86 12 8.24 22 5.15
3 28.99 13 7.71 23 4.99
4 22.06 14 7.26 24 4.84
5 17.91 15 6.87 25 4.71
6 15.14 16 6.53 26 4.59
7 13.16 17 6.23 27 4.47
8 11.68 18 5.96 28 4.37
9 10.53 19 5.73 29 4.27
10 9.61 20 5.51 30 4.18
- -------------------------------------------------------------------------------
SECOND OPTION: LIFE INCOME
The Company will make equal monthly payments. Payments will start on the Option
Date and will continue:
- - During the life of the Payee, with no payment after the death of the Payee,
called "Life Income, No Refund"; or
- - During the life of the Payee, but for at least 10 years, called "Life
Income, 10 Years Certain"; or
- - During the life of the Payee, but for at least 20 years, called "Life
Income, 20 Years Certain".
THIRD OPTION: LIFE INCOME WITH REFUND
The Company will make equal monthly payments. Payments will start on the Option
Date and will continue during the life of the Payee. At the death of the Payee,
if the total payments made are less than the total proceeds applied to the
Option, then:
- - The difference will be paid in one sum, called "Life Income, Cash Refund";
or
- - The equal monthly payments will continue until the total payments are equal
to the total proceeds applied to the Option, called "Life Income,
Instalment Refund".
FOURTH OPTION: INTEREST
The Company will hold the proceeds at interest during the life of the Payee or
for any other period agreed to by the Company. Interest on the proceeds:
- - Will be paid each month to the Payee starting one month after the Option
Date; or
- - Will be added to the principal amount each year and will earn interest.
At the death of the Payee, or at the end of the period agreed to, the balance of
principal and any accrued interest will be paid in one sum. The rate of interest
will be set each year by the Company; but the rate will not be less than 3% per
year.
FIFTH OPTION: SPECIFIED AMOUNT OF INCOME
The Company will make monthly payments which will include both principal and
interest. Payments will be in the amount chosen. Payments can be quarterly or at
any other frequency chosen, and payments can be for different amounts, all
subject to the consent of the Company. Payments will start on the Option Date
and will continue until the balance is fully paid out. At the death of the Payee
any unpaid balance and accrued interest will be paid in one sum. The rate of
interest will be set each year by the Company; but the rate will not be less
than 3% per year. Interest will be added each year to the principal and will
earn interest.
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NEV-18-E
SIXTH OPTION: LIFE INCOME FOR TWO LIVES
The Company will make monthly payments. Payments will start on the Option Date
and will continue:
- - While either of two Payees is living, called "Joint and Survivor Life
Income"; or
- - While either of two Payees is living, but for at least 10 years, called
"Joint and Survivor Life Income, 10 Years Certain"; or
- - While two Payees are living, and after the death of one Payee, two-thirds
of the monthly amount while the other Payee is living, called "Joint and
2/3 to Survivor Life Income".
61
20. Life Income Tables
LIFE INCOME TABLES
Guaranteed monthly payments per $1,000 of amounts applied to the Life Income
Options are shown below:
- -------------------------------------------------------------------------------
SECOND AND THIRD OPTIONS: LIFE INCOME
- -------------------------------------------------------------------------------
Age 10 20
of NO YEARS YEARS CASH INSTALMENT
Payee REFUND CERTAIN CERTAIN REFUND REFUND
- -------------------------------------------------------------------------------
*15 2.83 2.82 2.82 2.82 2.82
16 2.84 2.34 2.83 2.83 2.83
17 2.85 2.85 2.85 2.84 2.84
18 2.86 2.86 2.86 2.85 2.86
19 2.88 2.88 2.87 2.87 2.87
20 2.89 2.89 2.89 2.88 2.88
21 2.91 2.90 2.90 2.89 2.90
22 2.92 2.92 2.92 2.91 2.91
23 2.94 2.94 2.93 2.92 2.93
24 2.95 2.95 2.95 2.94 2.94
25 2.97 2.97 2.96 2.96 2.96
26 2.99 2.99 2.98 2.97 2.98
27 3.01 3.00 3.00 2.99 2.99
28 3.03 3.02 3.02 3.01 3.01
29 3.04 3.04 3.04 3.03 3.03
30 3.07 3.06 3.06 3.05 3.05
31 3.09 3.09 3.08 3.07 3.07
32 3.11 3.11 3.10 3.09 3.09
33 3.13 3.13 3.13 3.11 3.12
34 3.16 3.16 3.15 3.14 3.14
35 3.18 3.18 3.18 3.16 3.17
36 3.21 3.21 3.20 3.19 3.19
37 3.24 3.24 3.23 3.21 3.22
38 3.27 3.27 3.26 3.24 3.24
39 3.30 3.30 3.29 3.27 3.27
40 3.33 3.33 3.32 3.30 3.30
41 3.37 3.36 3.35 3.33 3.34
42 3.40 3.40 3.38 3.36 3.37
43 3.44 3.44 3.42 3.39 3.40
44 3.48 3.48 3.45 3.43 3.44
45 3.52 3.52 3.49 3.47 3.48
46 3.57 3.56 3.53 3.50 3.51
47 3.61 3.60 3.57 3.54 3.55
48 3.66 3.65 3.62 3.58 3.60
49 3.71 3.70 3.66 3.63 3.64
50 3.76 3.75 3.71 3.67 3.69
51 3.82 3.80 3.75 3.72 3.74
52 3.88 3.86 3.81 3.77 3.79
53 3.94 3.92 3.86 3.82 3.84
54 4.00 3.98 3.91 3.88 3.90
55 4.07 4.05 3.97 3.93 3.95
56 4.14 4.12 4.03 3.99 4.02
57 4.22 4.19 4.09 4.06 4.08
58 4.30 4.27 4.15 4.12 4.15
59 4.39 4.35 4.21 4.19 4.22
60 4.48 4.44 4.28 4.26 4.29
61 4.58 4.53 4.35 4.34 4.37
62 4.68 4.63 4.41 4.42 4.45
63 4.79 4.73 4.48 4.50 4.54
64 4.91 4.84 4.55 4.58 4.63
65 5.04 4.95 4.62 4.68 4.73
66 5.17 5.07 4.69 4.77 4.83
67 5.32 5.20 4.76 4.87 4.93
68 5.48 5.33 4.83 4.98 5.04
69 5.64 5.47 4.89 5.09 5.16
- -------------------------------------------------------------------------------
SECOND AND THIRD OPTIONS: LIFE INCOME
- -------------------------------------------------------------------------------
Age 10 20
of NO YEARS YEARS CASH INSTALMENT
Payee REFUND CERTAIN CERTAIN REFUND REFUND
- -------------------------------------------------------------------------------
70 5.82 5.62 4.96 5.20 5.28
71 6.01 5.77 5.02 5.32 5.41
72 6.22 5.92 5.08 5.45 5.55
73 6.44 6.09 5.13 5.59 5.69
74 6.67 6.26 5.18 5.72 5.84
75 6.92 6.43 5.23 5.87 6.00
76 7.19 6.61 5.27 6.02 6.17
77 7.48 6.79 5.31 6.18 6.34
78 7.79 6.97 5.34 6.35 6.53
79 8.12 7.15 5.37 6.53 6.72
80 8.48 7.34 5.40 6.71 6.93
81 8.85 7.52 5.42 6.90 7.14
82 9.25 7.69 5.44 7.11 7.36
83 9.67 7.87 5.46 7.31 7.59
84 10.13 8.04 5.47 7.53 7.84
**85 10.62 8.20 5.48 7.78 8.09
* and under **and over
- -------------------------------------------------------------------------------
SIXTH OPTION: LIFE INCOME FOR TWO LIVES
- -------------------------------------------------------------------------------
Age of One Age of Other Payee
Payee 55 60 65 70 75
- -------------------------------------------------------------------------------
JOINT AND SURVIVOR
55 $3.63 $3.75 $3.85 $3.93 $3.98
60 3.75 3.92 4.08 4.21 4.31
65 3.85 4.08 4.31 4.52 4.69
70 3.93 4.21 4.52 4.83 5.12
75 3.98 4.31 4.69 5.12 5.57
80 4.02 4.38 4.82 5.36 5.97
- -------------------------------------------------------------------------------
JOINT AND SURVIVOR, 10 YEARS CERTAIN
55 $3.63 $3.75 $3.85 $3.93 $3.98
60 3.75 3.92 4.08 4.20 4.30
65 3.85 4.08 4.30 4.51 4.68
70 3.93 4.20 4.51 4.82 5.10
75 3.98 4.30 4.68 5.10 5.51
80 4.01 4.37 4.80 5.32 5.87
- -------------------------------------------------------------------------------
JOINT AND 2/3 TO SURVIVOR
55 $3.91 $4.08 $4.26 $4.46 $4.68
60 4.08 4.28 4.50 4.74 5.00
65 4.26 4.50 4.77 5.07 5.40
70 4.46 4.74 5.07 5.45 5.87
75 4.68 5.00 5.40 5.87 6.40
80 4.90 5.27 5.73 6.30 6.98
- -------------------------------------------------------------------------------
Payments for other ages will be quoted by the Company on request.
The rates shown above are based on an interest rate of 3% per year; and on
mortality: using a 50/50 male/female weighting; based on the Individual
Annuitant Mortality Table for 1983; and with projection on Scale G to the year
2000 and then on Scale B Modified to year 2035.
NEV-18-E
62
Amendments and Endorsements (To be made only by the Company)
63
Please notify the Company of any change in your name or address. The Company
will communicate with you at your address on record with the Company.
New England Life
Insurance Company
501 Boylston Street
Boston, Massachusetts 02117
FLEXIBLE PREMIUM
ADJUSTABLE VARIABLE SURVIVORSHIP LIFE POLICY
- - The Death Proceeds are payable at the Last Death, if the Policy is in
force.
- - The Policy can be adjusted by decreasing the Face Amount.
- - The amount and frequency of premium payments can be changed.
- - The Policy does not share in dividends.
NEV-18-E
64
NEL APP-80-99
[NEW ENGLAND FINANCIAL LOGO] Policy Number
501 BOYLSTON STREET
BOSTON, MA 02116-3700
APPLICATION TO NEW ENGLAND LIFE INSURANCE COMPANY
FOR SURVIVORSHIP LIFE INSURANCE
PART I
Questions below pertain to each Proposed Insured unless otherwise indicated.
PROPOSED INSURED 1
1. Name as it should appear in the policy. (first name,
middle, last)
------------------------------------------------------
------------------------------------------------------
2. Residence Address
------------------------------------------------------
------------------------------------------------------
City State Zip
------------------------------------------------------
3. Home number ( )
------------------------------------------------------
4. Social Security Number
------------------------------------------------------
5. Sex / / Female / / Male
------------------------------------------------------
6. Date of Birth / /
------------------------------------------------------
7. Age Nearest Birthday
------------------------------------------------------
8. Birthplace: State Country
------------------------------------------------------
9. U.S. Citizen / / Yes / / No
------------------------------------------------------
If No, complete supplemental form
------------------------------------------------------
10. Marital Status / / Single / / Married
------------------------------------------------------
/ / Widowed / / Separated / / Divorced
------------------------------------------------------
11. If Proposed Insured's name has been changed in the past 10 years, give
former names.
------------------------------------------------------
12. a. Business/Employer's name
------------------------------------------------------
b. Business Address
------------------------------------------------------
------------------------------------------------------
City State Zip
------------------------------------------------------
c. Business number ( )
------------------------------------------------------
13. Preferred calling time for follow up Personal History Interview (EST
business hours)
AM PM at / / Home / / Business
------------------------------------------------------
14. a. Occupation If Juvenile or Dependent Insured
complete with payor data.
------------------------------------------------------
b. Exact duties
------------------------------------------------------
c. Annual income $
------------------------------------------------------
d. Net worth
------------------------------------------------------
e. Household Income if different than Annual $
------------------------------------------------------
f. Tax bracket for Variable products only %
------------------------------------------------------
PROPOSED INSURED 2
15. Name as it should appear in the policy. (first name, middle, last)
------------------------------------------------------
16. Residence Address
------------------------------------------------------
------------------------------------------------------
City State Zip
------------------------------------------------------
17. Home number ( )
------------------------------------------------------
18. Social Security Number
------------------------------------------------------
19. Sex / / Female / / Male
------------------------------------------------------
20. Date of Birth / /
------------------------------------------------------
21. Age Nearest Birthday
------------------------------------------------------
22. Birthplace: State Country
------------------------------------------------------
23. U.S. Citizen / / Yes / / No
------------------------------------------------------
If No, complete supplemental form
------------------------------------------------------
24. Marital Status / / Single / / Married
------------------------------------------------------
/ / Widowed / / Separated / / Divorced
------------------------------------------------------
25. If Proposed Insured's name has been changed in the past 10 years, give
former names.
------------------------------------------------------
26. a. Business/Employer's name
------------------------------------------------------
------------------------------------------------------
b. Business Address
------------------------------------------------------
------------------------------------------------------
City State Zip
------------------------------------------------------
c. Business number ( )
------------------------------------------------------
27. Preferred calling time for follow up Personal History Interview (EST
business hours)
AM PM at / / Home / / Business
------------------------------------------------------
28. a. Occupation If Juvenile or Dependent Insured
complete with payor data.
------------------------------------------------------
b. Exact duties
------------------------------------------------------
c. Annual income $
------------------------------------------------------
d. Net worth
------------------------------------------------------
e. Household Income if different than Annual $
------------------------------------------------------
f. Tax bracket for Variable products only %
------------------------------------------------------
Application for Survivorship Life 1
65
- -------------------------------------------------------------------------------
OWNER If business, also complete Business Supplement. List successive Owners and
relationship to Proposed Insureds in Remarks section, in a numbered sequence.
29. a. / / Proposed Insured 1 / / Proposed Insured 2
/ / Other Provide name, address and relationship below.
Name
-----------------------------------------------------------------------
-----------------------------------------------------------------------
Street Address
-----------------------------------------------------------------------
City State Zip
-----------------------------------------------------------------------
Relationship
----------------------------------------------------------------------
b. First Owner's Social Security/Taxpayer ID Complete if other than
Proposed Insured.
----------------------------------------------------------------------
- -------------------------------------------------------------------------------
PREMIUM NOTIFICATION
30. Home of: / / Proposed Insured 1 / / Proposed Insured 2
Business of: / / Proposed Insured 1 / / Proposed Insured 2
/ / Owner If other than either Proposed Insured.
/ / Other Provide name and address below.
Name
-----------------------------------------------------------------------
-----------------------------------------------------------------------
Street Address
-----------------------------------------------------------------------
City State Zip
-----------------------------------------------------------------------
- -------------------------------------------------------------------------------
BENEFICIARY If business, also complete Business Supplement. List additional
Beneficiaries and relationship to Proposed Insureds in Remarks section.
- --------------------------------------------------------------------------------
31. PRIMARY.
-----------------------------------------------------------------------
Name %
-----------------------------------------------------------------------
Relationship
-----------------------------------------------------------------------
Name %
-----------------------------------------------------------------------
Relationship
-----------------------------------------------------------------------
Name %
-----------------------------------------------------------------------
Relationship
-----------------------------------------------------------------------
32. SECONDARY.
-----------------------------------------------------------------------
Name %
-----------------------------------------------------------------------
Relationship
-----------------------------------------------------------------------
Name %
-----------------------------------------------------------------------
Relationship
-----------------------------------------------------------------------
Name %
-----------------------------------------------------------------------
Relationship
-----------------------------------------------------------------------
-----------------------------------------------------------------------
Application for Survivorship Life 2
66
- -------------------------------------------------------------------------------
PLAN
33. Plan
/ / Survivorship Whole Life
/ / Modified Premium Survivorship Life
/ / Flexible Premium Variable Adjustable Survivorship Life
/ / Other
----------------------------------------------------------------------
34. Face Amount $
----------------------------------------------------------
35. DIVIDEND OPTION For non-variable products only.
/ /Cash / /Accumulations / /Premium Reduction / /Paid-Up Additions
36. FOR VARIABLE PRODUCTS ONLY
a. Planned Annual Premium State source of funds, if $10,000 or greater.
----------------------------------------------------------------------
Year 1 $ Renewal $ Lump Sum $
----------------------------------------------------------------------
b. Death Benefit Option
/ /Option A Enhanced with Face Amount
/ /Option B Enhanced with Face Amount plus Cash Value
/ /Option C Face Amount
/ /Option D Face Amount plus Cash Value
/ /Other
COST OF INSURANCE RATES MAY CHANGE. The cost of insurance rates for the
policy may change. The rates currently being charged are not
guaranteed; and the Company may charge the full maximum guaranteed
rates.
- -------------------------------------------------------------------------------
BENEFITS/RIDERS
37. For all plans
-------------
a. / / Survivorship Four Year Term
b. / / Split Option
c. / / Single Life Level Term - Insured 1 $
---------------
/ / Single Life Level Term - Insured 2 $
---------------
d. / / Single Life Decreasing Term
Insured 1 $
---------------
/ / Single Life Decreasing Term
Insured 2 $
---------------
For variable products only Insured
-------------------------- -------
e. / / Survivorship Level Term
f. / / Waiver of Monthly / / 1 / / 2
Deductions
g. / / Benefits for Disability of / / 1 / / 2
Covered Insured
For non-variable products only Insured
------------------------------ -------
h. / / Waiver of Premiums / / 1 / / 2
i. / / One Year Term (dividends)
j. / / Additional Protection (TIO) $
---------------
k. / / Paid-Up Additions (PUAR)
State source of funds if $10,000 or greater.
----------------------------------------------------
/ / Lump sum at issue $
---------------
/ / Annual: at issue $
---------------
Thereafter $
---------------
l. / / Substitute Insured
m. / / Other
-------------------------------
/ / Other
-------------------------------
/ / Other
-------------------------------
/ / Other
-------------------------------
/ / Other
-------------------------------
- -------------------------------------------------------------------------------
Application for Survivorship Life Insurance 3
NEL APP-80-99
67
COMPLETE QUESTIONS 38-42 FOR VARIABLE PRODUCTS ONLY.
- ------------------------------------------------------------------------------
38. OWNER'S INFORMATION Complete questions 38 a-g only if Owner is other
than either Proposed Insured.
a. Occupation
----------------------------------------------------------------------
b. Employer's name and address
----------------------------------------------------------------------
----------------------------------------------------------------------
c. Age
----------------------------------------
d. State of residence
---------------------------------------------------------------
e. Annual Income $
----------------------------------------
f. Net Worth $
---------------------------------------------------------------
g. Tax Bracket %
----------------------------------------
h. Is Owner associated with a member firm of the NASD?
/ / Yes / /No If Yes, give name and address of firm.
--------------------------------------------------------------
--------------------------------------------------------------
39. Account Allocation* Indicate Whole Percentages Attach additional sheet
if necessary.
STABILITY
% Fixed Account
--------
% Back Bay Advisors Money Market
--------
INCOME
% Back Bay Advisors Bond Income
--------
% Fidelity VIP High Income
--------
GROWTH
% Back Bay Advisors Managed
--------
% Fidelity VIP II Asset Manager
--------
% Loomis Sayles Balanced
--------
% Westpeak Stock Index
--------
% Fidelity VIP Equity Income
--------
% Westpeak Growth & Income
--------
% Davis Venture Value
--------
% Goldman Sachs Midcap Value
--------
% Capital Growth
--------
% Alger Equity Growth
--------
% Fidelity VIP Overseas
--------
% Loomis Sayles Small Cap
--------
% Morgan Stanley International Equity
--------
OTHER
%
------- ----------------------------
%
------- ----------------------------
%
------- ----------------------------
%
------- ----------------------------
%
------- ----------------------------
%
------- ----------------------------
%
------- ----------------------------
%
------- ----------------------------
%
------- ----------------------------
*Total Account Allocations must equal 100%
- -------------------------------------------------------------------------------
SUITABILITY STATEMENT BY APPLICANT For variable products only. APPLICANT
-----------
40. Did you receive the prospectus? / / Yes / /No
a. Prospectus number
------------------
b. Prospectus date / /
------------------
41. Do you understand that:
a. the Option B and D death benefit may increase
or decrease depending on the policy's investment / / Yes / / No
return?
b. the cash value may increase or decrease
depending on the policy's investment / / Yes / / No
return?
42. Do you believe that this policy will meet
your insurance needs and financial objective? / / Yes / / No
The Cash Value will be allocated to the Money Market account for an initial
period described on page 1 of the prospectus.
THE DEATH BENEFIT MAY BE VARIABLE OR FIXED UNDER SPECIFIED CONDITIONS. THE CASH
VALUE MAY INCREASE OR DECREASE IN ACCORDANCE WITH SEPARATE INVESTMENT ACCOUNT
EXPERIENCE.
COST OF INSURANCE RATES MAY CHANGE. The cost of insurance rates for the policy
may change. The rates currently being charged are not guaranteed; and the
Company may charge the full maximum guaranteed rates.
- -------------------------------------------------------------------------------
Application for Survivorship Life Insurance 4
NEL APP-80-99
68
- -------------------------------------------------------------------------------
EXISTING INSURANCE
43. Indicate life insurance policies in force for each Proposed Insured. If
none, so state. Type: P=Personal, B=Business, G=Group
TYPE ACCIDENTAL DEATH
PROPOSED INSURED COMPANY (CIRCLE ONE) YEAR OF ISSUE LIFE AMOUNT BENEFIT AMOUNT
----------------- ----------------------- -------------- -------------- ------------- -------------------
/ / 1 / / 2 P B G
----------------- ----------------------- -------------- -------------- ------------- -------------------
/ / 1 / / 2 P B G
----------------- ----------------------- -------------- -------------- ------------- -------------------
/ / 1 / / 2 P B G
----------------- ----------------------- -------------- -------------- ------------- -------------------
/ / 1 / / 2 P B G
----------------- ----------------------- -------------- -------------- ------------- -------------------
/ / 1 / / 2 P B G
----------------- ----------------------- -------------- -------------- ------------- -------------------
44. If either Proposed Insured is a Juvenile or Dependent, state relation to and PROPOSED PROPOSED
amount of life insurance in force or applied for on person responsible for support INSURED 1 INSURED 2
of that Proposed Insured. --------------- -----------------
a. Relationship to Proposed Insured
--------------- -----------------
b. Amount of Insurance $ $
--------------- -----------------
c. If Juvenile, are there any other children insured for less than this child / / Yes / / No / / Yes / / No
(or these children)? If Yes, give details in Remarks.
- -------------------------------------------------------------------------------
REPLACEMENT
45. Will any life insurance or annuity issued by this or any other company be replaced / / Yes / / No / / Yes / / No
as a result of this Application for insurance? If Yes, complete the following
and submit replacement forms if required.
PROPOSED
INSURED COMPANY 1035 EXCHANGE POLICY DATE POLICY NUMBER AMOUNT
-------------- ------------------------ ---------------- ------------ --------------- --------------------
/ / 1 / / 2 / / Yes / / No $
-------------- ------------------------ ---------------- ------------ --------------- --------------------
/ / 1 / / 2 / / Yes / / No $
-------------- ------------------------ ---------------- ------------ --------------- --------------------
/ / 1 / / 2 / / Yes / / No $
-------------- ------------------------ ---------------- ------------ --------------- --------------------
/ / 1 / / 2 / / Yes / / No $
-------------- ------------------------ ---------------- ------------ --------------- --------------------
/ / 1 / / 2 / / Yes / / No $
-------------- ------------------------ ---------------- ------------ --------------- --------------------
46. Has life or disability insurance
on your life ever been declined,
postponed or modified as to plan,
amount or rate? / / Yes / /No / / Yes / / No
If Yes, give details in Remarks section.
- -------------------------------------------------------------------------------
Application for Survivorship Life Insurance 5
NEL APP-80-99
69
- -------------------------------------------------------------------------------
AVOCATION AND HEALTH
47. a. Driver's License No.
--------------- -----------------
b. State
--------------- -----------------
48. Have you used any form of tobacco in the past year? If Yes: / / Yes / / No / / Yes / / No
a. Cigarettes / / Yes / / No / / Yes / / No
b. Other (cigar, pipe, smokeless chew, patch, nicotine substitute) / / Yes / / No / / Yes / / No
49. Have you been convicted of: driving under the influence of alcohol or drugs in the / / Yes / / No / / Yes / / No
past 10 years; or two or more moving violations in the past 2 years?
If Yes, complete supplemental form.
50. Have you in the past 2 years participated in, or do you intend to participate in: / / Yes / / No / / Yes / / No
any flights as a trainee, pilot or crew member; underwater sports (SCUBA diving,
hardhat, skin diving, snorkeling); sky sports (skydiving, hang gliding,
parachuting, ballooning); or racing sports (auto, motorcycle, motorboat) or other
hazardous avocations? If Yes, complete supplemental form.
51. Do you intend to travel or reside outside of the United States (excluding / / Yes / / No / / Yes / / No
Canada)? If Yes, give details in Remarks section.
52. a. Have you had any treatment for or consultation with a physician concerning a / / Yes / / No / / Yes / / No
heart attack, a stroke or cancer (other than skin cancer) within the past 2
years? If Yes, give details in Remarks section.
b. Have you had any change in health or any treatment by or diagnostic / / Yes / / No / / Yes / / No
consultation with a physician since the date of Part II of this
Application? If Yes, give details in Remarks section.
PREMIUM PAYMENT
53. / / Annual / / Semi-Annual / / Quarterly
MSA Number
-----------------------------------------------------------------
/ / New account Complete separate MSA Authorization.
/ / Add to existing MSA
List Bill Number
-----------------------------------------------------------------
Payroll Deduct Case Number
-----------------------------------------------------------------
/ / Level Billing Option Complete additional form.
54. / / Automatic payment of premium in default if available.
a. From Dividend Accumulations
For non-Variable products only. / / Yes / / No
b. By Policy Loan / / Yes / / No
- -------------------------------------------------------------------------------
PREPAYMENT If questions 52 a. or b. were answered Yes,
no prepayment is permitted.
55. a. / / Amount $ / / None
Complete Prepayment Receipt & Temporary Life Insurance Agreement.
b. The Applicant understands and agrees to
all limits, conditions and provisions of / / Yes / / No
APP-535-98, the Prepayment Receipt and
Temporary Life Insurance Agreement?
- ------------------------------------------------------------------------------
POLICY DATE
56. If available, special Policy Date requested / /
is ----------------
- -------------------------------------------------------------------------------
Application for Survivorship Life Insurance 6
NEL APP-80-99
70
- -------------------------------------------------------------------------------
REMARKS/SPECIAL REQUESTS FOR ADDITIONAL COVERAGE Attach additional sheet, if
necessary.
NEL APP-80-99
Application for Survivorship Life Insurance 7
- -------------------------------------------------------------------------------
- -------------------------------------------------------------------------------
- -------------------------------------------------------------------------------
- -------------------------------------------------------------------------------
- -------------------------------------------------------------------------------
- -------------------------------------------------------------------------------
- -------------------------------------------------------------------------------
- -------------------------------------------------------------------------------
- -------------------------------------------------------------------------------
- -------------------------------------------------------------------------------
- -------------------------------------------------------------------------------
71
PART II MEDICAL HISTORY OF PROPOSED INSUREDS
- --------------------------------------------------------------------------------
For each Yes answer to questions 1-9, please provide details in question 11. PROPOSED PROPOSED
INSURED 1 INSURED 2
1. a. Name, address and phone # of your personal physician.
Proposed Insured 1
Proposed Insured 2
b. Have you in the past 5 years consulted this, or any other physician for a [ ] Yes [ ] No [ ] Yes [ ] No
routine checkup or physical examination?
2. Within the past 10 years have you been treated for or had any known indication of: [ ] Yes [ ] No [ ] Yes [ ] No
frequent fatigue; frequent loss of appetite; frequent night sweats; chronic
diarrhea; enlarged lymph nodes; unexplained infections; or unusual skin lesions?
3. Have you ever received treatment, advice or counseling from a [ ] Yes [ ] No [ ] Yes [ ] No
physician, other practitioner or an organization for
excess alcohol use?
4. Have you ever used cocaine or other drugs except as prescribed by a physician or [ ] Yes [ ] No [ ] Yes [ ] No
licensed practitioner?
5. Have you ever been treated by a member of the medical profession for, or been [ ] Yes [ ] No [ ] Yes [ ] No
diagnosed by a member of the medical profession as having, Acquired Immune
Deficiency Syndrome (AIDS) or AIDS-Related Complex (ARC)?
6. Have you ever been treated for or diagnosed as having:
a. Cancer; cyst; tumor; or diabetes? [ ] Yes [ ] No [ ] Yes [ ] No
b. High blood pressure; stroke; heart murmur; disease or disorder of the heart, [ ] Yes [ ] No [ ] Yes [ ] No
blood or circulatory system?
c. Any mental or nervous disorder; epilepsy; any muscular or skeletal disorder; [ ] Yes [ ] No [ ] Yes [ ] No
or any paralysis or deformity?
d. Disease or disorder of: kidneys, lungs, stomach, liver, lymph glands; [ ] Yes [ ] No [ ] Yes [ ] No
digestive system; or urinary system?
7. Are you now receiving any treatment or medication? [ ] Yes [ ] No [ ] Yes [ ] No
8. Other than above, do you have any other physical disorders, or have you within the [ ] Yes [ ] No [ ] Yes [ ] No
past 5 years: had any other diagnostic consultations for other than AIDS or ARC;
been a patient in a medical facility; or been advised to have any other diagnoostic
tests other than an HIV test, hospitalization or surgery?
9. a. Height ____ft. _____in. ____ft. _____in.
b. Weight __________lbs. ___________lbs.
c. Have you had any change in weight in the past year? [ ] Yes [ ] No [ ] Yes [ ] No
d. If yes, how much? ___lbs. Gain ___lbs. Gain
Loss Loss
10. Family PROPOSED INSURED 1 PROPOSED INSURED 2
History ------------------------------------ ---------------------------------
Age(s) Age(s) Health status Age(s) Age(s) Health Status
if At or cause of if At or cause of
Living Death death Living Death death
------ ----- ------------- ------ ----- -------------
Father
Mother
Siblings # Living ___ # Living __
# Deceased ___ # Deceased __
Application for Survivorship Life Insurance 8
NEL APP-80-99
72
11. Explain Yes answers to questions 1-9 below. Attach additional sheet, if
necessary.
- --------------------------------------------------------------------------------
PROPOSED INSURED 1
------------------
INITIAL LAST TYPE OF CONSULT,
QUESTION #/ CONSULT/ONSET CONSULT/RECOVERY DIAGNOSIS, TREATMENT, PHYSICIAN/FACILITY
LETTER MONTH/YEAR MONTH/YEAR MEDICATION, ETC. NAME & ADDRESS
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
PROPOSED INSURED 2
------------------
INITIAL LAST TYPE OF CONSULT,
QUESTION #/ CONSULT/ONSET CONSULT/RECOVERY DIAGNOSIS, TREATMENT, PHYSICIAN/FACILITY
LETTER MONTH/YEAR MONTH/YEAR MEDICATION, ETC. NAME & ADDRESS
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
------------- ---------------- ------------------ ---------------------- ----------------------------------
Application for Survivorship Life Insurance 9
NEL APP-80-99
73
NEW ENGLAND LIFE INSURANCE COMPANY
- --------------------------------------------------------------------------------
COMPANY USE ONLY: ADDITIONS AND AMENDMENTS
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
DECLARATIONS
GENERAL. To the best of my knowledge and belief, the answers recorded are true
and complete. In those states where written consent is required by law, my
agreement in writing is required to any entry made by the Company in the
"Company Use" section as to: (a) age; or (b) plan of insurance; or (c) riders;
or (d) amounts; or (e) rate class.
WHEN INSURANCE TAKES EFFECT. If a prepayment is made in connection with this
Application, the insurance will take effect as stated in the Prepayment Receipt
and Temporary Insurance Agreement. Otherwise, the insurance will take effect
only when the first premium is paid; provided that at the time of such payment:
(a) this Application has been approved by the Company; and (b) there has been no
change in insurability as represented in this Application since the date of the
Application.
LIMITATIONS ON AUTHORITY OF PRODUCERS AND EXAMINERS. Producers and examiners do
not have authority: (a) to determine insurability; (b) to change any terms of
the Application; or (c) to make a contract for the Company.
- --------------------------------------------------------------------------------
AUTHORIZATION
IN ORDER THAT INSURANCE CAN BE ISSUED, I authorize each of the following having
records or knowledge of me or my health to give this information to the Company:
a medical practitioner; a medical facility; an insurance company; the Medical
Information Bureau; a consumer reporting bureau; and any other company, concern
or person. If insurance on any minor child is applied for, this authorization
extends to the records and knowledge of that child and the child's health.
Information received by the Company may be disclosed to third parties in the
conduct of the Company's business.
I authorize the preparation and procurement of an investigative consumer report.
I UNDERSTAND THAT: I have a right of access to and correction of all information
obtained by the Company; I can ask to be interviewed with respect to any
investigative consumer report; and I can ask for a copy of any such report. A
photocopy of this authorization is as valid as the original. This authorization
is valid for 30 months from the date it is signed. I have received a Notice of
Information Practices; this Notice gives a more detailed description of the
information practices of the Company.
- --------------------------------------------------------------------------------
OWNER'S CERTIFICATION (In lieu of W9)
[ ] I am [ ] I am not subject to backup withholding under Section 3406(a)(1)(c)
of the Internal Revenue Code. Under penalties of perjury, I certify that the
information provided in this Certification is true, correct, and complete.
- --------------------------------------------------------------------------------
SIGNATURES
Signed at: City State Date / /
- ---------- ---- ----- ----------------
X Proposed Insured 1 (Parent, if Proposed Insured 1 is under age 15)
X Proposed Insured 2 (Parent, if Proposed Insured 2 is under age 15)
X Applicant if other than Proposed Insureds
X Owner if other than Proposed Insureds or Applicant Date / /
X Producer
- --------------------------------------------------------------------------------
Application for Survivorship Life Insurance 10
NEL APP-80-99