1
Exhibit 5
We will pay the proceeds to the beneficiary after we receive due proof that the
insured died while this contract was inforce. If the insured is living on the
maturity date, we will then pay to the owner the accumulation value less any
loans in effect.
Our home office is at One Financial Way, Cincinnati, Ohio 45242.
/s/ Ronald L. Benedict /s/ David ??????
Secretary President
20 DAY RIGHT TO EXAMINE THE POLICY: YOU HAVE A RIGHT TO CANCEL THIS CONTRACT
WITHIN 20 DAYS AFTER YOU RECEIVE IT. YOU MAY RETURN IT TO US OR TO OUR AGENT FOR
ANY REASON WITHIN THOSE 20 DAYS. THE CONTRACT WILL THEN BE TREATED AS THOUGH IT
WERE NEVER ISSUED. WE WILL THEN REFUND THE PREMIUMS THAT WERE PAID TO US.
DEATH BENEFITS AND ACCUMULATION VALUES MAY INCREASE OR DECREASE ACCORDING TO
THE INVESTMENT EXPERIENCE OF OHIO NATIONAL VARIABLE ACCOUNT R.
FOR DETAILS SEE NONFORFEITURE PROVISIONS, PAGES 13-17.
FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY
Nonparticipating
Adjustable Death Benefit Payable Before Maturity Date
Cash Surrender Value Payable on Maturity Date if Insured is Then Living
Flexible Premiums Until Maturity Date
Stated Amount: Page 3
Maturity Date: Page 3
INSURED John Doe POLICY NUMBER C0000000
AGE 35 FACE AMOUNT $100,000
CONTRACT DATE 01/01/1997 ISSUE DATE 01/01/1997
FORM 00-VL-1 PAGE 1
FORM 00-VL-1
2
POLICY CONTENTS
Page
POLICY SPECIFICATIONS 3
OPTION TABLES 5
TABLE OF RENEWAL PREMIUMS 6
GENERAL TERMS AND DEFINITIONS 7
Contract Months and Years 7
Fund 7
Guideline Premium 7
Issue Date 7
Maturity Date 7
Minimum Premium 7
Notice 7
Option 7
Payee 7
Proceeds 7
Process Days 7
Pronouns 8
Proof You Can Be Insured 8
Subaccount 8
VAR 8
Valuation Period 8
GENERAL PROVISIONS 8
Ownership 8
Assignment 8
Beneficiary 8
Contract 9
General Account and VAR 9
Investments of VAR 9
Voting Rights 9
Reports 9
Nonparticipating 10
Exchange Right 10
PREMIUMS 10
Payment 10
Net Premium 10
Allocation of Net Premiums 10
Planned Premium 10
Extra Premium 10
Minimum Premium Requirement 11
Policy Changes Affecting the Minimum
Premium Requirement 11
Death Benefit Guarantee 11
Grace Period 11
Reinstatement 11
BENEFITS 12
Death Proceeds Choices 12
Changes in Coverage 12
Change of Proceeds Plans 13
Extended Endowment 13
NONFORFEITURE 13
Accumulation Value 13
Fixed Accumulation Value 13
Interest for the Fixed Accumulation Value 13
Interest on Loan Collateral 13
Determination of Values for the General
Account 14
Variable Accumulation Value 14
Variable Accumulation Units 14
Unit Value 14
Net Investment Factor 14
Splitting Units 15
Transfers Among Subaccounts and General
Account 15
Taxes 15
Monthly Charges 15
Cost of Insurance 15
Cost of Insurance Rate 15
Net Amount at Risk 16
Surrender and Cash Surrender Value 16
Surrender Charge 16
Surrender Charge On Decreases 16
Partial Surrender 16
Deferral of Payment on Surrender, Partial
Surrenders and Loans 17
Paid-up Term Insurance 17
Paid-up Life Insurance 17
LOANS 17
Availability 17
Loan Value 17
Gross Loan Value 17
Preferred Loans 17
Loan Collateral 18
Interest 18
Repayment 18
CLAIMS 18
Payment of Proceeds 18
Misstatement of Age or Sex 18
Proceeds Protection 18
Incontestability 19
Suicide 19
PROCEEDS PAYMENT OPTIONS 19
Choice of Options 19
Minimum Amounts 19
Description of Options 19
Proceeds at Interest 20
Payments for a Certain Period 20
Life Income 20
Payments of a Certain Amount 20
Joint and Survivor Life Income 21
Alternate Life Income 21
Death of Payee 21
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 2
3
POLICY SPECIFICATIONS
BENEFIT SPECIFICATIONS PREMIUM SPECIFICATIONS
BENEFIT - - - - - DESCRIPTION OF BENEFITS- - - - - YEARS FORM
AMOUNTS PREMIUM PAYABLE NUMBER
INITIAL
$100,000 FLEXIBLE PREMIUM ADJUSTABLE LIFE $ 1000.00 00-VL-1
(STATED MATURITY AT AGE 100
AMOUNT) STANDARD NONSMOKER RISK CLASS
DEATH BENEFIT A - STATED AMOUNT PLANNED ANNUAL
INCLUDES ACCUMULATION VALUE $ 1000.00 65
NOTES:
MINIMUM STATED AMOUNT IS $50000
IT IS POSSIBLE THAT COVERAGE WILL EXPIRE PRIOR TO THE MATURITY
DATE SHOWN WHEN EITHER NO PREMIUMS ARE PAID FOLLOWING PAYMENT
OF THE FIRST YEAR PREMIUM ORE SUBSEQUENT PREMIUMS ARE
INSUFFICIENT TO CONTINUE COVERAGE TO SUCH DATE. THE DEATHE
BENEFIT, HOWEVER, IS GUARANTEED TO CONTINUE FOR 5 YEARS IF THE
MINIMUM PREMIUM REQUIREMENT IS MET.
MONTHLY MINIMUM PREMIUM TO MAINTAIN THE DEATH BENEFIT GUARANTEE:
$81.00
DEATH BENEFIT GUARANTEE PERIOD IS 5 YEARS.
GUIDELINE PREMIUM (ANNUAL) IS $1300.00
POLICY NUMBER CONTRACT DATE ISSUE DATE MATURITY DATE
I6345001 AUG 01 2000 AUG 01 2000 AUG 01 2065
INSURED ISSUE AGE & SEX
JOHN DOE 35 MALE
OWNER
THE INSURED
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 3
4
POLICY SPECIFICATIONS
BENEFIT SPECIFICATIONS PREMIUM SPECIFICATIONS
BENEFIT - - - - - DESCRIPTION OF BENEFITS- - - - - YEARS FORM
AMOUNTS PREMIUM PAYABLE NUMBER
INITIAL
$100,000 FLEXIBLE PREMIUM ADJUSTABLE LIFE $ 1000.00 00-VL-1U
(STATED MATURITY AT AGE 100
AMOUNT) STANDARD NONSMOKER RISK CLASS
DEATH BENEFIT A - STATED AMOUNT PLANNED ANNUAL
INCLUDES ACCUMULATION VALUE $ 1000.00 65
NOTES:
MINIMUM STATED AMOUNT IS $50000
IT IS POSSIBLE THAT COVERAGE WILL EXPIRE PRIOR TO THE MATURITY
DATE SHOWN WHEN EITHER NO PREMIUMS ARE PAID FOLLOWING PAYMENT
OF THE FIRST YEAR PREMIUM ORE SUBSEQUENT PREMIUMS ARE
INSUFFICIENT TO CONTINUE COVERAGE TO SUCH DATE. THE DEATHE
BENEFIT, HOWEVER, IS GUARANTEED TO CONTINUE FOR 5 YEARS IF THE
MINIMUM PREMIUM REQUIREMENT IS MET.
MONTHLY MINIMUM PREMIUM TO MAINTAIN THE DEATH BENEFIT GUARANTEE:
$75.00
DEATH BENEFIT GUARANTEE PERIOD IS 5 YEARS.
GUIDELINE PREMIUM (ANNUAL) IS $1217.00
POLICY NUMBER CONTRACT DATE ISSUE DATE MATURITY DATE
I6345002 AUG 01 2000 AUG 01 2000 AUG 01 2065
INSURED ISSUE AGE & SEX
JOHN DOE 35 UNISEX
OWNER
THE INSURED
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FORM 00-VL-1U OHIO NATIONAL LIFE ASSURANCE COMPANY PAGE 3
5
I6345001
TABLE OF GUARANTEED
MAXIMUM INSURANCE RATES
PER $1000 NET AMOUNT AT RISK
MALE STANDARD NONSMOKER RISK CLASS
ISSUE AGE: 35
STATED AMOUNT: $ 100,000 POLICY PLAN: FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE
ATTAINED MONTHLY INS ATTAINED MONTHLY INS
AGE RATE PER AGE RATE PER
$1000 $1000
35 0.14085 75 4.92413
36 0.14752 76 5.45122
37 0.15669 77 6.00585
38 0.16669 78 6.58221
39 0.17837 79 7.19473
40 0.19087 80 7.86724
41 0.20588 81 8.61695
42 0.22088 82 9.46542
43 0.23839 83 10.42336
44 0.25590 84 11.47263
45 0.27674 85 12.58987
46 0.29926 86 13.75325
47 0.32344 87 14.95279
48 0.34929 88 16.16464
49 0.37848 89 17.40526
50 0.40933 90 18.69215
51 0.44603 91 20.04733
52 0.48857 92 21.51567
53 0.53612 93 23.16008
54 0.59118 94 25.25984
55 0.65209 95 28.27411
56 0.71968 96 33.10677
57 0.79146 97 41.68475
58 0.86909 98 58.01259
59 0.95675 99 83.33266
60 1.05444
61 1.16302
62 1.28665
63 1.42787
64 1.58752
65 1.76394
66 1.95381
67 2.15965
68 2.38065
69 2.62186
70 2.89419
71 3.20272
72 3.55929
73 3.96902
74 4.42953
FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE COMPANY PAGE 6
6
I6345002
TABLE OF GUARANTEED
MAXIMUM INSURANCE RATES
PER $1000 NET AMOUNT AT RISK
UNISEX STANDARD NONSMOKER RISK CLASS
ISSUE AGE: 35
STATED AMOUNT: $100,000 POLICY PLAN: FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE
ATTAINED MONTHLY INS ATTAINED MONTHLY INS
AGE RATE PER AGE RATE PER
$1000 $1000
35 0.13168 75 3.93711
36 0.13919 76 4.38414
37 0.14752 77 4.85344
38 0.15836 78 5.34845
39 0.16920 79 5.88105
40 0.18253 80 6.47330
41 0.19671 81 7.14316
42 0.21255 82 7.90957
43 0.22755 83 8.78823
44 0.24423 84 9.75508
45 0.26340 85 10.80466
46 0.28258 86 11.91616
47 0.30426 87 13.09339
48 0.32677 88 14.31451
49 0.35179 89 15.60649
50 0.37931 90 16.96897
51 0.41017 91 18.43624
52 0.44687 92 20.05340
53 0.48774 93 21.92280
54 0.53195 94 24.22375
55 0.58117 95 27.46236
56 0.63373 96 32.51830
57 0.68881 97 41.36022
58 0.74639 98 57.86896
59 0.80899 99 83.33266
60 0.87994
61 0.96176
62 1.05611
63 1.16886
64 1.29835
65 1.43873
66 1.59170
67 1.75140
68 1.91951
69 2.10024
70 2.30530
71 2.56406
72 2.82043
73 3.14905
74 3.52572
FORM 00-VL-1U OHIO NATIONAL LIFE ASSURANCE COMPANY PAGE 6
7
I6345001
DESCRIPTION OF EXPENSE
CHARGES AND SURRENDER CHARGES
POLICY PLAN: FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE
EXPENSE CHARGES SURRENDER CHARGES
ALL PREMIUMS RECEIVED IN THE FIRST TWENTY A SURRENDER CHARGE AS SHOWN BELOW WILL
YEARS WILL BE REDUCED BY A 0.90% BE DEDUCTED IN THE EVENT OF SURRENDER.
CHARGE TO OFFSET FEDERAL TAX.
CONTRACT SURRENDER
ALL PREMIUMS RECEIVED WILL BE REDUCED YEAR CHARGE
BY APPLICABLE STATE PREMIUM TAX AND 1 $2,399
A 2% PREMIUM LOAD CHARGE. 2 2,374
3 2,348
A CONTRACT MAINTENANCE CHARGE OF $7 4 2,320
WILL BE DEDUCTED FROM THE ACCUMULATION 5 2,292
VALUE EACH MONTH. 6 2,264
7 2,234
A NO-LAPSE GUARANTEE CHARGE OF $ .00 8 2,204
PER THOUSAND WILL BE DEDUCTED MONTHLY 9 2,172
WHEN THIS BENEFIT IS IN EFFECT. 10 2,140
11 1,686
PREMIUM USED TO CALCULATE INVESTMENT 12 1,244
CREDIT: $972.00 13 815
14 400
15 & over 0
FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE COMPANY PAGE 6A
8
I6345002
DESCRIPTION OF EXPENSE
CHARGES AND SURRENDER CHARGES
POLICY PLAN: FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE
EXPENSE CHARGES SURRENDER CHARGES
ALL PREMIUMS RECEIVED IN THE FIRST TWENTY A SURRENDER CHARGE AS SHOWN BELOW WILL
YEARS WILL BE REDUCED BY A 0.90% BE DEDUCTED IN THE EVENT OF SURRENDER.
CHARGE TO OFFSET FEDERAL TAX.
CONTRACT SURRENDER
ALL PREMIUMS RECEIVED WILL BE REDUCED YEAR CHARGE
BY APPLICABLE STATE PREMIUM TAX AND 1 $2,303
A 2% PREMIUM LOAD CHARGE. 2 2,280
3 2,257
A CONTRACT MAINTENANCE CHARGE OF $7 4 2,233
WILL BE DEDUCTED FROM THE ACCUMULATION 5 2,208
VALUE EACH MONTH. 6 2,182
7 2,156
A NO-LAPSE GUARANTEE CHARGE OF $ .00 8 2,129
PER THOUSAND WILL BE DEDUCTED MONTHLY 9 2,101
WHEN THIS BENEFIT IS IN EFFECT. 10 2,073
11 1,635
PREMIUM USED TO CALCULATE INVESTMENT 12 1,208
CREDIT: $900.00 13 793
14 390
15 & over 0
FORM 00-VL-1U OHIO NATIONAL LIFE ASSURANCE COMPANY PAGE 6A
9
This Page Left Blank
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 4
10
OPTION TABLES
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 5
11
TABLE OF RENEWAL PREMIUMS
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 6
12
GENERAL TERMS AND DEFINITIONS
CONTRACT MONTHS AND YEARS
This contract takes effect on the contract date shown on page 3. Contract
months and years are marked from the contract date. The first day of the
contract year is the contract date and its anniversaries.
FUND
(a) Ohio National Fund, Inc. or (b) another open-end management investment
company registered under the Investment Company Act of 1940, as amended
(the "Act"). Shares of these investment companies are referred to as "Fund
Shares."
GUIDELINE PREMIUM
The guideline premium is shown on page 3.
ISSUE DATE
The issue date is shown on page 3.
MATURITY DATE
Unless we otherwise specify, the maturity date is the end of the contract
year nearest your 100th birthday. We will pay you the accumulation value on
the maturity date less any loans in effect.
MINIMUM PREMIUM
The minimum premium is shown on page 3. The minimum premium requirement
must be met to keep the death benefit guarantee.
NOTICE
A notice required by you under this contract must be in written form
acceptable to us. A notice of any action that requires us to determine your
accumulation value takes effect when we receive it. Otherwise, a notice
takes effect when signed; but it is subject to any payment made or action
taken by us before we receive it.
OPTION
Payment of the proceeds other than in one sum.
PAYEE
The person to whom payments are made under an option. If the option is a
life annuity, the payee is the person on whose life the option is based.
PROCEEDS
The amount payable on the first of: (1) surrender of the contract; (2)
death of the insured; or (3) the maturity date.
PROCESS DAYS
The first day of each contract month. Monthly charges and credits are made
as of each process day.
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 7
13
PRONOUNS
"Our", "us" or "we" means Ohio National Life Assurance Corporation. "You",
"your" or "yours" means the insured. If the insured is not the owner,
"you", "your" or "yours" means the owner when referring to contract rights,
payments and notices.
PROOF YOU CAN BE INSURED
When this contract requires you to send us proof that you can be insured,
the proof must be acceptable to us. We will supply forms or instructions
for you to provide us that proof. No new stated amount or reinstatement for
which you apply will take effect until we approve your application. We must
find that you are in an acceptable risk class. Unless we adopt other rules,
your risk class must be at least as good as it was when we last approved
you for insurance.
SUBACCOUNT
Any subaccounts that may be established within VAR and that correspond to a
portfolio of a Fund.
VAR
Ohio National Variable Account R. This is an account that consists of
assets we have set aside so that their investment results are kept separate
from those of our general assets. The assets of VAR will be available to
cover the liabilities of the general account only to the extent that the
assets of VAR exceed the liabilities of VAR arising under the variable life
policies in VAR.
VALUATION PERIOD
That period of time from one determination of accumulation unit values to
their next determination. Such values will be determined each day that the
New York Stock Exchange is open for business and any other day on which
there is sufficient trading to materially affect the value of VAR's assets.
GENERAL PROVISIONS
OWNERSHIP
The owner has all contract rights while the insured is living. After the
insured's death, the owner only has those rights set forth in the
beneficiary and proceeds payment options sections. The owner may act
without the consent of a revocable beneficiary or contingent owner. The
owner may name a contingent owner or new owner by notice to us.
ASSIGNMENT
You may assign your rights under this contract as security for a loan or
debt. We are not bound by an assignment unless we receive notice of it. The
person to whom you assign your rights has a first claim on proceeds in
place of you and your beneficiaries.
BENEFICIARY
You may name beneficiaries in the application or by notice to us or you may
later name or change beneficiaries by notice to us. If the owner is not the
insured, the owner may name or change beneficiaries by notice to us at any
time up to 60 days after your death.
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 8
14
Beneficiaries have rights in the order named. Contingent beneficiaries will
only receive proceeds if no prior beneficiary survives you. The rights of a
beneficiary who dies before you will pass to living beneficiaries of the
same class. If no beneficiary survives you, death proceeds will be paid to
the owner.
CONTRACT
Your application and payment of premiums are your consideration for this
contract. The entire contract is in your application and this policy. A
copy of your application is attached. Read it with care. You represent that
the statements made in your application are true as far as you know and
believe. We cannot base denial of a claim on any statement you make unless
it is contained in an attached application.
As stated in the application, the contract cannot be changed nor our rights
waived except in writing signed by one of our officers. No agent is
authorized to make or change a contract on our behalf nor waive any of our
rights or requirements.
GENERAL ACCOUNT AND VAR
The general account consists of all our assets other than those we allocate
to a separate account.
The separate account to which the variable part of contract values under
this contract relate is VAR which we have established under Ohio law to
provide variable benefits. We shall have sole and complete ownership and
control of all assets in VAR.
INVESTMENTS OF VAR
All amounts credited to VAR will be used to purchase Fund shares at net
asset value. Any and all distributions made by the Fund in respect of Fund
shares held by VAR will be reinvested in Fund shares in the same subaccount
at net asset value. Deductions and redemptions from VAR may be made by
redeeming a number of Fund shares, at net asset value, equal in total value
to the amount to be deducted or redeemed. If deemed by us to be in the best
interest of all contract owners, VAR may be operated as a management
company under the Act or it may be deregistered under the Act if
registration is no longer required.
If there is a substitution of Fund shares or change in operation of VAR, we
may issue an endorsement for the contract and take any other action as may
be necessary and appropriate to make the substitution or change. The
investment policy of any subaccount of VAR will not be changed without the
approval of the Ohio director of insurance and that approval will be on
file with the state insurance regulator of the state where this contract
was delivered.
VOTING RIGHTS
We will seek instructions for the voting of Fund shares held on account of
the variable part of your contract. From time to time, we will send you
reports on the Fund, proxy material and a form for instructing us how to
vote Fund shares.
REPORTS
We will send you an account report at least once each year showing as of
the date of the report: (1) the accumulation value; (2) the cash surrender
value; (3) the stated amount; (4) any policy loan; (5) any partial
withdrawal made since the last report; (6) any interest charge and any
premium paid since the last report; (7) charges made since the last report;
and (8) investment experience since the last report.
We will also make available a projection report. This report will be based
on planned premiums, guaranteed cost of insurance and guaranteed interest
if any. It will show the accumulation value one year from the date of the
report. We may charge a fee, not to exceed $100, if you ask for more than
one annual projection or account report.
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 9
15
NONPARTICIPATING
This contract is nonparticipating. It will not share in our divisible
surplus.
EXCHANGE RIGHT
For 2 years after the issue date, or for 2 years after any increase in
stated amount, you may exchange this contract for a flexible premium life
insurance policy. The accumulation value of the new policy will not vary
with the investment results of VAR. We will do this by moving, without
charge, the entire variable accumulation value to the general account. All
future premium payments will be allocated only to the general account. The
issue age, premium class and net amount at risk will be the same as those
of the contract being exchanged.
PREMIUMS
PAYMENT
Your first premium is due on the contract date. One minimum premium must be
paid to put this contract in effect. It may be paid to our agent or sent to
our home office. After the first premium has been paid, subsequent premiums
can be paid at any time. All later premiums must be sent to our home
office.
NET PREMIUM
a) your premium payments; less b) any premium tax that we determine to be
allocable to the contract; less c) 2% of the premium payment; less d) .90%
of all premiums paid in the first 20 years following issue.
ALLOCATION OF NET PREMIUMS
All net premiums paid in the first contract month after the issue date will
be allocated to the Money Market subaccount. On the first process day after
the issue date all such net premiums held in the Money Market subaccount
and each future net premium will be allocated to one or more subaccounts
and/or the general account based on the allocation percentage specified in
the application or as later changed by you.
Any change shall take effect with the first premium we receive after you
ask for the change to take effect or, if later, as of the end of the
valuation period during which we receive notice of a change at our home
office.
PLANNED PREMIUM
You may pay planned premiums each year, or every 6 months or 3 months. We
will send you a notice of each planned premium. We may also allow other
premium payment plans. You may change your planned premium amount, or how
often it is to be paid, by sending us notice of the change. We may limit
the amount of increase in your planned premium. Each planned premium must
be at least $25.
EXTRA PREMIUM
You may pay extra premiums (more than planned) at any time prior to the
maturity date. If you have a loan, extra premiums will first be applied to
reduce or pay off the loan. We may limit the amount and number of extra
premiums which may be paid.
Premiums that can be paid under this contract, without an increase in death
benefit, can be no more than allowed by the federal law that defines life
insurance. If a premium payment would exceed this limit, you can increase
your stated amount to allow that premium. To do this, you must apply in
writing and send us proof you can be insured. If you do not increase your
stated amount, we will refund premium in excess of the limit.
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 10
16
MINIMUM PREMIUM REQUIREMENT
The minimum premium requirement is met if, on each process day (a) is equal
to or greater than (b) where:
(a) is the sum of all premiums paid less any partial surrenders and
less any loan amount, and
(b) is the sum of the minimum premium since the policy date,
including the minimum premium for the current process day.
Although we will determine each month whether or not you have met the
minimum premium requirement, you do not have to pay premiums monthly.
POLICY CHANGES AFFECTING THE MINIMUM PREMIUM REQUIREMENT
The minimum monthly premiums will be affected by any change in stated
amount or change of proceeds plan. The minimum premium may also be changed
when a rider is added to or removed from this contract. We will send you
notice of the change in minimum premium.
DEATH BENEFIT GUARANTEE
If you meet the minimum premium requirement, we guarantee that this
contract will not lapse during the death benefit guarantee period shown on
Page 3 even if the investment performance of VAR has caused the cash
surrender value to fall below the amount needed to pay the monthly charges
due.
If the minimum premium requirement is not met on any process day, we will
send you notice of the required payment. If we do not receive the required
payment within 61 days of the date it is due, the death benefit guarantee
is no longer in effect and the guarantee cannot be reinstated.
We will assess a charge per $1,000 of stated amount for each month the
death benefit guarantee is in effect. The amount of this charge is shown on
Page 3.
GRACE PERIOD
A premium is due on any process day on which the cash surrender value, less
loans in effect, is not enough to cover the charges then due. The required
premium will equal the amount needed to allow the cash surrender value less
loans in effect to cover 2 monthly charges. We will mail you, and any
assignee of record, notice of the amount due. The contract will stay
inforce for 61 days after the due date of the required premium, but not
past the maturity date. If you do not pay the required premium by the end
of this grace period, the contract will end with no value. We will send you
a notice, at your last known address, 30 days before the contract ends. If
death occurs during a grace period, any required premium then due will be
subtracted from the death proceeds.
REINSTATEMENT
If this contract ends for failure to pay a required premium, you may
reinstate it within 5 years if:
(1) you apply to reinstate this contract and send us proof you can be
insured;
(2) we approve your application;
(3) you pay enough premium to keep the contract inforce for at least
2 months;
(4) you pay the monthly charges due from the grace period; and
(5) you pay or reinstate any loans then in effect with interest at 6%
per year.
You may not reinstate this contract after the maturity date.
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 11
17
BENEFITS
DEATH PROCEEDS CHOICES
PLAN A. If you choose Plan A, the death proceeds equal the larger of: (1)
the stated amount on the date of your death; or (2) the accumulation value
plus a percentage of the accumulation value which varies with your attained
age according to the table below. Death proceeds will be reduced by any
loans in effect.
PLAN B. If you choose Plan B, the death proceeds equal the larger of: (1)
the stated amount plus the accumulation value on the date of your death; or
(2) the accumulation value plus a percentage of the accumulation value
which varies with your attained age according to the table below. Death
proceeds will be reduced by any loans in effect.
The stated amount is shown on page 3.
ATTAINED ATTAINED ATTAINED
AGE % AGE % AGE %
------------------- ------- ----------------- -------- ----------------- -------
0-40 150 54 57 68 17
41 143 55 50 69 16
42 136 56 46 70 15
43 129 57 42 71 13
44 122 58 38 72 11
45 115 59 34 73 9
46 109 60 30 74 7
47 103 61 28 75-90 5
48 97 62 26 91 4
49 91 63 24 92 3
50 85 64 22 93 2
51 78 65 20 94 1
52 71 66 19 95 and over 0
53 64 67 18
CHANGES IN COVERAGE
At any time after the first contract year, you may request a change in the
stated amount to increase or decrease your coverage. The change must be at
least $5,000. If we approve the change, we will send you notice of the
change. The change will take effect on the first day of the next contract
month. We may limit you to 2 changes per contract year.
INCREASE. To request an increase in the stated amount, you must apply in
writing and send us proof you can be insured.
Any premium paid contingent upon our approval of an increase in stated
amount will be held by us in our general account, without interest, until
the increase takes effect. Premium will be applied to the increase in
proportion to the guideline premium for the increase to the guideline
premium for the original stated amount plus the guideline premium for all
increases in stated amount.
You have a right to cancel any increase within 20 days after you receive
notice of the increase, or 10 days after we mail notice of your right to
cancel this increase, or if later, within 45 days after the date of your
application for increase. You must give notice to us or to our agent within
that time. We will refund the monthly charges and any other charges from
that increase.
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 12
18
DECREASE. To request a decrease in the stated amount, send us notice to do
so. Any decrease will be applied against prior increases in the reverse
order in which the increases were made. You may not decrease the stated
amount in the first contract year. You may not decrease the stated amount
to less than the minimum stated amount shown on page 3. The surrender
charge will be taken for decreases.
CHANGE OF PROCEEDS PLANS
At any time after the first 2 contract years, you may change from Plan B to
Plan A by notice to us. The stated amount will then be increased by an
amount equal to the accumulation value on the date of the change. At any
time after the first 2 contract years, you may change from Plan A to Plan B
by notice to us. The stated amount will then be decreased by an amount
equal to the accumulation value on the date of change. When we change your
proceeds plan, we will send you notice of the change. You may not make a
change that will decrease the stated amount to less than the minimum stated
amount shown on page 3.
EXTENDED ENDOWMENT
You may choose to continue your contract after the maturity date. You must
give notice to us before the maturity date. Your death proceeds after the
maturity date will equal the accumulation value less any loans in effect on
the date of death. No additional premiums are payable and none may be made
after the maturity date. We will continue to credit interest on the
accumulation value of the contract after the maturity date at a rate that
we will then determine, but not less than 4.0% per year.
NONFORFEITURE
ACCUMULATION VALUE
The accumulation value is equal to the sum of: (1) the fixed accumulation
value, plus (2) the variable accumulation value, plus (3) the loan
collateral.
FIXED ACCUMULATION VALUE
The fixed accumulation value is: (1) the fixed accumulation value as of the
prior process day less the charges on that process day, plus interest from
that process day; plus (2) net premiums credited to the general account
since the prior process day, plus interest from the date premiums are
credited; plus (3) transfers from VAR to the general account since the last
process day, plus interest from the date of transfer; less (4) transfers to
VAR from the general account since the prior process day, plus interest
from the date of transfer; less (5) partial surrenders from the general
account since the last process day, plus interest from the date of
surrender; less (6) policy loans taken from the general account since the
last process day, plus interest from the date taken.
The fixed accumulation value excludes loan collateral held in the general
account.
INTEREST FOR THE FIXED ACCUMULATION VALUE
Each month, we will credit interest on the fixed accumulation value at an
effective rate of at least 4% per year.
INTEREST ON LOAN COLLATERAL
Each Month, we will credit interest on the loan collateral at an effective
rate of at least 4.0%. The rate credited to the portion of the loan
collateral which qualifies for preferred loans may be different from that
applied to the remaining loan collateral.
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 13
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DETERMINATION OF VALUES FOR THE GENERAL ACCOUNT
Minimum cash surrender values are calculated using the 1980 Commissioners'
Standard Ordinary mortality table, male or female, smoker or nonsmoker, age
nearest birthday, with interest at the rate of 4%. A detailed statement of
the way we compute cash surrender or loan values has been filed with the
state insurance officials. All values comply with state law and are at
least as great as the minimum required by law.
VARIABLE ACCUMULATION VALUE
The variable accumulation value is the total of your values in each
subaccount. Each subaccount is valued by multiplying the number of
accumulation units by the current unit value.
VARIABLE ACCUMULATION UNITS
We will credit this contract with variable accumulation units in relation
to the amount of each net premium allocated to each subaccount. To find the
number of variable accumulation units credited to each subaccount, divide
the amount allocated to that subaccount by the variable accumulation unit
value of that subaccount for the valuation period during which we receive
the premium at our home office.
The number of variable accumulation units for a subaccount will increase
when: (1) net premiums are credited to that subaccount; (2) transfers from
the general account or other subaccounts are credited to that subaccount;
or (3) policy loans are repaid or interest is credited from amounts held as
loan collateral in the general account. The number of variable accumulation
units for a subaccount will decrease when: (1) a policy loan is taken from
that subaccount; (2) partial surrender is taken from that subaccount; (3) a
portion of the monthly charges is taken from that subaccount; or (4)
transfers are made from that subaccount to the general account or other
subaccounts.
UNIT VALUE
The value of each variable accumulation unit was set at $10 when the first
premium was allocated to each subaccount. The value of a variable
accumulation unit for each subaccount varies for each later valuation
period. This value is found by multiplying the value of a variable
accumulation unit of that subaccount for the immediately preceding
valuation period by the net investment factor for the subaccount for the
valuation period for which the variable accumulation unit value is being
determined. The value of a variable accumulation unit for any valuation
period is determined as of the end of that valuation period.
NET INVESTMENT FACTOR
The net investment factor for a subaccount is found by dividing (a) by (b),
then subtracting (c) from the result, where (a) is: (1) the net asset value
of a Fund share in that subaccount determined as of the end of a valuation
period; plus (2) the per share amount of any dividends or other
distribution declared by the Fund during the valuation period; adjusted by
(3) a per share charge or credit with respect to any taxes paid or reserved
for, which we determine to be attributable to the maintenance or operation
of the subaccount; (b) is the net asset value of a Fund share in that
subaccount, adjusted by a per share credit or charge for any taxes reserved
for or paid, determined as of the end of the prior valuation period; and
(c) is a charge not to exceed .0020471% for each day in the valuation
period. This converts to 0.75% per year for mortality and expense risks.
Although we can not identify that part of the current risk charge that
applies to each of the risks involved, we estimate that a reasonable
allocation would be 0.30% for the mortality risk, and 0.45% for the expense
risk.
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 14
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INVESTMENT CREDIT
The mortality and expense risk charge will be reduced when the total
accumulation value exceeds certain levels. The reduction applies only to
the portion of the accumulation value in excess of those levels, and will
be applied to the various subaccounts pro-rata. At the end of each contract
month, we calculate the reduction based on the current accumulation value.
Any accumulation value in excess of 4 times the premium shown on Page 6A
receives a reduction in mortality and expense charges equivalent to .45%
per year. Accumulation value in excess of 8 times that premium receives a
reduction in mortality and expense charges equivalent to .55% per year.
SPLITTING UNITS
We reserve the right to split the value of the accumulation units. In any
such split of unit values, strict equity will be preserved. Such a split
will have no material effect on the benefits or other terms of this
contract. A split may either increase or decrease the number of units.
TRANSFERS AMONG SUBACCOUNTS AND GENERAL ACCOUNT
By notice to us, you may transfer your accumulation value from one
subaccount to another subaccount or to the general account at any time. The
sum of transfers from the general account to one or more subaccounts is
limited during any contract year. The limit is the greater of 25% of the
general account portion of the accumulation value as of the end of the last
prior contract year, or $1,000. The dollar amount of a transfer must be at
least $300, but the entire accumulation value of a subaccount or the
general account may be transferred if less than $300. No transfer of
accumulation value may be made after your death. Transfers shall be made as
of the end of the valuation period during which we receive the request at
our home office or at the end of any later valuation period as you may
request. A fee, of not more than $15, will be charged for each transfer.
Currently, this fee is $3.
TAXES
Any taxes that pertain to this contract or VAR will be charged against the
accumulation value when incurred or reserved for by us.
MONTHLY CHARGES
The charges for a contract month are: (1) the cost of insurance for the
month (which includes the charges for any riders); plus (2) a contract
maintenance charge of $7; plus (3) the death benefit guarantee charge per
$1,000 of stated amount as shown on Page 3.
COST OF INSURANCE
We calculate the cost of insurance for each month as of each process day.
The cost of insurance for the initial stated amount is determined
separately from the cost for each increase in stated amount.
The cost of insurance equals: (1) the cost of insurance rate; times (2) the
net amount at risk.
COST OF INSURANCE RATE
The cost of insurance rate (or any change in that rate) for each stated
amount is based on: (1) your sex; (2) your attained age on the contract
date and on the effective date of each increase in stated amount; (3) the
time elapsed since the contract date and since each increase in stated
amount; and (4) your rate class.
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 15
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We may change the cost of insurance rate. Any change in the cost of
insurance rates will be uniformly applied to all contracts of this class.
We will notify you prior to any change. We may not increase the rates to
more than those shown in the table of monthly guaranteed cost of insurance
rates on page 6. The guaranteed rates are based on the 1980 Commissioner
Standard Ordinary, Male or Female, Smoker or Nonsmoker mortality table, age
nearest birthday.
NET AMOUNT AT RISK
The net amount at risk on any process day equals the death proceeds divided
by 1.0032737, less the accumulation value.
If you have Plan A and the stated amount has been increased, the
accumulation value will first be subtracted from the initial stated amount
to determine the net amount at risk. If the accumulation value is more than
the initial stated amount, the excess will be subtracted from each increase
in the stated amount in the order made.
SURRENDER AND CASH SURRENDER VALUE
While you are living and before the maturity date, you may request the
surrender of this contract by notice to us. We will then pay you the cash
surrender value, less any loans in effect. The contract will then end. The
cash surrender value is the accumulation value less our surrender charge.
If the surrender charge is greater than the accumulation value, the cash
surrender value is zero.
SURRENDER CHARGE
We will take a surrender charge on complete surrender, lapse, decrease in
stated amount and certain partial surrenders. During the first 15 contract
years or for 15 years after you increase your stated amount, this charge
will apply. The charge is shown on page 6A.
SURRENDER CHARGE ON DECREASES
If you decrease your stated amount, a portion of the surrender charge will
be deducted from your accumulation value. This deduction is equal to the
surrender charge attributable to the portion of stated amount being
decreased. The surrender charge that remains will be the surrender charge
that applies to the remaining stated amount.
PARTIAL SURRENDER
After 1 year from the issue date, you may surrender part of your contract
for cash while you are living and before the maturity date. You may not do
this more than twice in any contract year. The amount of a partial
surrender may not exceed: (1) the cash surrender value; less (2) loans in
effect; less (3) enough to cover the next 2 monthly charges; and less (4)
the partial surrender service fee which is the lesser of $25 or 2% of the
amount surrendered. We will subtract the accumulation value taken by a
partial surrender from each increase in the stated amount in the proportion
of that increase to the total stated amount. The accumulation value is
reduced by the amount of partial surrender. If you have Plan A, the stated
amount is also reduced by the amount of partial surrender.
No partial surrender will be made if it would reduce the stated amount to
less than the minimum stated amount shown on page 3. We will charge a
service fee of the lesser of $25 or 2% of the amount surrendered for each
partial surrender. For the first 15 contract years and for 15 years after
an increase takes effect, an added partial surrender charge will also be
made on the amount of partial surrenders in a contract year that is more
than 10% of the cash surrender value as of the end of the last prior
contract year. This added partial surrender charge will equal a partial
surrender ratio multiplied by the surrender charge. The partial surrender
ratio equals: (1) the amount of partial surrender in excess of 10% of the
cash surrender value as of the last prior contract year; divided by (2) the
cash surrender value. The surrender charge will be reduced by the added
partial surrender charge.
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 16
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DEFERRAL OF PAYMENT ON SURRENDER, PARTIAL SURRENDERS AND LOANS
We may defer the calculation and payment of accumulation values or benefits
if: (1) the New York Stock Exchange is closed other than customary week-end
and holiday closings, or trading on the New York Stock Exchange is
restricted as determined by the Securities and Exchange Commission; (2) the
Commission by order permits postponement for the protection of contract
owners; or (3) an emergency exists, as determined by the Securities and
Exchange Commission, as a result of which disposal of securities is not
reasonably practicable or it is not reasonably practicable to determine the
value of VAR's net assets.
We can defer making a surrender, partial surrender, or loan from the
general account for up to 6 months after we get your notice. If we defer
for more than a month, the cash surrender value will bear interest at the
rate of 4.5% per year. We cannot defer a loan to pay premiums on any
contract issued by us.
PAID-UP TERM INSURANCE
If you stop paying premiums, the contract can continue and operate as
paid-up term insurance. The monthly charges for calculating the cost of
paid-up term insurance will be the same as those as when premiums were
being paid. The paid-up term period will run (a) for as long as the cash
surrender value less loans will purchase term insurance protection or (b)
until the maturity date, whichever is earlier. If the death benefit
guarantee is in effect, the insurance will continue as long as this
guarantee applies.
PAID-UP LIFE INSURANCE
On any process day, you may use the cash surrender value less any loans in
effect as a net single premium to purchase a paid-up endowment at age 100.
The insurance will begin on that process day. The amount of insurance will
be that which the cash surrender value less any loans in effect will buy as
a net single premium at the insured's then attained age. This option may
not be elected if the amount of paid-up insurance purchased would be less
than $1,000. At any time after this option is elected the cash surrender
value will be the amount of paid-up life insurance times the net single
premium per dollar of paid-up life insurance at the then attained age of
the insured. The net single premiums are based on the 1980 Commissioners'
Standard Ordinary, Male or Female, Smoker or Nonsmoker mortality table age
nearest birthday and 4% interest.
LOANS
AVAILABILITY
At any time after the first contract year, you may borrow up to the loan
value of this contract by notice to us. Loans are made on the security of
this contract assigned to us.
LOAN VALUE
The loan value is the cash surrender value less the cost of insurance
charges for your contract from the current date to the next policy
anniversary. In no case will the loan value be less than 90% of the cash
surrender value.
GROSS LOAN VALUE
The gross loan value is the cash surrender value less enough to cover the
monthly charges to the next policy anniversary. The gross loan value is not
reduced by any existing loans.
PREFERRED LOANS
A preferred loan is available at any time on or after the 10th contract
anniversary. In the first contract year in which you take a preferred loan,
the maximum preferred loan available is 10% of the gross loan value. In
later contract years, you may increase your preferred loan by an amount not
greater than 10% of the gross loan value. The total amount of the preferred
loan amount may never exceed the gross loan value. The interest rate
credited to the accumulation value equal to the loaned amount under this
preferred loan provision is described in the INTEREST ON LOAN COLLATERAL
section of the NONFORFEITURE provision.
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 17
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LOAN COLLATERAL
Accumulation value equal to the amount of the policy loan will be taken
from the general account and each subaccount. The allocation will be in
proportion to the accumulation value in each subaccount and the general
account. This value will be held in the general account as loan collateral
and will earn interest at an effective rate not less than 4% per year. We
may credit a higher rate.
INTEREST
Interest is charged on loans at 5.0% per year in advance, except for
Preferred Loans. Interest is charged on Preferred Loans at 3.846%. When a
loan is made, we will include the interest then due in the amount of the
loan. If you do not pay the interest in cash, we will transfer enough value
from the general account and each subaccount to cover the interest due. The
allocation of the transfer will be in proportion to the accumulation value
in each subaccount and the general account.
REPAYMENT
You may pay back a loan at any time before we pay the contract proceeds.
When a loan repayment is made, the loan collateral in the general account
will be reduced by the amount of the repayment. The value of the repayment
will be allocated first to the general account. After the general account
is repaid, any additional repayment will be allocated to the general
account and each subaccount using the same percentages used to allocate net
premiums unless you give notice otherwise.
Loans which have not yet been paid back will be repaid from death or
maturity proceeds.
CLAIMS
PAYMENT OF PROCEEDS
Death proceeds will be paid within 30 days after we receive due proof of
death of the insured. Proceeds are paid at our home office. Payment will be
made in one sum unless an option is chosen. We may require that the
contract be sent to us before proceeds are paid.
Death proceeds include interest at the rate of at least 4.5% per year from
the date of death to the date proceeds are paid or applied under an option.
MISSTATEMENT OF AGE OR SEX
If your age or sex was misstated, the death proceeds will be 1.0032737
times the sum of:
(1) the accumulation value; and
(2) the net amount at risk on the date of death multiplied by an age
adjustment ratio.
The age adjustment ratio is: (a) the cost of insurance charged on the
process day nearest the date of death, divided by (b) the cost of insurance
that should have been charged at your true age or sex. In no case will the
adjusted proceeds be less than the accumulation value plus a percentage of
the accumulation value which varies with your true attained age according
to the table on page 12.
If the misstatement is found before your death, we will charge from that
time the cost of insurance for your true age and sex based on your original
stated amount.
PROCEEDS PROTECTION
No one may commute, assign or encumber the proceeds or cash surrender value
unless this contract so provides. As far as allowed by law, no creditor may
claim the proceeds.
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 18
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INCONTESTABILITY
We may not deny a claim for any amount of death proceeds due to a false
statement made in your application for such amount of insurance if: (a) you
live more than 2 years after such amount takes effect; and (b) the contract
is inforce at the time of your death. We may always contest for non-payment
of premiums.
SUICIDE
If you die by suicide, while sane or insane, or self destruction while
insane we will not pay any stated amount or increase in stated amount which
has been in effect for less than 2 years. If the suicide or self
destruction is within the first 2 contract years, we will pay as death
proceeds the cash surrender value or, if greater, the premiums you paid.
After that, we will pay the death proceeds of any coverage which has been
in effect for more than 2 years plus any premium applied to an increase
which has been in effect for less than 2 years before the suicide or self
destruction.
PROCEEDS PAYMENT OPTIONS
CHOICE OF OPTIONS
BY OWNER. The choice or change of an option requires notice to us. If the
owner is not the insured, the owner may choose or change an option while
the insured is living or up to 60 days after the insured's death. If an
option is chosen for death proceeds, the payee, or one of the payees, must
be the beneficiary. A beneficiary change revokes any option chosen for the
beneficiary.
BY OTHERS. If you did not choose an option, the beneficiary may do so. An
assignee may not choose or change an option. Proceeds to an assignee will
be paid in one sum.
Proceeds to be paid to a corporation may be applied under option 2 or 4
with the corporation, the insured or the insured's spouse or child as
payee. If we agree:
(1) anyone else related to the insured by blood or marriage may be
the payee; or
(2) the corporation may also choose option 3 or 5 with any of these
related persons as payee and with payments made to the
corporation or to the payee.
Proceeds to be paid to a partnership, association, trustee or estate may be
paid under an option on the same basis as for a corporation.
MINIMUM AMOUNTS
An option may not be used if proceeds are less than $5,000. Payment will
then be made in one sum.
If payments to a payee would be less than $25, we may pay less often so
that each payment will be at least $25.
DESCRIPTION OF OPTIONS
We will endorse this contract or issue a new contract or certificate to
show the terms of any option. The option date is the date proceeds come due
or a later date which you request and we approve. The life income options
are based on the payee's sex and age. We may require proof of a payee's age
and survival.
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 19
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PROCEEDS AT INTEREST
OPTION 1
We will hold the proceeds at interest at the rate of at least 4.5% per
year. You may choose to receive interest each year, or every 6 months, 3
months or 1 month from the option date. Under the terms of this option, we
may limit:
(1) the payee's right to withdraw the proceeds; and
(2) the length of time proceeds are to be held.
Interest to be paid on each $1,000 held by us will be:
ANNUAL SEMIANNUAL QUARTERLY MONTHLY
--------- ------------- ------------- ------------
$45.00 $22.25 $11.07 $3.67
PAYMENTS FOR A CERTAIN PERIOD
OPTION 2
We will make equal payments for a stated number of years. Payments will be
made, as you choose, each year, or every 6 months, 3 months or 1 month.
Payment amounts are based on the option 2 table on page 5. The first
payment is due on the option date. Under the terms of the option, we may
limit the payee's right to withdraw the proceeds.
LIFE INCOME
OPTION 3
The first payment is due on the option date. Payment amounts are based on
the option 3 table on page 5.
NONREFUND. We will make payments in the same amount each month while
the payee is living. No more payments are due after the payee's death.
GUARANTEED PERIOD. We will make payments in the same amount each month
for 5, 10 or 20 years, as you choose. After that, we will still make
payments in the same amount each month for as long as the payee is
living.
INSTALLMENT REFUND. We will make payments in the same amount each
month until the sum of all payments equals the proceeds applied under
this option. After that, we will still pay each month for as long as
the payee is living.
PAYMENTS OF A CERTAIN AMOUNT
OPTION 4
We will make payments in the same amount, as you choose, each year, or
every 6 months, 3 months or 1 month until all the proceeds are paid. The
amount of each payment will be as you have chosen and we have approved.
Interest will be added to the proceeds at the rate of 4.5% per year on the
unpaid balance. We may determine and announce a higher rate from time to
time. The first payment is due on the option date. The last payment will
equal the unpaid balance of proceeds. Under the terms of this option, we
may limit the payee's right to withdraw the proceeds.
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 20
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JOINT AND SURVIVOR LIFE INCOME
OPTION 5
These options are for 2 payees. The first payment is due on the option
date. Payment amounts are based on the option 5 table on page 5.
JOINT GUARANTEED PERIOD 10 YEARS. We will make payments in the same
amount each month for 10 years. After that, we will still make
payments in the same amount each month for as long as one of the
payees is living.
JOINT AND FULL. We will make payments in the same amount each month as
long as one of the payees is living.
JOINT AND 2/3. We will make full payments in the same amount each
month for as long as both of the payees are living. After one payee's
death, 2/3 of that amount will still be paid each month for as long as
the other payee is living.
ALTERNATE LIFE INCOME
You may choose other income amounts for options 3 and 5 in place of those
shown on page 5. Such amounts will be based on rates at least as liberal as
the rates we charge as of the option date for a single premium immediate
annuity of the same kind.
DEATH OF PAYEE
If all payees have died, we will make one final payment to the estate of
the last surviving payee for any amount then due.
For option 1 or 4, the amount then due will be any balance held by us. For
option 2, 3 or 5, the amount then due will be the present value of unpaid
guaranteed payments commuted at the rate of 4.5% per year. We will specify
the commutation rate when you choose the alternate life income for option 3
or 5.
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 21
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 22
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FORM 00-VL-1 OHIO NATIONAL LIFE ASSURANCE CORPORATION PAGE 23
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OHIO NATIONAL
LIFE ASSURANCE CORPORATION
Ohio National Financial Services
--------------------------------
FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY
Nonparticipating
Adjustable Death Benefit payable Before Maturity Date
Cash Surrender Value Payable on Maturity Date if Insured is Then Living
Flexible Premiums Until Maturity Date
Stated Amount: Page 3
Maturity Date: Page 3
FORM 00-VL-1 PAGE 24