Exhibit (5)(a)
Specimen Flexible Premium Variable Life Insurance Policy
WESTERN RESERVE LIFE ASSURANCE CO. OF OHIO
(A STOCK COMPANY)
Home Office: Columbus, Ohio
Administrative Office: P.O.Box 5068
Clearwater, Florida 33758-5068
727-299-1800
- --------------------------------------------------------------------------------
IN THIS POLICY the Primary Insured is named on the Policy Schedule Page. The
Primary Insured will be referred to as YOU or YOUR. Western Reserve Life
Assurance Co. Of Ohio will be referred to as WE, OUR or US.
IF YOU DIE before the Maturity Date and while this Policy is In Force, WE WILL
PAY the Death Benefit Proceeds to the Beneficiary upon receipt of due proof of
Your death. THE AMOUNT OF THE DEATH BENEFIT PROCEEDS WILL INCREASE OR DECREASE
DEPENDING ON THE INVESTMENT EXPERIENCE OF THE SUBACCOUNTS IN THE SEPARATE
ACCOUNT AND ON THE DEATH BENEFIT OPTION SELECTED AS DESCRIBED IN THE DEATH
BENEFIT PROVISIONS.
IF YOU ARE ALIVE on the Maturity Date and this Policy is In Force, WE WILL PAY
the Net Surrender Value as of the Maturity Date. CASH VALUES WILL INCREASE OR
DECREASE IN ACCORDANCE WITH THE POLICY VALUE PROVISIONS AND THE INVESTMENT
EXPERIENCE OF THE SUBACCOUNTS IN THE SEPARATE ACCOUNT. CASH VALUES ARE NOT
GUARANTEED AS TO DOLLAR AMOUNT.
THE PROVISIONS on the following pages are part of this Policy. This policy is a
legal contract between the Owner and Us. READ YOUR CONTRACT CAREFULLY.
IN WITNESS WHEREOF, We have signed this Policy at Our Office in Clearwater,
Florida as of the Policy Date.
ABC ABC
- --------------------------------------------------------------------------------
RIGHT TO EXAMINE POLICY
The Owner may cancel this Policy by returning it to Us at P.O. Box 5068,
Clearwater, Florida 33758 or to the representative through whom it was purchased
within 10 days after receipt. If the Policy is returned within this period, it
will be void from the beginning and a refund will be made to the Owner. The
refund will equal the sum of:
1. The difference between the premiums paid and the amounts allocated to any
Accounts under the Policy; plus
2. The total amount of monthly deductions made and any other charges imposed on
amounts allocated to the Accounts; plus
3. The value of amounts allocated to the Accounts on the date We or Our agent
receive the returned Policy.
If state law prohibits the calculation above, the refund will be the total of
all premiums paid for this Policy.
- --------------------------------------------------------------------------------
Flexible Premium Variable Life Insurance Policy
Death Benefit Proceeds Payable at Death of Insured Prior to Maturity Date
Net Surrender Value Payable at Maturity Date
Flexible Premiums Payable During Lifetime of Insured Until the Maturity Date
Non-Participating - No Dividends
Some Benefits Reflect Investment Results
VL95
================================================================================
POLICY GUIDE
================================================================================
CONTRACT SCHEDULE...................................... 3 DEATH BENEFIT PROVISIONS (continued)
DEFINITIONS............................................ 5 Option Type...................................... 10
Accounts............................................ 5 Limitation Percentage............................ 10
Age................................................. 5 Changes.......................................... 11
Anniversary ........................................ 5 Death Benefit Proceeds........................... 12
Beneficiary ........................................ 5 PREMIUM PROVISIONS................................. 12
Death Benefit Proceeds.............................. 5 Payment.......................................... 12
Fixed Account....................................... 5 Premiums......................................... 12
In Force ........................................... 5 Grace Period..................................... 13
Initial Premium..................................... 5 Reinstatement.................................... 13
Internal Revenue Code............................... 5 SEPARATE ACCOUNT PROVISIONS........................ 13
Maturity Date....................................... 5 The Separate Account............................. 13
Monthiversary....................................... 5 Subaccounts...................................... 14
Net Premium ........................................ 5 Transfers........................................ 14
Net Surrender Value................................. 6 Addition, Deletion or Substitution of
No Lapse Date....................................... 6 Investments................................... 14
Office.............................................. 6 Change of Investment Objective................... 15
Policy Date......................................... 6 Unit Value....................................... 15
Record Date ........................................ 6 POLICY VALUE PROVISIONS............................ 15
Reallocation Date................................... 6 Net Premium...................................... 15
Rider............................................... 6 Allocation of Net Premiums....................... 16
SEC................................................. 6 Monthly Deductions............................... 16
Separate Account.................................... 6 Monthly Policy Charge............................ 16
Series Fund......................................... 6 Monthly Cost of Insurance........................ 16
Subaccount.......................................... 6 Monthly Cost of Insurance Rates.................. 17
Surrender........................................... 6 Subaccount Value................................. 17
Termination......................................... 6 Fixed Account Value.............................. 17
Valuation Date...................................... 7 Cash Value....................................... 18
Valuation Period.................................... 7 Surrender ....................................... 18
Written Notice...................................... 7 Net Surrender Value.............................. 18
GENERAL PROVISIONS..................................... 7 Surrender Charge................................. 18
The Policy.......................................... 7 Surrender Charge Upon Decrease in
Ownership .......................................... 7 Specified Amount.............................. 19
Beneficiary ........................................ 7 Withdrawals...................................... 19
Assignment.......................................... 8 Continuation of Insurance........................ 20
Extended Maturity Date.............................. 8 Insufficient Value............................... 20
Incontestability.................................... 8 Basis of Computations............................ 20
Suicide............................................. 9 Policy Loans..................................... 20
Issue Age and Sex................................... 9 SETTLEMENT OPTIONS................................. 21
Annual Report....................................... 9 Effective Date and First Payment Due.............. 21
Termination......................................... 9 Betterment of Monthly Annuity..................... 21
Policy Payment...................................... 9 Availability...................................... 21
Conversion Rights................................... 9 Age............................................... 21
Protection of Proceeds.............................. 10 Proof of Age and Sex.............................. 21
DEATH BENEFIT PROVISIONS............................... 10 Proof of Survival................................. 22
Death Benefit........................................ 10 Interest.......................................... 22
Specified Amount..................................... 10 Table of Optional Methods of Settlement........... 22
VL95 PAGE 2
WESTERN RESERVE LIFE ASSURANCE CO. OF OHIO
Clearwater, Florida
POLICY SCHEDULE
================================================================================
Primary Insured: JOHN DOE
Issue Age And Sex: 35 - Male Policy Number: 0112345678
Specified Amount: $ 250,000.00 Policy Date: December 01, 2000
Option Type: B Record Date: December 01, 2000
Planned Premium: $2,000.00 No Lapse Date: December 01, 2020
Payment Frequency: Annually Maturity Date: December 01, 2065
Initial Payment Notice: Direct Pay Notice Reallocation Date: December 21, 2000
Initial Premium: $2,000.00 Minimum Monthly
Guarantee Premium: $ 128.75
Rate Class: Ultimate Standard
Rate Band: Band 2
Minimum Specified Amount:
Band 1
Issue Age 0-49: $ 100,000.00
Issue Age 50 and Over: $ 50,000.00
Band 2 $ 250,000.00
Band 3 $ 500,000.00
Band 4 $1,000,000.00
Separate Account Provisions
Separate Account: WRL Series Life Account
Mortality and Expense Risk Charge:
Policy Years 1-15: .90% (Annually)
Policy Years 16+:
Current: .30% (Annually)
Guaranteed: .60% (Annually)
Reallocation Account: Fixed Account
Policy Value Provisions
Net Premium Factor
Band 1
Policy Years 1-10 94.00%
Policy Years 11+ 97.50%
Band 2
Policy Years 1-10 96.00%
Policy Years 11+ 97.50%
Band 3
All Policy Years 100%
Band 4
All Policy Years 100%
Collection Fee:
Direct Pay Notice: $ 3.00 Per Payment
All Other Payment Notices: $ 0.00
Monthly Policy Charge
Initial (Guaranteed for the First Policy Year): $5.00
Guaranteed: $7.50
VL95 PAGE 3
WESTERN RESERVE LIFE ASSURANCE CO. OF OHIO
Clearwater, Florida
POLICY SCHEDULE (CONTINUED)
POLICY NUMBER: 0112345678
TABLE OF SURRENDER CHARGES
PER $1000 OF SPECIFIED AMOUNT AS OF THE POLICY DATE
(APPLICABLE SPECIFIED AMOUNT EQUALS $250,000)
End of Year* Surrender Charge End of Year Surrender Charge
AT ISSUE $16.48 9 $ 9.89
1 $16.48 10 $ 8.24
2 $16.48 11 $ 6.59
3 $16.48 12 $ 4.94
4 $16.48 13 $ 3.30
5 $16.48 14 $ 1.65
6 $14.83 15 $ 0.00
7 $13.18 16+ $ 0.00
8 $11.54
*The surrender charge on any date other than an end of year will be interpolated
between the two end of year charges.
VL95 Page 4
WESTERN RESERVE LIFE ASSURANCE CO. OF OHIO
Clearwater, Florida
RIDER INFORMATION
================================================================================
Rider Monthly Deduction
- --------------------------------------------------------------------------------
NONE
Number: 0112345678
The monthly deductions shown above are applicable for the first policy month.
For monthly deductions after the first policy month, refer to the rider form.
VL95 Page 4
WESTERN RESERVE LIFE ASSURANCE CO. OF OHIO
Clearwater, Florida
POLICY SCHEDULE
================================================================================
Policy Number: 0112345678
TABLE OF GUARANTEED
MAXIMUM LIFE INSURANCE RATES
Guaranteed Rate Basis for Initial Specified Amount on Primary Insured
Commissioners 1980 Standard Ordinary Tobacco Smoker and Non-Tobacco Smoker
Mortality Table
Insured Name
Male Lives
Tobacco User Classification
Monthly Cost of Insurance Rates Per $ 1,000
Attained Age Monthly Rate Attained Age Monthly Rate
35 .21916 68 3.87916
36 .23416 69 4.19333
37 .25333 70 4.54000
38 .27500 71 4.92416
39 .30000 72 5.36083
40 .32833 73 5.85250
41 .36166 74 6.38833
42 .39583 75 6.98083
43 .43500 76 7.59166
44 .47583 77 8.21000
45 .52250 78 8.82583
46 .56916 79 9.45750
47 .62000 80 10.13250
48 .67333 81 10.86750
49 .73333 82 11.68333
50 .79166 83 12.58583
51 .87000 84 13.54083
52 .95166 85 14.51666
53 1.04500 86 15.48166
54 1.15000 87 16.42166
55 1.26166 88 17.44750
56 1.38250 89 18.46000
57 1.50750 90 19.47416
58 1.64083 91 20.51000
59 1.77916 92 21.61083
60 1.93250 93 23.02500
61 2.10500 94 24.84583
62 2.29916 95 27.49666
63 2.51916 96 32.04583
64 2.76166 97 40.01666
65 3.02416 98 54.83166
66 3.29750 99 83.33333
67 3.58416
VL95 Page 4A
DEFINITIONS
================================================================================
ACCOUNTS Allocation options including the Fixed Account
and the Subaccounts of the Separate Account.
AGE Issue Age refers to the Age on Your birthday
nearest the Policy Date. Attained Age refers to
the Issue Age plus the number of completed
policy years.
ANNIVERSARY The same day and month as the Policy Date for
each succeeding year the Policy remains In
Force.
BENEFICIARY The person or persons specified by the Owner to
receive the Death Benefit Proceeds upon Your
death.
DEATH BENEFIT The amount payable upon Your death in accordance
PROCEEDS with the Death Benefit Provisions.
FIXED ACCOUNT An allocation option(s) other than the Separate
Account.
IN FORCE Condition under which the coverage under this
Policy or Rider, if any, is active and Your life
remains insured.
INITIAL PREMIUM The amount which must be paid before coverage
begins. The amount is shown on the Policy
Schedule Page.
INTERNAL REVENUE CODE The Internal Revenue Code of 1986, as amended.
MATURITY DATE The Anniversary nearest Your 100th birthday on
which coverage under this Policy will terminate
if You are living and this Policy is In Force.
The Maturity Date may be extended as provided in
the Extension of Maturity Date section of the
General Provisions.
MONTHIVERSARY The day of each month coinciding with the Policy
Date. If there is no day in a calendar month
which coincides with the Policy Date, the
Monthiversary will be the first day of the next
month.
NET PREMIUM The portion of the premium available for
allocation as set forth in the Policy Value
Provisions.
VL95 Page 5
NET SURRENDER VALUE The amount payable upon Surrender in accordance
with the Policy Value Provisions of this Policy.
NO LAPSE DATE The date, as set forth on the Policy Schedule
Page, prior to which this Policy will not lapse
if certain conditions are met, even though the
Net Surrender Value is insufficient to meet the
monthly deduction.
OFFICE Refers to Our administrative Office located in
Clearwater, Florida.
POLICY DATE The date coverage is effective and monthly
deductions commence under the Policy. Policy
months, years and anniversaries are measured
from the Policy Date, as shown on the Policy
Schedule Page.
RECORD DATE The date the Policy is recorded on Our books as
an In Force Policy. The Record Date is shown on
the Policy Schedule Page.
REALLOCATION DATE The date on which any premiums are
reallocated from the Reallocation Account to the
Accounts as elected by the Owner on the
application. The Reallocation Date is shown on
the Policy Schedule Page.
RIDER Any attachment to this Policy which provides
additional coverages or benefits.
SEC The United States Securities and Exchange
Commission.
SEPARATE ACCOUNT A separate investment account shown on the
Policy Schedule Page which is composed of
several Subaccounts established to receive and
invest Net Premiums under the Policy.
SERIES FUND A designated mutual fund from which each
Subaccount of the Separate Account will buy
shares.
SUBACCOUNT A sub-division of the Separate Account. Each
Subaccount invests exclusively in the shares of
specified Series Fund portfolio.
SURRENDER The Termination of this Policy at the option of
the Owner.
TERMINATION Condition under which coverage under the Policy
or any Rider is no longer In Force and Your life
is no longer insured.
VL95 Page 6
VALUATION DATE Any day We are required by law to value the
assets of the Separate Account.
VALUATION PERIOD The period commencing at the end of one
Valuation Date and continuing to the end of the
next succeeding Valuation Date.
WRITTEN NOTICE Written Notice means a notice by the Owner to Us
requesting or exercising a right of the Owner as
provided in the Policy provisions. In order for
a notice to be considered a Written Notice, it
must: be in writing, signed by the Owner; be in
a form acceptable to Us; and contain the
information and documentation, as determined in
Our sole discretion, necessary for Us to take
the action requested or for the Owner to
exercise the right specified. A Written Notice
will not be considered complete until all
necessary supporting documentation required or
requested by Us has been received by Us at Our
administrative Office.
GENERAL PROVISIONS
================================================================================
THE POLICY This Policy is issued in consideration of the
attached application and payment of the Initial
Premium. This Policy, the attached application
and any additional applications at the time of
reinstatement constitute the entire contract.
All statements in these applications, in the
absence of fraud, will be deemed representations
and not warranties. No statement can be used to
void this Policy or be used in defense of a
claim unless it is contained in the written
application. No Policy provision can be waived
or changed except by endorsement. Such
endorsement must be signed by Our President or
Secretary.
OWNERSHIP This Policy belongs to the Owner. The Owner, as
named in the application or subsequently
changed, may exercise all rights under this
Policy during Your lifetime including the right
to transfer ownership. If the Owner should die
during Your lifetime, ownership of this Policy
will pass to the Owner's estate if no contingent
Owner is named.
We will not be bound by any change in the
ownership designation unless it is made by
Written Notice. The change will be effective on
the date the Written Notice is accepted by Us.
If We request, this Policy must be returned to
Our administrative Office for endorsement.
BENEFICIARY The Beneficiary, as named in the application or
subsequently changed, will receive the benefits
payable at Your death. If the Beneficiary dies
before You, the Contingent Beneficiary, if
named, becomes the Beneficiary. If no
Beneficiary or Contingent Beneficiary survives
You, the benefits payable at Your death will be
paid to the Owner or the Owner's estate.
VL95 Page 7
We will not be bound by any change in the
Beneficiary designation unless it is made by
Written Notice. The change will be effective on
the date the Written Notice was signed; however,
no change will apply to any payment We made
before the Written Notice is received. If We
request, this Policy must be returned to Our
Office for endorsement.
ASSIGNMENT This Policy may be assigned. We will not be
bound by any assignment unless made by Written
Notice and received at Our Office. The
assignment will be effective on the date it was
signed; however, no change will apply to any
payment We made before Written Notice was
received. We assume no responsibility for the
validity of any assignment.
EXTENDED MATURITY DATE The Owner may request that the Maturity Date
shown on the Policy Schedule page be extended.
The request must be in writing and received by
Us at least 90 days, but no more than 180 days,
prior to the scheduled Maturity Date. Any Riders
In Force on the scheduled Maturity Date will
terminate on that date and will not be extended.
Interest on any outstanding policy loan will
continue to accrue during the period for which
the Maturity Date is extended.
The Maturity Date will be extended in accordance
with either (1) or (2) below, as elected by the
Owner at the time the request is made. If (2) is
chosen, the Owner may elect to change to (1) at
any time. Changes from (1) to (2) are not
permitted.
(1) If the death benefit Option Type is other
than Option A, the Option Type will be
changed to Option A. Subsequent changes to
the Option Type will not be allowed. On each
Valuation Date, the Specified Amount will be
adjusted to equal the Cash Value, and the
Limitation Percentage will be 100%. No
additional Premium payments will be
permitted. All future monthly deductions
will be waived.
(2) The Maturity Date will be automatically
extended until the next Policy Anniversary.
At least 90 days, but no more than 180 days,
prior to each subsequent Policy Anniversary,
the Owner must request that the Maturity
Date be extended each Policy year. All
benefits and charges will continue as set
forth in this Policy. Monthly Cost of
Insurance Rates will be the then current
cost of insurance rates.
INCONTESTABILITY This Policy shall be incontestable after it has
been In Force, while You are still alive, for
two years from the Policy Date.
A new two year contestability period shall apply
to each increase in insurance amount beginning
on the effective date of each increase and will
apply only to statements made in the application
for the increase.
If this Policy is reinstated, a new two year
contestability period (apart from any remaining
contestability period) shall apply from the date
of the application for reinstatement and will
apply only to statements made in the application
for reinstatement.
VL95 Page 8
SUICIDE If You die by suicide, while sane or insane,
within two years from the Policy Date, or two
years from the effective date of any
reinstatement of this Policy, this Policy shall
terminate and Our total liability, including all
Riders attached to this Policy, will be limited
to the total premiums paid, less any loans and
prior withdrawals, during such period.
If You die by suicide, while sane or insane,
within two years from the effective date of any
increase in insurance, Our total liability with
respect to such increase will be its cost of
insurance.
ISSUE AGE If Your date of birth or sex is not correctly
AND SEX stated, the death benefit will be adjusted.
The death benefit will be adjusted based on what
the cost of insurance charge for the most recent
monthly deduction would have purchased based on
Your correct date of birth and sex.
ANNUAL REPORT We will send a report to the Owner at least once
each year. It will show for the Policy:
1. The current cash value;
2. The current Net Surrender Value;
3. The current death benefit;
4. Any current policy loans;
5. Activity since the last report;
6. Projected values.
Additional activity within each Subaccount
showing investment experience will also be
provided.
TERMINATION This Policy will terminate on the earliest of:
1. The Maturity Date unless extended;
2. The date of Your death;
3. The end of the grace period;
4. The date of Surrender.
POLICY PAYMENT All proceeds to be paid upon Termination will be
paid in one sum unless otherwise elected under
the Settlement Options of this Policy.
All payments and transfers from the Subaccounts
will be processed as provided in this Policy
unless one of the following situations exists:
1. The New York Stock Exchange is closed; or
2. The SEC requires that trading be restricted
or declares an emergency; or
3. The SEC allows Us to defer payments to
protect Our policyowners.
We reserve the right to defer the payment of any
Fixed Account values for the period permitted by
law, but not for more than six months.
CONVERSION RIGHTS At any time upon written request within the
first two policy years, the Owner may elect to
transfer all Subaccount Values to the Fixed
Account without a transfer charge.
VL95 Page 9
PROTECTION OF Unless the Owner directs by filing Written
PROCEEDS Notice, no Beneficiary may assign any payments
under this Policy before the same are due. To
the extent permitted by law, no payments under
this Policy will be subject to the claims of
creditors of any Beneficiary.
DEATH BENEFIT PROVISIONS
================================================================================
DEATH BENEFIT The death benefit is based upon the Specified
Amount, Option Type and the Limitation
Percentage applicable at time of death.
SPECIFIED AMOUNT The Specified Amount is as shown on the Policy
Schedule Page, unless changed in accordance with
the Changes section or reduced by a cash
withdrawal.
OPTION TYPE The Option Type is as shown on the Policy
Schedule Page, unless changed in accordance with
the Changes section of this provision.
If Option Type A is in effect, the death benefit
is the greater of:
1. the Specified Amount; or
2. the Limitation Percentage multiplied by the
cash value of this Policy on the date of Your
death.
If Option Type B is in effect, the death benefit
is the greater of:
1. the Specified Amount plus the cash value of
this Policy on the date of Your death; or
2. the Limitation Percentage multiplied by the
cash value of this Policy on the date of Your
death.
If Option Type C is in effect, the death benefit
is the greater of:
1. the Option Type A benefit; or
2. the Specified Amount multiplied by the factor
K plus the cash value of this Policy on the
date of Your death, where the factor K is
equal to the lesser of:
a. 1; or
b. .04 multiplied by (95 minus Your Attained
Age at death).
The factor K will never be less than zero.
LIMITATION PERCENTAGE The Limitation Percentage is a percentage based
on Your Attained Age at the beginning of the
policy year equal to:
VL95 Page 10
Attained Age Limitation Percentage
---------------------------------------------------------------
40 and under 250%
41 through 45 250% minus 7% for each Age over Age 40
46 through 50 215% minus 6% for each Age over Age 45
51 through 55 185% minus 7% for each Age over Age 50
56 through 60 150% minus 4% for each Age over Age 55
61 through 65 130% minus 2% for each Age over Age 60
66 through 70 120% minus 1% for each Age over Age 65
71 through 75 115% minus 2% for each Age over Age 70
76 through 90 105%
91 through 95 105% minus 1% for each Age over Age 90
96 through 99 100%
CHANGES After the third policy year, the Owner may
change the Option Type by Written Notice.
Changes will be effective on the first
Monthiversary on or next following the day We
receive Written Notice. No change in the Option
Type will be allowed if the resulting Specified
Amount would be less than the Band 1 Minimum
Specified Amount shown on the Policy Schedule
Page.
On the effective date of change to a new Option
Type, the Specified Amount will be adjusted so
that the amount determined under 1 and 2 of the
Monthly Cost of Insurance provision will be
equal to that determined under the prior Option
Type.
The Specified Amount may be increased or
decreased at any time after the third Policy
year by Written Notice. We reserve the right to
limit any decrease to no more than 20% of the
then current Specified Amount. All changes to
the Specified Amount are subject to the
following:
1. Any decrease will become effective on the
first Monthiversary on or next following
the date We receive Written Notice. Any
such decrease will reduce the Specified
Amount in the following order:
a) against insurance provided by the most
recent increase;
b) against the next most recent increases
successively; and
c) against insurance provided under the
original application.
No decrease will be allowed if:
a) the Specified Amount after any requested
decrease would be less than the Band 1
Minimum Specified Amount shown on the
Policy Schedule Page;
b) the requested decrease would force a cash
withdrawal in order to maintain compliance
with the definition of a life insurance
contract as defined by the United States
Internal Revenue Code and applicable
regulations; or
c) the decrease would cause the Policy to
enter the grace period.
VL95 Page 11
2. Any request for an increase in Specified
Amount must be applied for on a supplemental
application and must include evidence of
insurability satisfactory to Us. Such
increase, if approved by Us, will be
effective on the first Monthiversary on or
next following Our Written Approval. We
reserve the right to require any requested
increase to be at least $50,000.
Only one change in the Option Type or to the
Specified Amount will be allowed within each
policy year.
If the Specified Amount is changed and the
resulting Specified Amount causes a change in
the Rate Band, the Net Premium Factor for the
new band will be applied to all subsequent
premiums received following the effective date
of change.
DEATH BENEFIT PROCEEDS The Death Benefit Proceeds is the amount payable
by Us under this Policy provided this Policy has
not terminated prior to Your death. Except as
provided in the Suicide section of the General
Provisions, the Death Benefit Proceeds will be
equal to:
1. The death benefit; minus
2. Any monthly deductions due during the grace
period; minus
3. Any outstanding policy loan; minus
4. Any accrued loan interest.
PREMIUM PROVISIONS
================================================================================
PAYMENT The Initial Premium shown on the Policy Schedule
Page must be paid on or before the Policy Date.
All premiums after the Initial Premium are
payable at Our Office.
PREMIUMS The amount and frequency of Planned Premiums are
shown on the Policy Schedule Page. The amount
and frequency may be changed upon request,
subject to Our approval.
While this Policy is In Force, additional
premiums may be paid at any time prior to the
Maturity Date. We reserve the right to limit or
refund any premium if:
1. The amount is below Our current minimum
payment requirement; or
2. The premium would increase the death benefit
by more than the amount of the premium; or
3. The premium would disqualify this Policy as a
life insurance contract as defined by the
United States Internal Revenue Code and
applicable regulations.
VL95 Page 12
GRACE PERIOD If the Net Surrender Value on any Monthiversary
is not sufficient to cover the monthly
deductions on such day, We will mail a notice to
the last known address of the Owner and any
assignee of record. A grace period of 61 days
after the mailing date of the notice will be
allowed for the payment of premiums. The notice
will specify the minimum payment and the final
date on which such payment must be received by
Us to keep the Policy In Force. The Policy will
remain In Force during the grace period. If the
amount due is not received by Us within the
grace period, all coverage under the Policy and
any Riders will terminate without value at the
end of the grace period.
Until the No Lapse Date shown on the Policy
Schedule Page, no grace period will begin
provided the total premiums received (minus any
withdrawals, minus any outstanding loans, minus
any accrued loan interest, and minus any
Surrender Charge assessed upon a decrease in the
Specified Amount that has been deducted from the
cash value) equals or exceeds the Minimum
Monthly Guarantee Premium times the number of
months since the Policy Date, including the
current month. The Minimum Monthly Guarantee
Premium is as shown on the Policy Schedule Page
unless changed due to a requested change under
the Policy. Upon such change, the Owner will be
notified of the new Minimum Monthly Guarantee
Premium and the effective date for the new
premium.
REINSTATEMENT If this Policy terminates, as provided in the
Grace Period section, it may be reinstated. The
reinstatement is subject to:
1. Receipt at Our Office of a Written Notice.
Such notice must be within 5 years after the
date of Termination and prior to the Maturity
Date; and
2. Receipt of evidence of insurability
satisfactory to Us; and
3. Payment of a minimum premium sufficient to
provide a Net Premium to cover (a) one
monthly deduction at the time of Termination,
plus (b) the next two monthly deductions
which will become due after the time of
reinstatement; and
4. Payment of an additional amount sufficient to
cover any Surrender Charge as of the date of
reinstatement.
The effective date of a reinstatement shall be
the first Monthiversary on or next following the
day We approve the application for
reinstatement. Any policy loan as of the date of
Termination will not be reinstated. Any cash
value equal to the policy loan on the date of
reinstatement will also not be reinstated.
SEPARATE ACCOUNT PROVISIONS
================================================================================
THE SEPARATE ACCOUNT The variable benefits under this Policy are
provided through the Separate Account as shown
on the Policy Schedule Page. The assets of the
Separate Account are Our property. Assets equal
to the reserve and other contractual liabilities
under all policies issued in connection with the
Separate Account will not be charged with
liabilities arising out of any other business We
may conduct. If the assets of the Separate
Account exceed the liabilities arising under the
policies supported by the Separate Account, then
the excess may be used to cover the liabilities
of Our general account. The assets of the
Separate Account shall be valued as often as any
policy benefits vary, but at least monthly.
VL95 Page 13
SUBACCOUNTS The Separate Account has various Subaccounts
with different investment objectives. We reserve
the right to add or remove any Subaccount of the
Separate Account. Income, if any, and any gains
or losses, realized or unrealized, from assets
in each Subaccount are credited to, or charged
against, the amount allocated to that Subaccount
without regard to income, gains, or losses in
other Subaccounts. Any amount charged against
the investment base for federal or state income
taxes will be deducted from that Subaccount. The
assets of each Subaccount are invested in shares
of a corresponding Series Fund portfolio. The
value of a portfolio share is based on the value
of the assets of the portfolio determined at the
end of each Valuation Period in accordance with
applicable law.
TRANSFERS The Owner may transfer all or a portion of this
Policy's value in each Subaccount to other
Subaccounts or the Fixed Account. We reserve the
right to charge a $25 fee for each transfer in
excess of one per policy month or twelve per
policy year. This charge will be deducted from
the funds transferred. A request for a transfer
must be made in a form satisfactory to Us. The
transfer will ordinarily take effect on the
first Valuation Date on or following the date
the request is received at Our Office.
ADDITION, DELETION We reserve the right to transfer assets of the
OR SUBSTITUTION OF Separate Account, which We determine to be
INVESTMENTS associated with the class of contracts to which
this Policy belongs, to another Separate
Account. If this type of transfer is made, the
term "Separate Account", as used in this Policy,
shall then mean the Separate Account to which
the assets were transferred. We also reserve the
right to add, delete, or substitute investments
held by any Subaccount.
We reserve the right, when permitted by law, to:
1. Deregister the Separate Account under the
Investment Company Act of 1940;
2. Manage the Separate Account under the
direction of a committee at any time;
3. Restrict or eliminate any voting privileges
of owners or other persons who have voting
privileges as to the Separate Account;
4. Combine the Separate Account or any
Subaccount(s) with one or more other Separate
Accounts or Subaccounts;
5. Operate the Separate Account as a management
investment company;
6. Establish additional Subaccounts to invest in
either a new series of the Series Fund, or in
shares of another diversified, open-end
registered investment company; and
7. Fund additional classes of variable life
insurance contracts through the Separate
Account.
VL95 Page 14
CHANGE OF We reserve the right to change the investment
INVESTMENT objective of a Subaccount. If required by law or
OBJECTIVE regulation, an investment objective of the
Separate Account, or of a Series Fund portfolio
designated for a Subaccount, will not be
materially changed unless a statement of the
change is filed with and approved by the
appropriate insurance official of the state of
Our domicile or deemed approved in accordance
with such law or regulation. If required,
approval of or change of any investment
objective will be filed with the Insurance
Department of the state where this Policy is
delivered.
UNIT VALUE Some of the policy values fluctuate with the
investment results of the Subaccounts. In order
to determine how investment results affect the
policy values, a unit value is determined for
each Subaccount. The unit value of each
Subaccount was originally established at $10 per
unit. The unit value may increase or decrease
from one Valuation Period to the next. Unit
values also will vary between Subaccounts. The
unit value of any Subaccount at the end of a
Valuation Period is the result of:
1. The total value of the assets held in the
Subaccount. This value is determined by
multiplying the number of shares of the
designated Series Fund portfolio owned by the
Subaccount times the net asset value per
share; minus
2. The accrued risk charge for adverse mortality
and expense experience. The daily amount of
this charge is equal to the daily net assets
of the Subaccount multiplied by the daily
equivalent of the Mortality and Expense Risk
Charge. The maximum annual factor for the
Mortality and Expense Risk Charge is shown on
the Policy Schedule Page; minus
3. The accrued amount of reserve for any taxes
or other economic burden resulting from the
application of tax laws that are determined
by Us to be properly attributable to the
Subaccount; and the result divided by
4. The number of outstanding units in the
Subaccount.
The use of the unit value in determining
contract values is described in the Policy Value
Provisions.
POLICY VALUE PROVISIONS
================================================================================
NET PREMIUM The applicable Net Premium equals the premium
paid multiplied by the Net Premium Factor shown
on the Policy Schedule Page minus the Collection
Fee, if any, shown on the Policy Schedule Page.
VL95 Page 15
ALLOCATION OF Net Premiums will be allocated to the
NET PREMIUMS Subaccounts of the Separate Account and the
Fixed Account on the first Valuation Date on or
following the date the premium is received at
Our Office; except any Net Premium received
prior to the Policy Date will be allocated on
the first Valuation Date on or following the
Policy Date. All Net Premiums allocated prior to
the Reallocation Date will be allocated to the
Reallocation Account. On the first Valuation
Date on or following the Reallocation Date, the
values in the Reallocation Account will be
transferred in accordance with the Owner's
allocation as shown in the application.
We reserve the right to limit any allocation to
any Account to no less than 1%. No fractional
percentages may be permitted. The allocation may
be changed by the Owner. We reserve the right to
impose a charge of $25 for each change of
allocation in excess of one per policy year
quarter. The request for change of allocations
must be in a form satisfactory to Us. The
allocation change will be effective on the date
the request for change is recorded by Us.
MONTHLY DEDUCTIONS On each Monthiversary, a monthly deduction for
this Policy will be made equal to the sum of the
following:
1. The Monthly Policy Charge as shown on the
Policy Schedule Page;
2. The Monthly Cost of Insurance for this
Policy;
3. The charge for benefits provided by Riders
attached to this Policy;
4. The Surrender Charge upon a decrease in the
Specified Amount, on the effective date of
the decrease.
Deductions will be withdrawn from each account
in proportion to the value each bears to the
Cash Value.
MONTHLY POLICY CHARGE Both the Initial and Guaranteed Monthly Policy
Charge are shown on the Policy Schedule Page. It
is Our intention to charge the Initial Monthly
Policy Charge each month; however, We reserve
the right to increase the Monthly Policy Charge
up to the Guaranteed Monthly Policy Charge after
the first policy year. Any change in this charge
will be applied uniformly to all policies in
effect for the same length of time.
MONTHLY COST
OF INSURANCE The Monthly Cost of Insurance on each
Monthiversary is determined as follows:
1. divide the death benefit on the Monthiversary
by 1.0024663; and
2. reduce the result by the cash value on the
Monthiversary in the following order until
all cash value has been applied:
VL95 Page 16
a) against the insurance provided under the
original application;
b) against the insurance provided by the
oldest increase;
c) against the insurance provided by the next
oldest increase and each successive
increase;
d) against the insurance provided by the most
recent increase;
3. multiply the appropriate Monthly Cost of
Insurance rate(s) by each amount of insurance
provided under 2 above and sum.
MONTHLY COST OF The Monthly Cost of Insurance rates will vary
INSURANCE RATES by Your sex, Age at issue, Age at the time of
any increase in Specified Amount, Rate Band,
plan of insurance, Rate Class, and the duration
from the Policy Date or the date of any increase
in Specified Amount. Different Monthly Cost of
Insurance rates may apply to increases in the
Specified Amount following the Policy Date.
Monthly Cost of Insurance rates may be changed
by Us from time to time. A change in the cost of
insurance rates will apply to all persons of the
same Attained Age, sex, plan of insurance, Rate
Band, Rate Class, and whose policies or
increases have been in effect for the same
length of time. The rates will not exceed those
shown in the Table of Guaranteed Maximum Life
Insurance Rates.
SUBACCOUNT VALUE At the end of any Valuation Period, the
Subaccount Value is equal to the number of units
that the Policy has in the Subaccount,
multiplied by the unit value of that Subaccount.
The number of units that the Policy has in each
Subaccount is equal to:
1. The initial units purchased on the Policy
Date; plus
2. Units purchased at the time additional Net
Premiums are allocated to the Subaccount;
plus
3. Units purchased through transfers from
another Subaccount or the Fixed Account;
minus
4. Those units that are redeemed to pay for
monthly deductions as they are due; minus
5. Any units that are redeemed to pay for cash
withdrawals; minus
6. Any units that are redeemed as part of a
transfer to another Account.
FIXED ACCOUNT VALUE At the end of any Valuation Period, the Fixed
Account value is equal to:
1. The sum of all Net Premiums allocated to the
Fixed Account; plus
2. Any amounts transferred from a Subaccount to
the Fixed Account; plus
3. Total interest credited to the Fixed Account;
minus
4. Any amounts charged to pay for monthly
deductions as they are due; minus
5. Any amounts withdrawn from the Fixed Account
to pay for cash withdrawals; minus
6. Any amounts transferred from the Fixed
Account to a Subaccount.
VL95 Page 17
Interest on the Fixed Account will be compounded
daily at a minimum guaranteed effective annual
interest rate of 3% per year. We may declare
from time to time various higher current
interest rates on the unloaned portion of the
Fixed Account.
On transfers from the Fixed Account to a
Subaccount, We reserve the right to impose the
following limitations:
1. Written Notice be received by Us within 30
days after an Anniversary.
2. The transfer will take place on the date We
receive such Written Notice.
3. The maximum amount that may be transferred is
the greater of (a) 25% of the amount in the
Fixed Account; or (b) the amount transferred
in the prior policy year from the Fixed
Account.
We further reserve the right to defer payment of
any amounts from the Fixed Account for no longer
than six months after We receive such Written
Notice.
CASH VALUE At the end of any Valuation Period, the cash
value of the Policy is equal to the sum of the
Subaccount Values plus the Fixed Account value.
SURRENDER While this Policy is In Force, the Owner may
Surrender this Policy for the Net Surrender
Value. Payment will usually be made within seven
days of Written Notice, subject to the Policy
Payment section of the General Provisions.
NET SURRENDER VALUE The Net Surrender Value is the amount payable
upon Surrender of this Policy. The Net Surrender
Value as of any date is equal to:
1. the cash value as of such date; minus
2. any Surrender Charge as of such date; minus
3. any outstanding policy loan; minus
4. any accrued loan interest.
SURRENDER CHARGE During the first 15 policy years, a Surrender
Charge will be incurred upon Surrender of this
Policy. This charge will be based upon the Table
of Surrender Charges shown on the Policy
Schedule Page.
During the first 15 years following each
increase in the Specified Amount, an additional
Surrender Charge will be based upon the Table of
Surrender Charges shown on the supplemental
Policy Schedule Page provided at the time We
approve the requested increase.
VL95 Page 18
SURRENDER CHARGE During the first 15 policy years, or during the
UPON DECREASE 15 year period subsequent to each increase in
IN SPECIFIED AMOUNT Specified Amount, Surrender Charges will be
assessed against the cash value upon a requested
decrease in coverage. For decreases which reduce
any increase in its entirety, the full Surrender
Charge as determined under the Surrender Charge
provisions above will be assessed against that
portion of the decrease equal to the increase.
For decreases which partially reduce any
previous increase in Specified Amount or the
amount in (d) below, a partial Surrender Charge
will be assessed. This partial Surrender Charge
will be equal to:
1. the amount of the Specified Amount decrease;
multiplied by
2. the Surrender Charge shown on the Table of
Surrender Charges applicable to that portion
of the reduction in Specified Amount.
Surrender Charges upon a decrease in Specified
Amount will be charged in the following order:
(a) the Surrender Charges for the insurance
provided by the most recent increase;
(b) the Surrender Charges for insurance
provided by the next most recent increase
and each next most recent increase;
(c) the Surrender Charges for insurance
provided by the oldest increase;
(d) the Surrender Charges for the insurance
provided under the original application.
A Surrender Charge will not be deducted from the
cash value when a Specified Amount decrease
results from (a) a change in Option Type, or (b)
a withdrawal when the death benefit is Option
Type A, as described in the Withdrawals
Provision below. If a Surrender Charge is
deducted due to a decrease in Specified Amount,
any future Surrender Charges incurred during the
Surrender Charge period will be based on the
reduced Specified Amount.
WITHDRAWALS Cash withdrawals may be made any time after the
first policy year and while this Policy is In
Force. Only one withdrawal is allowed during a
policy year. The amount of a withdrawal may be
limited to no less than $500 and to no more than
10% of the Net Surrender Value. The remaining
Net Surrender Value following a withdrawal may
not be less than $500. The request for a
withdrawal must be by Written Notice. A
processing fee of the lesser of 2% of the amount
withdrawn or $25 will be deducted from each
withdrawal amount and the balance paid to the
Owner.
When a withdrawal is made, the cash value shall
be reduced by the amount of the withdrawal. If
the death benefit is Option Type A, the
Specified Amount shall also be reduced by the
amount of the withdrawal. These reductions will
result in a reduction in the death benefit,
which may be determined from the Death Benefit
section. If the Specified Amount following the
withdrawal results in a change in the Rate Band,
the Net Premium factors for the new band will be
applied to all subsequent premiums received
following the date of the withdrawal. No
withdrawal will be allowed if the resulting
Specified Amount would be less than the Band 1
minimum Specified Amount shown on the Policy
Schedule Page.
VL95 Page 19
The Accounts from which the withdrawal will be
made may be specified in the Written Notice. If
no Account is specified, the withdrawal amount
will be withdrawn from each Account in
accordance with the Owner's current premium
allocation instructions. Payment will usually be
made within seven days of Written Notice,
subject to the Policy Payment section of the
General Provisions of this Policy.
CONTINUATION OF INSURANCE Subject to the Grace Period section of the
Premium Provisions, insurance coverage under
this Policy and any benefits provided by Rider
will be continued In Force until the Net
Surrender Value is insufficient to cover the
monthly deductions. This provision shall not
continue this Policy beyond the Maturity Date
nor continue any Rider beyond the date for its
Termination, as provided in the Rider.
INSUFFICIENT VALUE If the Net Surrender Value on any Monthiversary
is not sufficient to cover the monthly
deductions then due, this Policy shall terminate
subject to the Grace Period section of the
Premium Provisions.
BASIS OF COMPUTATIONS Policy values and reserves are at least equal to
those required by law. A detailed statement of
the method of computation of values and reserves
has been filed with the insurance department of
the state in which this Policy was delivered.
POLICY LOANS After the first policy year and during the
continuance of this Policy, the Owner can borrow
against this Policy an amount which is not
greater than 90% of the cash value, less any
Surrender Charges and any outstanding policy
loan, including accrued interest. The amount of
any policy loan may be limited to no less than
$500, except as noted below.
When a loan is made, an amount equal to the loan
will be withdrawn from the Accounts and
transferred to the loan reserve. The loan
reserve is a portion of the Fixed Account used
as collateral for any policy loan. The Owner may
specify the Account or Accounts from which the
withdrawal will be made. If no Account is
specified, the withdrawal will be made from each
Account in accordance with the Owner's current
premium allocation instructions.
The loan date is the date We process a loan
request. Payment will usually be made within
seven days of the date We receive proper loan
request, subject to the Policy Payment section
of the General Provisions of this Policy. This
Policy will be the sole security for the loan.
While this Policy is In Force, any loan may be
repaid. Any amounts received on this Policy will
be considered premiums unless clearly marked as
loan repayments.
VL95 Page 20
Interest on any loan will be at the maximum
policy loan rate of 4%, payable in arrears. We
may declare from time to time various lower
policy loan interest rates. We may also apply
different loan interest rates to different parts
of the loan. Interest is due at each
Anniversary. Interest not paid when due will be
added to the loan and will bear interest up to
the maximum policy loan rate.
At each Anniversary, We will compare the amount
of the outstanding loan to the amount in the
loan reserve. At each such time, if this amount
plus any accrued loan interest exceeds the
amount in the loan reserve, We will withdraw the
difference from the Accounts and transfer it to
the loan reserve, in the same fashion as when a
loan is made. If the amount in the loan reserve
exceeds the amount of the outstanding loan, plus
any accrued loan interest, We will withdraw the
difference from the loan reserve and transfer it
to the Accounts in accordance with the Owner's
current allocation instructions. However, We
reserve the right to require that the transfer
be directed to the Fixed Account if such loans
were originally transferred from the Fixed
Account.
SETTLEMENT OPTIONS
================================================================================
EFFECTIVE DATE AND FIRST The effective date of a settlement provision
PAYMENT DUE will be either the date of Surrender or the date
of death. The first payment due will be on the
effective date of the settlement provision.
BETTERMENT OF
MONTHLY ANNUITY The payee will receive the greater of:
1. The income rate guaranteed in this Policy; or
2. The income rates in effect for Us at the time
income payments are made.
AVAILABILITY If the payee is not a natural person, an
optional method of settlement is only available
with Our permission. No optional method of
settlement is available if:
1. The payee is an assignee; or
2. The periodic payment is less than $100.
AGE Age, when required, means age nearest birthday
on the effective date of the option. We will
furnish rates for other ages and for two males
or two females upon request.
PROOF OF AGE Prior to making the first payment under this
AND SEX Policy, We reserve the right to require
satisfactory evidence of the birthdate and sex
of any payee. If required by law to ignore the
differences in sex of any payee, annuity
payments will be determined using unisex rates.
VL95 Page 21
PROOF OF SURVIVAL Prior to making any payment under this Policy,
We reserve the right to require satisfactory
evidence that any payee is alive on the due date
of such payment.
INTEREST All settlement options are based on the Annuity
2000 Mortality Table, if applicable, and a
guaranteed annual interest rate of 3%.
TABLE OF OPTIONAL METHODS OF SETTLEMENT
DESCRIPTION AND TABLES OF MONTHLY INSTALLMENT
PER $1,000 OF PROCEEDS.
Option A - Fixed Period The proceeds will be paid in equal installments.
The installments will be paid over a fixed
period determined from the following table:
Fixed Period
(in months) Factor
---------------------------
60 17.91
120 9.61
180 6.87
240 5.51
Option B - Life Income The proceeds will be paid in equal installments
determined from the following table. Such
installments are payable:
1. during the payee's lifetime only (Life
Annuity); or
2. during a 10-year fixed period certain and for
the payee's remaining lifetime (Certain
Period); or
3. until the sum of installments paid equals the
annuity proceeds applied and for the payee's
remaining lifetime (Installment Refund).
============== =================================== ===================================== ===================================
Payee's Life Annuity Certain Period Installment Refund
Age Male Female Unisex Male Female Unisex Male Female Unisex
----------- ------------ ---------- ------------ ----------- ------------ ----------- ------------ ----------
55 4.18 4.01 4.06 4.13 3.99 4.03 3.99 3.89 3.92
60 4.64 4.42 4.49 4.57 4.38 4.44 4.36 4.23 4.27
65 5.30 4.98 5.08 5.14 4.89 4.97 4.83 4.67 4.72
70 6.21 5.78 5.90 5.86 5.58 5.66 5.43 5.26 5.31
75 7.46 6.94 7.09 6.70 6.45 6.53 6.22 6.04 6.09
80 9.23 8.66 8.83 7.61 7.46 7.51 7.24 7.08 7.13
85 11.72 11.24 11.38 8.44 8.40 8.41 8.55 8.45 8.48
90 15.16 14.94 15.00 9.06 9.05 9.05 10.22 10.19 10.20
============== =========== ============ ========== ============ =========== ============ =========== ============ ==========
VL95 Page 22
Option C - Joint and Survivor The proceeds will be paid in equal installments
Life Income during the joint lifetime of two payees:
1. continuing upon the death of the first payee for 2. reduced by one-third upon the death of the
the remaining lifetime of the survivor; or first payee and continuing for the remaining
lifetime of the survivor.
Joint Life Income with Full Joint Life Income with 2/3
Amount to Survivor to Survivor
=========== =========== ========= ======== ========= ========= ==== ======= ============ ========= ======== ========= ========
FEMALE FEMALE
MALE 55 60 65 70 75 MALE 55 60 65 70 75
---- ----------- --------- -------- --------- --------- ---- ------------ --------- -------- --------- --------
55 3.61 3.74 3.86 3.96 4.04 55 3.91 4.09 4.29 4.51 4.75
60 3.72 3.91 4.09 4.26 4.39 60 4.08 4.30 4.54 4.81 5.11
65 3.81 4.06 4.32 4.57 4.80 65 4.28 4.53 4.83 5.17 5.54
70 3.88 4.18 4.52 4.89 5.25 70 4.49 4.79 5.15 5.57 6.05
75 3.93 4.27 4.69 5.17 5.70 75 4.70 5.05 5.47 5.99 6.61
=========== =========== ========= ======== ========= ========= ==== ======= ============ ========= ======== ========= ========
VL95 Page 23
WESTERN RESERVE LIFE
ASSURANCE CO. OF OHIO
- --------------------------------------------------------------------------------
Flexible Premium Variable Life Insurance Policy
Death Benefit Proceeds Payable at Death of Insured Prior to Maturity Date
Net Surrender Value Payable at Maturity Date
Flexible Premiums Payable During Lifetime of Insured Until the Maturity Date
Non-Participating - No Dividends
Some Benefits Reflect Investment Results
VL95