Exhibit (5)(d)
Other Insured Rider
WESTERN RESERVE LIFE ASSURANCE CO. OF OHIO
(A STOCK COMPANY)
Home Office: Columbus, Ohio
Administrative Office: Clearwater, Florida
OTHER INSURED RIDER
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IN THIS RIDER, the Primary Insured is named on Page 4 of the Policy. 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.
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BENEFIT We will pay the Face Amount of this Rider as
shown on Page 4 of the Policy to the Primary
Insured when We receive due proof that Your
death occurred while this Rider was In Force.
CONSIDERATION This Rider is issued in consideration of:
1. the application for this Rider; and
2. the payment of the Initial Premium.
INCONTESTABILITY This Rider shall be incontestable after it has
been In Force while You are still alive, for
two years after the effective date of this
Rider.
SUICIDE If this Rider is issued on the same date as the
Policy, the Suicide Provision of the Policy is
applicable to this Rider. If this Rider is
issued after the Policy and if You die by
suicide, while sane or insane, within two years
after the effective date of this Rider, Our
liability for this Rider shall be limited to an
amount equal to the total monthly deductions
for coverage under this Rider.
ISSUE AGE AND SEX If Your date of birth or sex is not correctly
stated, We will adjust the death benefit to the
amount payable had Your date of birth and sex
been correctly stated.
CONVERSION PRIVILEGE On any Monthiversary while this Rider is In
Force, the Owner may exchange this Rider
without evidence of insurability for a new
policy on Your life. Such new policy will be
issued upon written request subject to the
following:
1. the Rider has not reached the Anniversary
nearest Your 70th birthday; and
2. the new policy is on any permanent plan of
insurance then offered by Us; and
3. the amount of insurance upon conversion
will equal the Face Amount then In Force
under this Rider; and
4. the payment of the Premium based on Your
rate class under this Rider.
TERMINATION This Rider will terminate on the earliest of:
1. the Maturity Date of the Policy;
2. the Anniversary nearest Your 100th
birthday;
3. the date this Policy terminates for any
reason except for death of the Primary
Insured;
4. 31 days after the death of the Primary
Insured;
5. the date of conversion of this Rider;
6. the Monthiversary on which this Rider is
terminated on written request by the
Owner.
GENERAL This Rider is part of the Policy. It is subject
to all the terms of this Rider and the Policy.
This Rider has no cash value.
The monthly deduction for this Rider, for each
of the first 12 policy months, is shown on Page
4 of the Policy. Monthly deductions after the
first policy year will be calculated consistent
with the Monthly Cost of Insurance and Monthly
Cost of Insurance Rates provisions of the
Policy to which this Rider is attached.
EFFECTIVE DATE This Rider becomes effective on the same date
as the Policy unless a later date is shown
here.
WESTERN RESERVE LIFE ASSURANCE CO. OF OHIO
/s/ WILLIMA H. GEIGER
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