ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY
TERM LIFE INSURANCE RIDER
DESCRIPTION: This rider is part of the policy to which it is attached if it is
shown in the specifications page of the policy. The insured under this rider is
shown on the Term Insurance Schedule Page.
BENEFIT: We will pay the term insurance upon receipt of due proof that the
insured died prior to the term expiry date, while the rider is in force. Unless
otherwise requested, the term insurance benefit will be paid to the same
beneficiary who receives the policy's net death benefit.
The amount of the term insurance benefit may vary. The benefit will be
determined on each monthly processing date while the rider is in force. The term
insurance benefit amount will be the lesser of:
- - the term insurance amount (as shown in the Term Insurance Schedule Page);
or
- - the term insurance amount less the excess of the minimum death benefit of
the policy over the policy face amount (plus the policy value if the Death
Benefit Option 2 is in effect).
The Term Insurance Schedule Page will display the following information:
- - the name and age of the insured;
- - the term insurance amount;
- - the effective date of the term insurance;
- - the term expiry date.
CHANGE PROVISIONS: You may decrease the amount of term insurance if the request
is made:
- - during the lifetime of the insured; and
- - in writing while the policy and term rider are in force
A request to decrease the amount of term insurance will be effective on the
monthly processing date following the date of the written request. A
supplemental Term Insurance Schedule will be issued. The schedule will include
the following information:
- - effective date of the decrease in amount of term insurance.
- - the amount of the decrease in term insurance, and the remaining term
insurance amount.
- - the remaining term insurance amount.
The company reserves the right to establish a minimum limit for the amount of
any decrease.
CONTESTABILITY: Except for failure to pay premiums, this rider cannot be
contested after the term insurance has been in force during the insured's
lifetime for two years from the date of issue.
SUICIDE EXCLUSION: The risk of suicide of the insured, while sane or insane,
within two years of the issue date of this rider is not assumed. The beneficiary
will receive the sum of the term charges paid.
MISSTATEMENT OF AGE OR SEX: If the age or sex of the insured is misstated, the
amount payable under this rider will be such that the charges paid on the last
monthly processing date would have purchased at the insured's correct age or
sex. No adjustment will be made if the insured's underwriting class is unisex
and there has been a misstatement of sex.
CHARGES: The monthly term insurance charge will be the term rider benefit amount
as of the current monthly processing date, divided by 1,000 and multiplied by
the term insurance rate shown in the Term Insurance Schedule.
FORM 1103-99 1
Charges for this rider are payable as part of the monthly deduction due under
this policy.
The maximum term charges for each year are shown in the Term Insurance Schedule
page. The maximum term charges are based on:
- - the Commissioners 1980 Standard Ordinary Mortality Table, Male, Female or
Table B for unisex risks (Smoker or Non-smoker versions of these tables are
used if the insured is over age 17 year of age on the date of issue), and
- - the appropriate increases in such tables for rated risks.
TERMINATION: This rider will terminate on the first to occur of:
- - the end of the grace period; or
- - the termination or maturity of the policy; or
- - the monthly processing date following a request for termination; or
- - the term expiry date.
GENERAL: The Term Insurance Schedule page will show the date of issue of this
rider.
Except as otherwise provided, all conditions and provisions of the policy apply
to this rider.
Signed for the Company at Dover, Delaware
Secretary President
FORM 1103-99 2
TERM INSURANCE SCHEDULE
YOUR MONTHLY TERM INSURANCE PROTECTION CHARGES ARE GUARANTEED
NEVER TO GO HIGHER THAN THE FOLLOWING:
Insured's Name: John Doe Date of Issue: 11/15/1999
Term Insurance Amount: $50,000 Term Expiry Date: 11/15/2063
INSURANCE PROTECTION INSURANCE PROTECTION INSURANCE PROTECTION
AGE RATE PER $1000 AGE RATE PER $1000 AGE RATE PER $1000
35 0.141 60 1.061 85 13.556
36 0.148 61 1.171 86 14.918
37 0.157 62 1.296 87 16.344
38 0.167 63 1.439 88 17.808
39 0.179 64 1.602 89 19.333
40 0.191 65 1.781 90 20.942
41 0.206 66 1.975 91 22.668
42 0.221 67 2.186 92 24.577
43 0.239 68 2.412 93 26.764
44 0.256 69 2.660 94 29.637
45 0.277 70 2.941 95 33.931
46 0.300 71 3.313 96 41.279
47 0.324 72 3.631 97 56.040
48 0.350 73 4.058 98 83.333
49 0.379 74 4.541 99 83.333
50 0.410 75 5.063
51 0.447 76 5.622
52 0.490 77 6.214
53 0.538 78 6.833
54 0.593 79 7.496
55 0.654 80 8.230
56 0.723 81 9.054
57 0.795 82 9.997
58 0.873 83 11.073
59 0.962 84 12.267
FORM 1103-99 3