SECTION C Life Plans

Transcription

1 SECTION C Life Plans WL PLAN OR RIDER Premium Information... C - 2 Heritage (WL )... C - 3 Contender - (WL-05-95)... C - 4 Patriot - (WL-05-75)... C - 5 Sentinel -(WL-05-65)... C - 6 Liberty -(SPWL-05)... C - 7 Single Premium Paid-Up Additions Rider (SPUA-05)... C - 8 Level Premium Paid-Up Additions Rider (LPUA-05)... C - 10 Protector (WSI-07 and WGB-07)... C - 12 DISCONTINUED Premium and Value Information... C - 13 Contender - (WL-89-95)... C - 14 Patriot - (WL-89-75)... C - 15 Graded Premium Whole Life (GPWL-15)... C - 16 Single Premium Paid-Up Additions Rider (SPUA-89)... C - 17 Level Premium Paid-Up Additions Rider (LPUA-89)... C - 19 FPUA Rider... C - 20 (04/13) C-1

2 General Premium Information QDFs and Bands for the products described in this section vary as follows: QDF Bands Heritage $40 I - V Contender 100 $40 I - V Patriot 100 $40 II - V Sentinel $40 NA Liberty $150 NA Protector None NA QDF - A policy fee (Quantity Discount Factor) is used as a method of grading premiums by policy size. When used, the annual premium equals: 1. The premium for the amount of insurance involved, including any rider benefits; plus 2. The Quantity Discount Factor. BANDS Bands are also used for grading premiums by policy size. Band Policy Size I $1,000 - $24,999 II $25,000 - $99,999 III $100, ,999 IV $250, ,999 V $500,000 and over NONSMOKER - A reduced premium is available to Insureds age 18 and over who have not smoked a cigarette in the past 12 months. The Insured must attest to nonsmoking by answering the nonsmoking question on the application. PREFERRED NONSMOKER - For all plans except the Protector, a premium lower than the nonsmoker premium is available to Insured s that, in addition to being a nonsmoker, meet certain preferred underwriting criteria. See page B-16 for details. FRACTIONAL PREMIUMS Annual premiums are converted to more frequent premium modes by multiplying the annual premium (excluding any LPUA premium) by the following factors: Semiannual.51 Quarterly.26 Monthly (PAW).085 If there is an LPUA rider, the annual amount for it should then be divided by 2, 4, or 12 and added to the above modal premium. DIVIDEND INFORMATION The dividend for the first policy year is contingent upon payment of the first modal premium for the second policy year. It will be credited when the first modal premium of the second policy year has been paid. Thereafter each dividend will be credited on the policy anniversary. Dividends are not affected by policy loans. DIVIDENDS CANNOT BE GUARANTEED - It is most important when discussing dividends to make certain the proposed Insured understands that dividends are not and cannot be guaranteed. All proposals for life insurance are required by law to state this fact. Sample Calculations HERITAGE Age/Sex Benefit Amount Premium Units Total 35M WL (Pref) 100, x 100 = 1, WPD 100, x 100 = ADB 50, x 50 = CIR 10, x 10 = WPD 10, x 10 = 1.80 QDF Total Annual 1, PAW Mode Factor x Monthly PAW PATRIOT 100 Age/Sex Benefit Amount Premium Units Total 35M WL (Pref) 100, x 100 = 1, ADB 50, x 50 = QDF Total Annual 1, PAW Mode Factor x LPUA 900 Annual 900 / Monthly PAW (04/13) C-2

3 Heritage (WL ) DESCRIPTION Designed to generally provide low guaranteed premiums for those looking for a high, permanent death benefit and guaranteed cash value growth at low cost. PRODUCT TYPE - Participating Whole Life Insurance PREMIUMS - Payable to age 100 or 20 years whichever is longer Band I 5,000-24,999 QDF - $40 II 25,000-99,999 III 100, ,999 IV 250, ,999 V 500,000 - Up POLICY MATURITY - Age 121 DIVIDENDS - Any dividend for the first policy year will be credited upon payment of the first modal premium of the second policy year. Any subsequent dividend will be credited on the policy anniversary. Dividends are not guaranteed and may be changed by the company at any time and for any reason. Dividends are not affected by policy loans. LOANS The maximum loan value is the tabular cash value as of the next premium due date plus the cash value of any Paid-Up Additions or Dividend Accumulations less any premium due, any policy loan, and any policy loan interest to the next premium due date. The loan interest charged is the greater of 5% or the Monthly Average of the Composite Yield on seasoned Corporate Bonds as published by Moody s Investors Service, Inc. or any successor to that service. Dividends are not affected by policy loans. BASIS OF VALUES CSO Smoker/Nonsmoker Mortality Tables, Age Last Birthday, 4.5% Interest ISSUE AGES - 0 thru 85 MINIMUM AMOUNT ISSUED - Qualified Non-Qualified All States, Except Washington Nonsmoker/Smoker $1,000 $5,000 Preferred $100,000 $100,000 Qualified Non-Qualified Washington Nonsmoker/Smoker Issue Ages < 65 $3,000 $25,000 Issue Ages > 65 $25,000 $25,000 Preferred All Issue Ages $100,000 $100,000 DIVIDEND OPTIONS - Paid in Cash Reduce Premium Accumulate at Interest Purchase Paid-Up Additions (PUA) Purchase One Year Term (OYT) Insurance OYT = Net Cash Value, Bal to Accumulate (OYD) OYT = Net Cash Value, Bal to Prem Payment (OYR) OYT = Net Cash Value, Bal to Purchase PUA (OYP) Reduce Premiums with Balance to PUAs (#9) OPTIONAL RIDERS* - Long Term Care Rider Waiver of Premium Disability Single Premium Paid-Up Additions Rider Level Premium Paid-Up Additions Rider Accidental Death Benefit Guaranteed Purchase Option Survivor Purchase Option Term Rider Ten Year Term Rider Spouse Insurance Rider Children s Insurance Rider Payor Benefit Accelerated Benefit Rider (automatically added for face amount of at least $25,000 unless requested otherwise) * Riders may be subject to underwriting and availability. RATE CLASSES - Preferred Nonsmoker, Standard Nonsmoker, Smoker, Unisex, Substandard NONMEDICAL LIMITS - This plan may be written on a nonmedical basis subject to the regular nonmedical rules and limitations. If the GPO rider is attached, add the amount of the first option to the initial amount applied for and apply the total to the regular nonmedical limits. If the Payor Benefit is attached, see special rules in Section B. (04/13) C-3 SPECIAL CLASS - Substandard rates for the Heritage are shown in Section F. * Check the Lafayette Life web site ( for state specific limitations.

4 DESCRIPTION Designed to generally provide an excellent balance of death benefit and cash value accumulation. PRODUCT TYPE - Participating Whole Life Insurance PREMIUMS - Payable to age 95 or 20 years whichever is longer Band I 5,000-24,999 QDF - $40 II 25,000-99,999 III 100, ,999 IV 250, ,999 V 500,000 - Up POLICY MATURITY - Age 121 DIVIDENDS - Any dividend for the first policy year will be credited upon payment of the first modal premium of the second policy year. Any subsequent dividend will be credited on the policy anniversary. Dividends are not guaranteed and may be changed by the company at any time and for any reason. Dividends are not affected by policy loans. LOANS The maximum loan value is the tabular cash value as of the next premium due date plus the cash value of any Paid-Up Additions or Dividend Accumulations less any premium due, any policy loan, and any policy loan interest to the next premium due date. The loan interest charged is the greater of 5% or the Monthly Average of the Composite Yield on seasoned Corporate Bonds as published by Moody s Investors Service, Inc. or any successor to that service. Dividends are not affected by policy loans. BASIS OF VALUES CSO Smoker/Nonsmoker Mortality Tables, Age Last Birthday, 4.5% Interest ISSUE AGES - 0 thru 85 MINIMUM AMOUNT ISSUED - Qualified Non-Qualified All States, Except Washington Nonsmoker/Smoker $1,000 $5,000 Preferred $100,000 $100,000 Washington Nonsmoker/Smoker Issue Ages < 65 $3,000 $25,000 Issue Ages > 65 $25,000 $25,000 Preferred Contender 100 (WL-05-95) All Issue Ages $100,000 $100,000 (04/13) C-4 DIVIDEND OPTIONS - Paid in Cash Reduce Premium Accumulate at Interest Purchase Paid-Up Additions (PUA) Purchase One Year Term (OYT) Insurance OYT = Net Cash Value, Bal to Accumulate (OYD) OYT = Net Cash Value, Bal to Prem Payment (OYR) OYT = Net Cash Value, Bal to Purchase PUA (OYP) Reduce Premiums with Balance to PUAs (#9) OPTIONAL RIDERS* Long Term Care Rider Waiver of Premium Disability Single Premium Paid-Up Additions Rider Level Premium Paid-Up Additions Rider Accidental Death Benefit Guaranteed Purchase Option Survivor Purchase Option Term Rider Ten Year Term Rider Spouse Insurance Rider Children s Insurance Rider Payor Benefit Accelerated Benefit Rider (automatically added for face amount of at least $25,000 unless requested otherwise) * Riders may be subject to underwriting and availability. RATE CLASSES - Preferred Nonsmoker, Standard Nonsmoker, Smoker, Unisex, Substandard NONMEDICAL LIMITS - This plan may be written on a nonmedical basis subject to the regular nonmedical rules and limitations. If the GPO rider is attached, add the amount of the first option to the initial amount applied for and apply the total to the regular nonmedical limits. If the Payor Benefit is attached, see special rules in Section B. SPECIAL CLASS - Substandard rates for the Contender 100 are shown in Section F. * Check the Lafayette Life web site ( for state specific limitations.

5 Patriot 100 (WL-05-75) DESCRIPTION Designed to generally provide a limited payment policy with strong early cash values. PRODUCT TYPE - Participating Whole Life Insurance PREMIUMS - Payable to age 75 or 30 years whichever is longer Band II 25,000-99,999 QDF - $40 III 100, ,999 IV 250, ,999 V 500,000 - Up POLICY MATURITY - Age 121 DIVIDENDS - Any dividend for the first policy year will be credited upon payment of the first modal premium of the second policy year. Any subsequent dividend will be credited on the policy anniversary. Dividends are not guaranteed and may be changed by the company at any time and for any reason. Dividends are not affected by policy loans. LOANS The maximum loan value is the tabular cash value as of the next premium due date plus the cash value of any Paid-Up Additions or Dividend Accumulations less any premium due, any policy loan, and any policy loan interest to the next premium due date. The loan interest charged is the greater of 5% or the Monthly Average of the Composite Yield on seasoned Corporate Bonds as published by Moody s Investors Service, Inc. or any successor to that service. Dividends are not affected$ by policy loans. BASIS OF VALUES CSO Smoker/Nonsmoker Mortality Tables, Age Last Birthday, 4.0% Interest ISSUE AGES - 0 thru 85 MINIMUM AMOUNT ISSUED - *Qualified / Non-Qualified Nonsmoker/Smoker $25,000 Preferred $100,000 * Qualified not available in WA DIVIDEND OPTIONS - Paid in Cash Reduce Premium Accumulate at Interest Purchase Paid-Up Additions (PUA) Purchase One Year Term (OYT) Insurance OYT = Net Cash Value, Bal to Accumulate (OYD) OYT = Net Cash Value, Bal to Prem Payment (OYR) OYT = Net Cash Value, Bal to Purchase PUA (OYP) Reduce Premiums with Balance to PUAs (#9) OPTIONAL RIDERS* - Long Term Care Rider Waiver of Premium Disability Single Premium Paid-Up Additions Rider Level Premium Paid-Up Additions Rider Accidental Death Benefit Guaranteed Purchase Option Survivor Purchase Option Term Rider Ten Year Term Rider Spouse Insurance Rider Children s Insurance Rider Payor Benefit Accelerated Benefit Rider (automatically added for face amount of at least $25,000 unless requested otherwise) * Riders may be subject to underwriting and availability. RATE CLASSES - Preferred Nonsmoker, Standard Nonsmoker, Smoker, Unisex, Substandard NONMEDICAL LIMITS - This plan may be written on a nonmedical basis subject to the regular nonmedical rules and limitations. If the GPO rider is attached, add the amount of the first option to the initial amount applied for and apply the total to the regular nonmedical limits. If the Payor Benefit is attached, see special rules - Section B. SPECIAL CLASS - Substandard rates for the Patriot 100 are shown in Section F. * Check the Lafayette Life web site ( for state specific limitations. (04/13) C-5

6 Sentinel (WL-05-65) DESCRIPTION Designed to generally provide a limited payment policy with strong early cash value accumulations. Cash values are generally higher than our other life products, particularly in the early years. PRODUCT TYPE - Participating Whole Life Insurance PREMIUMS - Payable to age 65 or 20 years whichever is longer. QDF - $40 POLICY MATURITY - Age 121 DIVIDENDS - Any dividend for the first policy year will be credited upon payment of the first modal premium of the second policy year. Any subsequent dividend will be credited on the policy anniversary. Dividends are not guaranteed and may be changed by the company at any time and for any reason. Dividends are not affected by policy loans. LOANS The maximum loan value is the tabular cash value as of the next premium due date plus the cash value of any Paid-Up Additions or Dividend Accumulations less any premium due, any policy loan, and any policy loan interest to the next premium due date. The loan interest charged is the greater of 5% or the Monthly Average of the Composite Yield on seasoned Corporate Bonds as published by Moody s Investors Service, Inc. or any successor to that service. Dividends are not affected by policy loans. BASIS OF VALUES CSO Smoker/Nonsmoker Mortality Tables, Age Last Birthday, 4.0% Interest ISSUE AGES - 0 thru 85 MINIMUM AMOUNT ISSUED - *Qualified & Non-Qualified Nonsmoker/Smoker $25,000 Preferred $100,000 * Qualified not available in WA DIVIDEND OPTIONS - Paid in Cash Reduce Premium Accumulate at Interest Purchase Paid-Up Additions (PUA) Purchase One Year Term (OYT) Insurance OYT = Net Cash Value, Bal to Accumulate (OYD) OYT = Net Cash Value, Bal to Prem Payment (OYR) OYT = Net Cash Value, Bal to Purchase PUA (OYP) Reduce Premiums with Balance to PUAs (#9) OPTIONAL RIDERS* - Long Term Care Rider Waiver of Premium Disability Single Premium Paid-Up Additions Rider Level Premium Paid-Up Additions Rider Accidental Death Benefit Guaranteed Purchase Option Survivor Purchase Option Term Rider Ten Year Term Rider Spouse Insurance Rider Children s Insurance Rider Payor Benefit Accelerated Benefit Rider (automatically added for face amount of at least $25,000 unless requested otherwise) * Riders may be subject to underwriting and availability. RATE CLASSES - Preferred Nonsmoker, Standard Nonsmoker, Smoker, Unisex, Substandard NONMEDICAL LIMITS - This plan may be written on a nonmedical basis subject to the regular nonmedical rules and limitations. If the GPO rider is attached, add the amount of the first option to the initial amount applied for and apply the total to the regular nonmedical limits. If the Payor Benefit is attached, see special rules in Section B. SPECIAL CLASS - Substandard rates for the Sentinel are shown in Section F. * Check the Lafayette Life web site ( for state specific limitations. (04/13) C-6

7 Liberty (SPWL-05) DESCRIPTION A single premium whole life insurance product generally designed for those who prefer to pay for coverage in one lump sum premium. PRODUCT TYPE - Participating Whole Life Insurance PREMIUMS Single Premium QDF - $150 POLICY MATURITY - Age 121 DIVIDENDS - Any dividends will be credited on the policy anniversary. Dividends are not guaranteed and may be changed by the company at any time and for any reason. Dividends are not affected by policy loans. LOANS The maximum loan value is the tabular cash value as of the next premium due date plus the cash value of any Paid-Up Additions or Dividend Accumulations less any premium due, any policy loan, and any policy loan interest to the next premium due date. The loan interest charged is the greater of 5% or the Monthly Average of the Composite Yield on seasoned Corporate Bonds as published by Moody s Investors Service, Inc. or any successor to that service. Dividends are not affected by policy loans. BASIS OF VALUES CSO Smoker/Nonsmoker Mortality Tables, Age Last Birthday, 4.0% Interest ISSUE AGES - 0 thru 85 MINIMUM AMOUNT ISSUED - Non-Qualified Nonsmoker/Smoker $25,000 Preferred $100,000 DIVIDEND OPTIONS - Paid in Cash Accumulate at Interest Purchase Paid-Up Additions (PUA) Purchase One Year Term (OYT) Insurance OYT = Net Cash Value, Bal to Accumulate (OYD) OYT = Net Cash Value, Balance to PUA (OYP) OPTIONAL RIDERS* - Long Term Care Rider (If this rider is approved for use in your state, it will automatically be included. Please complete the LTC Rider Packet that is on the web.) Guaranteed Purchase Option Accelerated Benefit Rider (automatically added for face amount of at least $25,000 unless requested otherwise) * Riders may be subject to underwriting and availability. RATE CLASSES - Preferred Nonsmoker, Standard Nonsmoker, Smoker, Unisex, Substandard NONMEDICAL LIMITS - This plan may be written on a nonmedical basis subject to the regular nonmedical rules and limitations. SPECIAL CLASS - Substandard rates for the Liberty are shown in Section F. * Check the Lafayette Life web site ( for state specific limitations. (04/13) C-7

8 DESCRIPTION POLICY TO WHICH RIDER MAY BE ATTACHED - Heritage, Contender 100, Patriot 100, or Sentinel. PREMIUMS - Single Premium RIDER MATURITY - Age 121 Single Premium Paid-Up Additions Rider (SPUA-05) MAY BE APPLIED FOR - at time of application, within 90 days from the date the original policy is mailed from the Home Office, and on policy anniversaries. RIDER VALUES - Similar to PUAs purchased by the base policy dividend. The net premium (the gross rider premium less a 6% expense charge) is used as a net single premium to purchase a level amount of PUA. Rider dividends are used to purchase more PUAs. CASH VALUE - Equals the net single premium for the current amount of PUAs. There is no surrender charge. POLICY LOANS The Cash Value of the rider increases the loan value of the policy to which it is attached. Any loans or loan interest are charged to the loan value provided by the rider before that provided by the policy. BASIS OF VALUES CSO Smoker/Nonsmoker Mortality Tables, Age Last Birthday. Interest is 4.5% (if rider is attached to the Heritage or Contender 100) or 4.0% (if attached to the Patriot 100 or Sentinel). AUTOMATIC SURRENDER TO PAY PREMIUMS - Automatically takes effect when the base policy premium is not paid and there is sufficient rider Cash Value. May also take effect at Owner s request. No surrender charge. Surrender taken from most recently issued PUA (if there was more than one). Does decrease the death benefit of the rider. PARTIAL SURRENDER - The Owner may request a partial surrender subject to the following rules: At least $500 must be surrendered (unless used to automatically pay premiums). That part of any Cash Value borrowed may not be surrendered. No partial surrender may be made in the first rider year. The death benefit will be reduced to the amount the remaining cash value will purchase when applied as a net single premium. A Partial Surrender Form must be received. Cash Value will first be surrendered from the most recent single premium PUA (if more than one exists). DIVIDEND INFORMATION The dividend for the first policy year is contingent upon payment of the first modal premium for the second policy year. It will be credited when the first modal premium of the second policy year has been paid. Thereafter each dividend will be credited on the policy anniversary. Dividends are not affected by policy loans. DIVIDENDS CANNOT BE GUARANTEED - It is most important when discussing dividends to make certain the proposed Insured understands that dividends are not and cannot be guaranteed. All proposals for life insurance are required by law to state this fact. ISSUE AGES - 0 thru 85 MINIMUM PREMIUM - $120 MAXIMUM PREMIUM - $150,000 (without Company consent) Underwriting Rules continued on the next page. (04/13) C-8

9 NONMEDICAL LIMITS - In figuring limits, there is a set of factors that are multiplied times the amount of rider single premium. Previous insurance with us is taken into consideration and, for the initial application, the base policy face amount is added. The factors are: Issue Ages Factor & up 1 Example: Applicant age 34 wishes to pay $10,000 for rider. The rider would count as $40,000 (4 x 10,000) for nonmedical limits. APPLYING ON INITIAL APPLICATION - In Question 14 on the application entitled Additional Information & Special Benefits, write Single PUA Rider and the premium amount. If the single premium for this rider will be sent later (within 90 days from the application date), indicate that also. We will underwrite for it. If the single premium for this rider is not received by the issue date, the policy will be issued without the rider (except on 1035 Exchanges). This rider will be added without further underwriting evidence when the premium and policy are returned within 90 days from the app date. (See Discounting.) No redating is available when the base policy was previously put in force. APPLYING AFTER ISSUE (within 90 days from date that original policy was mailed to you from the Home Office) - Use Policy Change Form 1043 approved by your state. In Section 8 in the area entitle Other Instructions write Single PUA Rider and the premium amount. Complete Part II of Form Additional underwriting evidence may be required. Send the single premium for this rider along with the application. (1035 Exchange is NOT available after original issue.) Also return the policy. See Discounting. APPLYING ON ANNIVERSARY (within 90 days after the policy anniversary date) - Use Policy Change Form 1043 approved by your state. In Section 8 in the area entitle Other Instructions write Single PUA Rider and the premium amount. Send the single premium along with the app. Complete Part II of Form 1043 and Underwriting Authorization Additional underwriting evidence may be required. The attained age of the Insured on the anniversary is used as the issue age. See Discounting. DISCOUNTING - When the single premium for this rider is received after the policy (or anniversary) date, it will be discounted at the premium deposit fund interest rate for the number of days between the date it is received in the Home Office back to such policy (or anniversary) date. Example. At 1.5% interest, if a premium of $10,000 is received in the Home Office 45 days after the policy (or anniversary) date, the premium will be discounted by $ The policy would show a single premium of $9, (04/13) C-9

10 Level Premium Paid-Up Additions Rider (LPUA-05) DESCRIPTION Under this rider, the net premium is used to purchase paidup additional life insurance. The rider allows you to pay a premium equal to or less than the amount paid under the rider as applied for on the policy application and underwritten at issue. An expense charge is assessed against each premium paid. The rider contains a provision whereby, if the premium for the base policy is not paid before the end of its grace period and the policy has sufficient net cash value, we will automatically surrender a portion of the paid-up additional life insurance for the policy to pay the portion of the premium which remains unpaid. The waiver of premium benefit, if part of this policy, does not apply to premiums due under this Paid-Up Additions Rider. POLICY TO WHICH RIDER MAY BE ATTACHED - Heritage, Contender 100, Patriot 100, or Sentinel. PREMIUMS At initial planned level, but Insured is free to decrease or increase at any time so long as the annual premium for the rider does not exceed the defined maximum applied for at issue. RIDER MATURITY - Age 121 MAY BE APPLIED FOR - at time of application, within 90 days from the date the original policy is mailed from the Home Office, and on policy anniversaries. RIDER VALUES - Similar to PUAs purchased by the base policy dividend. The net premium (the gross rider premium less a 6% expense charge) is used as a net single premium to purchase a level amount of PUA. Rider dividends are used to purchase more PUAs. CASH VALUE - Equals the net single premium for the current amount of PUAs. There is no surrender charge. DIVIDEND INFORMATION The dividend for the first policy year is contingent upon payment of the first modal premium for the second policy year. It will be credited when the first modal premium of the second policy year has been paid. Thereafter each dividend will be credited on the policy anniversary. Dividends are not affected by policy loans. DIVIDENDS CANNOT BE GUARANTEED - It is most important when discussing dividends to make certain the proposed Insured understands that dividends are not and cannot be guaranteed. All proposals for life insurance are required by law to state this fact. PREMIUM CESSATION - Once the premiums for this rider are stopped, no future premiums will be accepted. POLICY LOANS The Cash Value of the rider increases the loan value of the policy to which it is attached. Any loans or loan interest are charged to the loan value provided by the rider before that provided by the policy. BASIS OF VALUES CSO Smoker/Nonsmoker Mortality Tables, Age Last Birthday. Interest is 4.5% (if rider is attached to the Heritage or Contender 100) or 4.0% (if attached to the Patriot 100 or Sentinel). AUTOMATIC SURRENDER TO PAY PREMIUMS - Automatically takes effect when the base policy premium is not paid and there is sufficient rider Cash Value. May also take effect at Owner s request. No surrender charge. Surrender taken from any SPUA additions in force before surrendering additions from LPUA. Does decrease the death benefit of the rider. No future premiums will be accepted. PARTIAL SURRENDER - The Owner may request a partial surrender subject to the following rules: At least $500 must be surrendered (unless used to automatically pay premiums). That part of any Cash Value borrowed may not be surrendered. No partial surrender may be made in the first rider year. The death benefit will be reduced to the amount the remaining cash value will purchase when applied as a net single premium. A Partial Surrender Form must be received. (04/13) C-10

11 ISSUE AGES - 0 thru 85 MINIMUM PREMIUM Premiums may vary; a minimum contribution of $1 at issue is necessary to put the rider in force. MAXIMUM PREMIUM - $150,000 (without Company consent) HOW TO APPLY - In Section III of the application: Check LPUA; Enter the initial annual premium that the Insured plans to pay for the rider and the word Initial below it; and In the area above, write Maximum LPUA, followed by the annual amount that the Insured defines will be the maximum, or limit, that will be paid for the rider. TO ADD LATER OR TO CHANGE THE ANNUAL LIMIT - Complete Application for Policy Change, form 1043 approved by your state: To add this rider later, or To increase the annual premium maximum above that defined in the application, or to make a dump-in in excess of such limit. Use the same wording as described in HOW TO APPLY above, in Section 8 of form 1043 in the area entitled Other Instructions. Also complete Part II of NONMEDICAL LIMITS - In figuring limits, previous insurance with us is taken into consideration and the base policy face amount is included. There is also a set of factors that are multiplied times the defined maximum annual premium for the rider. The factors are: Issue Ages Factor & up 3 Example. Applicant age 38 defines the maximum annual premium to be paid for the rider will be $2,400. The rider would count as $21,600 (9 x 2,400) for non medical limits. SPECIAL CLASS - This rider will not be issued on an Insured rated higher than Table F or over $15 per $1,000 flat extra. Substandard rates for this rider will be charged for an Insured rated above Table B or $5 per $1,000 flat extra. RECEIPT OF PREMIUM If the money is not received with the original application it will be discounted at the premium deposit fund interest rate back to the original policy date. When added at anniversary, the rider will be dated effective as of the anniversary date. The premium must be received within 90 days following the anniversary date and will be discounted at the premium deposit fund interest rate back to the anniversary date. NO WAIVER OF PREMIUM BENEFIT Notwithstanding any provision contained in a Waiver of Premium Benefit rider attached to the policy, no premium for the LPUA rider will be waived in the event of the Insured s total disability or in the event of the Insured s presumptive total disability. (04/13) C-11

12 Simplified Issue (WSI-07) * DESCRIPTION PRODUCT TYPE - Nonparticipating Whole Life PREMIUM PLANS - Level Pay for life 10-Pay (available to age 80) 5-Pay Single Premium ACCELERATED BENEFIT OPTION - Under this policy provision, policy benefits may be accelerated if: the Insured is confined to an Eligible Nursing Home and is expected to stay there until death due to a specific diagnosed accident or sickness condition; or the Insured s life expectancy is 12 months or less due to a terminal illness. The accelerated benefit is the net death benefit (death benefit less any existing loans) discounted for one year at the current loan interest rate. The policy will terminate if an acceleration is made. POLICY LOANS - Variable (Dynamic) basis. See pg B-52. ISSUE AGES - 40 thru 85 (Age Last Birthday) ISSUE LIMITS - Face Amount Purchase by Single Premium Ages the lesser of a maximum premium of $100,000 or a maximum face of $250,000 Ages $25,000 maximum premium 5, 10, & Level PayMaximum Face Amounts Ages $50,000 Ages $10,000 Minimum $3,000 ($5,000 SC, $25,000 WA). All Ages and Premium Plans. NONSMOKER - The proposed Insured is considered a nonsmoker if they have not smoked any cigarettes in the last 12 months; other forms of tobacco are acceptable. APPLICATION (Use your state s version of 1462-A) - Part 2 Medical Questions 1-6 are required. If health questions 1-6 can be answered with a no and the proposed Insured fits into the height and weight chart, the Simplified Issue will be underwritten. For any yes answers to health questions 1-6, application Part 3 must also be completed in addition to Part 2, and the Graded Death Benefit will be underwritten. Protector (WSI-07 / WGB-07) ABO DISCLOSURE Regulation requires that a disclosure for the Accelerated Benefit Option (form DISC-WSI-07 ABO) be provided to the applicant when taking the application for the Simplified Issue. PERSONAL HEALTH INTERVIEW - We require an applicant for this plan to complete a Personal Health Interview (PHI) with MAAS ( ). Significant time savings can be gained by doing this at time of sale. If you are taking the application at a time when MAAS is not available, contact them on their next business day to have them call the applicant. If you do not make the call to MAAS, we will order the PHI when we receive the application. Graded Death Benefit (WGB-07) * DESCRIPTION PRODUCT TYPE - Nonparticipating Whole Life. (alternative plan for prospective Insureds who do not qualify for Simplified Issue because of their health. It is not designed to be a mass marketed substandard product.) PREMIUM PLAN - Level Pay for life DEATH BENEFIT - During the Modified Benefit Period (first 3 years) the death benefit depends on whether or not death was accidental. Accidental the death benefit is a level $1,000 for every $1,000 of Face Amount. Not accidental the death benefit is the annual mode gross premiums accumulated at 10% interest compounded annually (but not to exceed $1,000) for every $1,000 of Face Amount. After the Modified Benefit Period the death benefit is a level $1,000 for every $1,000 of Face Amount. Nonsmoker Discount & Accelerated Benefit - N/A ISSUE AGES 40 thru 85 (Age Last Birthday) FACE AMOUNT LIMITS - Ages $3,000 - $25,000 Ages $3,000 - $10,000 DISCLOSURE for Graded Death Benefit Whole Life Policy required at policy delivery as an amendment. Both the Simplified Issue (WSI-07) and the Graded Death Benefit (WGB-07) require individual underwriting.graded Death Benefit not approved in: AR, MN, MO, NC, SC, & WA. * Check the Lafayette Life web site ( for state specific limitations. (04/13) C-12

13 This Section contains a description of each of our whole life products. AGE LAST BIRTHDAY -All premium rates are based on the age of the proposed Insured at his or her last birthday. CALCULATION OF PREMIUM - The annual premium is equal to: 1. The premium for the amount of insurance involved, including any riders or benefits; plus 2. The Quantity Discount Factor. Premium and Value Information Premiums for the base policy and all riders and benefits except Payor Benefit may be found on the ratecards. PREMIUMS DISCOUNTED FOR QUANTITY - All life insurance premiums are graded by policy size using the policy fee method (referred to as the Quantity Discount Factor or QDF). The QDF is $25.00 per policy for the Contender and Patriot, and $40.00 per policy for the GPWL-15. Thus, the total annual premium per thousand is less for larger policies. In addition, Contender and Patriot have a decrease in premium rates per thousand for larger policy sizes. This is generally called the banded premium method. Premium for policies from $5,000 to $24,999 use Band I. Band II is for policies between $25,000 and $99,999, Band III is for policies between $100,000 and $249,999, Band IV is for policies between $250,000 and $499,999, and Band V is for policies $500,000 and over. PREFERRED UNDERWRITING CLASS - We expect that an estimated 60% of Insureds, who qualify for the nontobacco use and whose issue ages are would qualify for the preferred class. Please refer to page B-16.1 for complete details. NONSMOKER DISCOUNT - Our plans of insurance at the time of issue offer a reduced premium to prospective Insureds age 18 and over who have not smoked a cigarette in the past 12 months. The Insured must attest to nonsmoking by answering the nonsmoking question on the application. FRACTIONAL PREMIUMS - All rates are shown on an annual premium basis only. Conversion to other frequencies can easily be made by multiplying the total Annual Premium (less LPUA) by the following factor: semiannual (.51), quarterly (.26), and (.085) for preauthorized withdrawal, government allotment and payroll deduction. The annual LPUA premium should then be divided by 2, 4, or 12 and added to the above number. See example below. dividend information All policies are issued on a participating basis. The dividend for the first policy year is contingent upon payment of the entire premium for the second policy year. It will be credited when the entire second policy year premium is paid. Thereafter each dividend will be credited on the policy anniversary. DIVIDENDS CANNOT BE GUARANTEED - It is most important when discussing dividends to make certain the proposed Insured understands that dividends are not and cannot be guaranteed. All proposals for life insurance are required by law to state this fact. CONTENDER SAMPLE CALCULATIONS Age/Sex Benefit Amount Premium x Units = Total 35M WL (Pref) 100, x 100 = 1, WPD 100, x 100 = ADB 50, x 50 = CIR 10, x 10 = WPD 10, x 10 = 1.80 QDF = Total Annual = 1, PAW Mode Factor = x.085 Monthly PAW = PATRIOT SAMPLE CALCULATIONS Age/Sex Benefit Amount Premium x Units= Total 35M WL (Pref) 100, x 100 = 1, ADB 50, x 50 = QDF = Total Annual= 1, PAW Mode Factor = x LPUA 900 Annual = C-2 Monthly PAW = /02 (04/13) C-13

14 DESCRIPTION The Contender policy is a permanent insurance plan which provides a level amount of insurance for life. Premiums are payable to age 95. The policy provides permanent insurance to age 100 and matures as an endowment at age 100. This plan will be issued with a variable loan interest rate (may be deferred to as Dynamic Policy Loan Rate). For a further description, see page B-52. Issue Ages - 0 through 80 Contender (WL-89-95) DIVIDEND OPTIONS AVAILABLE - 1. Cash 2. Premium Payment 3. Dividend Accumulations 4. Paid-Up Additions *5. One Year Term Insurance *6. OYT = Next Cash Value, Balance to Accumulate *7. OYT = Next Cash Value, Balance to Premium Payment *8. OYT = Next Cash Value, Balance to Paid-Up Additions 9. Premium Payment, Balance to Paid-Up Additions *Not available below issue age 15. NONMEDICAL LIMITS - This plan may be written on a nonmedical basis subject to the regular nonmedical rules and limitations. MINIMUM AMOUNT ISSUED -- $5,000 nonqualified $ 1,000 qualified If issued for less than $25,000 in Washington, maximum issue ages apply as follows: Minimum Amount Issued 5,000 (nonqual) 1,000 (qualified) Base Plan Waiver of Premium Accidental Death OPTIONAL RIDERS - Waiver of Premium Disability Benefit (WPD) Accidental Death Benefit (ADB) Guaranteed Purchase Option (GPO) Payor Benefit (with juvenile ages only) PYR Spouse Insurance Rider (SIR) Children's Insurance Rider (CIR) 10 Year Term Rider (10TR) Term Rider (TR) Single Premium Paid-Up Additions Rider (SPUA) Level Premium Paid-Up Additions Rider (LPUA) Survivor Purchase Option Rider (SPO-89) Accelerated Benefit Rider (ABR-92) The ABR-92 is automatically added at no extra cost if the face amount is at least $25,000 and there is no request to exclude it. If the GPO rider is attached, add the amount of the first option to the initial amount applied for and apply the total to the regular nonmedical limits. If the Payor Benefit is attached, see special rules in Section B. SPECIAL CLASS - Substandard rates for the Contender are shown in Section F. PAYOR DEATH/DISABILITY PREMIUMS PER $1,000 CHILD'S PAYOR AGE AGE /96 C-3 (04/13) C-14

15 DESCRIPTION Patriot (WL-89-75) The Patriot policy is a permanent insurance plan which provides a level amount of insurance for life. Premiums are payable to age 75, or for 30 years if longer. Cash values are generally higher than on the Contender, particularly in the early years. The policy provides permanent insurance to age 100 and matures as an endowment at age 100. This plan will be issued with a variable loan interest rate (may be deferred to as Dynamic Policy Loan Rate). For a further description, see page B-52. DIVIDEND OPTIONS AVAILABLE - 1. Cash 2. Premium Payment 3. Dividend Accumulations 4. Paid-Up Additions *5. One Year Term Insurance *6. OYT = Next Cash Value, Balance to Accumulate *7. OYT = Next Cash Value, Balance to Premium Payment *8. OYT = Next Cash Value, Balance to Paid-Up Additions 9. Premium Payment, Balance to Paid-Up Additions *Not available below issue age 15. NONMEDICAL LIMITS - This plan may be written on a nonmedical basis subject to the regular nonmedical rules and limitations. Issue Ages - 0 through 70 MINIMUM AMOUNT ISSUED -- $25,000 OPTIONAL RIDERS - Waiver of Premium Disability Benefit (WPD) Accidental Death Benefit (ADB) Guaranteed Purchase Option (GPO) Payor Benefit (with juvenile ages only) PYR Spouse Insurance Rider (SIR) Children's Insurance Rider (CIR) 10 Year Term Rider (10TR) Term Rider (TR) Single Premium Paid-Up Additions Rider (SPUA) Level Premium Paid-Up Additions Rider (LPUA) Survivor Purchase Option Rider (SPO-89) Accelerated Benefit Rider (ABR-92) The ABR-92 is automatically added at no extra cost if there is no request to exclude it. If the GPO rider is attached, add the amount of the first option to the initial amount applied for and apply the total to the regular nonmedical limits. If the Payor Benefit is attached, see special rules in Section B. SPECIAL CLASS - Substandard rates for the Contender are shown in Section F. PAYOR DEATH/DISABILITY PREMIUMS PER $1,000 CHILD'S PAYOR AGE AGE C-4 1/96 (04/13) C-15

16 Graded Premium Whole Life (GPWL-15) DESCRIPTION In South Carolina, the product must be referred to as Increasing Premium Whole Life. The GPWL-15 policy is a permanent insurance plan which provides a level amount of insurance for life. Premiums increase each year until the fifteenth year and remain level thereafter to age 100. These premiums are found on the following pages under the appropriate age and rate calss heading. Premiums are not banded by size. The policy provides permanent insurance to age 100 and matures as an endowment at age 100. This plan will be issued with a variable loan interest rate (may be deferred to as Dynamic Policy Loan Rate). For a further description, see page B-52. This plan may not utilize the Payroll Deduction or Government Allotment premium frequency. DIVIDEND OPTIONS AVAILABLE - 1. Cash 2. Premium Payment 3. Dividend Accumulations 4. Paid-Up Additions *5. One Year Term Insurance *6. OYT = Next Cash Value, Balance to Accumulate *7. OYT = Next Cash Value, Balance to Premium Payment *8. OYT = Next Cash Value, Balance to Paid-Up Additions 9. Premium Payment, Balance to Paid-Up Additions *Not available below issue age 15. NONMEDICAL LIMITS - This plan may be written on a nonmedical basis subject to the regular nonmedical rules and limitations. If the GPO rider is attached, add the amount of the first option to the initial amount applied for and apply the total to the regular nonmedical limits. Issue Ages - 0 through 75 MINIMUM AMOUNT ISSUED -- $25,000 (ages 0-59) $ 10,000 (ages 60-75) If issued for less than $25,000 in Washington, maximum issue ages apply as follows: Base Plan 71 Waiver of Premium 55 Accidental Death 64 OPTIONAL RIDERS - Waiver of Premium Disability Benefit (WPD) Accidental Death Benefit (ADB) Guaranteed Purchase Option (GPO) Payor Benefit (with juvenile ages only) PYR Spouse Insurance Rider (SIR) Children's Insurance Rider (CIR) 10 Year Term Rider (10TR) Term Rider (TR) Single Premium Paid-Up Additions Rider (SPUA) Level Premium Paid-Up Additions Rider (LPUA) Flexible Paid Up Additions Rider (FPUAR) Survivor Purchase Option Rider (SPO-89) Accelerated Benefit Rider (ABR-92) If the Payor Benefit is attached, see special rules in Section B. SPECIAL CLASS - Substandard rates for the Contender are shown in Section F. PAYOR DEATH/DISABILITY PREMIUMS PER $1,000 CHILD'S PAYOR AGE AGE The ABR-92 is automatically added at no extra cost if there is no request to exclude it. 1/96 C-5 (04/13) C-16

17 Single Premium Paid-Up Additions Rider (SPUA-89) The Single Premium Paid-Up Additions Rider (SPUA) is an optional rider which may be attached to the Contender, Patriot, or GPWL-15 policy. It allows the payment of a single sum of money which is used to purchase paid up additions. This rider can be used to customize a permanent life insurance plan to meet a specific insurance need. SPUA Rider may be applied for (1) at time of application, (2) within 90 days from the date the original policy is mailed from the Home Office, and (3) on policy anniversaries. The rider values are calculated in a similar fashion to paid-us additions purchased by the base policy dividend. After deducting the 6% expense charge, the net premium is used as a net single to purchase a level amount of insurance until at age 100. The net single premium is calculated using the 1980 CSO Table and 4% interest when attached to a Patriot base policy or 4 1/2% interest when attached to a Contender or GPWL-15 base policy. Dividends earned by the SPUA are used to purchase more paid-up additions. NONMEDICAL LIMITS - The SPUA has a set of factors which are multiplied by the amount of single premium paid. Previous insurance with us should be taken into consideration in figuring limits. For initial application, add the base policy face amount to determine whether a medical exam or other requirements are needed. The factors are listed below: Issue Ages Factor & up 1 e.g. - Applicant age 34 wishes to pay $10,000 into a SPUA. The rider would count as $40,000 (10,000 x 4) for nonmedical limits. CASH VALUE - Each SPUA has its own cash value. The cash value is equal to the net single premium for the current amount of paid-up additions. There is no surrender charge. This cash value increases the loan value of the policy. AUTOMATIC SURRENDER TO PAY PREMIUMS - The SPUA has a special provision which permits a partial surrender of the rider to pay a premium on the base policy. This provision will automatically take effect when the base policy premium is not paid and the SPUA has sufficient net cash value. It may also take effect at the Owner s request. There is no surrender charge. The automatic surrender will be taken from the most recently issued SPUA (if more than one exists). Note that this does result in a decrease in the death benefit provided by the rider. PARTIAL SURRENDER - The Owner may also make a partial surrender from an SPUA subject to the following rules: 1. At least $500 must be surrendered (unless used to automatically pay premiums on the base policy). 2. That part of any SPUA value that is borrowed may not be surrendered. 3. No partial surrender may be made in the first rider year. 4. The death benefit will be reduced to the amount the remaining cash value will purchase when used as a net single premium. 5. A Partial Surrender Form must be received. 6. Cash Value will first be surrendered from the most recent SPUA (if more than one exists). ISSUE AGES- 0 through 75 (with Contender, GPWL-15) 0 through 70 (with Patriot) MINIMUM PREMIUM - $120 MAXIMUM PREMIUM - $150,000 (without Company consent) C-6 3/93 (04/13) C-17 APPLYING ON INITIAL APPLICATION 1. In Question 14 on the application entitled Additional Information & Special Benefits, write Single PUA Rider and the Premium amount. If the SPUAR premium will be sent later (within 90 days from the application date), indicate that also. We will underwrite for it. 2. If the SPUAR premium is not received by issue, the policy will be issued without the rider (except on 1035 Exchanges). SPUAR will be added without further underwriting evidence when the premium and policy are returned within 90 days from the app date. (See Discounting below.) No redating is available when the base policy was previously put in force. APPLYING AFTER ISSUE - WITHIN 90 DAYS FROM DATE THAT ORIGINAL POLICY WAS MAILED TO YOU FROM THE HOME OFFICE 1. Use Policy Change Form 1043 approved by your state; Section 8, in the area entitled Other Instructions write SPUAR and the premium amount. 2. Complete Part II of Form Additional underwrit ing evidence may be required. 3. Send the single premium along with application. (1035 Exchange is NOT available after original issue.) Also return the policy. 4. See Discounting next page. SPECIAL CLASS - The SPUA will not be issued on an Insured rated higher than Table F or over $15 per $1,000 flat extra Substandard rates for the SPUA will be charged for an Insured rated above Table B or $5 per $1,000 flat extra. APPLYING ON ANNIVERSARY- WITHIN 90 DAYS AF- TER THE POLICY ANNIVERSARY DATE 1. Use Policy Change Application Form 1043 approved by your state; Section 8, in the area entitled Other Instructions write SPUAR and

18 Single Premium Paid-Up Additions Rider (SPUA-89) the premium amount. Send the single premium along with the app. 2. Complete Part II of Form 1043 and Underwriting Authorization Additional underwriting evidence may be required. 3. The attained age of the Insured on the anniversary is used as the issue age. 4. See Discounting below. DISCOUNTING SINGLE PREMIUM - When the single premium is received after the policy date or after policy anniversary, the premium will be discounted at the premium deposit fund interest rate for the number of days between the date the premium is received in the Home Office back to the policy date or the anniversary date. e.g. At 6% interest, if a premium of $10,000 is received in the Home Office 45 days after the issue (or anniversary) date, the premium will be discounted by $ The policy would show a single premium of $9, /92 C-6.1 (04/13) C-18

19 Level Premium Paid-Up Additions Rider (LPUA-89) The Level Premium Paid-Up Additions Rider (LPUA) is an optional rider which may be attached to the Contender, Patriot, or GPWL-15 policy. It allows for the payment of fixed periodic amounts of money which are used to purchase paid-up additions. This rider can be used to customize a permanent life insurance plan to meet a specific insurance need. LPUA Rider may be applied for (1) at time of application, (2) within 90 days from the date the original policy is mailed from the Home Office, or (3) on a policy anniversary. Premiums must be paid with the same frequency as the base policy premium. Once LPUA premiums are stopped, no future LPUA premiums can be accepted. The rider values are calculated in a similar fashion to paid-up additions purchased by the base policy dividend. After deducting the 6% expense charge, the net premium is used as a net single premium to purchase a level amount of insurance until maturity at age 100. The net single premium is calculated using the 1980 CSO Table and 4% interest when attached to a Patriot base policy or 4 1/2% interest when attached to a Contender or GPWL-15 base policy. Dividends earned by the LPUA are used to purchase more paid-up additions. CASH VALUE - The LPUA has its own cash value. The cash value is equal to the net single premium for the current amount of paid-up additions. There is no surrender charge. This cash value increases the loan value of the policy. AUTOMATIC SURRENDER TO PAY PREMIUMS - The LPUA has a special provision which permits a partial surrender of the rider to pay a premium on the base policy. This provision will automatically take effect when the base policy premium is not paid and the LPUA has sufficient net cash value. It may also take effect at the Owner s request. There is no surrender charge. Note that this does result in a decrease in the death benefit provided by the rider. Also, no future LPUA premiums will be accepted. PARTIAL SURRENDER - The Owner may also make a partial surrender from an LPUA subject the following rules: 1. At least $500 must be surrendered (unless used to automatically pay premiums on the base policy). 2. That part of any LPUA value that is borrowed may not be surrendered. 3. No partial surrender may be made in the first rider year 4. The death benefit will be reduced to the amount the remaining cash value will purchase when used as a net single premium. 5. A Partial Surrender Form must be received. ISSUE AGES -0 through 75 (with Contender, GWPL-15) 0 through 70 (with Patriot) MINIMUM PREMIUM - None MAXIMUM PREMIUM - $ 150,000 (without Company consent) NONMEDICAL LIMITS - The LPUA has a set of factors which are multiplied by the annualized amount of level premium paid. Previous insurance with us should be taken into consideration in figuring limits. For initial application add the base policy face amount to determine whether a medical exam or other 2/02 C-7 requirements are needed. The factors are listed below: Issue Ages Factor &Up 3 e.g. - Applicant age 38 wishes to pay $100 monthly into a LPUA. The ricer would count as $10,800 ((100 x 12) x 9) for nonmedical limits. HOW TO APPLY - In Question 14 on the original application entitled Additional Information & Special Benefits, write Level PUA Rider and the premium amount. When added later, use the same wording on policy change form 1043 approved by your state, Section 8 in the area entitled Other Instructions. Also complete Part II of SPECIAL CLASS - The LPUA will not be issued on an Insured rated higher than Table F or over $15 per $1,000 flat extra. Substandard rates for the LPUA will be charged for an Insured rated above Table B or $5 per $ 1,000 flat extra. RECEIPT OF PREMIUM - If the money is not received with the original application, it will be discounted at the premium deposit fund interest rate back to the original policy date. When added at anniversary, the rider will be dated effective as of the anniversary date. The premium must be received within 90 days following the anniversary date and will be discounted at the premium deposit fund interest rate back to the anniversary date. WAIVER OF PREMIUM - This benefit is available if included on the base policy. The maximum issue limit is 3 times the base policy premium. If a larger LPUA premium is desired, waiver is not available on either the base policy or rider. The waiver premium is calculated as a level percentage of premium as shown below. TABLE OF WAIVER PERCENTAGES Issue Issue Issue Age % Age % Age % e.g. - Applicant age 25 wishes to pay $1,000 annually into a LPUA with waiver. $ ($1,000 : 1.02) would be used as LPUA premium and $19.61 would be used as a waiver premium. (04/13) C-19

20 Paid-Up Additions Rider (FPUA-95) DESCRIPTION The Flexible Paid-Up Additions Rider (FPUA) may only be attached to the GPWL policy. Rider premiums are used to purchase paid-up additions. For the rider to be in force, it is required that the GPWL dividend option also be paid-up additions. LEVELIZE GOAL The goal of adding the FPUA rider to the GPWL policy is to levelize the total out-of-pocket premium cost for the policy and rider. The FPUA rider premium, and dividends from the base policy and the rider, generate additional insurance and cash value. When required, a portion of the paidup additional insurance will be surrendered to keep the total outof-pocket premium level. PREMIUM INCREASE RISK Under the Levelized GPWL Concept future premiums may have to be increased. The levelized premium for the GPWL with FPUA rider is computed using some illustrated level of dividends. If actual future dividends fall below this level, the original levelized premium will have to be increased. FLEXIBLE PREMIUMS FPUA premiums are flexible. Annualized premiums are generally equal to or less than the amount paid in the previous year. Annualized premiums greater than the amount paid in the previous year must be underwritten and approved. RIDER VALUES The FPUA death benefit is the amount of rider paid-up additions. The FPUA premium, net of a 6% expense charge, is used as a net single premium to purchase whole life paidup additions. The net single premium is calculated using the 1980 CSO Table and 4.5% interest. Dividends on the FPUA are used to purchase more paid-up additions. AUTOMATIC SURRENDER TO PAY PREMIUMS The FPUA provides for partial surrender of the PUAs to pay a premium on the base policy. This provision takes effect automatically when any part of the GPWL premium is not paid and the FPUA has sufficient net cash value. There is no surrender charge. The PUA death benefit is decreased when this occurs. ISSUE AGES 0 through 75. MINIMUM PREMIUM none. MAXIMUM PREMIUM $150,000 without prior company approval. NONMEDICAL LIMITS We consider previous insurance with us, and the GPWL face amount, to determine the need for a medical exam or other requirements. We also consider the product of (1) the first year annualized premium for the FPUA rider, and (2) the appropriate factor from the following table: Issue Ages Factor & up 3 e.g. FPUA first year annual premium is $500 for applicant age 38. The rider would count as $4,500 (500 x 9) for nonmedical limits. HOW TO APPLY (1) Elect the Paid-Up Additions Dividend Option for the GPWL. (2) In additional information box, write the following: Add FPUA, with first rider premium = $. A level premium outlay is desired. Surrender PUAs as needed. WHEN TO APPLY Generally the FPUA must be applied for at time of application for the GPWL. However, if the LPUA were used to implement the Levelized GPWL Concept, then the LPUA may be exchanged for the FPUA after the FPUA is approved for use in your state. SUBSTANDARD The FPUA will be issued on an Insured rated through Table F or $15 per $1,000 flat extra. Substandard rates for the FPUA will be charged for an Insured rated above Table B or $5 per $1,000 flat extra. PENSION ISSUE The Levelized GPWL Concept is available for regular, simplified or guaranteed issue on pension cases. GOVERNMENT ALLOTMENT & MONTHLY PAYROLL DEDUCTION Must be sold at no more than 85% of current dividend scale. PREMIUM WAIVER Not available on this rider. C-28 3/95 (04/13) C-20