Single Premium Whole Life Insurance Illustration

Transcription

1 24950 Chagrin Blvd., Beachwood Ohio Single Whole Life Insurance Illustration Life Illustration for: MRS CLIENT Phone: (###) ###-#### Presented by: TED MILLER, MGA, WI Phone: Page 1 of 8 Product Code: Date Prepared: 01/14/2009 Form Number: 01-SPWL-05

2 Information: Product Description: The product illustrated is an individual life insurance certificate. This product provides permanent life insurance in just ONE premium payment. s become PAID-UP Immediately. Savings are instant and grow through certificate cash value. The purchase establishes your membership in the FCSLA providing access to a variety of fraternal benefits and activities. Eligible Issue : 0 through 90 Minimum purchase of $2,000 required. : The will be paid in one lump sum payment. The Guaranteed is reflected under the columns in this illustration. The Non-Guaranteed is reflected under the Total column. : Cash value is immediate and grows throughout the life of the certificate. Cash value is available for loan or surrender options. The Guaranteed is reflected under the columns in this illustration. The Non-Guaranteed is reflected under the Total column. A single contract premium is due with the certificate application. See Guaranteed tabular detail for actual amounts. Class: The premium payments shown in this illustration assume that you qualify for the risk classification shown in the page header. Actual premiums will depend on the risk factors applied by our underwriters. If this varies from what is shown on this illustration, you will receive a revised illustration with your certificate. Non-Guaranteed Values: These benefits and values are not guaranteed. This illustration assumes that the currently illustrated non-guaranteed elements will continue unchanged for all years shown. This is not likely to occur, and actual results may be more or less favorable than those shown. Dividends: This product is a participating whole life contract. Dividends are determined annually and will be credited, after the second year, on the Anniversary at the end of the contract year of determination. The dividend is reflected under the Annual Dividend column in this illustration. The following dividend options are available: Option 1 - Accumulate: We will hold the dividend on deposit at annual, compound, interest. The interest rate will not be less than 3.0% per year. Interest will be credited each year on the Anniversary date. This option, if selected, is reflected under the of Accumulated Dividends column in this illustration. Option 2 - Cash: The dividend will be paid in cash. This option, if selected, is reflected under the Annual Dividend column in this illustration. Option 3 - *: The dividend will be applied as a net single premium to buy participating, paid-up, whole life insurance for the Insured. The amount of paid-up insurance will be determined: (a) at the sex and then of the Insured; (b) at the Class shown in this illustration; and (c) using Our then table of net single premium rates. The cash value of the additions, at any time, will not be less than the greater of: (a) the then net single premium for the additions; or (b) the sum of the dividends used to purchase the additions. This option, if selected, is reflected under the column in this illustration. Page 2 of 8

3 Information: You may withdraw all or part of the cash value of any additions or accumulation at any time. Any portion of the cash value used as security for Debt may not be withdrawn; however, if You so request, it may be applied to reduce the Debt. * Reinvesting your dividends by purchasing paid up additional insurance offers the greatest insurance value. Fraternal Benefits: Post Mortem Benefit: FCSLA enhances its permanent life insurance products by issuing a 25% Post Mortem Benefit (PMB). This benefit may pay an additional 25% on a member s first of permanent life insurance, and on any paid-up additional insurance associated with the first of permanent life coverage. This Non-Guaranteed benefit is paid to the beneficiary at time of claim. s become eligible for the PMB after the second year. Page 3 of 8

4 Information: Summary Information 1 71 $52, $0.00 $58, $0.00 $66, $0.00 $80, $0.00 Cost Comparison Indexes. An explanation of the intended use of the following indexes is provided in the Life Insurance Buyer's Guide. Net Payment Surrender Cost Index Cost Index 10, Basic 20, Basic REQUIRED SIGNATURES: Applicant, please initial where applicable, $58.16 $33.28 $7.73 $10.15 This illustration does not fully conform to the certificate for which I am applying for. For example, I may be applying for different amounts of insurance, premium amount, or optional benefits. These changes will impact the premiums illustrated. I understand that I will receive a conforming illustration at or prior to the time of any certificate delivery. I will carefully review that illustration upon receipt. I have received a copy of this illustration and understand that any non-guaranteed elements illustrated are subject to change and could be either higher or lower. The agent has told me they are not guaranteed. Applicant's or owner's Signature Date I certify that this illustration has been presented to the applicant and that I have explained that any non-guaranteed elements illustrated are subject to change. I have made no statements that are inconsistent with the illustration. Authorized Representative Signature Date Page 4 of 8

5 Information: Guaranteed Values ly Detail: 1 71 $52, $0.00 $54, $0.00 $55, $0.00 $57, $0.00 $58, $0.00 $60, $0.00 $62, $0.00 $63, $0.00 $65, $0.00 $66, $0.00 $68, $0.00 $69, $0.00 $71, $0.00 $72, $0.00 $74, $0.00 $75, $0.00 $76, $0.00 $78, $0.00 $79, $0.00 $80, $0.00 $81, $0.00 $82, $0.00 $83, $0.00 $84, $0.00 $85, $0.00 $86, $0.00 $87, $0.00 $88, $0.00 $88, $0.00 $89,600 Page 5 of 8

6 Information: Guaranteed Values ly Detail (Continued): $0.00 $90, $0.00 $91, $0.00 $91, $0.00 $92, $0.00 $92, $0.00 $93, $0.00 $93, $0.00 $94, $0.00 $94, $0.00 $95, $0.00 $95, $0.00 $95, $0.00 $96, $0.00 $96, $0.00 $96, $0.00 $96, $0.00 $97, $0.00 $97, $0.00 $97, $0.00 $97, $0.00 Page 6 of 8

7 Information: Non-Guaranteed Values ly Detail: Guaranteed Non-Guaranteed* Annual Dividend Paid Up Additions Total Total 1 71 $52, $0 $52, $0.00 $54, $1,051 $54,871 $101, $0.00 $55, $2,109 $56,978 $102, $0.00 $57, $3,175 $59,225 $103, $0.00 $58, $4,245 $61,412 $104,245 2, $0.00 $60, $5,327 $63,629 $105, $0.00 $62, $6,418 $65,986 $106, $0.00 $63, $7,517 $68,288 $107, $0.00 $65, $8,622 $70,636 $108, $0.00 $66, $9,742 $73,095 $109,742 5, $0.00 $68, $10,865 $75,542 $110, $0.00 $69, $12,000 $77,992 $112, $0.00 $71, $13,145 $80,489 $113, $0.00 $72, $14,296 $83,035 $114, $0.00 $74, $15,465 $85,455 $115,465 9, $0.00 $75, $16,637 $87,903 $116, $0.00 $76, $17,822 $90,409 $117, $0.00 $78, $19,020 $92,859 $119, $0.00 $79, $20,228 $95,254 $120, $0.00 $80, $21,445 $97,594 $121,445 14, $0.00 $81,400 1, $22,669 $99,981 $122, $0.00 $82,500 1, $23,911 $102,261 $123, $0.00 $83,700 1, $25,162 $104,844 $125, $0.00 $84,900 1, $26,418 $107,480 $126, $0.00 $85,900 1, $27,691 $109,772 $127,691 19, * These benefits and values are not guaranteed; the assumptions on which they are based are subject to change by the insurer and actual results may be more or less favorable. Page 7 of 8

8 Information: Non-Guaranteed Values ly Detail (Continued): Guaranteed Non-Guaranteed* Annual Dividend Paid Up Additions Total Total $0.00 $86,800 1, $28,979 $111,999 $128, $0.00 $87,500 1, $30,280 $114,061 $130, $0.00 $88,100 1, $31,592 $116,057 $131, $0.00 $88,800 1, $32,912 $118,186 $132, $0.00 $89,600 1, $34,245 $120,451 $134,245 25, $0.00 $90,300 1, $35,588 $122,653 $135, $0.00 $91,000 1, $36,942 $124,892 $136, $0.00 $91,700 1, $38,318 $126,854 $138, $0.00 $92,300 1, $39,705 $129,063 $139, $0.00 $92,900 1, $41,101 $131,312 $141,101 32, $0.00 $93,400 1, $42,518 $133,137 $142, $0.00 $93,900 1, $43,945 $135,357 $143, $0.00 $94,400 1, $45,391 $137,222 $145, $0.00 $94,800 1, $46,844 $139,414 $146, $0.00 $95,200 1, $48,317 $141,216 $148,317 38, $0.00 $95,500 1, $49,796 $143,381 $149, $0.00 $95,800 1, $51,293 $145,120 $151, $0.00 $96,100 1, $52,810 $146,879 $152, $0.00 $96,400 1, $54,332 $149,150 $154, $0.00 $96,700 1, $55,872 $150,945 $155,872 46, $0.00 $96,900 1, $57,433 $152,660 $157, $0.00 $97,200 1, $58,997 $155,040 $158, $0.00 $97,400 1, $60,580 $156,792 $160, $0.00 $97,600 1, $62,182 $158,562 $162, $0.00 $97,900 1, $63,803 $160,452 $163,803 53, $0.00 1, $65,426 $165,426 $165,426 55, * These benefits and values are not guaranteed; the assumptions on which they are based are subject to change by the insurer and actual results may be more or less favorable. Page 8 of 8