THIS IS AN EXACT COPY OF YOUR POLICY EXCEPT FOR YOUR SPECIFIC INFORMATION SUCH AS NAME, ADDRESS, COVERAGE, AND PREMIUMS

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1 American Century Life Insurance Company of Texas (a stipulated premium company) Phone (855) , Fax (855) THIS IS AN EXACT COPY OF YOUR POLICY EXCEPT FOR YOUR SPECIFIC INFORMATION SUCH AS NAME, ADDRESS, COVERAGE, AND PREMIUMS AMERICAN CENTURY LIFE INSURANCE COMPANY OF TEXAS Plano, Texas Hereinafter called the Company This policy is issued in consideration of the application, a copy of which is attached hereto and made a part hereof, the payment in advance of the initial premium, and the continuous payment of renewal premiums. The Company will pay to the Beneficiary (ies) designated below, at its Home Office in Plano, Texas, the sum set opposite the insured's name upon due proof of the death of the insured while this Policy is in full force and effect and subject to the terms and conditions herein set out. In the event of the death or withdrawal of any insured, the total premium payable as below provided shall be reduced by the portion of the total premium included for such deceased or withdrawn insured enumerated in the table of premiums. This policy pays limited benefits as shown on Page two (2), if death occurs in military or naval service or is caused by suicide. The conditions and privileges set forth in this and the succeeding pages hereof constitute a part of this contract as fully as though recited over the signatures thereto affixed. Signed at the Home Office of American Century Life Insurance Company of Texas, of Plano, Texas, on the date of issue as shown below, which is the effective date hereof. Roni Ido Secretary Raz Silberman President WHOLE LIFE POLICY SCHEDULE Policy Issue Annual Semi Bank Number Date Premium Annual Quarterly Monthly Draft XXXXXX XXXXXX $XX.XX $XX.XX $XX.XX $XX.XX $XX.XX Issue Insured Insured Age Amount John Smith XX $XX,XXX.XX Owner: John Smith 100 Main St. Main City, TX Policy L-222 NAME OF INSURED NOTE: BENEFICIARY(IES) ARE NAMED IN THE APPLICATION ATTACHED HERETO AND MADE A PART HEREOF.

2 IMPORTANT NOTICE To obtain information or make a complaint: AVISO IMPORTANTE Para obtener información o para presentar una queja: You may call American Century Life Insurance Company of Texas s toll-free telephone number for information or to make a complaint at: Usted puede Ilamar al número de teléfono gratuito de American Century Life Insurance Company of Texas s para obtener información o para presentar una queja al: (855) (855) You may also write to American Century Life Insurance Company of Texas at: American Century Life Insurance Co. of TX FAX: (855) customerservice@acl-tx.com Usted también puede escribir a American Century Life Insurance Company of Texas: American Century Life Insurance Co. of TX FAX: (855) customerservice@acl-tx.com You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights, or complaints at: Ustede puede comunicarse con el Departamento de Seguros de Texas para obtener información sobre compañías, coberturas, derechos, o quejas al: You may write the Texas Department of Insurance: P.O. Box Austin, TX Fax: (512) Web: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact American Century Life Insurance Company of Texas first. If the dispute is not resolved, you may contact the Texas Department of Insurance. Usted puede escribir al Departamento de Seguros de Texas a: P.O. Box Austin, TX Fax: (512) Sitio web: ConsumerProtection@tdi.texas.gov DISPUTAS POR PRIMAS DE SEGUROS O RECLAMACIONES: Si tiene una disputa relacionada con su prima de seguro o con una reclamación, usted debe comunicarse con American Century Life Insurance Company of Texas primero. Si la disputa no es resuelta, usted puede comunicarse con el Departamento de Seguros de Texas. ATTACH THIS NOTICE TO YOUR POLICY: ADJUNTE ESTE AVISO A SU PÓLIZA : This notice is for information only and does not Este aviso es solamente para propósitos informativos y become a part or condition of the attached no se convierte en parte o condición del documento document. adjunto.

3 EXCEPTIONS 1. Should the death of any Insured hereunder occur while such Insured is engaged in Military or Naval Service in time of War, or if death is caused by suicide, sane or insane, then and in that event the amount payable hereunder because of such death shall be limited to a sum equal to the amount of premiums paid on behalf of such Insured from the effective date hereof, not to exceed the Insured Amount for such Insured. For purposes of this exclusion the premium allocable or any individual Insured shall be the amount set opposite the name of such insured. A. PREMIUMS 1. All premiums are payable in advance or within thirty-one (31) days of the date set forth on the premium noticed as mailed from the office of the Company, and must be paid to said office direct, automated bank draft or to an authorized collecting agency. 2. Any balance of premium for any Insured for the current policy year remaining unpaid when the death of such Insured occurs shall be deducted from the amount for which the Company would otherwise be liable. 3. Failure of the Insured to pay the required premiums when due or within the grace period as herein set forth will cause this policy to automatically lapse in which event the Company shall be relieved of any and all liability thereunder. 4. A grace period of thirty-one (31) days is granted under the terms of this policy for the payment of each premium, except the first, without lapsation, and during which this policy will remain in full force and effect. 5. Premiums may be paid either annually, semi-annually, quarterly, or monthly, at the option of the Insured. If any premium is paid other than in cash or post office money order, any receipt issued by the Company may be void if such method of payment is not honored upon first presentation. 6. No obligation is assumed by the Company prior to delivery of this policy and then upon the condition that the Insured hereunder are alive and in good health both mentally and physically, and also only after the initial premium has been fully paid. 7. It is the duty of the Insured to keep the Company advised of change of address and the Company will assume no responsibility for the delivery of notices beyond the mailing of same to the last known address. B. REINSTATEMENT 1. Should this policy lapse through failure of the Insured to complete payments of the premiums as they are called for or within the grace period specified, this policy may be reinstated within nine (9) months after the date of lapsation by the Insured s executing an application for reinstatement, and paying thereon the delinquent premiums and one advanced premium, provided such policyholders present proof of good health as required in the application for reinstatement, and provided further that no reinstatement shall be binding upon the Company until accepted by the Company and written notice thereof has been given to the Insured under such policy. 2. Policies that have remained lapsed for a period longer than nine (9) months will not be reinstated under any circumstances. Policy L-222 3

4 Policy L C. GENERAL PROVISIONS 1. The issuance of this policy is based on the application therefore, a copy of which is attached hereto, as filed in the Home Office of the Company at Plano, Texas. Said application, reinstatement thereof, if any, with its representations, together with this policy, shall be, and constitute, the entire contract and agreement between the Insured and/or Beneficiary (ies) and AMERICAN CENTURY LIFE INSURANCE COMPANY OF TEXAS in every respect. If any misstatement had been made with intent to deceive in the application regarding health or physical condition of one applicant, or any other fact that would materially affect the liability assumed, or if any applicant shall not be in good and sound health at the time of this policy or at any reinstatement thereof, then this policy shall be null and void within the contestable periods as to such applicants, and the Company shall than be liable to such applicant only in a sum equal to the amount of premiums paid on behalf of such Insured from this effective date hereof, not to exceed the insured amount for such insured. All statements contained in the application for this policy or application for reinstatement shall, in the absence of fraud, be deemed representative and not warranties. 2. The Insured shall have the right (subject to any assignment) at any time to change the Beneficiary (ies) herein named by mailing notice to the Company, accompanied by the policy for proper endorsement thereon. Should any designated Beneficiary named be deceased at the date of death of any Insured, all sums due shall be paid to the Insured s estate. 3. The Insured shall, by agreement of all persons insured hereunder, have the right to assign this policy. Any such agreement must be made in duplicate on forms approved by the Company, and one copy filed with the same at its home office, the other copy to be attached to the policy. The Company will assume no liability as to the validity of such assignment. All claims arising where assignment has been made shall be subject to proof of interest and extent thereof satisfactory to the Company. 4. Any assignee of this policy shall take same subject to any existing indebtness against same, whether he or she has been given notice thereof or not. 5. The policy shall be incontestable after having been in force during lifetime of each insured for a period of two (2) full years from date of issue or six months from any date of reinstatement thereof except for the failure of the Insured to pay the specified premiums when due or within the grace period allowed. 6. All claims for benefits under this policy must be filed with and are payable at the Home Office of the Company in Plano, Texas and shall be filed within ninety-one (91) days after death of any Insured. Claims will be paid in the order in which they have been approved and within sixty (60) days from the date that full and complete proof of loss is filed. 7. No officers, agent, Board of Directors or any other managing or governing body of this Company shall ever be held liable or construed as in any manner individually liable for the payment of any kind of character of claims or obligation of the Company. The same shall be payable only out of funds of the company as collected from its policy holders and then only as provided by the laws of the State of Texas. 8. Agents are prohibited from making any changes, alterations or additions to the terms or provisions of this policy, and any representations to the contrary shall not be binding on the Company. 9. No proceeding in law or equity shall be brought or maintained to collect on any claim under this policy until after sixty (60) days from the date of the receipt of proofs of the validity of claim nor after two years and one day from date of the cause action accrues. 10. If the age of any Insured is misstated in the application, the amount of insurance payable shall be that which the premium actually paid would purchase at the correct age, based on the rates in force at the time of death of such Insured.

5 IMPORTANT INFORMATION ABOUT COVERAGE UNDER THE TEXAS LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION (For insurers declared insolvent or impaired on or after September 1, 2011) Texas law establishes a system to protect Texas policyholders if their life or health insurance company fails. The Texas Life and Health Insurance Guaranty Association ( the Association ) administers this protection system. Only the policyholders of insurance companies that are members of the Association are eligible for this protection which is subject to the terms, limitations, and conditions of the Association law. (The law is found in the Texas Insurance Code, Chapter 463.) It is possible that the Association may not protect all or part of your policy because of statutory limitations. Eligibility for Protection by the Association When a member insurance company is found to be insolvent and placed under an order of liquidation by a court or designated as impaired by the Texas Commissioner of Insurance, the Association provides coverage to policyholders who are: Residents of Texas (regardless of where the policyholder lived when the policy was issued) Residents of other states, ONLY if the following conditions are met: 1. The policyholder has a policy with a company domiciled in Texas; 2. The policyholder s state of residence has a similar guaranty association; and 3. The policyholder is not eligible for coverage by the guaranty association of the policyholder s state of residence. Limits of Protection by the Association Accident, Accident and Health, or Health Insurance: For each individual covered under one or more policies: up to a total of $500,000 for basic hospital, medical-surgical, and major medical insurance, $300,000 for disability or long term care insurance, or $200,000 for other types of health insurance. Life Insurance: Net cash surrender value or net cash withdrawal value up to a total of $100,000 under one or more policies on a single life; or Death benefits up to a total of $300,000 under one or more policies on a single life; or Total benefits up to a total of $5,000,000 to any owner of multiple non-group life policies. Individual Annuities: Present value of benefits up to a total of $250,000 under one or more contracts on any one life. Group Annuities: Present value of allocated benefits up to a total of $250,000 on any one life; or Present value of unallocated benefits up to a total of $5,000,000 for one contractholder regardless of the number of contracts. Aggregate Limit: $300,000 on any one life with the exception of the $500,000 health insurance limit, the $5,000,000 multiple owner life insurance limit, and the $5,000,000 unallocated group annuity limit. These limits are applied for each insolvent insurance company. Insurance companies and agents are prohibited by law from using the existence of the Association for the purpose of sales, solicitation, or inducement to purchase any form of insurance. When you are selecting an insurance company, you should not rely on Association coverage. For additional questions on Association protection or general information about an insurance company, please use the following contact information. Policy L-222 Texas Life and Health Insurance Guaranty Association Texas Department of Insurance 515 Congress Avenue, Suite 1875 P.O. Box Austin, Texas Austin, Texas or or