August 24, Dear Commissioners Bell and McCarty:

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2 Commissioner Walter Bell Co-Chair, NAIC Interstate Compact National Standards Working Group Department of Insurance, State of Alabama P O Box Montgomery, AL Commissioner Kevin McCarty Co-Chair, NAIC Interstate Compact National Standards Working Group Department of Financial Services, Office of Insurance Regulation 200 East Gaines Street Tallahassee, FL August 24, 2005 Dear Commissioners Bell and McCarty: We are writing to you in your roles as Co-Chairs of the NAIC Interstate Compact National Standards Working Group to share a document which we believe will be of great assistance to you in your current activities. As you may know, ACORD (Association for Cooperative Operations Research and Development) is a global, nonprofit insurance association whose mission is to facilitate the development and use of standards for the insurance, reinsurance and related financial services industries. For more than three decades, ACORD has served as a forum for insurance industry standards development and as such, is affiliated with close to 1,000 insurance and reinsurance companies and thousands of agents and brokers, related financial services organizations, software providers, and industry organizations worldwide. ACORD also works with other standards bodies to find areas of overlap or gaps to determine the best way to combine efforts and develop a unified flow of information. The attached document is a working, living document used by ACORD staff and subject to periodic review and update. It provides guidelines when ACORD acts as a third party filer submitting life insurance application forms to the states. The document also tracks differences in specific states which emanate from practice or statute which must be accommodated even in a standardized form. Since your Working Group is about to take on the task of creating a "Compact Application," we are pleased to share this information with you during the Speed To Market Summit as we feel it may be quite useful. ACORD stands ready to be of further assistance in the formation of the Compact. Our experience and expertise in creating operational standards within the insurance industry make us uniquely prepared to help with what is, essentially, a standards-setting process. As your Working Group s difficult and important work in developing product standards approaches completion, the next steps will be crucial in fulfilling the Compact s promise of true operational efficiency. We would be pleased to participate in any way which furthers the goals of the industry, the regulators, and ultimately, insurance consumers themselves. Please feel free to contact either of us at any time. Sincerely, Beth Grossman Assistant Vice President, Industry & Government Relations ACORD bgrossman@acord.org, , ext. 421 Ann Henstrand Consultant to ACORD, NAIC Matters MultiState Associates cc: Carolyn Johnson Speck, NAIC staff Members of the Interstate Compact National Standards Working Group Members of the Speed to Market Task Force: Interested persons

3 Table of Contents LIFE INSURANCE APPLICATION AND SUPPLEMENT FORMS...1 STATE SPECIFIC FORMS...2 FLORIDA...2 INDIANA...2 MAINE...2 MASSACHUSETTS...2 MARYLAND...3 MINNESOTA...4 MISSOURI...4 NEW JERSEY...5 PENNSYLVANIA...5 VERMONT...6 VIRGINIA...6 WISCONSIN...6 APPENDIX A: ACORD APPENDIX B: ACORD APPENDIX C: ACORD APPENDIX D: ACORD APPENDIX E: ACORD APPENDIX F: ACORD APPENDIX G: ACORD APPENDIX H: ACORD APPENDIX I: ACORD APPENDIX J: ACORD New York Two Blue Hill Plaza 3 rd Floor Pearl River, NY Fax London London Underwriting Centre Suite 2/5 3 Minster Court Mincing Lane London EC3R 7DD +44 (0) (0) Fax

4 Life Insurance Application and Comparison by State The following forms are acceptable in all states plus DC, except for: FL, IN, ME, MD, MA, MN, MO, NJ, PA, VT, VA, WI ACORD 701 (2003/09) Life Insurance Application, Part 1 ACORD 702 (2004/03) Life Insurance Application, Part 2 Medical History ACORD 703 (2004/03) Medical Examiners Report ACORD 754 (2003/09) Life Insurance Application Supplement, Additional Other Proposed Insured ACORD 755 (2003/09) Life Insurance Application Supplement, Additional Owners ACORD 756 (2003/09) Life Insurance Application Supplement, Additional Beneficiaries ACORD 761 (2005/03) Policy Effective Date Supplement, Date of Policy Application* ACORD 762 (2005/03) Policy Effective Date Supplement, Date of Policy Delivery* ACORD 763 (2005/03) Policy Effective Date Supplement, Date Policy Issued* ACORD 768 (2004/03) Life Insurance Application, Part 2 Medical History Supplement *KS will not accept a Policy Effective Date Supplement, since KS law states that no qualifications are allowed for the start of temporary insurance. *NY will approve only one of the three Policy Effective Date Supplements for each company. [ 1 ]

5 State Specific Forms The following are the state-specific forms, and a description of the differences between the state-specific forms and those shown above. Florida ACORD 702 FL (2004/10), Florida Life Insurance Application, Part 2 Medical History. 1. The form title includes the state name, and the edition date is changed to 2004/ The words "disorder or condition" are removed from 3. MEDICAL CONDITIONS question 52. The item now reads "Any other disease not mentioned above." ADDITIONAL MEDICAL CONDITIONS question 67 is replaced with "Within the last ten years have you been tested positive for exposure to the HIV infection or been diagnosed as having ARC or AIDS caused by the HIV infection or other sickness or condition derived from that infection?" 4. The words "within the last ten years" are inserted in 4. ADDITIONAL MEDICAL CONDITIONS question A Florida-specific fraud warning is added to the last page. ACORD 703 FL (2004/12), Florida Medical Examiners Report, and ACORD 768 FL (2004/10), Florida Life Insurance Application Part 2 Medical History Supplement. 1. The form title includes the state name, and the edition dates are changed. 2. A Florida-specific fraud warning is added to the second page. Indiana ACORD 702 IN (2004/10), Indiana Life Insurance Application Part 2, Medical History. 1. The form title includes the state name, and the edition date is changed to 2004/ The words "had any known indication of" are deleted from the sentence above the questions in 3. MEDICAL CONDITIONS on page The terms AIDS and HIV are defined in 3. MEDICAL CONDITIONS question 67 on page two. 4. A fraud warning is added to the last page. Maine ACORD 701 ME (2003/09), Maine Life Insurance Application, Part 1 1. The form title includes the state name. 2. The variable information in the DIVIDEND OPTIONS and SUPPLEMENTAL COVERAGES sections in 3. INSURANCE APPLIED FOR on page 1 are removed. 3. The words "with respect to insurance previously applied for" are added to the beginning of the first sentence in 10. GENERAL INFORMATION question b) 4. The sentence in 10. GENERAL INFORMATION question c) is now followed by "if yes, provide details." 5. The words "if yes, complete appropriate supplement" are deleted from 10. GENERAL INFORMATION questions 10 g) and 10 h). [ 2 ]

6 6. The words "any hazardous activities or sports such as" are deleted from 10. GENERAL INFORMATION question h), and "parachuting, hang gliding and rodeo riding" are added. 7. A caveat is added below 10.GENERAL INFORMATION question 10 J) as follows: "Answer this question "NO" if you have been tested positive for HIV but have not developed symptoms of the disease AIDS/ARC." 8. A Maine-specific fraud warning is added to the last page. ACORD 702 ME (2004/10), Maine Life Insurance Application, Part 2 Medical History. 1. The form title includes the state name. 2. The words "had any known indication of" are deleted from the second sentence in 3. MEDICALCONDITIONS MEDICAL CONDITIONS questions 28, 33 and 52, as well as 4. ADDITIONAL MEDICAL INFORMATION questions 55, 61, 62, 65 and 67, all have the same caveat added as is described in item 7 above with respect to ACORD 701 ME. 4. A Maine-specific fraud warning is added to the last page. ACORD 703 ME (2004/03), Maine Medical Examiners Report. 1. The form title includes the state name. 2. A Maine-specific fraud warning is added to Page 2. ACORD 754 ME (2003/09), Maine Life Insurance Application Supplement, Additional Other Proposed Insured. 1. The form title includes the state name. 2. The same caveat is added to GENERAL INFORMATION question 4 j) as is described in item 7 above with respect to ACORD 701 ME. 3. A Maine-specific fraud warning is added to page 3. ACORD 768 ME (2004/10), Maine Life Insurance Application Part 2, Medical History Supplement 1. The form title includes the state name. 2. The same caveat is added to this form as is described in item 7 above with respect to ACORD 701 ME. 3. A Maine-specific fraud warning is added to page 2. Massachusetts ACORD 701 MA (2004/08), Massachusetts Simplified Issue Life Insurance Application, Part 1 1. The form title includes the state name and the words "Simplified Issue," and the edition date is changed to 2004/ The variable information in the DIVIDEND OPTIONS and SUPPLEMENTAL COVERAGE sections in 3. INSURANCE APPLIED FOR on page 1 are removed. 3. The words "with respect to insurance previously applied for" are added to the beginning of the first sentence in 10 GENERAL INFORMATION question b). 4. The sentence in 10. GENERAL INFORMATION question c) is now followed by "if yes, provide details." 5. The words "if "yes" complete appropriate supplement" are deleted from 10. GENERAL INFORMATION question g) and h). 6. The words "any hazardous activities or sports such as" are deleted from 10 GENERAL INFORMATION question h), and "parachuting, hang gliding and rodeo riding" are added. 7. A warning is added to 10 GENERAL INFORMATION QUESTION i) "Note: a "yes" answer to this question could mean that coverage could be denied, the amount of insurance reduced, or an increased premium charged." [ 2 ]

7 8. A statement is added to Section 11 SIGNATURE "I acknowledge that I have received a copy of the Notice of Insurance Information Practices." 9. A Massachusetts-specific fraud warning is added to page 6. ACORD 702 MA (2004/08), Massachusetts Life Insurance Application, Part 2 Medical History 1. The form title includes the state name, and the edition date is changed to 2004/ The words "had any known indication of" are deleted from the second sentence in 3. MEDICALCONDITIONS. 3. The same statement described in item 8 for ACORD 701 MA is added to page A Massachusetts-specific fraud warning is added to page 3. ACORD 754 MA (2004/08), Massachusetts Simplified Issue Life Insurance Application Supplement, Additional Other Proposed Insured. 1. The form title and edition date are changed, same as ACORD 702 MA. 2. The same changes are made to the GENERAL INFORMATION questions as were made to ACORD 701 MA. 3. A Massachusetts-specific fraud warning is added to page 3. ACORD 755 MA (2004/08), ACORD 756 MA (2004/08), ACORD 761 MA (2004/08), ACORD 762 MA (2004/08), and ACORD 763 MA (2004/08) 1. The form title is changed, same as ACORD 701 MA. 2. A Massachusetts-specific fraud warning is added. Maryland Every form filed in Maryland is state-specific, but only to the extent of the differences noted below. ACORD 701 MD (2005/06), Maryland Life Insurance Application, Part 1 1. The form title includes the state name. 2. The words "NAME OF INSURANCE COMPANY MUST BE INSERTED BEFORE THIS FORM IS USED" are deleted from the COMPANY section at the top of the form. 3. The variable information in the DIVIDEND OPIONS and SUPPLEMENTAL COVERAGES sections in 3 INSURANCE APPLIED FOR on page 1 are removed. 4. BIRTH STATE/PROVINCE and BIRTH COUNTRY are deleted from 4. PROPOSED INSURED on page 1 and from 5. OTHER PROPOSED INSURED on page The words "with respect to insurance previously applied for" are added to the first sentence in 10 GENERAL INFORMATION question b). 6. The sentence in 10. GENERAL INFORMATION question c) is now followed by "if yes, provide details." 7. The words "any hazardous activities or sports such as "are deleted from 10. GENERAL INFORMATION question h), and "parachuting, hang gliding and rodeo riding" are added. 8. A state-specific fraud warning is added. ACORD 754 MD (2005/06), Maryland Life Insurance Application Supplement, Additional Other Proposed Insured. The same changes were made to this form as are described for ACORD 701 MD above, items 1 and 2, and 4 through 7. All other application supplements for Maryland were changed only to the extent of the two differences noted below. [ 3 ]

8 1. The form titles include the state name, and the form edition dates are 2004/ The words "NAME OF INSURANCE COMPANY MUST BE INSERTED BEFORE THIS FORM IS USED" is deleted from the COMPANY section at the top of each form. Minnesota ACORD 701 MN (2004/08), Minnesota Life Insurance Application, Part 1 1. The form title includes the state name, and the edition date is 2004/ The variable information in the DIVIDEND OPTIONS and SUPPLEMENTAL COVERAGES sections in 3 INSURANCE APPLIED FOR on page 1 are removed. 3. The words "with respect to insurance previously applied for" are added to the beginning of the first sentence in 10. GENERAL INFORMATION question b). 4. The sentence in 10. GENERAL INFORMATION question c) is now followed by "if yes provide details." 5. The words "any hazardous activities or sports such as" are deleted from 10. GENERAL INFORMATION question h), and "parachuting, hang gliding and rodeo riding" are added. Also, the word "organized" is inserted in front of "motor vehicle". 6. The word "medically" is inserted in front of the words "advised" in two places in 10. GENERAL INFORMATION question j). 7. The words "within the past five years" are added to the beginning of the sentence in 10. GENRAL INFORMATION question k). 8. A state-specific fraud warning is added. ACORD 702 MN (2005/02), Minnesota Life Insurance Application, Part 2 Medical History 1. The form title includes the state s initials, and the edition date is 2005/ The same changes are made to this form as are described in items 6 and 7 above for ACORD 701 MN. ACORD 754 MN (2004/08), Minnesota Life Insurance Application Supplement, Additional Other Proposed Insured The same changes were made to this form as are described for ACORD 701 MN, items 1 and 3 through 8. In addition to the above changes, ACORD 755 MN, ACORD 756 MN, ACORD 761 MN, ACORD 762 MN, and ACORD 763 MN now have the state name in the title, and the edition date of 2004/08. No other changes were made. Missouri ACORD 701 MO (2004/08), Missouri Life Insurance Application, Part 1 1. The form title includes the state name, and the edition date is changed to 2004/ The variable information in the DIVIDEND OPTIONS and SUPPLEMENTAL COVERAGES sections in 3. INSURANCE APPLIED FOR on page 1 are removed. 3. Question a) in 10. GENERAL INFORMATION is deleted. 4. The words "with respect to insurance previously applied for" are added to the beginning of the first sentence in 10. GENERAL INFORMATION question b). 5. The sentence in 10. GENERAL INFORMATION question c) is now followed by "if yes, provide details." 6. The words "any hazardous activities or sports such as" are deleted from 10. GENERAL INFORMATION question h), and "parachuting, hang gliding and rodeo riding" are added. 7. A state-specific fraud warning is added. [ 4 ]

9 ACORD 754 MO (2004/08), Missouri Life Insurance Application Supplement, Additional Other Proposed Insured The same changes were made to this form as are described for ACORD 701 MO above, items 1 3 through 7. In addition to the above changes, ACORD 755 MO, ACORD 756 MO, ACORD 761 MO, ACORD 762 MO and ACORD 763 MO now have the state name in the title, and the edition date of 2004/08. No other changes were made. New Jersey ACORD 701 NJ (2005/02), New Jersey Life Insurance Application Part 1 1. The form title includes the state name, and the edition date is 2005/ The variable information in the DIVIDEND OPTIONS and SUPPLEMENTAL COVERAGES sections in 3 INSURANCE APPLIED FOR on page 1 are removed. 3. Reference to CREDIT CARD in 9 PAYMENT PLAN is deleted. 4. The words "with respect to insurance previously applied for" are added to the beginning of the first sentence in 10. GENERAL INFORMATION question b). 5. The sentence in 10. GENERAL INFORMATION question c) is now followed by "if yes, provide details." 6. The words "any hazardous activities or sports such as" are deleted from 10. GENERAL INFORMATION question h), and "parachuting, hang gliding and rodeo riding" are added. 7. The "standard" fraud warning on the last page is replaced by a New Jersey-specific fraud warning. ACORD 702 NJ (2004/10), New Jersey Life Insurance Application Part 2, Medical History 1. The form title includes the state name, and the edition date is 2004/ The "standard" fraud warning on the last page is replaced by a New Jersey-specific fraud warning. ACORD 754 NJ (2005/02), New Jersey Life Insurance Application Supplement, Additional Other Proposed Insured The same changes were made to this form as are described above for ACORD 701 NJ, items 1 and 4 through 7. In addition, an "I agree" statement is added to the last page, just above the signature line. In addition to the above changes, ACORD 755 NJ, ACORD 756 NJ, ACORD 761 NJ, ACORD 762 NJ, ACORD 763 NJ and ACORD 768 NJ now have the state name in the title and the 2005/02 edition date. Also, an "I agree" statement identical to the statement added to ACORD 754 NJ was added to each of these forms, as well as a state-specific fraud warning. Pennsylvania ACORD 701 PA (2004/06), Pennsylvania Life Insurance Application, Part 1 1. The state name is added to the title, and the edition date is changed to 2004/ The same changes are made to this form as are described in items 2, 4, 5, and 6 for ACORD 701 NJ. ACORD 754 PA (2004/06), Pennsylvania Life Insurance Application Supplement, Additional Other Proposed Insured The same changes are made to this form as are described in items 4 through 6 for ACORD 701 NJ ACORD 755 PA (2004/06), and ACORD 756 PA (2004/06) The state name is included in the title of each form, and the edition dates are changed to 2004/06. [ 5 ]

10 Vermont ACORD 702 VT (2004/10), Vermont Life Insurance Application, Part 2 Medical History 1. The form title includes the state name, and the edition date is 2004/ The words "had any known indication of" are deleted from the second sentence in 3. MEDICAL CONDITIONS. 3. The words "member of the medical profession in" 4. ADDITIONAL MEDICAL INFORMATION question 67 are changed to "licensed medical physician," and the words "or HIV infection" are deleted.. ACORD 768 VT (2004/10), Vermont Life Insurance Application Part 2 Medical History Supplement The form title includes the state name, and the edition date is 2004/10. Virginia ACORD701VA(2004/06), ACORD754VA(2004/06), ACORD755VA(2004/06), ACORD756VA(2004/06) Wisconsin ACORD 702 WI (2004/10), Wisconsin Life Insurance Application Part 2 Medical History 1. The form title includes the state name, and the edition date is 2004/ The words "had any known indication of" are deleted from the second sentence in 3.MEDICAL INFORMATION. 3. The following statement is added to question 67 in 4. ADDITIONAL MEDICAL INFORMATION: "Note: Wisconsin law provides that the applicant need not report the results of the tests conducted at an anonymous counseling and testing site, or home test results." ACORD 768 WI (2004/10), Wisconsin Life Insurance Application Part 2 Medical History Supplement The form title includes the state name, and the edition date is 2004/10. All four forms were changed as described for the same forms in Pennsylvania. Please Note: Due to a limitation in the number of characters allowable in a form number by the Virginia Dept. of Insurance, the above form numbers deliberately have no spaces. [ 6 ]

11 Appendix A: ACORD 701 [ 7 ]

12 [ 8 ]

13 [ 9 ]

14 [ 10 ]

15 [ 11 ]

16 [ 12 ]

17 Appendix B: ACORD 702 [ 13 ]

18 [ 14 ]

19 [ 15 ]

20 Appendix C: ACORD 703 [ 16 ]

21 Appendix D: ACORD 754 [ 17 ]

22 [ 18 ]

23 [ 19 ]

24 Appendix E: ACORD 755 [ 20 ]

25 Appendix F: ACORD 756 [ 21 ]

26 Appendix G: ACORD 761 [ 22 ]

27 Appendix H: ACORD 762 [ 23 ]

28 Appendix I: ACORD 763 [ 24 ]

29 Appendix J: ACORD 768 [ 25 ]