Ten Year Term Life Insurance Renewable Term

Ten Year Term Life Insurance Renewable Term Premiums are Guaranteed for the Life of the Contract Convertible Non-Participating Western Life Assurance Company P.O. Box 3300 Winnipeg, Manitoba R3C 5S2 A Stock Company PLEASE READ YOUR POLICY CAREFULLY - This policy is a legal contract between the owner and us, Western Life Assurance Company. We agree to pay the proceeds of this policy to the beneficiary upon receipt of due proof of the insured's death and to provide the other rights and benefits in accordance with the terms of this policy. Signed by Western Life Assurance Company at its Administrative Office in Winnipeg, Manitoba Canada on the policy date. 10 - DAY RIGHT TO EXAMINE POLICY The owner may return this policy to the agent or the Administrative Office for any reason within 10 days after receiving it. The policy will then be void from its beginning and any premium paid will be refunded. Underwritten by: Western Life Assurance Company; Administrative Office: 717 Portage Avenue, Winnipeg, MB Mailing Address: P.O. Box 3300, Winnipeg, MB R3C 5S2; Telephone: 1-888-647-LIFE (5433) Fax: (204) 783-6913 METT1009_v07012012_357 QA00009328 Page 1 of 11

Table of Contents Section 1 Policy Schedule...3 Section 2 Policy Definitions...5 Section 3 Amount of Proceeds...6 Section 4 Payment of Proceeds...6 Section 5 Claims...6 Section 6 Beneficiary...7 Section 7 Conversion...7 Section 8 Premiums...8 Section 9 General Provisions...9 METT1009_v07012012_357 QA00009328 Page 2 of 11

Section 1 Policy Schedule Insured Art Sample Policy Number QA00009328 Amount of Insurance $500,000.00 Policy Date Jun 19, 2012 Plan Type Term 10 Premium Class Male Non-Tobacco User Issue Age 33 First Renewal Date Jun 19, 2022 Maturity Date Jun 19, 2064 Monthly Premium $53.74 Annual Premium $645.00 Premium Payable Chequing Owner Name Art Sample Primary Beneficiary Name Estate Relationship to the Insured Estate Percentage 100 The premiums for this policy are per the schedule below and are fully guaranteed. The following are renewal premiums (including applicable riders): Beginning On: Total Annual Premium Jun 19, 2022 $1,700.00 Jun 19, 2032 $3,470.00 Jun 19, 2042 $9,390.00 Jun 19, 2052 $22,490.00 Jun 19, 2062 $36,520.00 METT1009_v07012012_357 QA00009328 Page 3 of 11

Applicable Riders Benefits provided by rider for Policy Number QA00009328: Plan Type Amount Accidental Death Benefit Rider $250,000.00 Children Protection Benefit $10,000.00 METT1009_v07012012_357 QA00009328 Page 4 of 11

Section 2 Policy Definitions Attained age means the age of the insured as of their last birthday. For the purposes of this policy, the age will increase on every policy anniversary. Amount of insurance is the amount of insurance shown on the policy schedule. Application means the application for the policy, including any written statements, as proof of insurability. Beneficiary is the person(s) to receive the policy proceeds in the event of the life insured's death. Insured is the person named in the policy schedule whose life the policy insures. Maturity date is the maturity date shown on the policy schedule and means the policy anniversary date following the life insured's age 85 which is the date on which this policy will terminate. Month means a period starting at 12:01 a.m. on the 1st day in a given calendar month and ending at 12:01 a.m. on the 1st day in the next calendar month. Owner means you, the life insured, are the owner of this policy unless another owner is named in the application for this policy. The owner has rights and privileges in accordance with the terms of the policy. Policy date means the date the policy is in effect. It is the date from which policy anniversaries, policy years and premium due dates are determined. Coverage begins on this date at 12:01 a.m. standard time at the life insured's residence and ends, subject to the grace period, at 12:01 a.m. on the date any renewal premium is due. The policy date is used in the definition of time periods specified in the misrepresentation and incontestability provisions. Policy anniversary is the same day and month as the policy date for each succeeding year this policy remains in force. Reinstatement date is the date the insurance under this policy is put back into force if this policy terminates as a result of unpaid premiums. We, Us, Our, or the Company means the Insurer of this policy, Western Life Assurance Company. You, your means the owner of the policy. METT1009_v07012012_357 QA00009328 Page 5 of 11

Section 3 Amount of Proceeds 3.1 Proceeds The proceeds payable at the time of the life insured's death will be the sum of: a) the amount of insurance; and b) the portion of any premium paid which applied to a period beyond the date of death; less: c) the portion of any premium due and unpaid which applies to a period prior to the date of death. Section 4 Payment of Proceeds 4.1 Payment Any amount payable at the time of the life insured's death will be paid in one sum. Interest will be paid on the proceeds from the date of death until the date of payment. The rate will be consistent with the rate of interest paid on policy proceeds left on deposit with the company Section 5 Claims The amount of insurance will be paid when the company has received written proof of claim satisfactory to the company. 5.1 Notice and proof of claim includes: a) evidence of the death of the life insured and the cause of death; b) the return of this policy; and c) any other information which the company may reasonably require to establish the validity of the claim. METT1009_v07012012_357 QA00009328 Page 6 of 11

Section 6 Beneficiary 6.1 Designation 6.2 Change The beneficiary named in the application for this policy will receive the proceeds upon the death of the life insured unless the beneficiary designation has been changed by the owner. All beneficiary designations, including the spouse, are revocable unless stated otherwise. The owner may change any beneficiary designation during the life insured's lifetime unless otherwise provided in the previous designation. A change of beneficiary designation will automatically revoke any previous designation. A beneficiary designated irrevocably on our records may not be changed except with written consent of that beneficiary. A change of designation may be made by filing a written request in a form satisfactory to the company at its Administrative Office. The company reserves the right to require this policy for endorsement of a change of beneficiary designation. 6.3 Death of beneficiary Unless otherwise provided in the beneficiary designation: a) if any beneficiary dies before the life insured, that beneficiary's interest will pass to any other beneficiaries according to their respective interests; or b) if no beneficiary survives the life insured, the proceeds will be paid in one sum to the owner, if living, otherwise to the owner's estate. Section 7 Conversion 7.1 Conversion You may apply to convert this policy to a permanent life insurance policy without giving us new evidence of insurability subject to the following conditions: a) You must send us an application prior to your age sixty five (65) and while the policy and any rider (if applicable) is in force and no premiums are in default. The application must be signed by the owner, any assignee, and any beneficiary whose designation the owner has not reserved the right to change. This policy must also be returned with the application. b) The new policy may be any plan then designated by the company as a conversion product. The amount of insurance of the new policy may not be more than the insurance provided by this policy. c) If the amount of insurance provided by this policy was reduced for any reason, the amount of the new life insurance policy may not exceed the amount of the reduced amount of insurance. METT1009_v07012012_357 QA00009328 Page 7 of 11

Partial conversion d) If this policy contains a rider for Child Protection Benefit and/or Waiver of Premium providing additional benefits, then a similar rider may be included, at the owner's request, subject to our rules in effect at the time of application for the converted insurance. The amount of each benefit cannot be greater than the amount of that same benefit in this policy. The terms and conditions of each benefit in the new policy will be the standard terms and conditions we're offering at the time you convert your coverage. e) The premiums for the new policy will be based on our rate for the sex, premium class and age of the insured person on the effective date of the new policy. f) The date of issue of the new policy will be the date of conversion and the first payment for the new policy is due on the date the policy is issued. When a partial conversion is requested, the balance of the coverage being retained must meet the minimum sum insured under the policy or rider being converted. Section 8 Premiums 8.1 Premium payments The first premium is due on the policy date and the policy will not take effect without its payment. After the first premium, premiums are payable in the amount and at the interval shown on the policy schedule. The owner may request a change in the frequency of premium payments on any anniversary date. This request must be in writing and is subject to our rules and approval. 8.2 Grace period A grace period of thirty (30) days will be allowed for payment of each premium after the first. The policy will continue in force during the grace period. If the premium has not been paid at the expiry of the grace period or within such longer period as may be permitted by applicable law, insurance under this policy will immediately lapse and cease to be in force. If the amount of insurance becomes payable during the grace period, any unpaid premium will be deducted from the amount payable. 8.3 Reinstatement The policy may be reinstated at any time within two (2) years after default. The requirements for reinstatement are: a) presentation of evidence of good health and insurability satisfactory to the company at the time of reinstatement that the life insured is insurable on the same basis as when this policy was issued, including evidence of non-tobacco use, if applicable; b) paying all premiums from the date of default; c) payment of annually compounded interest from the date of default at a rate of six (6) percent; METT1009_v07012012_357 QA00009328 Page 8 of 11

8.4 Renewal d) any additional company rules in effect on the date of application for reinstatement. If this policy is in force at the end of a term period, a new term period may be established by the terms of this provision by payment of the renewal premium. Renewal will be effective upon payment of premium on or before its' due date. Renewal of this policy will establish a new term period which will be the lesser of: a) 10 years; and b) the number of years remaining to the maturity date shown in section 1 of this policy. In no event will this policy continue in force beyond the date shown in the policy schedule. Section 9 General Provisions 9.1 Assignment No assignment of this policy will be binding on the company unless it is in writing and received by the company at its Administrative Office. The company will not be responsible for the validity of any assignment. Unless otherwise provided, the interest of any revocable beneficiary shall be subordinate to the interest of any assignee. The company reserves the right to require this policy for endorsement of any assignment. 9.2 Absolute assignment If this policy is absolutely assigned, the assignee will become the owner. 9.3 Cancellation This policy while in force may be cancelled by the owner. Cancellation will be as of the date that we receive both the policy and the owner's written request on a form satisfactory to us. Any unearned premium amount will be calculated from this date based on a monthly mode. 9.4 Collateral assignment 9.5 Control 9.6 Currency A collateral assignment will not cause a change of ownership, however, the rights of any owner, beneficiary, or other payee will be subject to the terms of the collateral assignment. Consistent with the terms of any beneficiary designation and any assignment, the owner may, during the life insured's lifetime, assign or terminate this policy; amend or modify this policy with the consent of the company; and exercise, receive, and enjoy every other right, benefit and privilege contained in this policy. METT1009_v07012012_357 QA00009328 Page 9 of 11

All payments under this policy, either to or by the company, will be made in the lawful money of Canada. 9.7 Elections, designation, changes and requests All elections, designations, changes and requests must be made in a form satisfactory to the company and become effective when received by the company at its Administrative Office. 9.8 Insurance age The Insurance age is the insured's age as of the last birthday prior to the policy date. 9.9 Misrepresentation and incontestability After this policy has been in force for two (2) years from the policy date or the most recent reinstatement date during the life insured's lifetime, failure to disclose, or a misrepresentation of a fact that is material to this insurance, does not, in the absence of fraud, render this contract voidable. 9.10 Misstatement of age or sex If the life insured's age or sex has been misstated, the benefits available under this policy will be those which the premium paid would have purchased for the correct age and sex. 9.11 Misstatement of tobacco use The company uses a more favorable basis to calculate premiums and monthly charges for non-tobacco users. If the life insured falsely answers questions related to his or her tobacco use in any application for this policy (including any application to reinstate), the policy will be considered void from inception. The term "void" means that the policy is no longer a binding contract and is cancelled from inception. 9.12 Non-participating This policy is not eligible for dividends. 9.13 Suicide within two years We will not pay the claim proceeds if, within two (2) years from the policy date or most recent reinstatement date, the life insured takes his or her own life, whether or not in possession of his or her mental faculties or attempts to take his or her own life and death results directly or indirectly from such action. The liability of the company under this policy will be limited to the refund of all premiums paid since such date. 9.14 The Contract This policy is issued in consideration of the application and payment of the first premium. The application, this policy, any document attached at issue, and any amendment to the policy agreed upon in writing after issue constitutes the entire contract. Only an officer of the company has the power, on behalf of the company, to change, modify, or waive any provisions of the policy. Any changes or waiver must be in writing. The company will not be bound by any promises or representations made by any agent or other person except as specified above. 9.15 Duty to Disclose a) The applicant for insurance and the owner must each disclose to us in the application, on a medical METT1009_v07012012_357 QA00009328 Page 10 of 11

examination, if any, and in any written statements or answers furnished as evidence of insurability, every fact within their knowledge that is material to the insurance and is not disclosed by the other. b) Subject to sub-section (a) above, a failure to disclose, or a misrepresentation of, a fact referred to in subsection (a) above, renders the contract voidable by us. c) A failure to disclose or misrepresentation referred to in sub-section (a) relating to evidence of insurability with respect to an application for i. additional coverage under a contract, ii. iii. an increase in insurance under a contract, or any other change to insurance after the policy is issued renders the contract voidable by us but only in relation to the addition, increase or change. 9.16 Failure to Disclose If a contract, including renewals of it, or an addition, increase or change referred to in Section 9.15 Duty to Disclose has been in effect for two (2) years with respect to a person insured, a failure to disclose, or a misrepresentation of, a fact required to be disclosed in respect of that person insured does not, in the absence of fraud, render the contract voidable. 9.17 Limitation of Actions Every action or proceeding against the Insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Insurance Act (Alberta & British Columbia). Every action or proceeding against the Insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in The Insurance Act (Manitoba). Every action or proceeding against the Insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Limitations Act, 2002 (Ontario). Otherwise, in Quebec every action must be brought within three (3) years after the date evidence is furnished, and in all other provinces within one (1) year from the date of loss or such longer period as may be required under the law applicable in such province. METT1009_v07012012_357 QA00009328 Page 11 of 11