Term Life Insurance Illustration Prepared For: Client Prepared By: TIM FULLER SPECIAL RISK SERVICES 6901 S. PIERCE ST LITTLETON, CO 80128 ph: 303-309-3471 fax: 303-309-3470 lic #: 9999999
1 Life Insurance Supplemental Quote Client male age 45, preferred plus, non-smoker Initial ANNUAL Premium: Face Amount: Riders: $.00 $ NONE Life Insurance Money for your Beneficiary Face Amount $ on the insured. Accelerated Living Benefits Money for Accelerated Living Benefits See the following pages for more details on these living benefits that are included in your policy: * Terminal Illness Accelerated Death Benefit * Chronic Illness Accelerated Death Benefit * Critical Illness Accelerated Death Benefit Please review policy for all terms, conditions, and exclusions of each benefit listed. The quote shows guaranteed elements. Actual results may be more favorable than shown. This supplemental quote must be accompanied by a complete basic policy quote, so please refer to the basic policy quote for your life insurance policy s guaranteed elements and other important policy and rider information. Any benefits provided by the policy will be reduced if an accelerated death benefit is paid. Benefits accelerated may be taxable and affect eligibility to public assistance in some jurisdictions. Please consult your own tax advisor regarding your particular situation. THIS IS A SUPPLEMENTAL QUOTE ONLY. NOT AN OFFER OR CONTRACT. COVERAGE IS SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. THIS SUPPLEMENTAL QUOTE IS NOT VALID WITHOUT ALL THREE PAGES. This is a quote not a contract. Presented by TIM FULLER on JULY 23, 2013 CO. Version 16.80 W Page 1 of 3
For Client, male age 45, preferred plus, non-smoker Total Face Amount = $, 1st Year Premium Outlay = $, paid annually 2 Client male age 45, preferred plus, non-smoker Life Insurance Supplemental Quote SUMMARY OF ACCELERATED LIVING BENEFITS Initial ANNUAL Premium: Face Amount: Riders: $.00 $ NONE Please review policy for all terms, conditions, and exclusions of each benefit listed. These benefits are automatically included in your policy. These benefits give you the choice to access the death benefit if the insured has a terminal, chronic, or critical illness, subject to state availability. If you choose to elect less than the amount quoted below, the remaining death benefit amount will be higher. This policy gives flexibility and protection at times when you may need it most. Terminal Illness Terminal Illness Accelerated Death Benefit Benefit amount shown assumes the maximum acceleration has been elected. The maximum acceleration election is 100% of the policy face amount or $, whichever is less. $471,206 payable to the owner*. If 100% of the policy face amount has been accelerated, policy coverage terminates at the time of the payment and there would be no death benefit payable to the beneficiaries at the insured s death. Chronic Illness Chronic Illness Accelerated Death Benefit Benefit amount shown assumes the maximum annual election of 24% acceleration of the policy death benefit. The maximum benefit over the lifetime of the insured is 90% of the initial face amount or $, whichever is less. The benefit is paid out annually and the first year benefit is shown below. The benefit amount depends upon the severity of the chronic illness and its impact upon life expectancy. Estimated Maximum Accelerated Payout Age at Claim Minor Moderate Severe 47 $16,443 $40,632 $81,619 52 $9,840 $40,095 $83,960 60 $300 $28,468 $81,579 Remaining policy face amount in effect after the maximum payout of the first year benefit = $380,000. Premiums will be reduced proportionately and will continue to be payable on the reduced face amount remaining. Critical Illness Critical Illness Accelerated Death Benefit Benefit amounts shown assumes the maximum election of 90% acceleration of the policy death benefit. The maximum benefit is 90% of the initial face amount or $, whichever is less. Benefits are based on the severity of the illness and its impact upon life expectancy. Estimated Maximum Accelerated Payout Age at Claim Minor Moderate Severe 47 52 60 $62,777 $153,484 $307,185 $38,322 $151,778 $316,272 $1,000 $108,855 $308,023 Remaining policy face amount in effect after the maximum payout = $50,000. Premiums will be reduced proportionately and will continue to be payable on the reduced face amount remaining. THIS IS A SUPPLEMENTAL QUOTE ONLY. NOT AN OFFER OR CONTRACT. COVERAGE IS SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. THIS SUPPLEMENTAL QUOTE IS NOT VALID WITHOUT ALL THREE PAGES. This is a quote not a contract. Presented by TIM FULLER on JULY 23, 2013 CO. Version 16.80 W Page 2 of 3
For Client, male age 45, preferred plus, non-smoker Total Face Amount = $, 1st Year Premium Outlay = $, paid annually 2 Life Insurance Supplemental Quote SUMMARY OF ACCELERATED LIVING BENEFITS (CONTINUED) Client male age 45, preferred plus, non-smoker Initial ANNUAL Premium: $.00 Face Amount: $ Riders: NONE Severity is based on the effect the illness has on the insured s life expectancy (per the industry standard 2001 Valuation Basic Tables). Minor means life expectancy is reduced 30%, moderate means life expectancy is reduced 50%; and severe means life expectancy is reduced 80%. At the time of claim, the administrative charge for each Accelerated Death Benefit request will be $350, plus any future increases based on cumulative annual cost-of-living increases as measured by the Consumer Price Index for All Urban Consumers (CPI) since January 1, 2012. Cumulative annual cost-of-living increases will not exceed 5% per calendar year. Administrative charge and CPI increases may vary by jurisdiction. * Terminal Illness payout scenario assumes that a claim is made in policy year 8. THIS IS A SUPPLEMENTAL QUOTE ONLY. NOT AN OFFER OR CONTRACT. COVERAGE IS SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. THIS SUPPLEMENTAL QUOTE IS NOT VALID WITHOUT ALL THREE PAGES. This is a quote not a contract. Presented by TIM FULLER on JULY 23, 2013 CO. Version 16.80 W Page 3 of 3
For Client, male age 45, preferred plus, non-smoker Total Face Amount = $, 1st Year Premium Outlay = $, paid annually 3 Marketing Office 1150 S. Olive Street Los Angeles, CA 90015 A CUSTOM LIFE INSURANCE QUOTE OF OUR TERM LIFE INSURANCE: Policy Form Number: TL19 CO FOR Client PRESENTED BY TIM FULLER 6901 S. PIERCE ST LITTLETON, CO 80128 Telephone: 303-309-3471 Fax: 303-309-3470 License Number: 9999999 JULY 23, 2013 THIS IS A QUOTE SHOWING THE GUARANTEED ELEMENTS OF THE LIFE INSURANCE POLICY. CONSISTENT WITH TRANSAMERICA'S SALES PRACTICES, THE QUOTE REFLECTS THE GUARANTEED MAXIMUM CHARGES FOR THE SCENARIO REPRESENTED. This is a quote not a contract. Presented by TIM FULLER on JULY 23, 2013 CO. Version 16.80 W Page 1 of 4
For Client, male age 45, preferred plus, non-smoker Total Face Amount = $, 1st Year Premium Outlay = $, paid annually 4 GUIDE TO THE QUOTE Annual Premium Death Benefit For the policy form named above, the annual premium is guaranteed to remain level for the first fifteen policy years. This quote shows the sum of the modal premiums that you will pay during the year. For instance, if you select quarterly payments, the first year premium outlay shown above shows 4 times the quarterly premium being paid each year. Premiums increase annually starting in the sixteenth policy year. The death benefit of the policy is the amount payable to the beneficiary at the insured's death. Subject to all policy provisions, the face amount is guaranteed to remain level to the policy anniversary nearest the insured's age 105, as long as the required premium is paid before the end of the grace period. The policy owner may request a decrease in the face amount while the policy is in-force, but may not reduce the face amount below the policy minimum. Conversion Option Policy Issue Information This option allows the policy holder to exchange a Trendsetter term policy to a designated universal life insurance plan(s) made available by the Company at the time of the conversion. No underwriting will be required if the exchange is to a permanent policy with the same or lower face amount. The new policy will be issued at the class of risk of the in-force policy, if available. If such a class is not available at the time of conversion, the new policy will be issued at the class of risk that is most similar to the class of risk as the in-force policy. Actual premiums on this new policy will be based on the schedule in effect when the option is exercised. To qualify for a better class of risk, full underwriting may be required. This option must be exercised no later than the earlier of the end of the initial level premium period or the insured's 70th birthday (75th birthday on Preferred Plus class). The basic underwriting requirements based on this quote are: Paramedical, BCP, HOS Initial Modal Premiums.00 A 336.60 S/A 171.60 Q 171.60 Q/PAC 57.75 M/PAC Kind Code 6767 TD529B X D Terminal Illness Accelerated Death Benefit (TIADB) Chronic Illness Accelerated Death Benefit (CHADB) Critical Illness Accelerated Death Benefit (CRADB) Eligibility for the Terminal Illness Accelerated Death Benefit is determined by a condition resulting from bodily injury or disease which, as described by a Physician, has reduced life expectancy to not more than 12 months from the date of the Physician's statement. The Policy's benefits and values will be reduced proportionally in accordance with the benefits advanced under this option. Benefits advanced under TIADB may be subject to taxation. Allows the policy owner to accelerate the death benefit if the insured becomes chronically ill. Chronically ill means that the insured has been certified, within the last 12 months, by a licensed health care practitioner as being unable to perform two of the six activities of daily living without substantial assistance from another person for at least 90 days, or being severely cognitively impaired for at least 90 consecutive days. The activities of daily living include: bathing, continence, dressing, eating, toileting and transferring. No Chronic Illness accelerated benefits will be paid under this endorsement during the first 2 years it is in effect. Waiting period may vary by jurisdiction. After the waiting period, the policy owner can accelerate up to 24% of the Face Amount annually once the insured has been certified as chronically ill. The maximum amount of lifetime benefits that can be accelerated for CHADB is 90% of the Face Amount or $, whichever is less. However the actual payment will be, minus adjustments, less than the portion of the death benefits accelerated because the benefits are paid prior to death. Benefits may be subject to taxation. Benefits vary by jurisdiction. Allows the policy owner to accelerate the death benefit if the insured becomes critically ill. A critical illness is one of the qualifying events: heart attack, stroke, ALS (Lou Gehrig's disease), cancer, kidney failure, blindness due to diabetes, paralysis (loss of use of two or more limbs), and major organ transplant (Please see the policy for complete definitions of qualifying conditions). After a 30 day waiting period (may vary by jurisdiction), the policy owner can access up to 90% of the Face Amount or $, whichever is less. However the actual payment will be, minus adjustments, less than the portion of the death benefits accelerated because the benefits are paid prior to death. Benefits may be subject to taxation. Benefits vary by jurisdiction. This is a quote not a contract. Presented by TIM FULLER on JULY 23, 2013 CO. Version 16.80 W Page 2 of 4
For Client, male age 45, preferred plus, non-smoker Total Face Amount = $, 1st Year Premium Outlay = $, paid annually 4 Maximum Accelerated Death Benefit The maximum total amount of lifetime benefits that can be accelerated including all other Accelerated Death Benefits under all policies, endorsement, or riders issued by Transamerica and its affiliates covering the same insured is $ (subject to state variations). This is a quote not a contract. Presented by TIM FULLER on JULY 23, 2013 CO. Version 16.80 W Page 3 of 4
For Client, male age 45, preferred plus, non-smoker Total Face Amount = $, 1st Year Premium Outlay = $, paid annually 5 JULY 23, 2013 INITIAL TERM PREMIUM SUMMARY* For: Client Producer: TIM FULLER Version 16.80 W Annual Semi-Annual Quarterly Monthly-PAC Monthly Quarterly PAC Trendsetter LB 10 6758 530.00 270.30 137.80 137.80 46.38 N/A Trendsetter LB 15 6767.00 336.60 171.60 171.60 57.75 N/A Trendsetter LB 20 6776 790.00 402.90 205.40 205.40 69.13 N/A Trendsetter LB 25 6785 995.00 507.45 258.70 258.70 87.06 N/A Trendsetter LB 30 6794 1,135.00 578.85 295.10 295.10 99.31 99.31 * Premiums increase annually after the initial level premium period. Underwriting Requirements: Paramedical, BCP, HOS Trendsetter (R) LB 15 Policy Form Number: TL19 CO Kind Code / Plan Code: 6767 TD529B X D Sex: MALE Age: 45 Face Amount: $ Underwriting Class: PREFERRED PLUS NON-SMOKER Substandard Rating: Flat Extra Rating: 0.00 Flat Extra Period: 0 Payment Mode: ANNUALLY Premium Breakdown Base: $.00 Waiver of Premium(s): Accidental Indemnity: Childrens Insurance Rider: Summary of Premiums for Trendsetter (R) LB 15 Year Age 1 45 2 46 3 47 4 48 5 49 6 50 7 51 8 52 9 53 10 54 11 55 12 56 13 57 14 58 15 59 16 60 17 61 18 62 19 63 20 64 21 65 22 66 23 67 24 68 25 69 Guar. Premiums 9,450 10,560 11,850 13,260 14,730 16,260 17,810 19,430 21,140 23,060 All products may not be approved in all jurisdictions. This is a quote not a contract. Presented by TIM FULLER on JULY 23, 2013 CO. Version 16.80 W Page 4 of 4
Term Life Insurance Illustration Policy Amount $ Name: Client Male Age : 45-Premier Non-Smoker Date: 7/23/2013 Initial Payment $ Non-Guaranteed Interest Rate 0.00% Year Age Annual Premium Cumul. Premium Death Benefit 1 45 2 46 1,320 3 47 1,980 4 48 2,640 5 49 3,300 49 3,300 3,300 6 50 3,960 7 51 4,620 8 52 5,280 9 53 5,940 10 54 6,600 54 6,600 6,600 11 55 7,260 12 56 7,920 13 57 8,580 14 58 9,240 15 59 9,900 59 9,900 9,900 16 60 9,450 19,350 17 61 10,560 29,910 18 62 11,850 41,760 19 63 13,260 55,020 20 64 14,730 69,750 64 69,750 69,750 21 65 16,260 86,010 22 66 17,810 103,820 23 67 19,430 123,250 24 68 21,140 144,390 25 69 23,060 167,450 69 167,450 167,450 V2.51.00 C2.20.12. This is a supplemental quote. It must be accompanied by a Trendsetter (R) LB 15 proposal from Transamerica Life Insurance Company which contains guaranteed elements and other important information. Refer to the Federal Income Tax Considerations notes in the Guide to the Quote concerning MEC status and related information. Any non-guaranteed elements quoted are subject to change and can be either higher or lower. Presented by: TIM FULLER Page 1 of 3
Term Life Insurance Illustration Policy Amount $ Name: Client Male Age : 45-Premier Non-Smoker Date: 7/23/2013 Initial Payment $ Non-Guaranteed Interest Rate 0.00% Year Age Annual Premium Cumul. Premium Death Benefit 26 70 25,300 192,750 27 71 28,020 220,770 28 72 31,200 251,970 29 73 34,550 286,520 30 74 38,150 324,670 74 324,670 324,670 31 75 42,070 366,740 32 76 46,490 413,230 33 77 51,630 464,860 34 78 57,600 522,460 35 79 64,290 586,750 79 586,750 586,750 36 80 71,750 658,500 37 81 79,860 738,360 38 82 88,450 826,810 39 83 97,830 924,640 40 84 108,260 1,032,900 84 1,032,900 1,032,900 41 85 0 1,032,900 0 85 1,032,900 1,032,900 0 V2.51.00 C2.20.12. This is a supplemental quote. It must be accompanied by a Trendsetter (R) LB 15 proposal from Transamerica Life Insurance Company which contains guaranteed elements and other important information. Refer to the Federal Income Tax Considerations notes in the Guide to the Quote concerning MEC status and related information. Any non-guaranteed elements quoted are subject to change and can be either higher or lower. Presented by: TIM FULLER Page 2 of 3
Term Life Insurance Illustration Column Description Page July 23, 2013 Annual Premium Total annual premium including riders. Cumul. Premium Sum of net annual outlay. Death Benefit Gross death benefit. Transamerica Life Insurance Company Page 3 of 3
Client Input Summary Company: Transamerica Product: Trendsetter LB 15 July 23, 2013 2.51.00, 6.20.12 Insured Insured Name Client Sex Male Date of Birth Age 45 Class Preferred Plus Table Rating None Flat Extra State of Issue Colorado Policy Info Face Amount 500000 Premium Mode Annual Print IRR Report No Print Revised Illustration No Years to Print 115 Living Benefits Projected Benefit Age 1 47 Living Benefits Projected Benefit Age 2 52 Living Benefits Projected Benefit Age 3 60 Policy Riders Policy Riders No Agent Info Agent Name TIM FULLER Agent Company SPECIAL RISK SERVICES Agent Address 6901 S. PIERCE ST Agent City LITTLETON Agent State Colorado Agent Zip Code 80128 Agent Phone 303-309-3471 Agent Fax 303-309-3470 Agent License # 9999999 Agent Bank Sale No Term Illustration Title Line Tax Bracket 01 to 120-35 Page 1 of 1