Foresters Advantage Plus Whole Life Paid-Up at 100 Whole Life Insurance Life Insurance Illustration Pro p o sa l o n: Pre p a re d b y: Financial Brokerage Inc. EMI 17110 Marcy St Ste 100 Omaha, NE, 68118-3119 sstewart@fb-inc.com The Independent Order of Foresters US Mailing Address foresters.com 789 Don Mills Rd PO Box 179 T. 800 828 1540 Toronto, Ontario, Canada M3C 1T9 Buffalo, NY 14201-0179 Foresters TM is the trade name and a trademark of The Independent Order of Foresters, a fraternal benefit society. Foresters TM based on factors such as claims, investment earnings, expenses and overall economic environment. The actual results may be more or less favorable and are expected to vary from those shown. Review all pages of this illustration as it is incomplete without all 8 pages. Life Insured: Producer: Financial Brokerage Inc. Filed Certificate #: ICC11-WL-US01 State: Missouri Version: 1.70.002 Page 1 of 8
BASIC INFORMAT ION Pla n Deta ils Life Insure d : ise x: Male Issue Ag e : 70 Und e rwriting : Non-Medical Rating Cla ss: Standard Fa ce Amo unt: $25,000 Insura nce Cla ss: Non-Tobacco Co ve ra g e s Be ne fit Amo unt Ba se Insura nce Co ve ra g e includ ing Sta nd a rd Fe a ture s Basic Life Insurance (Certificate) $25,000 Common Carrier Accidental Rider $50,000 Family Health Rider Pre miums Pre mium Mo nthly Annua lize d Dura tio n $155.99 $1,871.88 30 Years Initia l Pre mium $155.99 $1,871.88 T o ta l Initia l Pre mium $155.99 $1,871.88 Illustration assumes premiums and payments are paid at issue and at the beginning of each certificate month, as applicable. s and values are shown as at the end of each certificate year. Foresters based on factors such as claims, investment earnings, expenses and overall economic environment. The actual results may be more or less favorable and are expected to vary from those shown. Review all pages of this illustration as it is incomplete without all 8 pages. Life Insured: Producer: Financial Brokerage Inc. Filed Certificate #: ICC11-WL-US01 State: Missouri Version: 1.70.002 Page 2 of 8
NARRATIVE SUMMARY The Narrative Summary provides a brief description of the certificate and each rider and is not intended to amend, alter, or change any of the terms and conditions of the certificate or the rider(s). Refer to the certificate and the applicable rider for variations, exclusions, terms and conditions. Pla n Descrip tio n This Foresters Whole Life certificate provides permanent individual life insurance protection with guaranteed premiums, payable to age 100, guaranteed cash values and a guaranteed death benefit amount. Issue of the certificate and riders, if any, at the Insurance Class and Rating Class illustrated is subject to Foresters' underwriting approval. Definitio ns The following words and phrases have specific meaning for purposes of this illustration. Many are column headings of the various tables shown in this illustration and are capitalized when they appear throughout this illustration. Accum Pa id -up Ad d. - The accumulated additional amounts of insurance purchased using the dividends Ag e - The Issue Age of the Life Insured plus the number of certificate years elapsed since issue. The Issue Age is based upon age nearest birthday. Annua l Divid e nd - The annual dividend amount that this illustration assumes will be paid at the end of each certificate year shown. The dividends are a portion of Foresters' divisible surplus available for distribution annually to the certificate owners and are not guaranteed. Annua lize d T o ta l Pre mium - The annualized total premium required each year for the base insurance coverage and optional coverage(s) illustrated in effect. Co ntra ct Pre mium - The Annualized Premium. Curre nt Va lue s - Certificate values and benefits based on Foresters' current dividend scale, and the current credited interest rate. This scale and rate are not guaranteed. End o f Ye a r - The end of the applicable certificate year. Gua r Ca sh Va lue - The guaranteed cash value of the certificate minus outstanding loan balance. Gua r Be ne fit - The guaranteed death benefit of the certificate minus outstanding loan balance. Insura nce Co ntra ct - The certificate and each rider. Mid p o int Va lue s - Certificate values and benefits based on 50% of Foresters' current dividend scale and applicable interest, which are not guaranteed. Pa id -up Ad d Ca sh Va lue - The cash equivalent of the Accum Paid-up Add amount Pre mium Outla y - The Contract Premium plus loan repayments, if any. Foresters based on factors such as claims, investment earnings, expenses and overall economic environment. The actual results may be more or less favorable and are expected to vary from those shown. Review all pages of this illustration as it is incomplete without all 8 pages. Life Insured: Producer: Financial Brokerage Inc. State: Version: Missouri 1.70.002 Filed Certificate #: ICC11-WL-US01 Page 3 of 8
NARRATIVE SUMMARY Ga in o n Surre nd e r - The amount gained under the insurance contract if it was to be surrendered at the end of the certificate year. This amount is considered reportable and may be taxable. The amounts shown are based on Current Assumptions and the scenarios illustrated. Changes in scenarios will produce different results. T o ta l Ca sh Va lue - The total amount payable upon surrender of the insurance contract. It includes both guaranteed values and non-guaranteed values, such as dividend accumulations, and is net of the oustanding loan balance. T o ta l Be ne fit - The total amount payable, if any, under the insurance contract for the death of the insured, not including the amount payable under a rider(s) providing a benefit for accidental death only. It includes both guaranteed values and nonguaranteed values, such as dividend accumulations, and is net of the outstanding loan balance. Rid e rs Co mmo n Ca rrie r Accid e nta l Rid e r This standard protection feature (included at no additional premium) provides a benefit if the Life Insured's death is caused by an accidental bodily injury, directly and independently from all other causes, that occurs while riding as a fare-paying passenger on a common carrier (examples are: passenger airplanes, commuter trains, etc.). must occur within a specified number of days of the accidental bodily injury. Payment of the benefit is limited by the maximum accidental death amount. If payment of this benefit, when added to the benefit(s) paid for the death of the Life Insured under other Foresters accidental death coverage, if any, causes the maximum accidental death amount to be exceeded, this benefit will be reduced. This rider cannot be in effect after the certificate anniversary on which the Life Insured is age 100. Fa mily Health Be ne fit Rid e r This standard protection feature (included at no additional premium) provides specific benefits for qualified health situations that result, directly and independently of all other causes, from a catastrophic event. It is not intended to cover all of the costs associated with these health situations or to provide health insurance. Catastrophic events are: typhoons, hurricanes, earthquakes, volcanic eruptions, tsunamis, tornadoes or lightning strikes. Qualified health situations are: hospital stays, hospital emergency room examinations and ambulance transportation. This rider cannot be in effect after the certificate anniversary on which the Life Insured is age 100. W ithd ra wa ls, Lo a ns a nd Co ve ra g e Cha ng e s Each withdrawal, loan and early coverage termination illustrated, if any, must be requested, by the certificate owner, when desired, does not occur automatically based on the illustration and is subject to Foresters approval and completion of the required request forms. If you were shown an illustration that included a withdrawal(s), loan(s) and/or early coverage termination(s), it was meant to provide an example of what can be done using the values and benefits of an insurance contract. In many instances, the certificate's guaranteed cash values alone will not be sufficient to allow each withdrawal and/or loan illustrated. Each withdrawal, loan and/or coverage change illustrated occurs at the beginning of the year specified. Foresters based on factors such as claims, investment earnings, expenses and overall economic environment. The actual results may be more or less favorable and are expected to vary from those shown. Review all pages of this illustration as it is incomplete without all 8 pages. Life Insured: Producer: Financial Brokerage Inc. State: Version: Missouri 1.70.002 Filed Certificate #: ICC11-WL-US01 Page 4 of 8
NUMERIC SUMMARY The following table summarizes certificate values from the anteed and Current Assumptions as well as a Midpoint Assumption, based on the information displayed in the Basic Information section of the illustration. anteed End o f Year Year 5 $3,950 $25,000 Year 10 $9,155 $25,000 Year 20 $16,570 $25,000 Midpoint $4,322 $10,173 $21,174 Non anteed Current $25,555 $4,703 $26,373 $11,250 $30,422 $26,305 $26,122 $27,826 $36,462 Sta te me nt o f Ap p lica nt/owne r 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 Producer has told me they are not guaranteed. Sta te me nt o f Pro d uce r I certify that this illustration has been presented to the applicant/owner 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. Applicant/Owner (Signature) Date (mmm/dd/yyyy) Producer (Signature) Date (mmm/dd/yyyy) Producer #: 500228 Foresters based on factors such as claims, investment earnings, expenses and overall economic environment. The actual results may be more or less favorable and are expected to vary from those shown. Review all pages of this illustration as it is incomplete without all 8 pages. Life Insured: Producer: Financial Brokerage Inc. Filed Certificate #: ICC11-WL-US01 State: Missouri Version: 1.70.002 Page 5 of 8
ADDITIONAL INFORMATION Net Payment Cost Index anteed Current Basic Life Insuranc e Year 10 $71.31 $64.61 Year 20 $71.31 $58.47 Surrender Cost Index anteed Current $43.58 $36.88 $52.22 $39.38 Equiv alent Lev el Annual Div idend anteed Current $0.00 $167.60 $0.00 $321.11 Indices assume the time value of money to be 5.0%. The Net Payment Cost Index and Surrender Cost Index are measures of the relative cost of similar plans of insurance. A lower index number represents a lower cost than a higher index number. An explanation of the intended use of these indices and the Equivalent Level Annual Dividend is provided in the Life Insurance Buyer's Guide. Non-1035 Lump Sum $0.00 1035 Lump Sum $0.00 Se ve n Pa y Pre mium $2,602.27 annually Foresters based on factors such as claims, investment earnings, expenses and overall economic environment. The actual results may be more or less favorable and are expected to vary from those shown. Review all pages of this illustration as it is incomplete without all 8 pages. Life Insured: Producer: Financial Brokerage Inc. Filed Certificate #: ICC11-WL-US01 State: Missouri Version: 1.70.002 Page 6 of 8
TABULAR DETAILS End o f Year Age 1 71 2 72 3 73 4 74 5 75 Contrac t Annual Premium Div idend $1,871.88 $0 $25,000 $0.00 $1,871.88 $722 $25,000 $174.89 $1,871.88 $1,796 $25,000 $179.02 $1,871.88 $2,860 $25,000 $179.27 $1,871.88 $3,950 $25,000 $179.52 Ac c um Paid-Up Paid-Up Add. Add. $0 $0 $278 $175 $561 $361 $842 $554 $1,122 $754 $0 $25,000 $897 $25,278 $2,157 $25,561 $3,414 $25,842 $4,703 $26,122 6 76 7 77 8 78 9 79 10 80 $1,871.88 $4,991 $25,000 $204.33 $1,871.88 $6,045 $25,000 $204.58 $1,871.88 $7,113 $25,000 $204.83 $1,871.88 $8,152 $25,000 $232.09 $1,871.88 $9,155 $25,000 $279.13 $1,437 $986 $1,750 $1,226 $2,063 $1,474 $2,413 $1,757 $2,826 $2,095 $5,976 $26,437 $7,270 $26,750 $8,587 $27,063 $9,909 $27,413 $11,250 $27,826 11 81 12 82 13 83 14 84 15 85 $1,871.88 $10,117 $25,000 $373.91 $1,871.88 $11,027 $25,000 $440.91 $1,871.88 $11,883 $25,000 $519.80 $1,871.88 $12,678 $25,000 $597.10 $1,871.88 $13,399 $25,000 $684.87 $3,368 $2,541 $3,998 $3,067 $4,731 $3,686 $5,565 $4,400 $6,510 $5,221 $12,658 $28,368 $14,094 $28,998 $15,569 $29,731 $17,078 $30,565 $18,621 $31,510 16 86 17 87 18 88 19 89 20 90 $1,871.88 $14,097 $25,000 $692.72 $1,871.88 $14,768 $25,000 $696.60 $1,871.88 $15,413 $25,000 $715.89 $1,871.88 $16,019 $25,000 $716.14 $1,871.88 $16,570 $25,000 $716.39 $7,470 $6,071 $8,440 $6,945 $9,439 $7,857 $10,447 $8,787 $11,462 $9,735 $20,168 $32,470 $21,713 $33,440 $23,270 $34,439 $24,806 $35,447 $26,305 $36,462 21 91 22 92 23 93 24 94 25 95 $1,871.88 $17,084 $25,000 $857.03 $1,871.88 $17,577 $25,000 $857.28 $1,871.88 $18,055 $25,000 $857.53 $1,871.88 $18,504 $25,000 $857.78 $1,871.88 $18,965 $25,000 $858.03 $12,661 $10,847 $13,871 $11,982 $15,096 $13,139 $16,335 $14,319 $17,589 $15,520 $27,930 $37,661 $29,559 $38,871 $31,195 $40,096 $32,823 $41,335 $34,485 $42,589 26 96 27 97 $1,871.88 $19,456 $25,000 $858.28 $1,871.88 $20,029 $25,000 $858.53 $18,859 $16,741 $20,146 $17,985 $36,197 $43,859 $38,014 $45,146 The amounts shown in the Tabular Detail pages apply to the certificate year for which they are shown. Contract Premium changes shown are due to the expiry of riders, ratings and benefits, or the renewal of the term rider, whenever applicable. Foresters based on factors such as claims, investment earnings, expenses and overall economic environment. The actual results may be more or less favorable and are expected to vary from those shown. Review all pages of this illustration as it is incomplete without all 8 pages. Life Insured: Producer: Financial Brokerage Inc. Filed Certificate #: ICC11-WL-US01 State: Missouri Version: 1.70.002 Page 7 of 8
TABULAR DETAILS End o f Year Age 28 98 29 99 30 100 Contrac t Annual Premium Div idend $1,871.88 $20,743 $25,000 $858.78 $1,871.88 $21,705 $25,000 $859.03 $1,871.88 $23,105 $25,000 $859.28 Ac c um Paid-Up Paid-Up Add. Add. $21,451 $19,253 $22,773 $20,543 $24,114 $21,852 $39,996 $46,451 $42,247 $47,773 $44,957 $49,114 31 101 32 102 33 103 34 104 35 105 $0.00 $23,196 $25,000 $859.53 $0.00 $23,286 $25,000 $859.78 $0.00 $23,373 $25,000 $860.03 $0.00 $23,458 $25,000 $860.28 $0.00 $23,541 $25,000 $860.53 $25,475 $23,176 $26,856 $24,527 $28,257 $25,904 $29,680 $27,307 $31,124 $28,736 $46,372 $50,475 $47,812 $51,856 $49,277 $53,257 $50,765 $54,680 $52,277 $56,124 36 106 37 107 38 108 39 109 40 110 $0.00 $23,621 $25,000 $860.78 $0.00 $23,700 $25,000 $861.03 $0.00 $23,776 $25,000 $861.28 $0.00 $23,850 $25,000 $861.53 $0.00 $23,922 $25,000 $861.78 $32,590 $30,193 $34,078 $31,677 $35,589 $33,188 $37,124 $34,727 $38,683 $36,295 $53,814 $57,590 $55,376 $59,078 $56,964 $60,589 $58,578 $62,124 $60,217 $63,683 41 111 42 112 43 113 44 114 45 115 $0.00 $23,992 $25,000 $862.03 $0.00 $24,059 $25,000 $862.28 $0.00 $24,124 $25,000 $862.53 $0.00 $24,187 $25,000 $862.78 $0.00 $24,248 $25,000 $863.03 $40,267 $37,890 $41,875 $39,514 $43,509 $41,167 $45,169 $42,849 $46,856 $44,561 $61,882 $65,267 $63,573 $66,875 $65,292 $68,509 $67,036 $70,169 $68,809 $71,856 46 116 47 117 48 118 49 119 50 120 $0.00 $24,306 $25,000 $863.28 $0.00 $24,362 $25,000 $863.53 $0.00 $24,416 $25,000 $863.78 $0.00 $24,468 $25,000 $864.03 $0.00 $24,516 $25,000 $864.28 $48,569 $46,302 $50,311 $48,073 $52,081 $49,874 $53,880 $51,706 $55,708 $53,565 $70,608 $73,569 $72,435 $75,311 $74,291 $77,081 $76,174 $78,880 $78,081 $80,708 51 121 $0.00 $25,000 $25,000 $864.53 $57,533 $57,533 $82,533 $82,533 The amounts shown in the Tabular Detail pages apply to the certificate year for which they are shown. Contract Premium changes shown are due to the expiry of riders, ratings and benefits, or the renewal of the term rider, whenever applicable. Foresters based on factors such as claims, investment earnings, expenses and overall economic environment. The actual results may be more or less favorable and are expected to vary from those shown. Review all pages of this illustration as it is incomplete without all 8 pages. Life Insured: Producer: Financial Brokerage Inc. Filed Certificate #: ICC11-WL-US01 State: Missouri Version: 1.70.002 Page 8 of 8