VALLEY FORGE LIFE INSURANCE COMPANY
A Stock Company
Executive Office: Home Office:
CNA Plaza 401 Penn St.
Chicago, Illinois 60685 Reading, Pennsylvania 19601
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SPLIT POLICY OPTION RIDER
This rider is a part of the policy. It is subject to all the terms of the policy
unless we state otherwise.
EFFECTIVE DATE
This rider is issued with the policy. Its effective date is the policy date of
the Original Policy shown in the Policy Schedule. If coverage under this rider
is reinstated, the effective date of the reinstatement is shown in an amendment
to the Policy Schedule.
CONSIDERATION
This rider is issued in consideration of the application for this rider and
payment of the first premium. The cost of this rider will be added to the
monthly deduction described in the policy. Its cost is shown in the Policy
Schedule.
DEFINITIONS
The following are key words used in this rider. They are important in describing
both your rights and ours. When these words or forms of them are used, they are
capitalized.
Original Policy is the policy to which this rider is attached.
New Policy is the policy purchased under the conditions of this rider.
Policy Date is the Policy Date of the New Policy.
BENEFIT
We will exchange the Original Policy without evidence of insurability for two
new policies, one on the life of each of the Insureds. The exchange is subject
to the terms of this rider and rules with regard to insurable interest. We must
receive your Written Notice requesting such exchange while the Original Policy
is in force.
EXCHANGE DATE
The exchange date will be on the next Monthly Date after we receive your request
and the first premium at our Administrative Office.
CONDITIONS
We will allow exchange of the policy if:
1. A final decree of divorce is issued terminating a marriage of the two
Insureds to each other; or
2. There is a change in the Federal Estate Tax law which results in either:
(a) an end to the unlimited marital deduction available to the Insureds if
they were to die; or
(b) a 50% or more reduction in the maximum Federal Estate Tax rate.
We must receive your Written Notice requesting an exchange:
1. within one year after the date of final divorce decree or annulment; or
2. within six months of the effective date of a change in the Federal Estate
Tax law, whichever applies.
Any outstanding debt on the Original Policy on the exchange date must be repaid.
TERMS OF THE NEW POLICY
Each New Policy will be issued subject to these terms:
1. Each New Policy will be an individual permanent plan of variable life
insurance then available from us for the amount of insurance requested at
the Insured's then attained age.
2. To exercise the Split Policy Option, you must send written notice and the
first premium to our Administrative Office.
3. Each Insured to be covered by a New Policy must be alive on the Policy
Date.
4. The exchange will be to a permanent plan of variable life insurance then
available from us.
Terms of the exchange are:
(a) The Policy Date will be the exchange date.
(b) Each New Policy will be issued based on the Insureds' respective
sexes and attained ages on the exchange date.
(c) Each New Policy will be issued in the same underwriting class
of each Insured on the Policy Date of the Original Policy.
(d) The specified amount of each New Policy will be one-half of the
specified amount of the Original Policy.
(e) The cash surrender value of each New Policy will be one-half of
the Original Policy's cash surrender value on the exchange date.
5. The Incontestability and Suicide provisions for each New Policy will run
from the effective date of the Original Policy.
6. A New Policy will not include any benefits provided by rider under the
Original Policy without our consent.
7. Each New Policy will be subject to any assignment against the Original
Policy.
REINSTATEMENT
This rider may be reinstated if:
1. this rider terminated due to the termination of the policy;
2. the policy is being reinstated; and
3. both Insureds are alive and legally married to each other.
For such reinstatement, we will require evidence of insurability satisfactory to
us.
RIDER TERMINATION
This rider will terminate on the earliest of:
1. the date of death of either Insured;
2. the date the Original Policy is exchanged under the terms of this rider;
3. the date the policy terminates; and
4. the monthly date following receipt by us of your Written Notice canceling
this rider.
Signed for the Company at its Executive Offices in Chicago, Illinois on the
policy effective date.
/s/BERNARD L. HENGESBAUGH /s/DAVID L. STONE
Chief Executive Officer Group Vice President
VULR-119 (8/00)
