VALLEY FORGE LIFE INSURANCE COMPANY
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Executive Office: A Stock Company Home Office:
CNA Plaza 401 Penn St.
Chicago, Illinois 60685 Reading, Pennsylvania 19601
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ACCIDENTAL DEATH BENEFIT RIDER
This rider forms a part of the policy to which it is attached. It is issued in
consideration of your application and premium paid.
BENEFIT
We will pay the accidental benefit amount shown in the Policy Schedule as soon
as we receive due written proof that the Insured's death was accidental. The
injury that caused death must occur after attained age one and before the policy
anniversary on or next following the Insured's age 70.
ACCIDENTAL DEATH
Accidental death means death that results from injury (not sickness). The
accidental injury must cause death, independently of all other causes.
EXCLUSIONS
We will not pay the accidental death benefit if death is the result of:
(1) suicide (while sane or insane);
(2) voluntarily taking poison;
(3) voluntarily inhaling gas or fumes, except while conducting one's duties
during the course of employment;
(4) voluntarily taking drugs, narcotics or hallucinogens except as prescribed
by a physician;
(5) illness or disease or medical treatment thereof;
(6) injury during the commission of a crime;
(7) aircraft accident (unless the Insured is a passenger with no duties on the
aircraft);
(8) participation in a hazardous sport such as parachuting, hang gliding,
motorcycle racing, automobile racing, etc. where the Insured should have
known the sport could result in death;
(9) war (declared or not) or acts of war; or
(10) the Intoxication of the Insured. Intoxication means a blood alcohol level
of .1% by weight, unless the state of residence of the Insured has a lower
standard, in which case the standard of the Insured's state of residence
shall apply.
COST
The monthly cost for this rider is shown in the Policy Schedule.
RIDER TERMINATION
This rider terminates:
(1) on the policy anniversary on or next following the Insured's age 70;
(2) if you give us written notice to terminate it; or
(3) when the policy terminates.
This rider may be reinstated as part of the policy if the policy is reinstated
unless this rider was terminated because of age or at your request.
GENERAL
All provisions of the policy not in conflict with this rider apply to this
rider. If this rider is issued with the policy, its effective date is the policy
date shown on the Policy Schedule. If this rider is issued after the policy
date, or if coverage is increased, decreased or reinstated, its effective date
is shown in a Supplemental Policy Schedule.
Signed for the Company at its Executive Office, CNA Plaza, Chicago, Illinois
60685.
/s/BERNARD L. HENGESBAUGH /s/DAVID L. STONE
Chief Executive Officer Group Vice President
VULR-102 (6/99)
