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
TERM INSURANCE ON CHILDREN 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 agree to pay the beneficiary the following amount for each unit of coverage
if a covered child's death occurs while this rider is in force or within the
conversion period described below:
1. $250 if the covered child's death occurs after his or her 14th day of age
and before his or her age of 6 months; or
2. $1,000 if the covered child's death occurs on or after his or her age 6
months and before the policy anniversary nearest the covered child's 22nd
birthday.
COVERED CHILD
Covered child means a child, stepchild or legally adopted child of the Insured
who is more than 14 days old but less than 22 years old and who is either:
1. named in the application for this rider and is under eighteen years of age
on or before the date of the application; or
2. acquired by the Insured after the date of the application but before such
child's 18th birthday and before the expiry date of this rider.
BENEFITS AFTER THE INSURED'S DEATH
If the policy terminates by the death of the Insured, existing coverage on any
child under this rider will be continued as fully paid-up insurance until the
child's 22nd birthday. At age 22, conversion will be allowed as provided below.
The paid-up insurance will have policy value based on the 1980 CSO Mortality
Table Age Nearest Birthday with interest at 5 1/2% compounded annually. The
paid-up insurance may be surrendered for its surrender value. Information about
the policy value will be furnished upon request.
COST
The cost of this rider will be added to the monthly deduction described in the
policy. Its cost is shown in the Policy Schedule.
CHANGE OF BENEFITS
The units of coverage may be changed any time after this rider is one year old
by written notice. The following conditions apply:
1. Any approved change will become effective on the business day after we
receive notice.
2. Changed benefits will be shown on a Supplemental Policy Schedule.
CONVERSION
Any covered child may convert his or her insurance to a permanent plan of
insurance then available from us at the child's attained age. The amount
converted may not be less than the amount of insurance then in force under this
rider and no more than five times that amount. No proof of insurability will be
required for the conversion policy, except for any benefits added by rider. The
suicide and incontestability provisions of the converted policy will be waived.
BENEFICIARY
Unless changed by written notice, the beneficiary of this rider will be
determined in the following order:
1. the Insured under the base policy, if living; then
2. the Insured's spouse, if living; then
3. the children, step-children and legally adopted children of the Insured
equally, if living; then
4. the estate of the deceased covered child.
ASSIGNMENT
The benefits of this rider cannot be assigned.
OWNERSHIP
The owner of this policy is the owner of this rider.
TERMINATION
This rider terminates:
1. When you give us written notice to terminate it and send us the policy to
show the change; or
2. On the policy anniversary on or nearest the Insured's age 65; or
3. When the policy terminates.
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-104 (8/99)
