VALLEY FORGE LIFE INSURANCE COMPANY
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Executive Office: A Stock Company Home Office:
CNA Plaza 401 Penn Street
Chicago, Illinois 60685 Reading, Pennsylvania 19601
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READ YOUR POLICY CAREFULLY
This is a legal contract between you, the owner, and Valley Forge Life Insurance
Company (referred to as the Company, we, us and our).
We will pay the death proceeds to the beneficiary when we receive due proof of
the Insured's death while this policy is in force. Details of the Death Proceeds
are found in the Death Benefit provisions.
RIGHT TO EXAMINE POLICY - If for any reason you are not satisfied with this
policy, you may return it to: (a) the agent through whom it was purchased; or
(b) our Administrative Office within 10 days after you receive it. We will
refund an amount equal to the cash value plus fees or charges deducted from
premiums less any debt.
Signed for the Company at its Executive Office, CNA Plaza, Chicago, Illinois
60685 on the policy date.
/s/BERNARD L. HENGESBAUGH /s/DAVID L. STONE
Chief Executive Officer Group Vice President
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Cash Value benefits provided by this policy are based on the investment
performance of the subaccounts of the Variable Account. Such benefits may
increase or decrease and are not guaranteed as to dollar amount. The amount of
the death benefit may vary based on the investment performance of the
subaccounts of the Variable Account but it will never be less than the specified
amount. The Variable Account Provisions begin on Page 18.
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FLEXIBLE PREMIUM VARIABLE AND FIXED LIFE INSURANCE POLICY
Premiums are payable until the earlier of Insured's death or the Insured's
attained age 95.
Adjustable Death Benefit
Death Proceeds Payable at Insured's Death
Non-Participating
Investment Experience Reflected in Benefits
VUL-104 (8/00)
POLICY SCHEDULE
Owner: [John Doe]
Insured: [John Doe] Insured's Age: [35]
Insured's Sex: [Male] Policy Date: [July 1, 2000]
Policy Number: [1234567]
Risk Class: [Preferred - Nonsmoker]
Beneficiary: As stated in the application for this policy unless changed in
accordance with policy provisions
Administrative Office: 100 CNA Drive, Nashville, TN 37214 [1-800-262-1755]
Death Benefit Option: [1]
Monthly Date: [1st] Day Of Each Month
Base Specified Amount: [$100,000]
Additional Insurance Rider Specified Amount: [$100,000]
Total Specified Amount: [$200,000]
Minimum Specified Amount $100,000
Minimum Change In Specified Amount: $ 25,000
Minimum Monthly Premium Payment: [$ 50.00]
Initial Premium: [$673.00 Annually]
Planned Premium [$1,100.00 Annually]
Target Premium Payment: [$1,400.00 Annually]
Minimum Additional Premium Payment: [$100.00]
Guideline Annual Premium Payment: [$2,006.00 Annually]
Lapse Prevention Premium [$673.00 Annually]
Lapse Prevention Guarantee Period [5 years]
Minimum Partial Surrender Amount: $500.00
Free Partial Surrender Amount: 10% of cash value at time of first free partial
surrender during a policy year after the first
policy year.
Minimum Loan Amount: $500.00
Policy Loan Interest Rate: 8.0%
Preferred Policy Loan Credited Rate: 8.0%
Policy Loan Credited Rate: 6.0%
<PAGE>
CHARGES AND FEES
(Maximum Charges)
PREMIUM CHARGES:
All Years: 4% of premium payments
EXPENSE CHARGES:
Policy Years 1 - 10: .002477% (Daily Factor);
(0.90% Approximate Annual Rate)
Policy Years 11+: .001236% (Daily Factor);
(0.45% Approximate Annual Rate)
POLICY CHARGES
Cost of Insurance: See Cost of Insurance Provision
TRANSACTIONAL CHARGES
Monthly Specified Amount Increase Fee
(For First 12 Months After Increase): [$10.00]
Transfer Processing Fee: [$25] Each After First [12] In A
Policy Year (Assessed After The
First [12] Transfers In A Policy
Year. Not applicable to dollar
cost averaging or automatic
transfers.)
SURRENDER CHARGE
The initial Surrender Charge Is [$ 1600.00].
The Surrender Charge Grades Off As Follows:
100% Of The Surrender Charge In Policy Years 1-5
80% Of The Surrender Charge In Policy Year 6
60% Of The Surrender Charge In Policy Year 7
40% Of The Surrender Charge In Policy Year 8
20% Of The Surrender Charge In Policy Year 9
No Surrender Charge In Policy Years 10 And Later
FIXED ACCOUNT
Fixed Account I:
---------------
Minimum Guaranteed Interest Rate: 4.00%
Interest Rate as of Policy Date: [x%.] The interest rate as of
policy date applies only to premium payments allocated or
transferred to Fixed Account I during the calendar month
following the Policy Date. This rate is guaranteed for one
policy year.
<PAGE>
ALLOCATION GUIDELINES:
1. Currently, you may select as many investment options as you wish. In the
future we reserve the right to limit the number of options available. There
will never be fewer than 4 investment options available.
2. Currently, you may also select any fixed account which is available at the
time the premium payment or transfer is made.
3. The initial premium will be allocated to the investment options on the
latest of:
a. Two business days after the policy date;
b. Two business days after our receipt of your initial premium
at our Administrative Office; or
c. The date our underwriters approve this policy. Additional premium
payments will be credited to your policy as of the business day
they are received.
4. Allocation percentages must be in whole numbers. Each allocation must be at
least 1%.
TRANSFERS:
Transfers from Subaccounts: You are permitted unlimited transfers among
subaccounts. We may change this unlimited transfer right by endorsement
approved by the Insurance regulatory authority of the state in which
this policy was issued.
Transfers from Fixed Account I: You may transfer up to 25% of the value
of Fixed Account I from that account to any other account, subject to
the minimum amount to be transferred.
Minimum Amount to be Transferred: The minimum amount which may be
transferred is [$250.00] or your entire interest in any subaccount or
fixed account, if less. This requirement is waived if the transfer is
pursuant to a prescheduled transfer.
Prescheduled Transfers: You may elect the dollar cost averaging option
or the automatic transfer option. However, that portion of the cash
value held in Fixed Account I is included in any prescheduled transfer
option. We reserve the right to limit the availability of any fixed
account option or subaccount for a prescheduled transfer.
<PAGE>
<TABLE>
<CAPTION>
INVESTMENT OPTIONS
<S> <C> <C> <C> <C> <C> <C>
[Federated High Income Bond Fund II] [Fidelity VIP II Asset Manager]
[Federated Prime Money Fund II] [Fidelity VIP II Contrafund]
[Federated Utility Fund II] [Fidelity Equity-Income]
[Fidelity VIP II Index 500]
[Alger American Growth Portfolio]
[Alger American Mid-Cap Growth Portfolio] [MFS Emerging Growth]
[Alger American Small Capitalization Portfolio] [MFS Growth With Income]
[Alger American Leveraged AllCap Portfolio] [MFS Research]
[MFS Total Return]
[Templeton Developing Markets Securities Fund]
[Templeton Asset Strategy Fund] [Janus Aspen Capital Appreciation Portfolio]
[Janus Aspen Growth Portfolio]
[Alliance Growth and Income Portfolio] [Janus Aspen Balanced Portfolio]
[Alliance Premier Growth Portfolio] [Janus Aspen Flexible Income Portfolio]
[Janus Aspen International Growth Portfolio]
[Lazard Retirement Equity Portfolio] [Janus Aspen Worldwide Growth Portfolio]
[Lazard Retirement Small Cap Portfolio]
[American Century VP Income & Growth Fund]
[American Century VP Value Fund]
[Morgan Stanley Emerging Markets Equity Portfolio]
[Morgan Stanley International Magnum Portfolio]
</TABLE>
VARIABLE ACCOUNT: VFL Variable Life Insurance Separate Account
ADDITIONAL BENEFITS PROVIDED BY RIDER
MONTHLY COST
BENEFIT DESCRIPTION EXPIRY DATE OF RIDER
[Additional Insurance Rider July 1, 2024 [$15.00]
[$100,000]]
[Term Insurance On Children - [10-]
Units July 1, 2019 [$4.75]
Each Unit Provides $1,000 Of Coverage For Each Child]]
<PAGE>
TABLE OF MAXIMUM MONTHLY COST OF INSURANCE RATES
PER $1,000 OF NET AMOUNT AT RISK
<TABLE>
<CAPTION>
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
ATTAINED ATTAINED ATTAINED
AGE COST AGE COST AGE COST
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
<S> <C> <C> <C> <C>
35 0.140833 70 2.885833
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
36 0.147500 71 3.242500
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
37 0.156667 72 3.546667
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
38 0.166667 73 3.953333
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
39 0.178333 74 4.410000
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
40 0.190833 75 4.900000
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
41 0.205833 76 5.421667
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
42 0.220833 77 5.970000
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
43 0.238333 78 6.539167
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
44 0.255833 79 7.143333
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
45 0.276667 80 7.805833
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
46 0.299167 81 8.543333
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
47 0.323333 82 9.376667
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
48 0.349167 83 10.315833
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
49 0.378333 84 11.342500
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
50 0.409167 85 12.433333
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
51 0.445833 86 13.566667
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
52 0.488333 87 14.732500
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
53 0.535833 88 15.907500
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
54 0.590833 89 17.107500
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
55 0.651667 90 18.349167
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
56 0.719167 91 19.653333
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
57 0.790833 92 21.062500
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
58 0.868333 93 22.635833
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
59 0.955833 94 24.637500
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
60 1.053333 95 27.496667
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
61 1.161667
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
62 1.285000
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
63 1.425833
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
64 1.585000
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
65 1.760833
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
66 1.950000
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
67 2.155000
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
68 2.375000
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
69 2.615000
----------------------- -------------------- -------------------- -------------------- --------------------- --------------------
</TABLE>
THE MAXIMUM COST OF INSURANCE RATES DO NOT EXCEED THE COST OF INSURANCE RATES
BASED ON THE APPLICABLE (MALE OR FEMALE, SMOKER OR NONSMOKER) 1980 COMMISSIONERS
STANDARD ORDINARY MORTALITY TABLE, AGE NEAREST BIRTHDAY.
<PAGE>
The table below gives the "applicable percentage" for each attained age in
accordance with Section 7702 of the Internal Revenue Code.
<TABLE>
<CAPTION>
APPLICABLE PERCENTAGE OF CASH VALUE TABLE
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
Attained Percentage Attained Percentage Attained Percentage Attained Percentage
Age of Age of Age of Age of
Policy Policy Policy Policy
Value Value Value Value
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
Through 40 250 50 185 60 130 70 115
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
41 243 51 178 61 128 71 113
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
42 236 52 171 62 126 72 111
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
43 229 53 164 63 124 73 109
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
44 222 54 157 64 122 74 107
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
45 215 55 150 65 120 75 thru 90 105
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
46 209 56 146 66 119 91 104
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
47 203 57 142 67 118 92 103
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
48 197 58 138 68 117 93 102
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
49 191 59 134 69 116 94 101
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
95+ 100
----------------- ------------ ------------- ------------ -------------- ------------ -------------- ------------
</TABLE>
SUPPLEMENTAL SCHEDULE
_________________SCHEDULE OF MONTHLY COST OF INSURANCE RATES____________________
WAIVER OF MONTHLY DEDUCTION
RATES PER $1 OF MONTHLY DEDUCTION
ATTAINED
AGE COST
--- ----
[
35 0.05790
36 0.05850
37 0.05880
38 0.05910
39 0.05940
40 0.05990
41 0.06070
42 0.06210
43 0.06400
44 0.06680
45 0.07040
46 0.07570
47 0.08280
48 0.09120
49 0.10030
50 0.10970
51 0.11880
52 0.12700
53 0.13380
54 0.13860
55 0.14160
56 0.14330
57 0.14400
58 0.14420
59 0.14430
60 0.13940
61 0.13250
62 0.12360
63 0.11270
64 0.09980]
<PAGE>
TABLE OF CONTENTS
Policy Schedule
Definitions
Owner, Beneficiary and Assignment Provisions
Owner
Contingent Owner
Beneficiary
Assignment
Premium Provisions
Premium Payments
Right to Refund
Grace Period
Reinstatement
Lapse Prevention Guarantee
Death Benefit Provisions
Death Benefit
Death Benefit Charges
Death Proceeds
Payment of Claims
Policy Value Provisions
Cash Value
Subaccount
Policy Loan Account
Fixed Account I
Interest Crediting
Minimum Values
Basis of Computations
Policy Cost Factors
Monthly Deduction
Monthly Cost of Insurance
Expense Charge
Premium Charges
Surrender Charge
Transfer Processing Fee
Changes in Policy Cost Factor
Charges after the Insured's Attained Age 95
<PAGE>
TABLE OF CONTENTS - CONTINUED
Surrender Provisions
Total Surrender
Partial Surrenders
Free Partial Surrender Amount
Loan Provisions
Maximum Loan Value
Policy Loan
Loan Interest
Loan Repayment
Termination of Policy
Effect of Loan
The Variable Account
Variable Account
Investments of the Variable Account
Valuation of Assets
Change in Operation of the Variable Account
Accumulation Units
Accumulation Unit Value
Net Investment Factor
Fixed Account I
Transfers
Transfer Rules
Transfer Processing Fee
General Policy Provisions
Entire Contract
Changes
Incontestability
Suicide
Error in Age or Sex
Payment of Proceeds
Right to Defer Payments or Transfers from any fixed account
Termination
Annual Report
Non-Participating
Currency
Signature Guarantee
Settlement
<PAGE>
DEFINITIONS
Attained Age: The issue age plus the number of full policy years since your
policy was issued.
Base Specified Amount: The Specified Amount for the policy without any added
insurance provided by rider. It is shown in the Policy Schedule.
Business Day: Any day that Valley Forge Life Insurance Company and the New York
Stock Exchange are open.
Cash Surrender Value: The cash value less any surrender charge.
Cash Value: The total of all values under this policy held in the Variable
Account, in any fixed accounts and in the loan account. Refer to the Policy
Values Provisions for details.
Death Proceeds: The amount of money payable to the beneficiary if the Insured
dies while this policy is in force. Refer to the Death Benefit Provisions for
details.
Debt: Any amount you owe us as the result of a policy loan. This includes any
accrued loan interest.
Insured: The person, named on the policy schedule, whose life is insured by this
policy.
Investment Option: An investment choice within the Variable Account available
under the policy. Current investment options are shown on the Policy Schedule.
Issue Age: The Insured's age as of the nearest birthday on the policy date.
Monthly Date: The same day as the policy date for each succeeding month.
Policy Anniversary: The same day as the policy date for each succeeding policy
year.
Policy Date: The date coverage under this policy becomes effective and from
which the Incontestibility and Suicide provisions are determined.
Policy Loan Account: That portion of the cash value resulting from a policy
loan.
Policy Year: The twelve month period beginning on the policy date and ending the
day before the same date in the next calendar year; and each succeeding twelve
month period.
Net Cash Value: Cash surrender value less any debt.
Total Specified Amount: A dollar amount used to determine the death benefit of
your policy. It includes any specified added by any additional insurance rider
attached to the policy. The total specified amount may not be less than the
minimum total specified amount. The total specified amount and the minimum total
specified amount are shown on the Policy Schedule.
Subaccount: A subdivision of the Variable Account.
Variable Account: Valley Forge Life Insurance Variable Life Separate Account.
Written Notice: A notice or request signed by you and received and recorded at
our Administrative Office.
OWNER, BENEFICIARY AND ASSIGNMENT PROVISIONS
Owner: The person(s) or entity(ies) named in the Policy Schedule who has all
rights under this policy while the Insured is living. Your rights in this policy
belong to your estate if you die before the Insured dies and there is no joint
owner or contingent owner. All references to owner shall include joint owners.
If there is more than one owner, each owner shall be a joint owner of the
policy. Joint owners have equal ownership rights and both must authorize any
exercising of these rights except for transfers and allocations.
Contingent Owner: The contingent owner, if any, will become the owner if the
named owner dies before the date of the Insured's death. In the event of Joint
Owners, the contingent owner will become the owner if both named joint owners
die before the Insured. The contingent owner, if any, is as named in the
application, unless changed. You may name a contingent owner at any time while
the Insured is living. Such designation must be by written notice. Once
recorded, the designation will be effective as of the date the written notice
was signed. Such change will not affect any payment we make or action we take
before it was recorded.
Beneficiary: There are two categories of beneficiary - primary and contingent.
The primary beneficiary is the person to whom the death proceeds are paid when
the Insured dies. The contingent beneficiary, if any, will become the
beneficiary if no primary beneficiary is living on the date of the Insured's
death. The primary beneficiary and contingent beneficiary on the policy date are
as named in the application. More than one primary or contingent beneficiary may
be named. If more than one primary beneficiary is alive when the Insured dies,
we will pay such primary beneficiaries in equal shares unless you have provided
otherwise.
If any beneficiary dies before the Insured, that beneficiary's interest in the
death benefit will end.
If any beneficiary dies at the same time as the Insured, or within 30 days after
the Insured, that beneficiary's interest in the death benefit will end if no
benefits have been paid to that beneficiary unless you direct otherwise. If the
interest of all designated beneficiaries has ended when the Insured dies, we
will pay the death benefit to you. If you are not living at that time, we will
pay the death benefit to your estate.
While the Insured is alive, you may change any beneficiary. Any change must be
by written notice. Once recorded, the change will take effect as of the date you
signed it. Such change will not affect any payment we make or action we take
before it was recorded. An irrevocable beneficiary must consent in writing to
any change in beneficiary.
Assignment: While the Insured is living, you may assign any or all rights under
your policy. Assignment of all rights is a change of ownership. An irrevocable
beneficiary must agree in writing to any assignment. We will not be bound by any
assignment unless it is by written notice. An assignment will not affect any
payments we have made or actions we have taken before we receive notice of the
assignment. We are not responsible for the sufficiency or validity of any
assignment.
PREMIUM PROVISIONS
Premium Payments: The initial premium is due on the policy date. Other premiums
may be required as described below. Unless specified, any payments received will
be considered premiums and not loan repayments.
All premiums must be sent to us at our Administrative Office. A receipt signed
by one of our authorized officers will be furnished upon request. No premium
will be accepted after the policy anniversary nearest the Insured's attained age
95.
You may change the allocation for future premiums at any time while your policy
is in force by written notice. The change will take effect on the date we
receive your request at our Administrative Office. Future premium payments will
be required if additional premium payments are necessary to keep the policy in
force in accordance with the grace period provision.
Premiums are allocated to one or more subaccounts of the Variable Account or to
any fixed account in accordance with your election. We will accept subsequent
premiums at any time. All subsequent premiums are allocated in the same manner
as the initial premium payment unless you direct us otherwise. Allocations of
premiums are subject to the allocation guidelines shown on the Policy Schedule.
Right to Refund: We reserve the right to return any premium that would cause the
policy to be disqualified as life insurance under the Internal Revenue Code.
Grace Period: If the net cash value on any business day is not sufficient to
cover any expense charges which are due but unpaid, a grace period of 61 days
will be allowed for the payment of sufficient premium to keep your policy in
force. A minimum payment of a sum equal to two monthly deductions must be paid.
We will send you a notice at the start of the grace period to your last known
address and to any assignee. The grace period will end 61 days after we mail you
the notice.
If sufficient premium is not paid by the end of the grace period, the policy
will terminate without value. If the Insured dies during the grace period, we
will pay the death proceeds. (See the Death Benefit Provisions for details.)
If the lapse prevention guarantee described below is in effect, the grace period
will not apply until the beginning of the policy year following the lapse
prevention guarantee period shown on the Policy Schedule.
Reinstatement: If this policy terminates as provided in the grace period
provision, you may apply to reinstate this policy unless you have surrendered it
for its cash surrender value. To reinstate this policy , you must:
(1) submit a written request at any time within three years after the end of
the grace period;
(2) provide proof of insurability satisfactory to us;
(3) pay an amount large enough to pay the next two monthly deductions;
(4) pay any negative cash surrender value that existed at the end of the grace
period; and
(5) repay or reinstate any debt which existed at the end of the grace period.
The effective date of a reinstatement will be the monthly date on or next
following the date we approve the application for reinstatement.
If a surrender charge was applied when the policy lapsed, the surrender charge
applied will be credited to the cash value. The surrender charge on the date of
reinstatement will be the same as it was on the date of lapse. For the purpose
of determining the surrender charge on any date after the effective date of
reinstatement, the period the policy was lapsed will not count. Unless you have
provided otherwise, the allocation of the amount of the surrender charge,
additional premiums, and loan repayments will be based on the allocations in
effect at the start of the grace period.
Lapse Prevention Guarantee: The Company guarantees that the policy will not
lapse during the lapse prevention guarantee period shown on the Policy Schedule
if, throughout that period, (a) equals or exceeds (b) where:
(a) is the aggregate premium payments made less the amount of any surrenders
(including applicable surrender charges) less any loan amount; and
(b) is the minimum monthly lapse prevention guarantee premium multiplied by the
number of complete months since the policy date, including the current
month.
DEATH BENEFIT PROVISIONS
Death Benefit:
We will pay the death benefit as soon as we receive due written proof that the
Insured has died while this policy is in force.
If death benefit option 1 is shown on the policy schedule, the death benefit
will be the greater of:
1. The total specified amount; or
2. The applicable percentage of the cash value on the date of death.
If death benefit option 2 is shown on the policy schedule, the death benefit
will be the greater of:
1. The total specified amount plus the cash value on the date of death; or
2. The applicable percentage of the cash value on the date of death.
Death Benefit Changes:
Death benefit changes are made only by written notice. You may change the
specified amount after this policy has been in force for one year. A change will
be effective on the monthly date following our approval or recording of the
change. Any change is subject to the following:
1. a decrease will be applied first against prior increases, if any, on a
last-in, first-out basis, then against the initial specified amount. A
decrease in total specified amount shall not reduce the specified
amount lower than the minimum total specified amount shown on the
Policy Schedule. A pro rata share of any applicable surrender charge
may apply;
2. an increase will require proof of insurability.
We will show the effective date of any change in total specified amount in a
Supplemental Policy Schedule we will send you. Any changes are subject to the
minimum total specified amount and the minimum change in total specified amount
shown on the Policy Schedule.
You may change the death benefit from Option 2 to Option 1. This will increase
the Total Specified Amount by the amount of cash value.
You may change the death benefit from Option 1 to Option 2. Proof of
insurability satisfactory to us is required. In such case, the total Specified
Amount will be reduced by the amount of cash value so that the death benefit is
not increased as of the date of change.
Death Proceeds: The death proceeds equals:
1. the death benefit provided by your policy; plus
2. any life insurance benefits that may be provided by rider; less
3. any debt; less
4. any due and unpaid monthly deductions during the grace period.
We will pay the death proceeds after we receive due proof of death at our
Administrative Office. The death proceeds will be adjusted under certain
conditions. Refer to the Incontestability, Suicide, and Error in Age or Sex
Provision.
Payment of Claims: When this policy becomes a claim by the death of the Insured,
settlement will be made upon receipt of due proof of death. If proceeds are not
paid within 30 days of receipt of due proof of death, the payment will include
interest at the legal rate from the date of death of the Insured until the date
the claim is paid.
POLICY VALUE PROVISIONS
Cash Value: The cash value is the sum of the value in each subaccount, any fixed
account and the policy loan account. The value in each subaccount on the policy
date is equal to the portion of the initial premium allocated to the subaccount.
The cash value reflects net premiums paid, monthly deductions, the investment
experience of the subaccounts selected, any interest credited on any fixed
account selected, any interest earned or interest charged on amounts allocated
to the policy loan account, and any deductions due as a result of a transfer or
a partial surrender.
Subaccount: The value in each subaccount on each subsequent business day is
equal to:
1) the value in the subaccount on the preceding business day multiplied by its
net investment factor; plus
2) any amounts allocated to the subaccount; plus
3) any amounts transferred to the subaccount; less
4) any amounts transferred from the subaccount; less
5) the portion of any charges which are due and charged to the subaccount,
less
6) any partial surrender amounts allocated to the subaccount.
Policy Loan Account: The value in the policy loan account is zero, unless you
take a policy loan. On the business day a policy loan is taken, the value in the
policy loan account is equal to the amount of any previous loans with accrued
interest plus the amount of the requested loan.
The value in the policy loan account on each subsequent business day is equal
to:
1) the value in the policy loan account on the preceding business day; plus
2) guaranteed interest credited; plus
3) any amounts transferred to the policy loan account because of additional
policy loans; plus
4) any due and unpaid loan interest during the current business day; less
5) the amount of any loan repayments you make during the current business day.
Fixed Account I : The value in Fixed Account I is equal to:
1) the premiums allocated to Fixed Account I; plus
2) guaranteed interest credited; plus
3) any excess interest credited; plus
4) any amounts transferred to Fixed Account I; less
5) any amounts transferred from Fixed Account I; less
6) the portion of any charges which are due and charged to Fixed Account I;
less
7) any surrender amounts and surrender charges deducted from Fixed Account I.
Interest Crediting: We credit interest daily to Fixed Account I at the minimum
guaranteed interest rate shown on the policy schedule. We may credit excess
interest to Fixed Account I in an amount which we will declare from time to
time. Declared interest rates will be guaranteed for one Policy Year.
Minimum Values: Your policy values are at least equal to those set by law in the
state where the policy was issued. Where required, we have given insurance
regulators a detailed statement of how we compute values and benefits.
Basis of Computation: All values are based on the applicable (male or female,
smoker or non-smoker) Commissioners 1980 Standard Ordinary Mortality Table, Age
nearest Birthday.
POLICY COST FACTORS
Monthly Deduction: Each monthly date, we will make certain deductions from the
cash value of your policy. The monthly deduction is for:
1. Cost of insurance for the following month;
2. The monthly cost of any rider attached to this policy.
The first monthly deduction will be determined as of the policy date.
The monthly deduction will be deducted on a pro-rata basis from the cash
surrender value allocated to the subaccounts and any fixed accounts based on the
proportion of the cash value that is attributable to each subaccount and any
fixed accounts.
Monthly Cost of Insurance Rate: The monthly cost of insurance rate is a rate per
$1,000 of coverage. We determine the monthly cost of insurance rate each year as
of the policy anniversary. This rate will be charged for the next policy year.
The monthly cost of insurance rate will not exceed the maximum guaranteed
monthly cost of insurance rate shown on the Policy Schedule.
The monthly cost of insurance is determined as (1) times (2) where:
(1) is the net amount at risk which is equal to the Death Benefit divided by
the monthly equivalent of the guaranteed interest rate, minus cash value
before charges, all divided by 1,000; and
(2) is the monthly cost of insurance rate per $1,000 of coverage on the monthly
date.
Expense Charge: We deduct an expense charge daily from each subaccount of the
Variable Account. The expense charge is shown on the Policy Schedule.
Premium Charges: Premium charges are levied on premiums received as shown on the
Policy Schedule
Surrender Charge: The surrender charge is levied when you make a partial or
total surrender of the cash value. The surrender charge is a charge per $1,000
times the decrease in specified amount divided by 1,000and is assessed based on
the amount surrendered. Subsequent surrender charges will be calculated in the
same way. The surrender charge is shown on the Policy Schedule.
Transfer Processing Fee: Transfer processing fees are levied when the number of
transfers among subaccounts and/or any fixed accounts exceeds the number of free
transfers allowed in a policy year. The amount of the Transfer Processing Fee
and the number of free transfers are shown on the Policy Schedule.
Changes in Policy Cost Factors: Changes in cost of insurance rates, credited
interest rates, policy expense charges or other charges will be by class and
will be based on changes in future expectations.
If required, the procedures for making such changes are on file with the
insurance regulators in the state in which this policy was delivered.
Charges after the Insured's Attained Age 95: Policy Charges as shown on the
Policy Schedule will not apply on and after the policy anniversary nearest the
Insured's attained age 95.
<PAGE>
SURRENDER PROVISIONS
Total Surrender: You may surrender your policy for its net cash value at any
time while it is in force by written notice. We may also require return of your
policy.
The date of surrender will be the date we receive your written request. The net
cash value will be determined as of the end of the normal business day during
which your written notice is received. All coverage will end on the date of
surrender.
Partial Surrenders: A partial surrender may be made at any time after the first
policy anniversary by written notice. The Free partial surrender Amount as
defined below may be withdrawn free of surrender charges in any policy year. Any
excess above a 10% partial surrender in any policy year will be subject to a
partial surrender charge if a surrender charge would apply to a total surrender.
When you make a partial surrender, we will reduce the cash value and the
specified amount by the partial surrender amount and any surrender charges. A
new Policy Schedule will be issued reflecting the changes.
The minimum partial surrender amount is shown on the Policy Schedule. We may
require that any partial surrender amounts be first deducted from the cash value
in the subaccounts.
Partial surrenders will be allowed only if this policy continues to qualify as a
contract of life insurance under IRC Section 7702. We may limit the maximum
amount of all partial surrenders in each policy year to the greater of:
1) 10% of the total premium payments; or
2) cash value less total premiums paid less any debt.
Free Partial Surrender Amount: The free partial surrender amount (determined as
shown on the Policy Schedule) will not be subject to the surrender charge. The
free partial surrender amount for any policy year after the first policy year is
determined at the time of the first partial surrender in a policy year. If the
free partial surrender amount for a policy year is not taken in the first
partial surrender of a policy year, the free partial surrender amount available
for any other partial surrender in a policy year equals (a) minus (b), where:
(a) is the free partial surrender amount for that policy year; and
(b) is the total of prior free partial surrender amounts withdrawn the same
policy year.
LOAN PROVISIONS
Maximum Loan Value: The maximum loan value is 90% of the net cash value as of
the date of the loan.
Policy Loan: You may obtain a loan at any time while your policy is in force by
written notice. The amount of the loan and all existing loans may not be more
than the maximum loan value as of the date we process the loan. The minimum loan
amount is shown on the Policy Schedule. The loan will be made upon the sole
security and proper assignment of this policy to us.
Loan Interest: The loan interest rate is as stated in the Policy Schedule.
Interest is charged daily and is payable at the end of each policy year or upon
repayment, if earlier. Unpaid interest will be added to the existing debt as of
the due date and will be charged interest at the same rate as the rest of the
loan.
The Company credits a higher effective annual interest rate on: (1) amounts
borrowed up to an amount equal to cash value less aggregate premium payments
made to date; (2) all loans against policies in the 11th policy year or later;
and (3) the amount of any outstanding policy loan transferred in a tax-free
exchange. These loans are considered preferred loans.
Loan Repayment: All or part of a loan may be repaid to us at any time while this
policy is in force.
Termination of Policy: If the total debt ever equals or exceeds the cash value
less the surrender charge, your policy will terminate without value, subject to
31 days prior notice and to the Grace Period provision.
Effect of a Loan: When you take a policy loan, we will transfer an amount equal
to the policy loan from a subaccount or Fixed Account I to the policy loan
account. We will also transfer any loan interest that becomes due and unpaid .
Amounts transferred to the policy loan account will earn interest daily from the
date of transfer. When you repay part or all of a loan, we will transfer an
amount equal to the portion of the loan principal repaid plus any interest
credited in the loan account on that portion of the principal repaid, to a
subaccount or any fixed account.
Unless otherwise specified, transfers from the subaccounts to the policy loan
account will be in proportion to the cash value in each subaccount as of the
loan date. Loan amounts will be transferred from any fixed account only when
insufficient amounts are available in the subaccounts.
Since the amount you borrow is removed from a subaccount or Fixed Account I, a
loan will have a permanent effect on any death benefit and cash surrender value
of this policy. The effect may be favorable or unfavorable. This is true whether
you repay the loan or not. If the loan is not repaid, debt will reduce the
amount of any death proceeds.
THE VARIABLE ACCOUNT
Variable Account: The Variable Account is designated on the Policy Schedule and
consists of assets set aside by us, which are kept separate from our general
assets and all of our other Variable Account assets. The assets of the Variable
Account, equal to reserves and other liabilities of your policy and those of
other owners, will not be charged with liabilities arising out of any other
business we may do. The Variable Account is used to fund only the variable life
insurance benefits.
The Variable Account assets are divided into subaccounts. The assets of the
subaccounts are allocated to the investment options shown on the Policy
Schedule.
Investments of the Variable Account: We may, from time to time, add additional
investment options to those options shown on the Policy Schedule. You may be
permitted to transfer cash value to the additional investment option(s).
If the shares of any of the investment options become unavailable for investment
by the Variable Account, or we deem further investment in these shares
inappropriate, we may limit further purchase of such shares or substitute shares
of another investment option for shares already purchased under this policy. The
investment policy of the Variable Account may not be changed without the
approval of the Pennsylvania Insurance Commissioner. The approval process for
such changes is on file with the Pennsylvania Insurance Commissioner.
Valuation of Assets: Assets of the Variable Account are valued at their fair
market value in accordance with our procedures.
Change in Operation of the Variable Account: We reserve the right to modify the
structure or operation of the Variable Account. In such an event, we guarantee
that such modification will not affect the value of your contract and such
changes shall be made in accordance with any regulatory requirements.
Accumulation Units: Accumulation Units shall be used to account for all amounts
allocated to or surrendered from a subaccount as a result of premium payments,
transfers, surrenders, or fees and charges. We will determine the number of
accumulation units of a subaccount purchased or canceled. This is done by
dividing the amount allocated to (or the amount surrendered from) the
subaccount, by the dollar value of one accumulation unit of the subaccount as of
the business day during which we received written notice.
Accumulation Unit Value: The Accumulation Unit Value for each subaccount was set
at $10 when the subaccount became part of the Variable Account. Subsequent
accumulation unit values for each subaccount are determined by multiplying the
accumulation unit value for the immediate preceding business day by the net
investment factor of the subaccount for the current business day. The
accumulation unit value may increase or decrease from business day to business
day.
Net Investment Factor: The net investment factor for each subaccount is
determined by dividing (1) by (2) and subtracting (3) from the result, where:
1) is the result of:
(a) the net asset value per share of the investment option held in the
subaccount, determined at the end of the business day; plus
(b) the per share amount of any dividend or capital gain distributions made by
the investment option held in the subaccount, if the "ex-dividend" date
occurs as of the current business day; plus or minus
(c) a per share charge or credit for any taxes reserved for, which we determine
to have resulted from the operations of the subaccount.
2) is the net asset value per share of the investment option held in the
subaccount, determined at the end of the last prior business day.
3) is a daily factor representing the expense charges (shown on the Policy
Schedule) deducted from the subaccount.
FIXED ACCOUNT I
Fixed Account I is funded by the general account of the Company. The general
account consists of all of our assets other than those held in any separate
investment account. Fixed Account I is credited with interest as described under
the Policy Value Provisions. In addition to allocating your premiums to one or
more of the subaccounts described above, you may direct all or part of your
premium payments into any fixed account.
TRANSFERS
Transfer Rules: A transfer is subject to the following:
1) The maximum number of transfers without a Transfer Processing Fee is shown
on the Policy Schedule;
2) We reserve the right to assess a Transfer Processing Fee as shown on the
Policy Schedule if the number of transfers exceeds the maximum number of
free transfers shown on the Policy Schedule. We will notify you if we
deduct a Transfer Processing Fee and will deduct such fee from the amount
which is transferred;
3) You may not make a transfer until after the end of the free look period;
4) The minimum amount which may be transferred is shown on the Policy
Schedule;
5) A transfer will be effected as of the end of the normal business day when
we receive an acceptable transfer request;
6) We are not liable for a transfer made in accordance with your instructions;
7) Your right to make transfers is subject to modification if we determine
that the exercise of the right by one or more owners of this policy is, or
would be, to the disadvantage of other owners of this policy. Restrictions
may be applied in any manner reasonably designed to prevent any use of the
transfer right which we consider to be to the disadvantage of other owners
of this policy. A modification could be applied to transfers to or from one
or more of the subaccounts and could include:
a. the requirement of a minimum time period between each transfer; or
b. not accepting a transfer request from an agent acting under a power of
attorney on behalf of more than one owner; or
c. limiting the dollar amount that may be transferred between the subaccounts
at any one time;
8) During times of drastic economic or market conditions, we may suspend the
transfer privilege temporarily without notice and treat transfer requests
based on their separate components (a redemption order with a simultaneous
request for purchase of another subaccount). In such a case, the redemption
order would be processed at the source subaccount's next determined
accumulation unit. However, the purchase into the new subaccount would be
effective at the next determined accumulation unit value for the new
subaccount only after we receive proceeds from the source subaccount, or we
otherwise receive cash on behalf of the source subaccount;
9) Transfers do not change the allocation instructions for future premium
payments;
10) You may elect to make transfers by telephone. However, to elect this option
you must first make a written request. If there are joint owners, unless we
are instructed to the contrary, instructions by telephone will be accepted
from either of the joint owners. We will use reasonable procedures to
confirm that instructions communicated by telephone are genuine.
Transfer Processing Fee: A number of transfers during each policy year are free
as shown on the Policy Schedule. We will deduct from the amount being
transferred the processing fee shown on the Policy Schedule for transfers in
excess of the free amount of transfers. Each written notice of transfer is
considered to be one request regardless of the number of subaccounts or any
fixed account affected by the transfer.
GENERAL POLICY PROVISIONS
Entire Contract: We have issued this policy in consideration of the application
and initial premium payment. A copy of the application is attached to and made a
part of this policy. The policy, including the application and any attached
riders or endorsements, forms our entire contract with you. All statements made
by or for the Insured in the application or any supplemental application will be
considered representations and not warranties. In the absence of fraud we will
not use any statement made by or for the Insured to deny a claim unless the
statement is in the application or supplemental application and a copy of the
statement has been furnished to the claimant.
Changes: No change may be made to this policy unless it is in writing and has
been signed by our Chairman, President, a Vice President or our Secretary.
Incontestability: We cannot contest the validity of this policy after it has
been in force during the lifetime of the Insured for two years from the policy
date; nor can we contest any increased benefit or reinstatement after it has
been in force, while the Insured is alive, for two years after the effective
date of such increase or reinstatement.
We cannot contest this policy, any reinstatement or any increase in benefits
during the two year period after the policy effective date, the effective date
of a reinstatement, or the effective date of an increase in benefits unless:
1) An answer in the application for the policy, reinstatement or increase in
benefits was not true or complete; and
2) If we had known the truth, we would not have issued the policy as we did or
increased the benefits.
Any statement made by the Insured will not be used in any contest unless a copy
is furnished to the beneficiary.
Suicide: If the Insured commits suicide, while sane or insane, within two years
from the policy date, our liability shall be limited to the premiums paid prior
to death, less any debt and less any partial surrenders.
If the Insured commits suicide, while sane or insane, within two years from the
effective date of any increase in the specified amount, the total liability with
respect to such increase shall be limited to the monthly deductions for such
increase.
Error in Age or Sex: If the age or sex of the Insured has been misstated, all
payments and benefits under the policy will be those which the most recent cost
of insurance rates would have purchased at the Insured's correct age or sex.
Payment of Proceeds: Unless we agree to a different mode of settlement, all
benefits will be paid in one sum to the beneficiary.
Postponement of Payments: We will pay surrender proceeds or the amount of a
policy loan as soon as possible after we receive your written notice. We will
pay any death proceeds when we receive due proof of death. (Due proof of death
includes all information we may reasonably require.)
The payment or transfer from the Variable Account may be postponed if:
1. The New York Stock Exchange is closed, other than customary weekend or
holiday closing, or trading on the exchange is restricted as determined by
the Securities and Exchange Commission ("SEC"); or
2. The SEC permits, by an order, the postponement for your protection; or
3. The SEC determines that an emergency exists that would make the disposal of
securities held in the variable account or determination of their value not
reasonably practicable.
Right to Defer Payments or Transfers from any Fixed Account: Except for a policy
loan to pay premiums, we have the right to defer payment of any loan, surrender
or transfer of any fixed account value for up to six months from the date we
receive your written notice, unless the law in your state provides otherwise.
Termination: This policy will terminate on the date when the earliest of the
following events occurs:
1. you request in writing that coverage terminate; or
2. the Insured dies; or
3. the grace period ends.
Annual Report: At least once each policy year, we will send you a report showing
current cash values and any other information required by law or regulation. We
will mail this report to you at your last known address.
Non-Participating: This policy will not share in our profits or surplus
earnings.
Currency: Any money we pay, or that is paid to us, must be in United States
currency.
Signature Guarantee: For your protection, a request for surrender, policy loan,
or a change in ownership must be by written notice. We may require the signature
to be guaranteed by a member firm of the New York, Boston, Midwest,
Philadelphia, or Pacific Stock Exchange, or by a commercial bank (not a savings
bank), which is a member of the Federal Deposit Insurance Corporation. In some
cases, the Company may require additional documentation of a customary nature.
SETTLEMENT
Proceeds will be paid in a lump sum, or in in any other mutually agreed upon
payment option.
FLEXIBLE PREMIUM VARIABLE AND FIXED LIFE INSURANCE POLICY
Premiums are payable until the earlier of Insured's death or
the Insured's attained age 95.
Adjustable Death Benefit
Death Proceeds Payable at Insured's Death
Non-Participating
Investment Experience Reflected in Benefits
VUL-104 (8/00)
