<PAGE>
Transamerica Occidental POLICY FORM TRUL-VUL
Life Insurance Company Individual Life Insurance
1150 South Olive Street
Los Angeles, CA 90015
INSURED POLICY NUMBER
FACE AMOUNT DATE OF ISSUE
Transamerica Occidental Life Insurance Company will pay the death benefit to the
beneficiary if the insured dies while this policy is in force. All payments are
subject to the provisions of this policy.
Signed for the Company at Los Angeles, California, on the date of issue.
Executive Vice President, General Counsel President
And Corporate Secretary
RIGHT TO EXAMINE AND RETURN POLICY WITHIN 10 DAYS -- At any time within 10 days
after you receive this policy, you may return it to us or the agent through whom
you bought it. We will cancel the policy and void it from the beginning. We will
refund to you: (1) the difference between any premiums paid, including fees or
other charges, and the amounts allocated to the separate account; PLUS (2) the
value of the amounts in the separate account on the date this policy is received
at our administrative office; PLUS (3) any fees or other charges imposed on
amounts in the separate account.
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VARIABLE UNIVERSAL LIFE INSURANCE
MINIMUM PREMIUM REQUIREMENT
SHOWN IN THE POLICY DATA
FLEXIBLE PREMIUMS PAYABLE THEREAFTER DURING
LIFE OF INSURED PRIOR TO AGE 100
SUBJECT TO THE LIMITATIONS DESCRIBED
IN THE PREMIUMS PROVISION
DEATH BENEFIT PAYABLE AT DEATH OF INSURED
NONPARTICIPATING - NO ANNUAL DIVIDENDS
THIS POLICY CONTAINS A PREMIUM QUALIFICATION CREDIT PROVISION. TO RECEIVE THIS
CREDIT, YOU MUST PAY SPECIFIC PREMIUMS ON OR BEFORE THEIR DUE DATE. SEE DETAILS
ON PAGES 12-13.
YOU MAY ELECT TO ALLOCATE YOUR NET PREMIUMS TO THE SEPARATE ACCOUNT AND/OR THE
FIXED ACCOUNT.
THE VALUE IN THE SEPARATE ACCOUNT MAY INCREASE OR DECREASE DEPENDING ON
INVESTMENT RESULTS. PLEASE SEE THE SEPARATE ACCOUNT PROVISION FOR MORE DETAILS.
THE VALUE IN THE FIXED ACCOUNT WILL EARN INTEREST AT A RATE NOT LESS THAN THE
GUARANTEED MINIMUM INTEREST RATE SHOWN IN THE POLICY DATA.
THE AMOUNT OF THE DEATH BENEFIT MAY BE VARIABLE OR FIXED. THE LENGTH OF TIME
THIS POLICY WILL REMAIN IN FORCE WILL BE VARIABLE. PLEASE SEE THE DEATH BENEFIT
AND ACCUMULATION VALUES PROVISIONS FOR MORE DETAILS.
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This policy is a legal contract between you, the
owner of this policy, and Transamerica
Occidental Life Insurance Company.
READ YOUR POLICY CAREFULLY
POLICY SUMMARY
We will pay the death benefit to the beneficiary if the insured dies
while the policy is in force.
You must pay at least the minimum premium per year during the required
premium period shown in the Policy Data or your policy will lapse. If
you request an increase in the face amount of this policy, you must
also pay at least the minimum premium per year for the increased
portion for that portion's required premium period following the date
of the increase, or your policy will lapse. After that, you may vary
the amount of premiums and how often you pay them, within certain
limits, as described in the Premiums provision. Generally, you may pay
premiums as long as the insured is living, up to the policy anniversary
nearest age 100.
Additional benefits, if any, are provided by rider.
This is only a brief description. The insurance is fully described in
the various provisions of the policy.
<TABLE>
<CAPTION>
GUIDE TO POLICY PROVISIONS
PAGE PAGE
<S> <C> <C>
Accumulation Values..................................17,18 Option to Change the Face Amount........................24,25
Application Copy..................................after 34 Ownership and Beneficiary Provisions........................8
Beneficiary's Rights.....................................8 Payment of Cash Value and Loans............................29
Cash Value..............................................20 Payment of Death Benefit.................................9,10
Change of Beneficiary....................................8 Policy Data...............................................2-4
Death Benefit.........................................9,10 Policy Loans............................................20,21
Death Benefit Factors...............................32, 33 Policy Statements and Illustrations........................29
Definitions............................................5-8 Postponement of Transfers..................................28
Fixed Account........................................16,17 Premium Allocation......................................14,15
Grace Period............................................12 Premium Qualification Credit............................12,13
Guaranteed Exchange Option...........................26-28 Premiums................................................10,11
Guaranteed Maximum Monthly Deduction Rates...............3 Reinstatement...........................................13,14
Misstatement of Age.....................................30 Riders...............................................after 34
Monthly Deductions...................................19,20 Separate Account........................................15,16
Nonforfeiture Option....................................25 Transfers...............................................18,19
</TABLE>
1-12411101 PAGE 1A
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<TABLE>
<CAPTION>
P O L I C Y D A T A
LOAN INTEREST RATE MAY 01, 2001 POLICY DATE
<S> <C> <C> <C> <C>
POLICY YEARS 1-10 5.88% IN ADVANCE
MAY 01, 2001 DATE OF ISSUE
LOAN INTEREST RATE
POLICY YEARS 11+ 4.07% IN ADVANCE SPECIMEN POLICY NUMBER
REINSTATEMENT DEATH BENEFIT
INTEREST RATE 6.00% OPTION 1 OPTION
INSURED JOHN DOE 35 AGE OF INSURED
OWNER JOHN DOE $100,000 FACE AMOUNT
REALLOCATION DATE MAY 22, 2001 PREFERRED NON-SMOKER CLASS OF RISK
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - -
</TABLE>
MINIMUM INITIAL PREMIUM: $42.00
PLANNED PERIODIC PREMIUMS: $415.00 ANNUAL
REQUIRED PREMIUM PERIOD: 10 YEARS
REQUIRED PREMIUM PER YEAR FOR THE BASE POLICY: $252.00
REQUIRED PREMIUM PER YEAR FOR THE BASE POLICY AND ALL
ADDITIONAL RIDERS: $252.00
PREMIUM QUALIFICATION CREDIT PERIOD: 10 YEARS
PREMIUM QUALIFICATION CREDIT PERCENTAGE: 2%
GUARANTEED MAXIMUM MONTHLY POLICY FEE: POLICY YEARS 1-10: $6.00
POLICY YEARS 11 AND LATER: $10.00
ADMINISTRATIVE CHARGE: 7%
ANNUAL MORTALITY AND EXPENSE RISK CHARGE: 0.25%
DAILY MORTALITY AND EXPENSE RISK CHARGE: 0.000685787%
GUARANTEED MAXIMUM MONTHLY EXPENSE
CHARGE PER THOUSAND: $0.0942
GUARANTEED MINIMUM INTEREST RATE: 4.0%
(FOR THE FIXED ACCOUNT)
SELECT MONTHLY PREMIUM: $26.67
SELECT PERIOD: 10 YEARS
NOTE: THIS POLICY MAY TERMINATE IF:
(1) THE ACCUMULATION VALUE MINUS ANY LOAN(S) IS LESS THAN THE MONTHLY DEDUCTION
DUE, OR
(2) THE REQUIRED PREMIUMS PER YEAR FOR THE BASE POLICY AND ANY RIDERS AND ANY
LAYERS IN THEIR REQUIRED PREMIUM PERIOD ARE NOT PAID.
1-12411101
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<TABLE>
<CAPTION>
P O L I C Y D A T A ( C O N T I N U E D )
TABLE OF GUARANTEED MAXIMUM MONTHLY DEDUCTION RATES PER $1,000
FOR BASE POLICY *
POLICY POLICY POLICY POLICY POLICY POLICY
YEAR EXCLUDING YEAR EXCLUDING YEAR EXCLUDING
RIDERS RIDERS RIDERS
<S> <C> <C> <C> <C> <C> <C>
1 0.0208 31 1.7608 61 27.4967
2 0.0275 32 1.9500 62 32.0458
3 0.0342 33 2.1550 63 40.0167
4 0.0392 34 2.3750 64 54.8317
5 0.0425 35 2.6150 65 83.3333
6 0.0475 36 2.8858 66 0.0000
7 0.0525 37 3.2425
8 0.0583 38 3.5467
9 0.0650 39 3.9533
10 0.0725 40 4.4100
11 0.2767 41 4.9000
12 0.2992 42 5.4217
13 0.3233 43 5.9700
14 0.3492 44 6.5392
15 0.3783 45 7.1433
16 0.4092 46 7.8058
17 0.4458 47 8.5433
18 0.4883 48 9.3767
19 0.5358 49 10.3158
20 0.5908 50 11.3425
21 0.6517 51 12.4333
22 0.7192 52 13.5667
23 0.7908 53 14.7325
24 0.8683 54 15.9075
25 0.9558 55 17.1075
26 1.0533 56 18.3492
27 1.1617 57 19.6533
28 1.2850 58 21.0625
29 1.4258 59 22.6358
30 1.5850 60 24.6375
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- -
* TO FIND THE AMOUNT OF MONTHLY DEDUCTION DURING EACH POLICY YEAR, SEE THE
MONTHLY DEDUCTIONS SECTION. A MONTHLY POLICY FEE OF $6.00 WILL BE ADDED INTO
EACH MONTHLY DEDUCTION FOR THE FIRST TEN POLICY YEARS. IN SUBSEQUENT YEARS, THE
POLICY FEE WILL NOT EXCEED $10.00. A MONTHLY EXPENSE CHARGE PER THOUSAND WILL
ALSO BE ADDED TO EACH MONTHLY DEDUCTION. THE GUARANTEED MAXIMUM MONTHLY EXPENSE
CHARGE PER THOUSAND IS SHOWN ON POLICY DATA PAGE 2.
1-12411101
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P O L I C Y D A T A (C O N T I N U E D)
TABLE OF SURRENDER PENALTY FACTORS PER $1,000 OF BASE POLICY FACE AMOUNT
POLICY SURRENDER
YEAR PENALTY
FACTOR
1 23.90
2 23.70
3 23.40
4 23.10
5 22.80
6 19.00
7 15.20
8 11.40
9 7.60
10 3.80
11+ 0
</TABLE>
TO CALCULATE THE FULL SURRENDER PENALTY FOR THE BASE POLICY, FIND THE FACTOR FOR
THE CURRENT POLICY YEAR. MULTIPLY THIS FACTOR BY THE NUMBER OF THOUSANDS OF FACE
AMOUNT OF THE BASE POLICY.
1-12411101 END OF POLICY
DATA PAGE 4
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DEFINITIONS In this policy:
WE, OUR or US means Transamerica Occidental Life Insurance Company.
YOU and YOUR means the owner of this policy.
ACCUMULATION VALUE of the policy means the sum of the accumulation value of the
base policy and the accumulation value of each layer as described in the
Accumulation Values provision.
ADMINISTRATIVE OFFICE means Transamerica Occidental Life Insurance Company, Box
417002, Kansas City, Missouri 64141-7002. This address is for regular mail. Our
address for express delivery is Transamerica Occidental Life Insurance Company,
[Attention -- VUL Administration (K26), 1100 Walnut Street, Kansas City,
Missouri 64106-2152].
AGE means the insured's age on his or her nearest birthday.
The BASE POLICY is this policy excluding any layers and any riders.
The BENEFICIARY is the person you designate to receive the death benefit under
this policy.
CASH VALUE of the base policy or a layer means its accumulation value, less any
surrender penalty that would be assessed on a full surrender of the policy. The
policy's cash value is the policy's accumulation value, less the surrender
penalties that would be assessed on a full surrender of the policy.
DELIVERY REQUIREMENT means any requirement that must be completed before this
policy can become effective and before this policy may be delivered to you.
Examples include any application amendment or additional evidence of
insurability that we require. Except as otherwise provided in the conditional
receipt, this policy cannot become effective until after all delivery
requirements are satisfied.
The DESIGNATED INDIVIDUAL is the person upon whose life expectancy a settlement
option may be based and upon whose life continued payments under a settlement
option may depend.
The FIXED ACCOUNT is one of the investment options under this policy. The fixed
account is part of our general account. The net premiums you allocate to the
fixed account and the portion of the accumulation value in the fixed account
will earn interest as described in the Fixed Account provision. The total
accumulation value in the fixed account is equal to the accumulation value in
the fixed account for the base policy and the accumulation value in the fixed
account for all layers.
FREE-LOOK PERIOD means the initial period of time after you first receive this
policy during which you have the right to examine and return this policy for a
refund. The length of the free-look period and the amount of the refund are
described on page 1.
A GROSS PREMIUM is 100% of any premium you pay.
HOME OFFICE means Transamerica Occidental Life Insurance Company, Box 2101, Los
Angeles, California 90051-0101.
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INVESTMENT OPTION means the fixed account or any sub-account of the separate
account.
LAPSE means termination of the policy at the end of the grace period.
A LAYER is coverage provided by an increase in the face amount of this policy.
A LAYER DATE is the effective date of a layer. We will use the layer date to
determine the layer anniversaries and layer years.
The LOAN ACCOUNT is part of the fixed account. The loan account includes
outstanding loans. The loan account of the policy is equal to the sum of the
loan account for the base policy and the loan account for each layer. The loan
account is not an investment option.
The MAXIMUM LOAN AMOUNT is the largest amount you may borrow under the Policy
Loans provision. There is a maximum loan amount for the base policy and for each
layer.
A MONTHLY DEDUCTION is an amount we take from the accumulation value of the
policy or of each layer, respectively, on the policy date and on each monthly
policy date after the policy date.
NET ASSET VALUE is the per share value of a portfolio as calculated by the
portfolio and reported to us.
The NET CASH VALUE of the policy is the cash value of the policy less any
existing loans. The net cash value of the base policy or a layer is its cash
value, less any existing loans allocated to the base policy or layer.
The NET LOAN AMOUNT is a policy loan, less any loan interest due.
A NET PREMIUM is any gross premium minus an administrative charge. The
administrative charge is shown in the Policy Data.
The PAYEE is the person who has the right to receive payments under a settlement
option. If you surrender this policy, you are the payee under any settlement
option you elect. After the insured's death, the beneficiary is the payee under
the settlement option you elect.
The POLICY DATE shown in the Policy Data is the effective date of coverage. We
will use the policy date to determine the monthly policy dates, policy
anniversaries and policy years.
The POLICY FEE is part of the monthly deduction. The guaranteed maximum policy
fee is shown in the Policy Data.
A POLICY LOAN is indebtedness to us for a loan secured by this policy.
A PORTFOLIO is a mutual fund investment or other investment pool held in a
sub-account.
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PRO-RATA means a proportionate allocation among investment options. For the base
policy, a pro-rata allocation is equal to the portion of the accumulation value
in the base policy in an investment option divided by the total accumulation
value of the base policy (excluding the portion of the accumulation value in the
loan account). For a layer, a pro-rata allocation is equal to the portion of the
accumulation value in the layer in an investment option divided by the total
accumulation value of the layer (excluding the portion of the accumulation value
in the loan account). Any fees, charges, reductions or deductions from the
accumulation value will be allocated on a pro-rata basis, unless you choose the
investment options to which you want to allocate these amounts pursuant to
procedures we establish.
REALLOCATION DATE means the date that net premiums initially allocated to the
money market sub-account (plus any earnings on those net premiums) are
transferred to one or more other sub-accounts of the separate account in
accordance with the allocations then in effect. The reallocation date is shown
in the Policy Data.
REINSTATE means to restore coverage after the policy has lapsed, subject to the
requirements in the Reinstatement provision.
REQUIRED PREMIUM is the minimum amount of premium you must pay each year for the
base policy or a layer during its required premium period. The base policy and
each layer have separate required premium amounts. You may pay all or any part
of this premium in advance.
REQUIRED PREMIUM PERIOD is the total number of consecutive years that any
required premium must be paid. This period is shown in the Policy Data. This
period begins on the policy date for the base policy, and on the layer date for
a layer.
A RIDER is an attachment to the policy that provides an additional benefit.
The SEPARATE ACCOUNT is established and maintained by us for the investment of a
portion of our assets. It consists of the sub-accounts.
A SUB-ACCOUNT is an investment option under this policy. A sub-account is a
subdivision of the separate account that holds shares of a portfolio. The
portion of the accumulation value in any sub-account may increase or decrease
depending on investment performance in the underlying portfolio.
TELEPHONE ACCESS PRIVILEGE is an option to transfer amounts between or among
investment options, change your premium allocation or request a loan by
telephone (within limits). The telephone access privilege will apply, unless you
advise us in writing that you do not want this option. Unless you elect not to
have the option available, you or your registered representative may exercise
this option. We reserve the right to discontinue this option at any time.
UNIT means a measure of interest in a sub-account.
UNIT VALUE means the value of a unit on a particular valuation date.
VALUATION DATE is any day that the stock market (New York Stock Exchange) is
open for business. A valuation date ends when the stock market closes for the
day, generally at 4 p.m. Eastern Time.
1-12411101.................
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VALUATION PERIOD is the period between the end of one valuation date and the end
of the next valuation date.
WRITTEN REQUEST means a signed request in a form satisfactory to us that is
received at our administrative office.
OWNERSHIP OWNER OF THE POLICY -- The owner is entitled to the rights granted
under this policy before the insured's death. The insured will be the owner,
unless someone else is named as the owner in the application, or otherwise in
accordance with this policy. Ownership of this policy may be shared by two or
more persons. If one such person is an individual other than the insured and
dies before the insured, the rights of that person belong to the executor or
administrator of his or her estate unless otherwise provided in the policy. If
the owner is a partnership, the rights belong to the partnership as it exists
when a right is exercised.
EXERCISING POLICY RIGHTS -- If ownership of this policy is shared by more than
one person, all such persons must sign each written request to exercise any
right under this policy. The telephone access privilege may be exercised by any
one person who shares ownership, or by your registered representative.
HOW TO CHANGE THE OWNER -- You may change the owner while the insured is living
by notifying us in a form and manner acceptable to us. The change will not be
effective until we record it at our administrative office. The written consent
of any irrevocable beneficiaries will be required.
ASSIGNMENT OF THE POLICY -- We are not responsible for the adequacy of any
assignment. However, if you file the assignment with us and we record it at our
administrative office, your rights and those of any revocable beneficiary will
be subject to it. The written consent of any irrevocable beneficiaries will be
required.
THE BENEFICIARY WHO RECEIVES THE DEATH BENEFIT -- If the insured dies while this
policy is in force, we will pay the death benefit to the beneficiary. The
beneficiary is as designated in the application, unless changed as shown under
"How to Change a Beneficiary" below. If the beneficiary is a partnership, we
will pay the death benefit to the partnership as it exists when the insured
dies.
PROTECTION OF THE DEATH BENEFIT -- To the extent permitted by law, no death
benefit will be subject to the claims of the beneficiary's creditors or to any
legal process against the beneficiary.
IF THE BENEFICIARY DIES -- 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. If the interests of all designated beneficiaries have
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.
HOW TO CHANGE A BENEFICIARY -- You may change the designated beneficiary while
the insured is living by sending a written notice to us. The change will not be
effective until we record it at our administrative office. Even if the insured
is not living when we record the change, the change will take effect as of the
date it was signed. However, any benefits we pay before we record the change
will not be subject to the change. An irrevocable beneficiary may not be changed
without the written consent of that beneficiary.
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PAYMENT OF THE DEATH BENEFIT DEATH BENEFIT -- The amount of the death benefit
may be affected by other provisions of this policy such as Policy Loans,
Misstatement of Age or Sex and Partial Surrenders.
DEATH BENEFIT OPTION -- The death benefit before the policy anniversary nearest
age 100 will be based on whether you have chosen Option 1, Option 2 or Option 3,
as shown in the Policy Data. If you do not choose an option in the application,
Option 1 will automatically take effect. Prior to the policy anniversary nearest
age 100, the death benefit is defined as follows:
OPTION 1: The death benefit will be the greatest of:
a. the total of the face amount of the base policy and each layer on the date of
the insured's death;
b. the death benefit factor multiplied by the policy's accumulation value on the
date of the insured's death; or
c. the amount required for the policy to qualify as a life insurance contract
under Section 7702 of the Internal Revenue Code.
OPTION 2: The death benefit will be the greatest of:
a. the total of the face amount of the base policy and each layer on the date of
the insured's death plus the policy's accumulation value on the date of the
insured's death;
b. the death benefit factor multiplied by the policy's accumulation value on the
date of the insured's death; or
c. the amount required for the policy to qualify as a life insurance contract
under Section 7702 of the Internal Revenue Code.
OPTION 3: The death benefit will be the greatest of:
a. the total of the face amount of the base policy and each layer on the date of
the insured's death plus the excess, if any, of all gross premium payments over
the sum of any partial surrenders, surrender penalty free withdrawals and/or
premium refunds on the date of the insured's death;
b. the death benefit factor multiplied by the policy's accumulation value on the
date of the insured's death; or
c. the amount required for the policy to qualify as a life insurance contract
under Section 7702 of the Internal Revenue Code.
Beginning with the policy anniversary nearest age 100, the death benefit will be
the greater of:
1. the death benefit factor multiplied by the policy's accumulation value as of
the date of the insured's death; or
2. the amount required for the policy to qualify as a life insurance contract
under Section 7702 of the Internal Revenue Code.
1-12411101 ......... PAGE 9
The death benefit factors are shown in the table of Death Benefit Factors on
pages 32 and 33. The applicable death benefit factor will be based on the
insured's age as of the last policy anniversary, and on the number of full
policy years that have elapsed since the date of issue.
If the date of the insured's death is not a day that the New York Stock Exchange
is open for business, any death benefit based on the accumulation value will be
determined by using the accumulation value as of the next valuation date.
We will reduce the death benefit by any existing policy loans and by the portion
of any grace period premium payment necessary to provide insurance to the date
of the insured's death.
This policy is intended to qualify under Section 7702 of the Internal Revenue
Code as a life insurance contract for federal tax purposes. The death benefit
under this policy is intended to qualify for the federal income tax exclusion.
The provisions of this policy (including any riders or endorsements) will be
interpreted to ensure qualification of this policy as a life insurance contract
for federal tax purposes, regardless of any language to the contrary.
To the extent that the death benefit is increased to maintain qualification as a
life insurance policy, we will make appropriate adjustments to any monthly
deductions or supplemental benefits (retroactively and prospectively) that are
consistent with such an increase. Retroactive adjustments may be deducted from
the accumulation value or may be made by right of setoff against any death
benefits payable. Prospective adjustments will be reflected in the monthly
deduction.
PROOF OF DEATH -- Any death benefit payable because of the death of the insured
will be paid when we receive due proof of the death of the insured while this
policy was in force. We will send appropriate forms to the beneficiary upon
request. Any of our agents will help the beneficiary fill out the forms without
charge.
TRANSFERS AFTER THE INSURED'S DEATH -- After we receive notice of the insured's
death, we may:
1. transfer any portion of the accumulation value in any sub-account to our
general account; and
2. not allow any portion of the accumulation value to be transferred into or to
remain in any sub-account.
PREMIUMS PREMIUM PAYMENTS -- This policy will not be in force until you pay the
minimum initial premium shown in the Policy Data. Subsequent premiums may be
sent to our administrative office or you may deliver them to an agent we
authorize. We will give you a receipt if you ask for one.
Subject to the Required Premiums provision below, you may pay premiums at any
time prior to the policy anniversary nearest age 100. Each premium must be at
least $25 and may not exceed the limits described in the Premium Limitation
provision below.
At the policy anniversary nearest age 100, billing will cease and no further
premium payments will be accepted.
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<PAGE>
REQUIRED PREMIUMS -- By the end of each policy or layer year during any
applicable required premium period, the total gross premiums paid for this
policy, less the amount of any premium refunds, partial surrenders and surrender
penalty free withdrawals, must equal or exceed the cumulative required premiums
for the base policy and all layers, or this policy will enter the grace period.
On any applicable policy or layer anniversary, the cumulative required premium
for the base policy or any layer, respectively, is equal to A times B, adjusted
for any decreases in the face amount, where:
A is the required premium for the base policy or layer; and
B is the number of full years that have elapsed in the required premium period
for the base policy or layer.
You may pay all or any part of the required premiums at any time before they are
due.
LAYER ALLOCATION -- Net premiums will be allocated among the base policy and any
layers as follows:
1. The net premium will first be applied to any required premiums not yet paid
that are due by the end of the current policy or layer year. Amounts so applied
will be allocated in proportion to such required premiums not yet paid for the
base policy and each layer.
2. Any remaining net premium will next be applied to any required premiums not
yet paid for future policy and layer years. Amounts so applied will be allocated
in proportion to the amounts required to meet the future required premiums for
the base policy and each layer.
3. The remainder, if any, will be allocated in proportion to the required
premium most recently in effect for the base policy and each layer.
PREMIUM LIMITATION -- We reserve the right to refund any unscheduled premium
during a particular policy year if the total premium paid:
1. increases the difference between the death benefit and the accumulation
value; and
2. is more than 1% of the policy's face amount and more than three times the
total of the monthly deductions for the last year.
We also reserve the right to refund any unscheduled premiums that exceed $25,000
in any 12-month period. We will not refund any amount if doing so would cause
this policy to enter the grace period before the next anniversary. The amount
refundable will not exceed the net cash value of this policy.
If we believe any portion of a premium payment will cause a policy to become a
Modified Endowment Contract (MEC) under the tax laws, we will not accept that
portion of the premium payment and will immediately notify the owner. We will
refund the excess portion when the premium payment check has had time to clear
the banking system (but in no case more than two weeks after receipt), except in
the following circumstances:
1. The premium payment would no longer cause the policy to become a MEC as of
the date the refund is to be made; or
2. We receive a signed acknowledgement from the owner prior to the refund date
instructing us to process the premium notwithstanding the tax issues involved.
1-12411101 ......... PAGE
11
<PAGE>
In the above cases, we will treat the excess premium as having been received on
the date the excess premium would no longer create a MEC or the date we receive
the signed acknowledgment. We will then process it accordingly. The owner may
submit a written authorization to us with the premium payment instructing us to
apply the premium to the policy even though applying that premium would cause
the policy to become a MEC. In that event, we will treat such authorization as
the signed acknowledgment noted above and will credit the net premium to the
policy according to our regular premium allocation rules.
CONTINUATION OF INSURANCE -- If you stop paying premiums, we will continue this
policy at the face amount then in effect and with any additional benefits
provided by rider, subject to the grace period and any premium requirements that
may be in effect. See the Premiums and the Monthly Deductions provisions for
further explanation.
GRACE PERIOD -- During any required premium period, a grace period is a period
of 61 days beginning on:
1. a policy or layer anniversary on which the cumulative required premiums as
specified in the Required Premiums provision have not been paid; or
2. a monthly policy date when the policy's accumulation value minus any existing
loan is less than the total monthly deductions due.
After all required premium periods and prior to the policy anniversary nearest
age 100, a grace period is a period of 61 days beginning on a monthly policy
date when the policy's accumulation value minus any existing loan is less than
the total monthly deductions due.
After the policy anniversary nearest age 100, a grace period is a period of 61
days beginning on a policy anniversary on which any loan interest due has not
been paid in cash, and the policy's accumulation value minus any existing loan
is less than the loan interest due.
If this policy enters the grace period, we will let you know by sending you a
notice. The notice will tell you the amount you must pay to keep the policy in
force. You must pay this amount before the grace period ends. If you do not pay
enough, this policy will lapse at the end of the 61 days. If there is any net
cash value remaining at the end of the grace period, we will apply it to the
nonforfeiture option. (See Nonforfeiture Option provision.)
During the grace period, we will not charge interest on the amount due. If the
insured dies during the grace period and before you pay the amount due, we will
subtract from the death benefit the amount required to provide insurance to the
date the insured died.
PREMIUM QUALIFICATION CREDIT -- At the end of each policy year during the
required premium period of the base policy, if you have paid the cumulative
required premiums for the base policy as described in the Required Premiums
provision, we will add a premium qualification credit to the accumulation value
of the base policy. The credit will be a percentage of the base policy's
required premium as shown in the Policy Data.
At the end of each layer year during the required premium period of each layer,
if you have paid the cumulative required premiums for the layer as described in
the Required Premiums provision, we will add a premium qualification credit to
the accumulation value of that layer. The credit will be a percentage of the
layer's required premium as shown in the Policy Data.
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<PAGE>
The premium qualification credit will be allocated among your investment options
according to the most recent premium allocation election we have received from
you. We will allocate the premium qualification credit on the policy or layer
anniversary if that day is a valuation date. If the policy or layer anniversary
is not a valuation date, we will allocate the premium qualification credit on
the next valuation date.
REINSTATEMENT -- If this policy lapses, it may be reinstated provided it was not
surrendered. To reinstate the policy, you must meet the following conditions:
1. You must request reinstatement in writing within three years after the date
of lapse and before the policy anniversary nearest age 100.
2. The insured must provide evidence of insurability satisfactory to us.
3. If any loans existed when the policy lapsed, you must repay or reinstate
them, with interest. Interest will be compounded annually from the date of lapse
at the loan reinstatement interest rate of 6.25% (5.88% in advance). Any loan
interest due after the effective date of the reinstatement will be at the
effective annual rate for the policy year during which the interest is due.
4. The reinstated policy will be subject to the minimum premium requirement
during the required premium period. (See the Premium Payments provision.) Any
increase in the face amount of the base policy will also be subject to the
minimum premium requirement during the layer's required premium period. This
means that the required premium period will be calculated from the original
policy date or original layer date. It will not start anew.
If the policy lapsed during any required premium period, you must pay a premium
large enough to meet any minimum premium requirement at the time of
reinstatement, with interest. Interest will be compounded annually at the
reinstatement interest rate shown in the Policy Data.
If the policy lapsed after any required premium period, you must pay a premium
large enough to cover two monthly deductions due when the policy lapsed and
three monthly deductions due when the policy is reinstated. The amount
equivalent to the two monthly deductions due when the policy lapsed will be used
to reimburse us for the insurance provided during the grace period.
5. You must repay any net cash value given to you at the time of lapse, with
interest. Interest will be compounded annually at the reinstatement interest
rate shown in the Policy Data.
6. Surrender penalty periods in the reinstated policy will be calculated from
the original policy and layer dates, as applicable.
The effective date of a reinstatement will be the date we approve your request.
We will resume taking monthly deductions for the policy as of the nearest
monthly policy date. If a person other than the insured is covered by any
attached rider, that person's coverage may be reinstated under the reinstatement
terms of that rider.
The accumulation value of the reinstated policy will be: any surrender penalty
assessed at the time of lapse; plus any net cash value we paid you at the time
of lapse; plus any loan repaid or reinstated; plus any net premium you pay at
reinstatement; minus any monthly deductions due at the time of lapse.
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We will allocate any loan repaid and any net premium you pay at reinstatement
according to the most recent premium allocation election we have received from
you. We will restore any surrender penalty assessed at the time of lapse. We
will allocate any restored surrender penalty and any net cash value you repay at
reinstatement between the base policy and any layers in the same proportion as
these amounts were deducted at the time of lapse. We will then allocate the base
policy and layer amounts among your investment options in the same proportion as
these amounts were deducted at the time of lapse.
We will allocate the amount you pay within one valuation date after the later
of:
1. the valuation date that we approve the reinstatement; or
2. the valuation date that we receive the required premium and any other
payments.
<PAGE>
PREMIUM ALLOCATION PREMIUM ALLOCATION ELECTION -- You may allocate your net
premiums among the investment options we make available from time to time. The
premium allocation percentages you elect must be whole numbers. The total
allocation to all elected investment options must equal 100%. We may limit the
number of investment options to which you may allocate your net premiums. The
premium allocation percentages you elect on the application will apply to all
premiums we receive, unless you change your premium allocation election as
provided in the Premium Allocation Changes provision. Your premium allocation
election applies to the base policy and all layers.
INITIAL PREMIUM -- The initial net premium accepted under this policy will be
allocated to this policy no later than the second valuation date that next
follows the latest of:
1. The date we approve the issuance of this policy.
2. The date we receive the premium.
3. The policy date.
4. The date we approve the last delivery requirement returned to us, if the
policy was issued with delivery requirements.
SUBSEQUENT PREMIUMS -- We will allocate net premiums on the day we receive them.
If the date that we receive a premium is not a valuation date, we will allocate
the net premium on the next valuation date.
CREDITING OF NET PREMIUMS AND REALLOCATION DATE -- If any net premium is
credited under this policy prior to the reallocation date shown in the Policy
Data, any amounts you elected to allocate to the separate account will initially
be allocated solely to the money market sub-account. On the reallocation date,
we will reallocate the portion of the accumulation value in the money market
sub-account among the sub-accounts that you elected in the application (unless
you change your premium allocation election as provided in the Premium
Allocation Changes provision). If the reallocation date is not a valuation date,
we will make the reallocation on the next valuation date.
We will allocate any net premium credited to this policy on or after the
reallocation date directly to the fixed account or the sub-accounts you have
elected.
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<PAGE>
PREMIUM ALLOCATION CHANGES -- You may change your premium allocation at any time
by sending us a written request or by exercising your telephone access
privilege. Any premium allocation change will apply to all premiums we receive
on or after the effective date of the change, unless you change your premium
allocation election again. Any premium allocation change will be subject to the
limitations in the Premium Allocation Election provision. We reserve the right
to charge a fee up to $25 for each premium allocation change. We will deduct any
such fee from the accumulation value of the base policy on a pro-rata basis.
SEPARATE ACCOUNT
<PAGE>
You may allocate any portion of your net premiums to the separate account.
The assets of the separate account are our property, but they are segregated
from our other assets. Income (if any) and gains and losses (realized or
unrealized) from assets in the separate account will be credited to or charged
against the amounts allocated to the separate account without regard to our
other income, gains or losses. Assets equal to the liabilities of the separate
account will not be charged with liabilities arising out of any other business
we may conduct.
Any amount allocated to the separate account for state or federal income taxes
may be deducted from the separate account.
The separate account is divided into various sub-accounts. Each sub-account's
assets are invested in shares of a corresponding portfolio.
We reserve the right to change the name and investments of the separate account
and/or any of its sub-accounts.
We will allocate net premiums, transfers and any applicable premium
qualification credit to purchase units in the sub-accounts you have elected. All
net premiums will be allocated in accordance with the Premium Allocation
provisions.
This policy will be credited with a number of units equal to the amounts
allocated to a sub-account divided by the value of the applicable unit. The
value of the applicable unit will be determined on the day the amount is
allocated to the sub-account.
The number of units in a sub-account will remain fixed unless:
1. increased by a net premium, premium qualification credit or a transfer
allocated to the sub-account; or
2. reduced because of a partial surrender, surrender penalty free withdrawal,
surrender penalty, monthly deduction, policy loan, or other charges or fees
allocated to the sub-account, or because of a transfer from the sub-account; or
3. changed by a subsequent split of a unit value.
Any transaction described in 2. will result in the cancellation of a number of
units that are equal in value to the amount of the transaction.
On each valuation date, we will value the assets of each sub-account and
determine the value of each unit.
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The unit values for all sub-accounts except the money market sub-account were
initially set at $10.00. The unit value for the money market sub-account was
initially set at $1.00. The unit value for a sub-account on any subsequent
valuation date is equal to ((A times B) minus C) divided by D, where:
A is the number of shares held in the underlying portfolio at the end of the
valuation date;
B is the net asset value (NAV) per share of the underlying portfolio as of the
end of the valuation date, plus the per share amount of any capital gains or
dividends declared on that valuation date;
C is a charge for each day in the valuation period equal to the net assets of
the sub-account multiplied by the daily mortality and expense risk factor; and
D is the number of units outstanding at the close of the prior valuation date.
The unit value may increase or decrease from one valuation date to the next. You
bear this investment risk. We reserve the right to change the method we use to
determine the unit value, subject to any required regulatory approvals.
ADDITION, DELETION OR SUBSTITUTION OF INVESTMENTS -- We reserve the right to
add, delete or substitute the shares of a portfolio that the separate account
holds or may buy. We also reserve the right to eliminate the shares of any
portfolio.
We may make any substitutions or changes that we believe are necessary or
appropriate. If we think it is in the best interests of our policy owners, we
may operate the separate account as a management company under the Investment
Company Act of 1940, or we may de-register it under that act if registration is
no longer required. We may also combine it with other separate accounts that we
may have.
We reserve the right to establish other sub-accounts and to make them available
to any class or series of policies that we deem appropriate. The assets of each
new sub-account will be invested in a new investment company or in the shares of
another open-end investment company. We also reserve the right to eliminate or
combine existing sub-accounts and to transfer assets among sub-accounts, when
allowed by law.
FEDERAL TAXES -- If we have to pay federal taxes on the separate account, we
reserve the right to charge a proportionate share of such taxes against this
policy. We may reflect the amount of such charge in the calculation of the unit
values.
SPLITTING OF UNITS -- We reserve the right to split the value of a unit. Any
splitting of units will not have any material effect on this policy's benefits.
FIXED ACCOUNT FIXED ACCOUNT -- You may allocate any portion of your net premiums
to the fixed account. The fixed account is part of our general account. Our
general account consists of all assets that we own except those in the separate
account and other separate accounts we may have. Except as limited by law, we
have sole control over investment of the assets in our general account. You may
allocate net premiums to the fixed account and transfer funds between the
separate account and the fixed account (subject to the Transfers provisions).
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<PAGE>
FIXED ACCOUNT INTEREST RATES -- The net premium you elect to allocate to the
fixed account will accrue interest from the valuation date on which we allocate
it to the fixed account, as described in the Premium Allocation provision.
Interest is credited monthly on each monthly policy date. The guaranteed minimum
interest rate for all policy years is shown in the Policy Data. We may declare
an interest rate that is higher than the guaranteed minimum interest rate at any
time prior to the policy anniversary nearest age 100. We will never declare an
interest rate that is lower than the guaranteed minimum interest rate. We may
change the declared interest rate at any time without notice. Beginning on the
policy anniversary nearest age 100, the accumulation value of the fixed account
will accrue interest at the guaranteed minimum interest rate.
ACCUMULATION VALUES The base policy and each layer have separate
accumulation values.
The accumulation value of the base policy at the time the initial net premium is
accepted under this policy is equal to:
1. the initial net premium;
minus 2. the monthly deduction(s) that start on the policy date.
The accumulation value of the base policy or a layer on any specified date after
the date the initial net premium is allocated to the policy is equal to the sum
of the accumulation values in the separate account and the fixed account
(including the loan account) for the base policy or layer on that date.
SEPARATE ACCOUNT -- For the base policy and each layer, the accumulation value
in the separate account on any date after the date the initial net premium was
allocated to the policy is equal to the sum of the values in each sub-account.
The value in a sub-account is the number of units in that sub-account for the
policy multiplied by the unit value for that sub-account at the end of the
valuation date for which the accumulation value is being determined. The number
of units in a sub-account is equal to:
1. the number of units purchased by the net premium initially allocated to that
sub-account;
plus 2. the number of units purchased by subsequent net premiums allocated to
that sub-account;
plus 3. the number of units purchased by any transfers to that sub-account from
one or more other sub-accounts or the fixed account (including the loan
account);
plus 4. the number of units purchased by any premium qualification credit
allocated to the sub-account;
minus 5. the number of units redeemed from the sub-account due to monthly
deductions allocated to that sub-account;
minus 6. the number of units redeemed from that sub-account due to any partial
surrenders, surrender penalties and surrender penalty free withdrawals allocated
to that sub-account;
minus 7. the number of units redeemed from that sub-account that were
transferred out of that sub-account to one or more other sub-accounts or the
fixed account (including the loan account);
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minus 8. the number of units redeemed from that sub-account to cover any
transfer fees or other charges or fees that were allocated to that sub-account;
minus 9. the number of units redeemed from that sub-account due to any refund of
premium allocated to that sub-account.
FIXED ACCOUNT -- For the base policy and each layer, the accumulation value in
the fixed account (including the loan account) on a specified date after the
date the initial net premium was allocated to to the policy is equal to:
1. the accumulation value on the last monthly policy date, plus accrued interest
from the last monthly policy date to the specified date;
plus 2. any premium qualification credit amount deposited to it on the last
monthly policy date, plus accrued interest on that amount;
plus 3. all net premiums paid into it, less any refunds since the last monthly
policy date, plus accrued interest from the date each net premium is allocated
to it;
plus 4. any amounts transferred from the separate account, plus accrued interest
on those amounts since the date of the transfer;
minus 5. the monthly deduction charged against it on the last monthly policy
date, plus accrued interest on that amount;
minus 6. any partial surrenders and surrender penalty free withdrawals charged
against it, including surrender penalties, since the last monthly policy date,
plus accrued interest on that amount from each partial surrender date and/or
surrender penalty free withdrawal date to the specified date;
minus 7. any amounts transferred from the fixed account to the separate account,
plus accrued interest on those amounts since the date of the transfer;
minus 8. any transfer fees or other charges or fees allocated to the fixed
account, plus accrued interest on those amounts since the date of the deduction.
TRANSFERS At any time after the end of the free-look period, you may transfer
amounts between or among the investment options available under this policy.
Each transfer will be subject to our transfer rules in effect at the time the
transfer is made. We may set rules specifying, among other things:
1. the minimum and maximum amounts you may transfer; and
2. how frequently you may make transfers.
Different rules may apply to different investment options.
If you choose to make a transfer, you must request it in a form and manner
acceptable to us. You may request a transfer by using your telephone access
privilege.
We will make the transfer on the day we receive your transfer request in good
order. If that day is not a valuation date, we will make the transfer on the
next valuation date.
We may also establish procedures that will allow you to schedule automatic
transfers. If we do so, the procedures will be described in the current
prospectus for this policy.
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<PAGE>
LAYER ALLOCATION -- You may not transfer any portion of the accumulation value
among the base policy and layers.
TRANSFER FEE -- You will not be charged for the first eighteen transfers you
make during a policy year. If you make more than eighteen transfers during a
policy year, we may charge you up to $25 for each additional transfer. Any
transfer fee will be deducted from the amount that you are transferring. The
transfer fee will be allocated between or among the investment options in
proportion to A divided by B, where:
A is the amount transferred from an investment option; and
B is the total amount transferred from all investment options.
The following do not count toward the first eighteen transfers during a policy
year, and will not be charged a transfer fee:
1. Transfers made on the reallocation date from the money market sub-account to
other sub-accounts.
2. Transfers to or from the loan account.
3. Transfers under any automatic transfer option.
4. Transfers we may make after we receive notice of the insured's death.
5. Transfers due to a material change in investment policy.
MONTHLY DEDUCTIONS The monthly deduction for the base policy is equal to:
1. the monthly deduction rate for the base policy, times .001, times the
difference between the death benefit and the accumulation value of the base
policy on the applicable monthly policy date;
plus 2. the monthly deduction for any riders;
plus 3. the policy fee;
plus 4. the monthly expense charge per thousand for the base policy, times .001,
times the face amount of the base policy.
The monthly deduction for each layer is equal to:
1. the monthly deduction rate for the layer, times .001, times the difference
between the death benefit and the accumulation value of the layer on the
applicable monthly policy date;
plus 2. the monthly expense charge per thousand for the layer, times .001, times
the face amount of the layer.
MONTHLY DEDUCTION RATES -- We will determine the monthly deduction rate for the
base policy and each layer on each monthly policy date.
The monthly deduction rate for the base policy will depend on the face amount of
the base policy, the insured's sex, the insured's smoker or nonsmoker status,
the insured's class of risk as of the policy date, the number of years that the
policy has been in force and the insured's age as of the policy date.
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A table of guaranteed maximum monthly deduction rates for the base policy is
shown in the Policy Data. We may use rates lower than these guaranteed maximum
monthly deduction rates. We will never use higher rates.
The monthly deduction rate for a layer will depend on the face amount of the
policy, the insured's sex, the insured's smoker or nonsmoker status, the
insured's class of risk as of the layer date, the number of years that layer has
been in force and the insured's age as of the layer date.
A table of guaranteed maximum monthly deduction rates for a layer will be shown
in supplemental Policy Data pages that we will issue on its layer date. We may
use rates lower than these guaranteed maximum monthly deduction rates. We will
never use higher rates.
Any change in the monthly deduction rates will be prospective and will be based
on our expectations as to future cost factors. Such cost factors may include,
but are not limited to, mortality, expenses, interest, persistency and any
applicable federal, state and local taxes.
GUARANTEED MAXIMUM MONTHLY EXPENSE CHARGE PER THOUSAND -- The guaranteed maximum
monthly expense charges per thousand for the base policy and for each layer are
shown in the Policy Data. We may use an expense charge that is lower than the
guaranteed maximum monthly expense charge per thousand. We will never use higher
expense charges.
ALLOCATION OF MONTHLY DEDUCTION -- On each monthly policy date, we will take the
monthly deduction for that policy month. If the monthly policy date is not a
valuation date, we will take the monthly deduction on the next valuation date.
The monthly deduction for the base policy and for each layer will be taken from
the applicable accumulation value. If the monthly deduction amount for a layer
exceeds the layer's accumulation value minus any existing loan, the excess
portion of the monthly deduction for the layer will be taken first from the
accumulation value of the most recently added layers, in order, and then from
the accumulation value of the base policy. The amount of the monthly deduction
taken from the accumulation value of the base policy and any layers will be
deducted from your investment options within the base policy or layer on a
pro-rata basis.
CASH VALUE You may borrow any portion of the net cash value, or take part of it
or all of it as a partial or full surrender of the policy. All of these
transactions are described in this section. The written consent of any
irrevocable beneficiaries will be required.
POLICY LOANS -- We will process a loan on the day we receive your loan request
in good order. If that day is not a valuation date, we will process the loan on
the next valuation date. The following terms and conditions apply to policy
loans:
1. The maximum loan amount is the policy's accumulation value as of the date of
the loan request, minus the sum of:
a. any existing policy loan(s);
b. interest on the amount of the loan to the end of the policy year; and
c. the surrender penalty that would be assessed for a full surrender of the
policy or, if greater, two monthly deductions for the base policy and all
layers.
We will calculate the maximum loan amount for the base policy and each layer in
a similar manner.
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2. Interest on loans is due in advance each year on the policy anniversary. The
annual effective loan interest rate is shown in the Policy Data.
We may charge lower interest rates than the rates shown. We will never charge
higher interest rates. If you do not pay the interest when it is due, we will
add the amount of the interest to the loan. (See number 5. below).
3. If the insured dies, we will deduct the outstanding loan from the death
benefit before we pay the death benefit to the beneficiary.
4. We will allocate the net loan amount to the base policy and any layers in the
same proportion that the maximum loan amount for each bears to the total of the
maximum loan amounts for the base policy and all layers. We will then deduct the
allocated amount from the base policy's or layer's investment options on a
pro-rata basis, unless you specify, in a form and manner acceptable to us, the
investment options to which you want to allocate the net loan amount. We will
transfer the net loan amount to the loan account.
5. We will allocate the loan interest to the base policy and any layers in the
same proportion that the outstanding loan amount for each bears to the
outstanding loan amount for the policy. We will then deduct the allocated amount
from the base policy's or layer's investment options on a pro-rata basis. We
will transfer the loan interest to the loan account. The loan interest will
become part of the loan.
LOAN REPAYMENT -- You may repay any part of any outstanding loan at any time
while the insured is living. We will allocate the loan repayment on the day we
receive it. If that day is not a valuation date, we will allocate it on the next
valuation date.
If you wish to make a loan repayment, you must tell us that the payment you send
us is for that purpose. Unless your payment is clearly marked as a loan
repayment, we will assume it is a premium payment (unless it is received after
the policy anniversary nearest age 100). When we receive a loan repayment, we
will apply it to the outstanding loan. The loan repayment will be allocated
first to the most recent portion of the outstanding loan, and then to the next
most recent portions in order. For each such portion of the loan being repaid,
the loan repayment is first allocated to the portion of the loan amount in the
base policy, and then successively to any layers in the order of their layer
dates. After we have allocated the loan repayment among the base policy and any
layers, we will allocate those amounts to your investment options according to
the allocation percentages provided in the most recent premium allocation
election we have received from you.
Your policy will not automatically lapse if you do not repay a loan. However, it
will enter the grace period if the accumulation value less any loans is not
large enough to cover the monthly deduction due and any loan interest due not
paid in cash.
LOAN INTEREST -- Each year, we will calculate the interest due on any
outstanding loans and add it to the loan balance. Interest on loans is due in
advance at the rate specified in the Policy Data. We will deduct the loan
interest from your investment options on a pro-rata basis, and then transfer the
loan interest to the loan account. The loan interest deduction and transfer will
be effective on the policy anniversary if that day is a valuation date. If the
policy anniversary is not a valuation date, the loan interest deduction and
transfer will be effective on the next valuation date. You may choose to pay an
amount equal to the loan interest due in cash. Any amount paid will be credited
to the loan balance outstanding at the time it is received.
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<PAGE>
PARTIAL SURRENDER -- At any time after the end of the free-look period, you may
surrender a portion of this policy's value by sending us a written request,
subject to the limitations described below. We will deduct the surrender amount
and any surrender penalty from the policy's accumulation value and allocate it
among your investment options on the day we receive your surrender request in
good order. If that day is not a valuation date, we will deduct the surrender
amount and any surrender penalty from your investment options on the next
valuation date.
In any policy year, the maximum amount that you may receive by partial surrender
is:
1. the accumulation value of the policy;
minus 2. any existing policy loan(s);
minus 3. The sum of 3 times the most recent monthly deductions;
minus 4. the greater of $25 or the surrender penalty that would apply for a full
surrender of this policy.
If you request a partial surrender larger than the maximum described above, we
will treat it as a request for a full surrender of the policy.
We will calculate the maximum partial surrender amount for the base policy and
each layer in a similar manner.
We will allocate the partial surrender among the base policy and any layers
based on the proportion that the maximum partial surrender amount for each bears
to the total of the maximum partial surrender amounts for the base policy and
all layers. The amounts so allocated will be deducted from the accumulation
value of the base policy or layer.
During the first 10 policy or layer years or until the policy anniversary
nearest age 100 (whichever is the shorter time period), we will assess a
surrender penalty on any partial surrender amount that exceeds the amount
eligible for a surrender penalty free withdrawal as described below. This excess
will be attributed first to the most recent layer, if any. To the extent the
excess is greater than the face amount of the most recent layer, the remainder
will be attributed to the next most recent layers, in order, and then to the
base policy.
For each layer where the amount attributed equals the face amount, the surrender
penalty will be equal to A times B divided by C, below. For the base policy or
layer to which any lesser amount is attributed, the surrender penalty will be
equal to A times B divided by D, below, but not more than A times B divided by
C. For purposes of these calculations:
A is the amount of the excess attributed to the base policy or layer;
B is the surrender penalty factor for the current policy or layer year, as
applicable;
C is 1000; and
D is 1000 minus the surrender penalty factor for the current policy or layer
year, as applicable.
The surrender penalty factors are shown in the Policy Data. However, if the sum
of the surrender penalties for the base policy and any layers as computed by the
above formulas is less than $25, the surrender penalty will be $25.
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After all surrender penalty periods have expired, we will assess a $25
transaction fee on any surrender amount that exceeds the amount eligible for a
surrender penalty free withdrawal as described below.
The surrender penalty will be deducted from the accumulation value of the newest
layer. If the accumulation value of that layer is insufficient, the remainder
will be deducted successively from the next most recent layer(s) and then from
the base policy.
After we have allocated the surrender amount and surrender penalty among the
base policy and any layers, we will deduct the allocated amounts from your
investment options on a pro-rata basis unless you specify, in a form and manner
acceptable to us, the investment options to which you want to allocate the
surrender amount.
If you chose Death Benefit Option 1, we will also reduce the face amount of the
most recent layer by:
1. the surrender amount that exceeds the amount eligible for a surrender penalty
free withdrawal.
2. any applicable surrender penalty.
If the amount of the reduction exceeds the face amount of the most recent layer,
the excess amount will reduce the face amount of the next most recently added
layers, in order, and then the face amount of the base policy.
If you chose Death Benefit Option 3, we will also reduce the face amount of the
most recent layer by:
1. the surrender amount that exceeds the greater of:
a. the amount eligible for a surrender penalty free withdrawal; or
b. the cumulative gross premiums paid minus the sum of all previous surrenders
and premium refunds.
2. the surrender penalty on the amount that exceeds the amount eligible for a
surrender penalty free withdrawal.
If the amount of the reduction exceeds the face amount of the most recent layer,
the excess amount will reduce the face amount of the next most recently added
layers, in order, and then the face amount of the base policy.
If the new face amount would be less than our published minimum for this plan,
the partial surrender will not be allowed.
SURRENDER PENALTY FREE WITHDRAWAL -- After the first policy year, a portion of
any partial surrender amount larger than $100 is available without surrender
penalties and without reductions in face amount. The portion so available will
be 10% of the policy's accumulation value, minus 100% of the sum of all
surrender penalty free withdrawals since the last policy anniversary. This
amount may not exceed the maximum amount available as a partial surrender under
the Partial Surrender provision.
1-12411101
PAGE 23
<PAGE>
OPTION TO CHANGE THE FACE DECREASING THE FACE AMOUNT -- You may request a
decrease in the face amount of this policy AMOUNT if all the
conditions described below are met.
1. You must make a written request to us.
2. At the request date, this policy must be in force and the insured must be
living.
3. The decrease of the face amount of this policy may only be effective as of a
policy anniversary.
4. The amount of the reduction in face amount must be at least $25,000.
5. The new face amount may not be less than our published minimum face amount
for this plan.
The decrease of the face amount of this policy may cause a change in the monthly
deduction to be charged.
LAYER ALLOCATION -- The decrease will be allocated first to the most recent
layer, if any. To the extent the decrease exceeds the face amount of the most
recent layer, the additional amount of the decrease will be allocated to the
next most recent layers in order, and then to the base policy.
SURRENDER PENALTY -- A surrender penalty will result from the decrease in the
face amount to the extent the decrease is allocated to the base policy during
the 10 year surrender penalty period of the base policy or is allocated to a
layer during the 10 year surrender penalty period for the layer. If the
surrender penalty period is still in effect, the surrender penalty period for
the base policy and all layers ends immediately before the policy anniversary
nearest age 100. We will allocate the surrender penalty among the base policy
and any layers based on the face amount of the decrease allocated to the base
policy or the layer. If the surrender penalty for a layer exceeds the
accumulation value minus any outstanding loan for the layer, the excess
surrender penalty amount will be allocated to the next most recently added
layers, in order, and then to the base policy. After we have allocated the
surrender penalty among the base policy and any layers, we will deduct the
surrender penalty from your investment options on a pro-rata basis on the date
the decrease in the face amount is effective. If that date is not a valuation
date, we will deduct the surrender penalty amounts on the next valuation date.
The surrender penalty for the base policy or a layer is equal to A times B
divided by C, where:
A is the full surrender penalty for the current policy or layer year;
B is the amount of the decrease allocated to the base policy or layer; and
C is the face amount of the base policy or layer before the decrease.
If a decrease in face amount reduces a layer's face amount to zero but the
layer's accumulation value exceeds zero, the remaining accumulation value in the
layer will be transferred to the base policy's accumulation value. The amounts
in each investment option will be transferred directly to the same investment
options in the base policy.
We will issue new policy data pages showing the new face amount. After the
decrease, the monthly deduction rates and any future surrender penalties will be
based on the new face amount of the policy.
1-12411101
PAGE 24
<PAGE>
If the face amount of this policy is decreased during any required premium
period, we will recalculate the required premium per year for the remainder of
any required premium period based on the new face amount.
INCREASING THE FACE AMOUNT -- Effective on any policy anniversary, you may
request an increase in the face amount of this policy. This policy must be in
force on the layer date, and the insured must be alive and no older than age 80.
The following conditions will apply:
1. You must make a written request to us.
2. The amount of the increase in face amount must be at least $25,000.
3. You must submit evidence of insurability satisfactory to us.
4. The amount of the increase will be contestable and subject to the suicide
limitation for two years after the effective date of the increase.
5. The death benefit option for the layer must be the same as the base policy.
6. If the base policy has a Waiver Provision attached, the layer must also have
a Waiver Provision (subject to our underwriting rules).
The increase in coverage will be issued as a separate layer on this policy. It
will have a required premium per year, beginning on the layer date. It will also
have its own surrender penalty period for 10 years, beginning on the layer date.
The monthly deductions for that layer will be based on the face amount and
accumulation value of the layer, the insured's sex, the insured's smoker or
nonsmoker status, the insured's class of risk as of the layer date and the
insured's age as of the layer date.
We will issue new Policy Data pages showing the increased face amount. After the
increase, the monthly deduction rates for the base policy and for each layer
will be based on the new total face amount of the policy.
NONFORFEITURE You may surrender this policy for its net cash value. The
surrender penalty for a full OPTION surrender of this policy is equal to the
surrender penalty (if any) for the base policy plus
the surrender penalty (if any) for each layer.
The surrender penalty factors are shown in the Table of Surrender Penalty
Factors in the Policy Data. We will use the factors in the table to determine
the surrender penalty we will apply.
To calculate the surrender penalty for the base policy, find the factor for the
current policy year. Multiply this factor by the number of thousands of face
amount of the base policy. This is the surrender penalty for the base policy.
There is no surrender penalty for the base policy after the first 10 policy
years, or the policy anniversary nearest age 100.
To calculate the surrender penalty for a layer, find the factor for the current
layer year. Multiply this factor by the number of thousands of face amount of
that layer. This is the surrender penalty for that layer. There is no surrender
penalty for a layer after 10 layer years, or the policy anniversary nearest age
100.
We will deduct the surrender amount and any surrender penalty from your
investment options on the day we receive your surrender request in good order.
If that day is not a valuation date, we will deduct the surrender amount and any
surrender penalty from your investment options on the next valuation date.
1-12411101
PAGE 25
<PAGE>
GUARANTEED BENEFIT -- Subject to the following conditions and restrictions, this
benefit provides you EXCHANGE OPTION with an option ("the option") to exchange
this policy for a fixed policy ("the new policy").
You may exercise this option at any time prior to the 20th policy anniversary or
the policy anniversary nearest age 95 (whichever comes first) if all of the
following conditions are met:
1. The insured is living.
2. This policy does not have any outstanding loans.
3. Monthly deductions are not being waived under a Waiver Provision rider.
The accumulation value of this policy on the date this policy is exchanged will
be transferred to the new policy. If this policy includes one or more layers,
and the new policy allows for layers, the accumulation value in each layer and
in the base policy will be transferred accordingly to layers and the base policy
on the new policy.
EFFECTIVE DATE -- The effective date of the new policy will be the date this
policy is exchanged. The policy date of the new policy will be the same as the
policy date of this policy. If the new policy allows for layers, the layer date
for each layer on the new policy will be the same as the layer date for the
equivalent layer on this policy.
APPLICATION -- We must receive all of the following in order to process the
exchange:
1. A policy change application indicating your request to exercise this option
and your request to surrender this policy.
2. The release of any lien against or assignment of this policy. However, you
may instead submit written approval by the lienholders or assignees of the
exchange of this policy in a form satisfactory to us with such other documents
as we may require.
3. This policy.
4. Payment of any amount due for the exchange, if applicable.
The application for this policy together with the policy change application will
be considered to be the application for the new policy.
NEW POLICY -- The exchange must be to an adjustable life insurance policy that
would have been available at the time you applied for this policy. The new
policy will be based on the sex, age, class of risk and smoking status of the
insured as of the policy date of this policy. If this policy includes one or
more layers, and the new policy allows for layers, the sex, age, class of risk
and smoking status of the insured under a layer will apply to the equivalent
layer on the new policy. The premiums for the new policy will be based on our
published rates in effect on the date you request the exchange. Any Accelerated
Death Benefit Option Endorsement that is a part of this policy will
automatically become a part of the new policy. Any other riders that form a part
of this policy, and any new riders requested, will become a part of the new
policy only if we agree to provide them on the date of the exchange. The new
policy will take effect immediately upon termination of this policy. Under no
circumstances will we pay a death benefit under both this policy and the new
policy.
1-12411101
PAGE 26
ASSIGNMENT -- If there is an assignment on this policy and you want to carry
over that assignment to the new policy, you will have to execute a new
assignment.
EXCHANGE ADJUSTMENTS -- The minimum initial premium for the new policy will be
equal to:
1. the cumulative total of the required annual premiums applicable to the new
policy for the number of years that this policy was in force; minus
2. the total accumulation value transferred to the new policy.
If this policy includes one or more layers, and the new policy allows for
layers, then the minimum initial premium for the new policy will be equal to:
1. the cumulative total of the required annual premiums applicable to the base
policy of the new policy for the number of years that this policy was in force
MINUS the total accumulation value transferred to the base policy of the new
policy from this policy's base policy; plus
2. the cumulative total of the required annual premiums applicable to each layer
on the new policy for the number of years that the applicable layer on this
policy was in force MINUS the total accumulation value transferred to each layer
on the new policy from the applicable layer on this policy.
The minimum initial premium will be applied to the new policy as a gross
premium, subject to any administrative or other charges.
SURRENDER PENALTY PERIOD -- The period for which this policy was in effect prior
to the date of the exchange will be used to offset the surrender penalty period
under the new policy. If this policy has one or more layers, and the new policy
allows for layers, then the period for which this policy was in effect prior to
the date of the exchange will be determined for the base policy and for each
layer, separately.
EVIDENCE OF INSURABILITY -- When you exercise this option, we will not require
evidence of insurability from the insured.
SUICIDE AND INCONTESTABILITY -- The period for which this policy was in effect
prior to the date of the exchange will be used to offset the time period for any
suicide exclusion and incontestability provision under the new policy. If this
policy has one or more layers, and the new policy allows for layers, then the
period for which this policy was in effect prior to the date of the exchange
will be determined for the base policy and for each layer, separately.
OWNERSHIP -- The owner of the new policy will be the same as the owner of this
policy, unless otherwise provided in the policy change application. If the owner
of this policy will not be the owner of the new policy, you must complete a
transfer of ownership form. We may also require that the owner of the new policy
provide us with evidence of insurable interest in the life of the insured.
BENEFICIARY -- The beneficiary of the new policy will be the same as the
beneficiary of this policy, unless otherwise provided in the policy change
application. If the beneficiary of this policy will not be the beneficiary of
the new policy, you must complete a change of beneficiary form. We may also
require that the new beneficiary provide us with evidence of insurable interest
in the life of the insured.
1-12411101 PAGE 27
TERMINATION OF OPTION -- This option terminates on the earliest of:
1. The 20th policy anniversary.
2. The policy anniversary nearest age 95.
3. The date this policy is surrendered or terminated.
4. The date this policy lapses under the Grace Period provision.
MISSTATEMENT OF AGE OR SEX -- We will follow these rules:
1. If a misstatement of the insured's age or sex is found before this option is
exercised and this policy's death benefit is reduced as a result, the face
amount of the new policy will be based on the adjusted face amount of this
policy.
2. If a misstatement of the insured's age or sex is found after this option is
exercised, the death benefit amount under the new policy will be subject to the
Misstatement of Age or Sex provision of the new policy.
POLICY CHANGES -- If the face amount of this policy is changed for any reason,
we will proportionately change the benefit amount of the option.
POSTPONEMENT We may postpone transactions involving the separate
account during any period when:
OF TRANSFERS
1. trading on the New York Stock Exchange is restricted as determined by the
Securities and Exchange Commission, or the New York Stock Exchange is closed for
days other than weekends or holidays;
2. the Securities and Exchange Commission has allowed or ordered the suspension
described in 1. above; or
3. the Securities and Exchange Commission has determined that an emergency
exists such that disposal of mutual fund securities or valuation of assets is
not reasonably practical.
Transactions involving the separate account include the following, to the extent
the amounts of the transactions come from the portion of the accumulation value
in the separate account:
1. Transfers between or among sub-accounts.
2. Transfers to or from the separate account.
3. Policy loans.
4. Partial or full surrenders.
5. Death benefit payments.
6. Exchange of this policy under the Guaranteed Exchange Option provision.
1-12411101
PAGE 28
<PAGE>
PAYMENT OF CASH VALUE AND LOANS We may delay paying you any portion of a partial
or full surrender that comes from the accumulation value of the fixed account
for up to six months after we receive your written request for the surrender.
We may delay making a loan to you to the extent that the loan is deducted from
the portion of the accumulation value in the fixed account for up to six months
after we receive your written request for the loan. We will not delay any loan
made to pay premiums due us on any policy.
POLICY STATEMENTS AND We will send you a statement at least once a year, without
charge, showing the face amount; ILLUSTRATIONS accumulation value; cash value;
loans; partial surrenders; surrender penalty free
withdrawals; premium qualification credits; premiums paid; and charges as of the
statement date. The statement will also include summary information about the
portions of the accumulation value in the fixed account, the sub-accounts and
the loan account. We may include additional information.
Upon written request at any time we will send you an illustration of your
policy's benefits and values. There will be no charge for the first such
illustration in each policy year. We reserve the right to charge a fee up to $25
for any illustration after the first in any policy year. We will deduct any such
fee from the accumulation value of the base policy on a pro-rata basis.
BASIS OF The guaranteed cash values of the fixed account are not less than the
minimum values COMPUTATION required by the jurisdiction in which the application
for this policy was signed. The guaranteed cash values are equal to the
accumulation value based on the guaranteed monthly deductions and the guaranteed
minimum interest rate shown in the Policy Data, less any surrender penalty. The
guaranteed cash values only apply to that portion of the cash value that is in
the fixed account.
Calculations of the minimum cash values and nonforfeiture benefits are based on
the 1980 Commissioners Standard Ordinary, Smoker or Nonsmoker, Ultimate
Mortality Tables for males or females, age nearest birthday. Deaths are assumed
to occur at the end of the policy year.
As required, we have filed the method we used to compute minimum cash values and
nonforfeiture benefits with the supervisory official of the jurisdiction in
which the application for this policy was signed.
GENERAL PROVISIONS INCONTESTABILITY OF THE POLICY -- Except for fraud or
nonpayment of premiums, this policy will be incontestable after it has been in
force during the insured's lifetime for two years from the date of issue. This
provision does not apply to any rider providing benefits specifically for
disability or accidental death.
When a layer is added to this policy, this incontestability provision will start
anew with respect to that layer, beginning on the layer date.
If the base policy is rescinded for any contestable reason, we will be liable
only for the amount of premiums, less any partial surrenders, surrender penalty
free withdrawals, loans and loan interest due, allocated to the base policy. The
policy will be rescinded as of the policy date. If a layer is rescinded for any
contestable reason, we will be liable only for the amount of premiums, less any
partial surrenders, surrender penalty free withdrawals, loans and loan interest
due, that have been allocated to that layer. The layer will be rescinded as of
the layer date.
1-12411101 PAGE 29 AMOUNT WE PAY IS LIMITED IN THE EVENT OF SUICIDE -- If the
insured dies by suicide, while sane or insane, within two years from the date of
issue, we will be liable only for the amount of premiums paid, less any partial
surrenders, surrender penalty free withdrawals, loans and loan interest due.
When a layer is added to this policy, this suicide provision will start anew
with respect to that layer, beginning on the layer date. If the insured dies by
suicide, while sane or insane, within two years from the layer date, we will be
liable only for the amount of premiums, less any partial surrenders, surrender
penalty free withdrawals, loans and loan interest due, that have been allocated
to that layer.
MISSTATEMENT OF AGE OR SEX IN THE APPLICATION -- If there is a misstatement of
the insured's age or sex in the application, we will adjust the face amount of
the base policy and each layer. We will do this by comparing the excess of the
death benefit over the accumulation value to that which would be purchased by
the most recent monthly deduction at the correct age or sex to such excess as of
the date of the last monthly deduction. If the newly calculated excess is
higher, we will add the difference to the face amount. If it is lower, we will
subtract the difference from the face amount. There will be no adjustment beyond
the policy anniversary nearest age 100.
THE POLICY IS OUR CONTRACT WITH YOU -- We have issued this policy in
consideration of the application and your initial premium payment. A copy of the
application is attached and is part of this policy. The policy, including the
application and any endorsements and riders, forms our contract with you. All
statements made by or for the insured will be considered representations and not
warranties. We will not use any statement made by or for the insured to deny a
claim unless the statement is in the application, a layer application or a
reinstatement application and the application is attached to this policy when we
issue, deliver or reinstate it.
WHO CAN MAKE CHANGES IN THE POLICY -- Only our President or a Vice President,
together with our Secretary, have the authority to make any change in this
policy. Any change must be in writing.
NOTICES -- We will send any notice under the provisions of this policy to your
last known address as it appears in our records and to any assignee of record.
TERMINATION OF INSURANCE -- This policy will terminate at the earliest of:
1. The date of your written request to surrender or terminate.
2. The date of lapse.
3. The date the policy is exchanged under the Guaranteed Exchange Option
provision.
NO DIVIDENDS ARE PAYABLE -- This is nonparticipating insurance. It does not
participate in our profits or surplus. We do not distribute past surplus or
recover past losses by changing the monthly deduction rates.
SETTLEMENT PROVISIONS When the insured dies while the policy is in force, we
will pay the death benefit in a lump sum unless you or the beneficiary choose a
settlement option. You may choose a settlement option while the insured is
living. You may also choose one of these options as a method of receiving any
surrender proceeds that are available under this policy. The beneficiary may
choose a settlement option after the insured has died. The beneficiary's right
to choose will be subject to any settlement agreement in effect at the insured's
death.
1-12411101 PAGE 30 Settlement options are obligations of and are paid from our
general account and are not based on the investment experience of the separate
account.
When we receive a satisfactory written request, we will pay the benefit
according to one of these options:
OPTION A: INSTALLMENTS FOR A GUARANTEED PERIOD -- We will pay equal installments
for a guaranteed period of from one to thirty years. Each installment will
consist of part benefit and part interest. We will pay the installments monthly,
quarterly, semi-annually or annually, as requested. See Table A on the last
page.
OPTION B: INSTALLMENTS FOR LIFE WITH A GUARANTEED PERIOD -- We will pay equal
monthly installments as long as the designated individual is living, but we will
not make payments for less than the guaranteed period the payee chooses. The
guaranteed period may be either 10 years or 20 years. We will pay the
installments monthly. See Table B on the last page.
OPTION C: BENEFIT DEPOSITED WITH INTEREST -- We will hold the benefit on
deposit. It will earn interest at the annual interest rate we are paying as of
the date of the insured's death or the date you surrender this policy. We will
not pay less than 2 1/2% annual interest. We will pay the earned interest
monthly, quarterly, semi-annually or annually, as requested. The payee may
withdraw part or all of the benefit and earned interest at any time.
OPTION D: INSTALLMENTS OF A SELECTED AMOUNT -- We will pay installments of a
selected amount until we have paid the entire benefit and accumulated interest.
OPTION E: ANNUITY -- We will use the benefit as a single premium to buy an
annuity. The annuity may be payable to one or two designated individuals. It may
be payable for life with or without a guaranteed period, as requested. The
annuity payment will not be less than payments available under our then-current
annuity contracts.
GENERAL: The payee may arrange any other method of settlement as long as we
agree to it. There must be at least $10,000 available for any option. The amount
of each installment must be at least $100. If the benefit amount is not enough
to meet these requirements, we will pay the benefit in a lump sum.
Installments that depend on the designated individual's age are based on his or
her age nearest birthday on the date of the insured's death or the date you
surrender this policy. If the death benefit is payable, the settlement option
will start on the date of the insured's death. If you surrender this policy, the
settlement option will start on the date we receive your written surrender
request.
We will pay the first installment under any option on the date the option
starts. Any unpaid balance we hold under Options A, B or D will earn interest at
the rate we are paying at the time of settlement. We will not pay less than 3%
annual interest.
If the payee does not live to receive all guaranteed payments under Options A, B
or D or any amount deposited under Option C (plus any accumulated interest), we
will pay the remaining benefit as scheduled to the payee's estate. If the payee
does not live to receive all guaranteed payments under Option E, we will pay the
remaining benefit as scheduled to the payee's estate. The payee may name and
change a successor payee for any amount we would otherwise pay the payee's
estate.
1-12411101
PAGE 31
<PAGE>
<TABLE>
<CAPTION>
DEATH BENEFIT FACTORS
Attained Policy Years 1-10 Attained Policy Years 1-10
Age Age
Male Female Male Female
Smoker Nonsmoker Smoker Nonsmoker Smoker Nonsmoker Smoker Nonsmoker
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
16 6.80 8.52 8.45 9.70 61 1.96 2.17 2.21 2.37
17 6.59 8.25 8.17 9.39 62 1.92 2.12 2.15 2.31
18 6.38 7.99 7.91 9.09 63 1.89 2.07 2.11 2.26
19 6.19 7.74 7.65 8.79 64 1.85 2.03 2.06 2.20
20 6.01 7.50 7.41 8.51 65 1.82 1.99 2.02 2.15
21 5.84 7.27 7.18 8.23 66 1.79 1.95 1.98 2.10
22 5.66 7.04 6.95 7.97 67 1.76 1.92 1.94 2.04
23 5.49 6.81 6.73 7.71 68 1.74 1.89 1.90 2.01
24 5.33 6.59 6.51 7.45 69 1.71 1.86 1.85 1.97
25 5.16 6.38 6.30 7.21 70 1.69 1.83 1.82 1.93
26 5.01 6.18 6.09 6.97 71 1.67 1.80 1.79 1.89
27 4.86 5.98 5.90 6.74 72 1.64 1.77 1.75 1.86
28 4.70 5.78 5.71 6.52 73 1.61 1.74 1.72 1.82
29 4.56 5.59 5.53 6.30 74 1.58 1.71 1.68 1.79
30 4.41 5.41 5.35 6.10 75 1.55 1.68 1.65 1.76
31 4.28 5.23 5.18 5.90 76 1.53 1.66 1.62 1.73
32 4.15 5.06 5.02 5.71 77 1.50 1.63 1.59 1.70
33 4.02 4.90 4.87 5.52 78 1.47 1.61 1.57 1.68
34 3.90 4.74 4.72 5.35 79 1.45 1.59 1.54 1.65
35 3.78 4.58 4.57 5.17 80 1.43 1.57 1.51 1.63
36 3.67 4.44 4.43 5.01 81 1.39 1.51 1.47 1.57
37 3.56 4.29 4.30 4.85 82 1.35 1.47 1.42 1.52
38 3.45 4.15 4.17 4.69 83 1.33 1.42 1.38 1.47
39 3.35 4.02 4.04 4.55 84 1.31 1.38 1.36 1.42
40 3.26 3.89 3.92 4.40 85 1.29 1.35 1.34 1.39
41 3.16 3.77 3.81 4.26 86 1.27 1.34 1.31 1.36
42 3.07 3.65 3.70 4.13 87 1.25 1.32 1.29 1.34
43 2.99 3.54 3.59 4.00 88 1.23 1.30 1.26 1.32
44 2.90 3.43 3.48 3.88 89 1.21 1.28 1.23 1.29
45 2.82 3.32 3.38 3.76 90 1.19 1.24 1.20 1.25
46 2.75 3.22 3.28 3.64 91 1.17 1.21 1.18 1.21
47 2.68 3.13 3.19 3.53 92 1.15 1.18 1.15 1.18
48 2.61 3.04 3.10 3.43 93 1.13 1.14 1.13 1.15
49 2.54 2.95 3.02 3.33 94 1.11 1.11 1.12 1.12
50 2.48 2.86 2.94 3.23 95 1.10 1.10 1.10 1.10
51 2.42 2.78 2.86 3.13 96 1.09 1.09 1.09 1.09
52 2.36 2.71 2.78 3.04 97 1.07 1.07 1.07 1.07
53 2.31 2.63 2.71 2.96 98 1.06 1.06 1.06 1.06
54 2.26 2.57 2.63 2.87
55 2.21 2.50 2.56 2.79
56 2.16 2.44 2.50 2.71
57 2.12 2.38 2.44 2.64
58 2.07 2.32 2.38 2.57
59 2.03 2.27 2.32 2.50
60 2.00 2.22 2.26 2.44
1-12411101
PAGE 32
<PAGE>
DEATH BENEFIT FACTORS
Attained Policy Years 11+ Attained Policy Years 11+
Age Age
Male Female Male Female
Smoker Nonsmoker Smoker Nonsmoker Smoker Nonsmoker Smoker Nonsmoker
26 4.82 5.91 5.84 6.64 66 1.55 1.70 1.78 1.88
27 4.67 5.72 5.65 6.43 67 1.52 1.66 1.74 1.83
28 4.52 5.54 5.47 6.22 68 1.49 1.62 1.70 1.78
29 4.38 5.36 5.29 6.01 69 1.47 1.58 1.66 1.74
30 4.24 5.18 5.12 5.81 70 1.44 1.55 1.62 1.69
31 4.10 5.01 4.95 5.62 71 1.42 1.52 1.59 1.65
32 3.97 4.85 4.79 5.44 72 1.40 1.48 1.55 1.61
33 3.84 4.69 4.63 5.26 73 1.37 1.45 1.52 1.57
34 3.71 4.53 4.48 5.08 74 1.35 1.43 1.49 1.53
35 3.59 4.38 4.34 4.91 75 1.33 1.40 1.46 1.50
36 3.48 4.24 4.20 4.75 76 1.32 1.38 1.43 1.47
37 3.37 4.10 4.06 4.59 77 1.30 1.35 1.40 1.43
38 3.26 3.96 3.93 4.44 78 1.28 1.33 1.38 1.41
39 3.16 3.83 3.81 4.30 79 1.27 1.31 1.35 1.38
40 3.06 3.70 3.69 4.16 80 1.26 1.29 1.33 1.35
41 2.96 3.58 3.57 4.02 81 1.24 1.27 1.31 1.33
42 2.87 3.47 3.46 3.89 82 1.23 1.26 1.29 1.30
43 2.79 3.35 3.36 3.77 83 1.22 1.24 1.27 1.28
44 2.70 3.24 3.26 3.65 84 1.21 1.23 1.25 1.26
45 2.62 3.14 3.16 3.53 85 1.20 1.21 1.23 1.24
46 2.55 3.04 3.07 3.42 86 1.19 1.20 1.22 1.23
47 2.47 2.94 2.98 3.32 87 1.18 1.19 1.20 1.21
48 2.40 2.85 2.89 3.21 88 1.17 1.18 1.19 1.19
49 2.34 2.76 2.81 3.11 89 1.16 1.17 1.18 1.18
50 2.27 2.68 2.73 3.02 90 1.15 1.16 1.17 1.17
51 2.21 2.59 2.66 2.92 91 1.14 1.15 1.15 1.15
52 2.15 2.51 2.58 2.84 92 1.13 1.14 1.14 1.14
53 2.09 2.44 2.51 2.75 93 1.12 1.12 1.13 1.13
54 2.04 2.36 2.44 2.67 94 1.11 1.11 1.12 1.12
55 1.99 2.29 2.38 2.59 95 1.10 1.10 1.10 1.10
56 1.94 2.23 2.31 2.51 96 1.09 1.09 1.09 1.09
57 1.89 2.16 2.25 2.44 97 1.07 1.07 1.07 1.07
58 1.85 2.10 2.19 2.37 98 1.06 1.06 1.06 1.06
59 1.80 2.04 2.14 2.30 99 1.04 1.04 1.04 1.04
60 1.76 1.99 2.08 2.23 100 1.04 1.04 1.04 1,04
61 1.72 1.93 2.03 2.17
62 1.68 1.88 1.97 2.10
63 1.65 1.83 1.92 2.04
64 1.61 1.79 1.87 1.99
65 1.58 1.74 1.83 1.93
FOR ALL ATTAINED AGES AFTER THOSE SHOWN, THE DEATH BENEFIT FACTOR IS 1.04.
</TABLE>
1-12411101
PAGE 33
<PAGE>
<TABLE>
<CAPTION>
TABLE A
INSTALLMENTS FOR EACH $1,000 PAYABLE UNDER OPTION A
---------------------------------------------------------------------------------------------------------------------------------
Multiply the Monthly Installment by 11.83895 for Annual, by 5.96322 for Semi-Annual, or by 2.99263 for Quarterly Installments
---------------------------------------------------------------------------------------------------------------------------------
----------------------- -------------------- -------------------- -------------------- -------------------- ---------------------
Guaranteed Monthly Guaranteed Monthly Guaranteed Monthly
Period (Yrs.) Installment Period (Yrs.) Installment Period (Yrs.) Installment
----------------------- -------------------- -------------------- -------------------- -------------------- ---------------------
<S> <C> <C> <C> <C> <C> <C>
1 $84.47 11 $8.86 21 $5.32
2 42.86 12 8.24 22 5.15
3 28.99 13 7.71 23 4.99
4 22.06 14 7.26 24 4.84
5 17.91 15 6.87 25 4.71
6 15.14 16 6.53 26 4.59
7 13.16 17 6.23 27 4.48
8 11.68 18 5.96 28 4.37
9 10.53 19 5.73 29 4.27
10 9.61 20 5.51 30 4.18
---------------------------------------------------------------------------------------------------------------------------------
</TABLE>
<TABLE>
<CAPTION>
TABLE B
MONTHLY INSTALLMENT FOR EACH $1,000 PAYABLE UNDER OPTION B
---------------------------------------------------------------------------------------------------------------------------------
MALE DESIGNATED INDIVIDUAL
---------------------------------------------------------------------------------------------------------------------------------
--------------------------- ------------------------ ------------------------- ------------------------ -------------------------
Guaranteed Period Guaranteed Period Guaranteed Period Guaranteed Period Guaranteed Period
Age 10 Yrs. 20 Yrs. Age 10 Yrs. 20 Yrs. Age 10 Yrs. 20 Yrs. Age 10 Yrs. 20 Yrs. Age 10 Yrs. 20 Yrs.
--------------------------- ------------------------ ------------------------- ------------------------ -------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
11 $2.90 $2.89 26 $3.20 $3.19 41 $3.77 $3.71 56 $4.92 $4.59 71 $7.27 $5.42
12 2.91 2.91 27 3.22 3.21 42 3.82 3.76 57 5.03 4.66 72 7.48 5.45
13 2.93 2.92 28 3.25 3.24 43 3.88 3.81 58 5.15 4.73 73 7.68 5.46
14 2.94 2.94 29 3.28 3.27 44 3.94 3.86 59 5.27 4.80 74 7.88 5.48
15 2.96 2.96 30 3.31 3.30 45 4.00 3.91 60 5.40 4.87 75 8.08 5.49
16 2.98 2.97 31 3.34 3.33 46 4.07 3.97 61 5.53 4.94 76 8.27 5.50
17 3.00 2.99 32 3.38 3.36 47 4.14 4.02 62 5.68 5.00 77 8.46 5.50
18 3.01 3.01 33 3.41 3.39 48 4.21 4.08 63 5.83 5.07 78 8.63 5.51
19 3.03 3.03 34 3.45 3.43 49 4.28 4.14 64 5.98 5.13 79 8.79 5.51
20 3.05 3.05 35 3.49 3.46 50 4.36 4.20 65 6.15 5.18 80 8.94 5.51
21 3.08 3.07 36 3.53 3.50 51 4.44 4.26 66 6.32 5.24 81 9.07 5.51
22 3.10 3.09 37 3.57 3.54 52 4.53 4.32 67 6.50 5.28 82 9.18 5.51
23 3.12 3.11 38 3.62 3.58 53 4.62 4.39 68 6.68 5.33 83 9.28 5.51
24 3.14 3.14 39 3.67 3.62 54 4.71 4.46 69 6.88 5.36 84 9.36 5.51
25 3.17 3.16 40 3.72 3.67 55 4.81 4.52 70 7.07 5.40 85 9.42 5.51
--------------------------- ------------------------ ------------------------- ------------------------ -------------------------
---------------------------------------------------------------------------------------------------------------------------------
FEMALE DESIGNATED INDIVIDUAL
--------------------------- ------------------------ ------------------------- ------------------------ -------------------------
Guaranteed Period Guaranteed Period Guaranteed Period Guaranteed Period Guaranteed Period
Age 10 Yrs. 20 Yrs. Age 10 Yrs. 20 Yrs. Age 10 Yrs. 20 Yrs. Age 10 Yrs. 20 Yrs. Age 10 Yrs. 20 Yrs.
--------------------------- ------------------------ ------------------------- ------------------------ -------------------------
11 $2.83 $2.83 26 $3.08 $3.07 41 $3.54 $3.52 56 $4.51 $4.35 71 $6.73 $5.36
12 2.84 2.84 27 3.10 3.10 42 3.59 3.56 57 4.61 4.42 72 6.94 5.40
13 2.86 2.85 28 3.12 3.12 43 3.63 3.60 58 4.71 4.50 73 7.16 5.43
14 2.87 2.87 29 3.15 3.14 44 3.68 3.65 59 4.82 4.57 74 7.38 5.48
15 2.88 2.88 30 3.17 3.17 45 3.73 3.69 60 4.94 4.65 75 7.60 5.47
16 2.90 2.90 31 3.20 3.19 46 3.78 3.74 61 5.06 4.72 76 7.82 5.48
17 2.91 2.91 32 3.23 3.22 47 3.84 3.79 62 5.19 4.80 77 8.04 5.49
18 2.93 2.93 33 3.26 3.25 48 3.90 3.85 63 5.33 4.88 78 8.25 5.50
19 2.95 2.94 34 3.29 3.28 49 3.96 3.90 64 5.47 4.95 79 8.45 5.51
20 2.96 2.96 35 3.32 3.31 50 4.03 3.96 65 5.63 5.02 80 8.64 5.51
21 2.98 2.98 36 3.35 3.34 51 4.10 4.02 66 5.79 5.09 81 8.82 5.51
22 3.00 2.99 37 3.39 3.37 52 4.17 4.08 67 5.96 5.15 82 8.97 5.51
23 3.02 3.01 38 3.42 3.41 52 4.25 4.14 68 6.14 5.21 83 9.11 5.51
24 3.04 3.03 39 3.46 3.44 54 4.33 4.21 69 6.33 5.27 84 9.23 5.51
25 3.06 3.05 40 3.50 3.48 55 4.42 4.28 70 6.53 5.32 85 9.32 5.51
---------------------------------------------------------------------------------------------------------------------------------
Ages younger than 11 are the same as shown for age 11, and ages older than 85
are the same as shown for age 85.
---------------------------------------------------------------------------------------------------------------------------------
</TABLE>
1-12411101
PAGE 34
<PAGE>
Transamerica Occidental Policy Form TRUL-VUL
Life Insurance Company Individual Life Insurance
1150 South Olive Street
Los Angeles, CA 90015
VARIABLE UNIVERSAL LIFE INSURANCE
MINIMUM PREMIUM REQUIREMENT
SHOWN IN THE POLICY DATA
FLEXIBLE PREMIUMS PAYABLE THEREAFTER
DURING LIFE OF INSURED PRIOR TO AGE 100
SUBJECT TO THE LIMITATIONS DESCRIBED
IN THE PREMIUMS PROVISION
DEATH BENEFIT PAYABLE AT DEATH OF INSURED
NONPARTICIPATING - NO ANNUAL DIVIDENDS
1-12411101
<PAGE>
TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY
INSURANCE ON CHILDREN RIDER
<PAGE>
TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY has issued this rider as a part
of the policy to which it is attached.
If a child dies before becoming 25 years old and before the policy anniversary
nearest age 65 of the insured, we will pay the amount of insurance shown for
this rider in the Policy Data, subject to the provisions of this rider.
PAYMENT OF PROCEEDS -- Any proceeds payable under this rider because of the
death of a child will be paid to the insured when we receive due proof of the
death. However, upon request of the owner, any proceeds will be paid to a
beneficiary other than the insured, but only if:
1. the beneficiary change is made in accordance with the How to Change a
Beneficiary provision of the policy; and
2. the beneficiary change specifically states that it is applicable to insurance
provided on a child under this rider.
Any proceeds may be applied under one of the Settlement Provisions of the
policy.
DEFINITIONS -- In this rider:
"Insured" means the insured under the policy to which this rider is
attached.
"Child" means: (1) any child named in the application for this rider who
was born to the insured, or is a stepchild or legally adopted child of the
insured, and who is at least 15 days old or becomes 15 days old, and who is
not yet 19 years old on the date of the application, and (2) any child born
to the insured, or a stepchild or child legally adopted by the insured,
after the date of application for this rider, who is at least 15 days old
or becomes 15 days old, and who is not yet 19 years of age.
PAID-UP TERM LIFE INSURANCE -- If the insured dies while this rider is in force,
this rider automatically will be changed to non-participating paid-up term life
insurance as then written by us. A policy on each child will provide the amount
of insurance of this rider to that child's 25th birthday. The child will be the
owner of each such policy.
If the insurance on a child becomes paid-up under the provisions of this rider,
we will furnish the cash values of the paid-up insurance to the owner upon
request.
CONVERSION -- Insurance under this rider may be converted to any plan of level
premium whole life or endowment insurance as follows:
1. Insurance on a child may be converted, without providing evidence of
insurability, to a new policy up to five times the amount of insurance
provided on that child under this rider or $50,000, whichever is less, on
the following dates: a. the child's 25th birthday, or the policy
anniversary nearest age 65 of the insured, whichever comes first; or b.
within 90 days after the child marries or receives a Baccalaureate degree
or higher degree from a fully
accredited college or university prior to the child's 25th birthday and
prior to the policy anniversary nearest age 65 of the insured.
2. Insurance on a child may be converted at any other time prior to the
child's 25th birthday and prior to the policy anniversary nearest age 65 of
the insured. The face amount of the new policy may not be greater than the
amount of insurance provided on that child under this rider.
3. Written request for conversion and payment of the required premium must be
made to us before, or within 31 days after, the date allowed for
conversion. The terminating insurance will not be in force during the
31-day period following the date allowed for conversion.
4. The face amount of each new policy may not be less than our published
minimum for the plan selected. At least one plan will be available for
conversion of $1,000 of insurance.
5. Each new policy will be effective on the date of conversion. The child will
be the owner of the new policy.
6. The premium for each new policy will be based on our published rates for the
plan selected at the time of conversion. We will use the age of the child
insured on the date of conversion to determine this rate.
<PAGE>
1-058 11-101 PAGE 1
<PAGE>
7. The date of issue of all new policies issued under the Conversion Provision
will be the date of issue of this rider. The Incontestability and Suicide
periods in the new policies will continue from such dates of issue and will
not start anew in the new policies. However, if there is an increase in the
face amount over the amount of this rider, the increase will be subject to
new incontestability and suicide periods.
AUTOMATIC TERMINATION -- This rider will automatically terminate:
1. if any premium remains unpaid after the grace period;
2. a) when, in the case of flexible premium policies, the policy is surrendered
or continued under the Paid-Up Life Non-Forfeiture Option, or
b) when, in the case of fixed premium policies, the policy is surrendered or
continued under any non-forfeiture option; 3. if the policy becomes paid-up,
matures or terminates; 4. on the policy anniversary nearest age 65 of the
insured; or 5. at the death of the insured subject to the provisions for paid-up
term life insurance.
Insurance on a child under this rider will automatically terminate on such
child's 25th birthday or when all or part of such insurance is converted.
REINSTATEMENT -- In addition to the provisions of the policy relating to
reinstatement, this rider may be reinstated only as to each child who provides
proof of insurability satisfactory to us.
INCONTESTABILITY -- In applying the provisions of the policy relating to
incontestability to this rider, the "date of issue" will be the date this rider
is signed by us. Any paid-up term life insurance issued under this rider will be
incontestable from its date of issue.
SUICIDE -- In applying the provision of the policy relating to suicide to this
rider, the "date of issue" will be the date this rider is signed by us. If the
insured dies by suicide and our liability is limited to the amount of the
premiums paid, no insurance will be provided under the paid-up term life
insurance provision of this rider. Instead, insurance on each child may be
converted to any plan of whole life or endowment insurance then offered by us.
Such conversion will be subject to the conversion provisions of this rider. The
suicide provision of the policy will not apply to death of a child by suicide.
CONTINUATION -- If the policy, exclusive of riders, provides term insurance
which is converted, this rider will be continued as a part of the new policy.
CANCELLATION -- Upon written request by the owner of the policy, this rider may
be cancelled on any premium due date.
NO DIVIDENDS ARE PAYABLE -- This rider does not participate in our profits or
surplus.
CONSIDERATION -- We have issued this rider in consideration of the application
and payment of the premiums. A copy of the application is attached to the
policy. In the case of flexible premium policies one-twelfth of the annual
premium for the rider will be paid in the manner specified in the policy. In the
case of fixed premium policies, the annual premium for this rider is shown in
the Policy Data and is payable as provided by this policy. In either case, no
premium for this rider will be payable after this rider terminates.
RIDER DATE -- The rider date of this rider will be the policy date of the policy
unless a different rider date is shown here.
<PAGE>
Signed for the Company at Los Angeles, California, and effective on the date the
policy is issued unless a different effective date is shown here.
Executive Vice President, General Counsel President
And Corporate Secretary
1-058 11-101 PAGE 2
<PAGE>
TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY
FULL DEATH BENEFIT RIDER
<PAGE>
TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY has issued this rider as part of
the policy to which it is attached. It is subject to all of the provisions,
definitions, and conditions of the policy that do not conflict with this rider.
In case of conflict between the policy and this rider, the rider will control.
DEFINITIONS
In this rider:
AGE as used in this rider means the insured's age, or exact age, if any, as
defined in the policy.
The INSURED under this rider means the insured, or joint insureds, if any, as
defined in the policy.
The MONTHLY DEDUCTION for this rider is an amount we withdraw from the policy's
accumulation value at the beginning of each policy month.
REINSTATE means to restore coverage after the policy and this rider have lapsed.
DEATH BENEFIT
Beginning with the policy anniversary nearest age 100, the death benefit will be
the death benefit as defined and determined by the policy on the day before the
policy anniversary nearest age 100. The death benefit will be subject to the
adjustments and conditions stated in this rider. We will reduce the death
benefit by any existing loans. The death benefit will be subject to adjustment
after age 100 for misstatement of age or sex or gender, as applicable.
REINSTATEMENT
This rider is subject to the Reinstatement provision of the policy.
RIDER MONTHLY DEDUCTIONS
We will take the monthly deduction for this rider starting on the policy
anniversary nearest age 90. We will continue to take the monthly deduction for
this rider until the policy anniversary nearest age 100. The amount of the
monthly deduction will be no more than $1.00 times .001, times the difference
between the death benefit and the accumulation value of the policy at the
beginning of the policy month.
GENERAL PROVISIONS
GRACE PERIOD -- This rider is subject to the Grace Period provision of the
policy.
TERMINATION OF INSURANCE -- This rider will terminate at the earliest of:
1. the date the insured dies under an individual policy; or
2. the date the survivor dies under a joint and last survivor policy; or
3. the date the policy lapses; or
4. the date the policy is continued under a nonforfeiture option; or
5. the date we receive your written request to surrender or terminate the policy
or this rider; or
6. the maturity date of the policy.
CONSIDERATION -- We have issued this rider in consideration of: (1) the
application; and (2) payment of the premium. A copy of the application is
attached to the policy.
<PAGE>
Signed for the Company at Los Angeles, California and effective on the date of
issue of the policy to which this rider is attached, unless a different date is
shown here.
Executive Vice President, General Counsel President
And Corporate Secretary
1-056 11-101 PAGE 1
<PAGE>
TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY
WAIVER PROVISION RIDER
<PAGE>
TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY has issued this rider as a part
of the policy to which it is attached.
WAIVER BENEFIT -- We will waive each monthly deduction due immediately on or
after age 10 of the insured during the insured's total disability. This
deduction (referred to as "such deduction") is described in the Monthly
Deductions provision of the policy. The waiver is subject to the provisions of
this rider.
While monthly deductions are being waived under this benefit, premium payments
are not required.
Any monthly deduction eligible for waiver under this rider that is taken before
we approve a claim will be credited to the accumulation value of the policy.
This credit will be treated as a new net premium. We will credit the
accumulation value as of the date of notice of claim or the date at the end of
the first six months of such disability, whichever is later. If that date is not
a valuation date, we will credit the accumulation value on the next valuation
date.
TOTAL DISABILITY -- Disability will be total when the insured becomes so
disabled by injury or disease which first manifests itself after the date this
rider is signed by us, as to be unable to perform substantially all of the
material duties of any gainful work for which the insured is, or becomes, fitted
by reason of education, training or experience. If the occupation of the insured
is, or becomes, that of a student, then "any gainful work" will include going to
school. The total loss of sight of both eyes, or of the use of both hands, both
feet or one hand and one foot, will be presumed total disability while such
total loss continues. Total disability is called "such disability" in this
rider.
The beginning of such disability will be the beginning of the disability which
totally disables the insured for not less than six months. In no event will such
disability be considered to have begun more than one year before the date due
proof of such disability is received by us.
AGE LIMITATIONS -- No waiver will be allowed under this rider during any period
of disability before the insured's 10th birthday. If such disability continues
beyond the 10th birthday, we will waive each such deduction due after that
birthday and during such disability. No waiver will be allowed under this rider
if such disability begins after the policy anniversary nearest age 60 of the
insured.
EXCLUSION FROM COVERAGE -- No benefits will be allowed under this rider if such
disability results directly or indirectly from:
1. Intentionally self-inflicted injury.
2. Participation in insurrection.
3. War, declared or undeclared, or any act of war.
AUTOMATIC TERMINATION -- This rider will automatically terminate:
1. If the policy is surrendered.
2. If the policy lapses.
3. At the policy anniversary nearest age 60 of the insured, subject to any
claims under this rider.
NOTICE AND PROOF OF DISABILITY -- Written notice of such disability must be
given to us at our administrative office while the insured is living and while
such disability continues. Failure to give such notice will not invalidate any
claim if such notice was given as soon as was reasonably possible. Due proof of
such disability must be given to us at our administrative office. Although proof
of such disability may have been accepted by us as satisfactory, the insured
must at any time, when we request it, furnish due proof of the continuance of
such disability. At our option, such proof may include an examination of the
insured by a medical examiner chosen by us. Such proof will not be required by
us more than once each year after such disability has continued for two full
years.
<PAGE>
1-011 06-101 PAGE 1
<PAGE>
RECOVERY FROM DISABILITY -- The benefits provided by this rider will end:
1. If the insured fails to give us any due proof, or refuses to submit to a
requested medical examination.
2. If the insured is no longer totally disabled.
CANCELLATION -- Upon written request by the owner, this rider may be cancelled
on any monthly policy date.
NO DIVIDENDS ARE PAYABLE -- This rider does not participate in our profits or
surplus.
CONSIDERATION -- We have issued this rider in consideration of the application
and payment of the initial premium shown in the Policy Data. A copy of the
application is attached to the policy. Monthly deductions for this rider are
based on the rates shown in the Policy Data and are payable as provided in the
policy, except that when this rider terminates, such monthly deductions will no
longer be payable.
<PAGE>
Signed for the Company at Los Angeles, California, on the date of issue of the
policy unless a different date is shown here.
Executive Vice President, General Counsel President
And Corporate Secretary
1-011 06-101 PAGE 2
<PAGE>
TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY
ENDORSEMENT TO MODIFY GRACE PERIOD
<PAGE>
TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY has issued this endorsement as
part of the policy to which it is attached.
While the policy is in force and subject to the terms of this endorsement, the
policy will not enter its grace period.
DEFINITIONS
In this endorsement:
GRACE PERIOD is the 60 day period starting on a monthly policy date or policy
anniversary, as described in the policy.
NET DEPOSITS mean the total premiums paid, less the sum of any premium refunds,
partial surrenders, and surrender penalty free withdrawals since the policy
date. In calculating the net deposits, premium paid in a policy year prior to
the policy year in which the select monthly premium is due will reflect a time
value of money at 4 percent per annum.
SELECT MONTHLY PREMIUM is the amount you must pay each month during the select
period to maintain this endorsement. This amount is shown in the Policy Data.
This amount may be paid cumulatively in advance.
SELECT PERIOD is the period this endorsement is in effect. This period is shown
in the Policy Data.
WE means Transamerica Occidental Life Insurance Company.
YOU means the Owner.
HOW IT WORKS
During the select period, the policy will not enter its grace period due to lack
of policy value if: (1) there is no outstanding loan; and (2) the select monthly
premium requirement has been met. The select monthly premium requirement will be
met if, at the start of each policy month, the net deposits equal or exceed the
cumulative select monthly premiums due since the policy date.
If the preceding requirements are met, the Grace Period provision will be
modified so that the base policy and this endorsement, and, if applicable, any
layers, Supplemental Adjustable Life Insurance Rider, Full Death Benefit Rider
and waiver provision will remain in effect. All other riders will be terminated.
Any conversion privilege included in those terminated riders may be exercised at
that time.
We will continue to deduct the monthly deductions from the policy accumulation
value as they come due.
WAIVER PROVISION
If the policy contains a waiver provision benefit and a disability claim is
approved while this endorsement is effective, the select monthly premium will be
waived. The select monthly premium will be waived for the same length of time
that the policy is on waiver. Any waiver of a select monthly premium is subject
to the terms of this endorsement. The select period will not be extended.
POLICY CHANGES
If a requested increase or decrease in the face amount of the policy is
processed during the select period, the select monthly premium will be adjusted
from that point forward. The select period will not be adjusted.
AUTOMATIC TERMINATION
This endorsement will automatically terminate upon the first of the following to
occur:
1. The select monthly premium requirement is not met;
2. the select period has ended;
3. the death benefit option on the policy has been changed from Option 1 to
another option; or
4. the policy terminates for any reason.
<PAGE>
1-006 58-101
Page 1
Page 1
REINSTATEMENT
If this endorsement terminates solely due to the select monthly premium
requirement not being met, you may reinstate this rider within 30 days of the
termination date.
To reinstate the rider, you must, within 30 days from the termination date:
1. Request reinstatement of the rider in writing.
2. Pay us the necessary premium to reinstate the rider.
The necessary premium to reinstate the rider is equal to:
1. the difference between the cumulative select monthly premiums due and the net
deposits as of the termination date; plus
2. two select monthly premiums, or if less, the select monthly premiums due to
the end of the select period.
Reinstatement of this rider will be subject to all other provisions of this
rider.
<PAGE>
Signed for Transamerica Occidental Life Insurance Company at Los Angeles,
California, and effective on the date of issue of the policy to which this
endorsement is attached.
Executive Vice President, General Counsel President and CEO
And Corporate Secretary
1-006 58-101 Page 2
<PAGE>
ACCELERATED DEATH BENEFIT OPTION ENDORSEMENT
<PAGE>
Transamerica Occidental Life Insurance Company has issued this endorsement as a
part of policy number [OBJECT OMITTED] ("the policy").
NOTICE: BENEFITS ADVANCED UNDER THIS OPTION MAY BE TAXABLE. AS WITH ALL TAX
MATTERS, THE OWNER SHOULD CONSULT A PERSONAL TAX ADVISOR TO ASSESS THE IMPACT OF
THIS BENEFIT ON THE OWNER AND THE POLICY.
While the policy is in force, we will pay an Accelerated Death Benefit to you,
upon your request, subject to all the provisions and limitations of this
endorsement.
DEFINITIONS
In this endorsement:
ACCELERATED DEATH BENEFIT is the amount we pay under this option.
ADMINISTRATIVE FEE is the $250.00 that will be charged at the time each
Accelerated Death Benefit is paid.
EFFECTIVE DATE is the date we approve your written request to exercise this
option.
IMMEDIATE FAMILY MEMBERS are members of either the Insured's or Owner's family
who may be described as follows: spouse (includes common law spouse), children,
stepchildren, parents, grandparents, grandchildren, brothers and sisters and
their spouses (includes common law spouse).
INSURED means only the Insured covered under the policy and not any other
individuals covered for additional riders or benefits.
PHYSICIAN is an individual, other than the Insured, the Owner, or Immediate
Family Member, who is a doctor of medicine or osteopathy, licensed in the
jurisdiction in which the advice is given or diagnosis is made and who is acting
within the scope of that license.
POLICY BASIC DEATH BENEFIT means the death benefit provided by the policy, any
policy layer, any Supplemental Adjustable Life Insurance Rider and any level
term rider on the life of the Insured. It does not include any death benefit
provided by any other riders or benefits attached to the policy.
POLICY CHARGES means any monthly deductions, any surrender charges or surrender
penalties, or any other charges specified in the policy.
TERMINAL ILLNESS is a medical condition, resulting from bodily injury or
disease, or both, and:
-- which has been diagnosed by a Physician after the issue date of the
policy; and,
-- for which the diagnosis is supported by clinical, radiological,
laboratory or other evidence of the medical condition which is
satisfactory to us; and,
-- which is not curable by any means available to the medical profession;
and,
-- which a Physician certifies is expected to result in death within 12
months of diagnosis and the certification is within 30 days of the
Accelerated Death Benefit request.
"YOU" AND "YOUR" mean the Owner
LIMITATIONS
1. The availability of this option is subject to all the terms of the policy,
including contestability and suicide.
2. No benefit will be paid if Terminal Illness results from intentionally
self-inflicted injury(ies) at any time.
3. At each request to exercise this option, there must be at least 2 years
remaining from the Effective Date to the expiry or maturity date of each
portion of the Policy Basic Death Benefit.
4. The Owner may not exercise this option:
a) if required by law to use the Accelerated Death Benefit to meet the claims of
creditors, whether in bankruptcy or otherwise, or
b) if required by a government agency to use the Accelerated Death
Benefit in order to apply for, obtain, or otherwise keep a
government benefit or entitlement, or
c) until there is only one surviving Joint Insured if the policy is a
Joint and Last Survivor policy.
5. This option is not available if the maximum Accelerated Death Benefit has
been paid.
6. The face amount of the policy on which this option is exercised must be at
least $50,000 at the time of the first written request.
<PAGE>
1-005 84-195 PAGE 1
<PAGE>
AMOUNT OF THE ACCELERATED DEATH BENEFIT
1. The Owner can request an Accelerated Death Benefit payment in any amount
subject to the following minimum and maximum. The minimum Accelerated
Death Benefit allowed will be $10,000. The maximum Accelerated Death
Benefit allowed for all policies combined covering the Insured issued by
the Company will be the lesser of $250,000 or 75% of the combined Policy
Basic Death Benefit for those policies as of the first Accelerated Death
Benefit payment. If the first Accelerated Death Benefit payment is less
than the maximum, then no more than the remaining balance of the maximum
can be paid out later as an Accelerated Death Benefit.
2. If there is an outstanding loan on the policy, the Accelerated Death
Benefit payment may be reduced to repay a prorata portion of the policy
loan.
3. At the time we pay the Accelerated Death Benefit, if the policy is in the
grace period, we will deduct any unpaid premium in accordance with the
grace period provision in the policy.
4. The $250.00 Administrative Fee will be deducted from each Accelerated Death
Benefit payment.
PREMIUM
Premium billing and premium payment requirements will continue, subject to the
adjustments described below.
EFFECT OF THE ACCELERATED DEATH BENEFIT PAYMENT ON THE POLICY
After an Accelerated Death Benefit is paid, the policy and any riders and
benefits will remain in force subject to the following adjustments:
1. The Policy Basic Death Benefit after payment of an Accelerated Death
Benefit will equal the amount of the Policy Basic Death Benefit before the
payment of the Accelerated Death Benefit minus the result of multiplying
(a) by (b), where:
(a) is the Accelerated Death Benefit; and
(b) is 1 (one) plus an interest rate that is the greater of,
(i) the federal interest rate under Internal Revenue Code (IRC) section
846(c)(2), or
(ii) the policy loan effective interest rate.
2. The Policy Basic Death Benefit, and, if applicable, the policy's face
amount, accumulation value, cash value, policy loan, and required premium
will be adjusted as of the Effective Date. The adjustments to the Policy
Basic Death Benefit will be made in the following order: (1) level term
rider(s) on the Insured, if any, beginning with the most recent rider; (2)
policy layer(s), if any, beginning with the most recent layer; and, (3)
remaining portions of the Policy Basic Death Benefit. New Policy Charges
and premiums will be based on the rates in effect for the policy's
resulting face amount.
3. We will provide new policy data pages showing the reduced coverage amount
resulting from the Accelerated Death Benefit payment.
EXERCISING THE OPTION
We must receive a written request to exercise this option at the Home Office or
our designated Administrative Office within 30 days after the certification of
diagnosis of the Terminal Illness, or as soon as reasonably possible. The
request should include the name of the Insured, the policy number and, must be
signed and dated by the Owner. If the policy has an irrevocable beneficiary,
that person(s) must also sign the request. If the policy is assigned, we must
receive a completed and signed release of assignment. If the policy was issued
in a community property state, we may require your spouse to sign the request.
PROOF OF TERMINAL ILLNESS
We must receive written proof of the Insured's Terminal Illness before we make
an Accelerated Death Benefit payment. This proof will consist of a Physician's
certification acceptable to us. We may request additional medical information
from the Physician submitting the certification or any Physician we consider
qualified.
PHYSICAL EXAMINATION
While a claim is pending, we reserve the right to obtain a second medical
opinion and to have the Insured examined at our expense.
TIME OF PAYMENT OF CLAIMS
After we receive satisfactory written proof of Terminal Illness, we will pay the
Accelerated Death Benefit due.
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1-005 84-195 PAGE 2
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PAYMENT OF CLAIMS
If approved, the Accelerated Death Benefit will be paid in a lump sum to the
Owner. If the Insured dies before payment is made, we will pay the entire death
benefit of the policy to the Beneficiary in accordance with the policy
provisions.
LEGAL ACTIONS
No legal action may be brought to recover the payment requested under this
option within 60 days after written proof of Terminal Illness has been given to
us. No such action may be brought after 3 years from the time written proof of
the Insured's Terminal Illness has been given to us.
LIVING BENEFIT RIDER
If the policy contains a Living Benefit Rider and there is a simultaneous
request to exercise the Living Benefit and the Accelerated Death Benefit Option,
the Living Benefit request will be processed first; the Accelerated Death
Benefit Option request will be processed second and will be based on the
adjusted policy values resulting after payment of the Living Benefit.
TAX QUALIFICATION
Any amount payable under this option is intended to qualify for federal income
tax exclusion (to the maximum extent possible). To that end, the provisions of
this endorsement and the policy to which it is attached are to be interpreted to
ensure or maintain such tax qualification, notwithstanding any other provisions
to the contrary. The Company reserves the right to amend this endorsement and
the policy to which it is attached to reflect any clarifications that may be
needed or are appropriate to maintain such qualification, or to conform this
endorsement and the policy to which it is attached to any applicable changes in
the tax qualification requirements. You will be sent a copy of any such
amendment.
<PAGE>
Signed for the Company at Los Angeles, California, on the date of issue of the
policy unless a different date is shown here.
Executive Vice President, General Counsel President
And Corporate Secretary
1-005 84-195 PAGE 3
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ACCIDENT INDEMNITY RIDER
BENEFIT FOR DEATH BY ACCIDENT
<PAGE>
Transamerica Occidental Life Insurance Company has issued this rider as a part
of the policy to which it is attached.
If the Insured dies as a result of accidental bodily injury, we will pay the
accidental death benefit subject to all of the provisions of the policy and this
rider.
In this rider accidental bodily injury means injury which results, directly and
independently of all other causes, from an accident that occurs while this rider
is in force, and which results in the Insured's death within 90 days from the
date of the accident. We will have the right to examine the body of the Insured
and to request an autopsy, unless prohibited by law.
AMOUNT PAYABLE -- The amount of the accidental death benefit is shown in the
policy data. However, if an accidental death benefit becomes payable under this
rider for accidental bodily injury sustained in an accident which occurs while
the Insured is a fare-paying passenger in an aircraft, bus, train or other means
of public conveyance while it is being operated by a licensed common carrier for
passenger service, then the accidental death benefit will be twice the amount
shown for this rider in the policy data.
EXCLUSIONS FROM COVERAGE -- No amount will be payable under this rider if the
Insured's death results directly or indirectly from:
1. suicide or any attempted suicide, while sane or insane;
2. any poison or gas voluntarily or involuntarily, accidentally or
otherwise taken, administered, absorbed, or inhaled;
3. any bacterial infection except when caused by accidental bodily injury;
4. bodily or mental infirmity;
5. disease of any kind;
6. the commission of, or attempt to commit, an assault or felony;
7. service, travel or flight in any kind of aircraft except as a passenger;
8. participation in insurrection; or
9. war, declared or undeclared, or any act of war.
CONTESTABILITY -- This rider will be contestable as long as it is in force.
CONTINUATION -- If the policy, exclusive of riders, provides term insurance
which is converted, this rider will continue at the current premium as part of
the new policy. However, if this policy is converted to a limited payment plan,
this rider will continue at the premium charge used by us at the date of
conversion for the limited payment plan selected and the class of risk of this
rider.
AUTOMATIC TERMINATION -- This rider will automatically terminate:
1. if any premium for this rider remains unpaid after the end of the
grace period; or
2. a) when, in the case of flexible premium policies, the policy is
surrendered or continued under the
Paid-up Life Non-Forfeiture Option, or
b) when, in the case of fixed premium policies, the policy is
surrendered or continued under any
non-forfeiture option; or
3. when the policy terminates or matures; or
4. at policy anniversary nearest age 70 of the Insured.
CANCELLATION -- Upon written request by the owner of the policy, this rider may
be cancelled on any monthly anniversary.
NO DIVIDENDS ARE PAYABLE -- This rider does not participate in our profits or
surplus.
CONSIDERATION -- We have issued this rider in consideration of the application
and payment of the premiums. A copy of the application is attached to the
policy. In the case of flexible premium policies one-twelfth of the annual
premium for the rider will be deducted in the manner specified in the policy. In
the case of fixed premium policies, the annual premium for this rider is shown
in the policy data and is payable as provided by this policy. In either case, no
premium will be payable when this rider terminates.
<PAGE>
Signed for the Company at Los Angeles, California, on the date of issue of the
policy unless a different date is shown here.
Executive Vice President, General Counsel President
And Corporate Secretary
1-032 11-284
<PAGE>
AUTOMATIC PREMIUM LOAN ENDORSEMENT
(FOR POLICIES THAT HAVE A REQUIRED ANNUAL PREMIUM)
<PAGE>
TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY has issued this endorsement as a
part of the policy to which it is attached.
If any portion of the required annual premium remains unpaid at the end of the
grace period, we will make an automatic premium loan, subject to the following:
1. The policy must have enough net cash value to pay both the required annual
premium due and the interest due on the automatic premium loan. If the
policy does not have enough net cash value to pay both the required annual
premium due and the interest due on the automatic premium loan, the policy
will lapse (subject to the Nonforfeiture provision).
2. We will deduct the automatic premium loan and the interest due on it from
your investment options on a pro-rata basis. We will allocate the
automatic premium loan to your investment options according to the most
recent premium allocation election we have received from you. We will
transfer the automatic premium loan and the interest due on it to the loan
account.
The automatic premium loan and the interest due it will be effective on
the last day of the grace period if that day is a valuation date. If the
last day of the grace period is not a valuation date, the automatic
premium loan and the interest due on it will be effective on the next
valuation date.
3. The automatic premium loan will be subject to all sections of this policy
that pertain to policy loans.
This endorsement will terminate at the end of the required annual premium
period.
<PAGE>
Signed for Transamerica Occidental Life Insurance Company at Los Angeles,
California, and effective on the date of issue of the policy to which this
endorsement is attached.
Executive Vice President, General Counsel President
And Corporate Secretary
1-002 65-101
<PAGE>
TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY
EXTRA SURRENDER PENALTY FREE WITHDRAWAL ENDORSEMENT
<PAGE>
Transamerica Occidental Life Insurance Company has issued this endorsement as
part of the policy to which it is attached.
Wherever the term "Surrender Penalty Free Withdrawal" appears in the policy to
which this endorsement is attached, it is also meant to include the term "Extra
Surrender Penalty Free Withdrawal". There is only one exception; that is in the
section of the policy titled "Surrender Penalty Free Withdrawal", "(a)". That
calculation of the eligible amount for surrender without penalty will NOT
include "Extra Surrender Penalty Free Withdrawals".
DEFINITIONS
In this endorsement:
EXTRA WITHDRAWAL means Extra Surrender Penalty Free Withdrawal.
WE means Transamerica Occidental Life Insurance Company.
WITHDRAWAL means Surrender Penalty Free Withdrawal.
YOU means the Owner.
This Extra Withdrawal may be taken in addition to the Withdrawal in the policy
to which this endorsement is attached. If requested at the same time, the Extra
Withdrawal will be processed first. Then, the Withdrawal will be processed based
on the remaining accumulation value.
At any time after the first policy year, you may make an Extra Withdrawal
without a partial surrender penalty; the limits are outlined below.
Your Extra Withdrawals may only be taken if we receive written proof that the
Insured requires medical care for one of these conditions: heart attack; stroke;
cancer (malignant tumor); renal failure; or major organ transplant. This proof
will consist of a doctor's certification acceptable to us. We may request
additional medical information from the doctor submitting the certification or
any doctor we deem qualified. While a request is pending, we reserve the right
to obtain a second medical opinion; we also reserve the right to have the
Insured examined at our expense.
The minimum amount of an Extra Withdrawal is $100.
When you request an Extra Withdrawal, we will calculate the maximum amount
eligible for surrender without a Company imposed penalty, as follows:
1) 10% of the policy's current accumulation value as of the request
date;
less 2) the sum of all Extra Withdrawals since the last policy anniversary.
The total amount available from all Withdrawals, Extra Withdrawals and partial
surrenders shall not exceed:
1) the current accumulation value as of the request date;
less 2) any existing policy loans;
less 3) the sum of three monthly deductions;
less 4) the greater of $25 or the full surrender penalty.
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1-005 11-196 PAGE 1
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During any required premium period, the total amount available from all
Withdrawals, Extra Withdrawals and partial surrenders also may not exceed:
1) the sum of all gross premiums paid;
less 2) the sum of all required premiums since the policy date.
(See # 2 of the Premiums provision in the policy.)
We will process an Extra Withdrawal for the eligible amount. The remainder, if
any, of the amount you request will be processed first as a Withdrawal; any
excess over that amount will be processed as a partial surrender.
We will deduct the amount withdrawn from the policy's accumulation value.
<PAGE>
Signed for Transamerica Occidental Life Insurance Company at Los Angeles,
California on the date of issue of this policy.
Executive Vice President, General Counsel President
And Corporate Secretary
1-005 11-196 PAGE 2
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GUARANTEED INSURABILITY RIDER
<PAGE>
Transamerica Occidental Life Insurance Company has issued this rider as a part
of the policy to which it is attached.
Upon written application, we will issue additional insurance on the Insured on
each option date, subject to the provisions of this rider. The maximum amount of
additional insurance that we will issue on each option date is the "Maximum
Amount Per Option" shown for this rider in the policy data.
OPTION DATES -- The policy anniversary nearest the date the Insured attains each
age of 25, 28, 31, 34, 37, and 40 after the rider date of this rider will be a
regular option date. The maximum number of such option dates will be the number
of such anniversaries remaining at the date of this rider.
Alternate option dates will be:
1. The date the Insured is granted a baccalaureate or higher degree from a
college or university fully accredited by the accrediting committee of the
Regional Association for Schools and Colleges in which such college or
university is located.
2. The date of marriage of the Insured
3. The date of birth of a child of the Insured.
4. The date of the final order of adoption of a child by the Insured.
If additional insurance is issued on an alternate option date, then such
alternate option date will replace one of the regular option dates so that the
number of option dates on which additional insurance is available does not
exceed the maximum number of option dates. Only one alternate option date is
granted with respect to multiple births or adoptions at the same time.
DEFERMENT OF THE OPTION DATES -- If any option date occurs while the Insured is
on active duty in the military, naval or air forces of any country,
international organization or combination of countries or in any civilian
non-combatant unit serving with such forces, such option date will be deferred
to any date selected by the owner within one year after termination of active
duty. A deferred option, however, will not be available beyond the policy
anniversary nearest the Insured's age 40, or after this rider has terminated.
APPLICATION FOR ADDITIONAL INSURANCE -- The Insured must be living when the
written application for the additional insurance is made by the owner of this
policy. The application must be submitted and the initial minimum premium paid
to us within 31 days, before or after, a regular option date, or within 3 months
after an alternate option date. Any additional insurance will become effective
on the option date only if the Insured is then living and only if all conditions
of this rider are met.
The additional insurance applied for may be any plan of level premium, level
face amount whole life or endowment insurance offered by us at the option date
subject to the minimum face amount allowed by us for the plan selected. At least
one plan will be available for issue of the maximum amount per option shown in
the policy data. Any amount not purchased on an option date cannot be used to
increase the amount available on a subsequent option date.
The new policy will not include an option for additional insurance.
WAIVER OF PREMIUM -- If this policy includes a waiver of premium benefit or a
waiver provision rider and if the premium rate for the new policy is not greater
than that for our non-participating whole life plan with premiums payable to at
least age 95, a similar waiver benefit may be included in the new policy. The
premium for such benefit will be at our published rate for the plan selected. We
will use the Insured's age on the date the additional insurance is issued to
determine this rate. The waiver benefit will be issued at the class of risk of
this policy.
<PAGE>
1-071 11-186 PAGE 1
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PREMIUM RATES -- The premium for the new policy will be at our published rate at
the time the additional insurance is issued. We will use the Insured's age on
the date the new policy is issued to determine this rate. The new policy will be
issued at the class of risk of this policy.
AUTOMATIC TERMINATION -- This rider will automatically terminate:
1. if any premium remains unpaid after the end of the grace period, unless
premiums are being paid under an automatic premium payment provision or the
automatic loan provision; or
2. a) when, in the case of flexible premium policies, the policy is surrendered
or continued under the Paid-up Life Non-Forfeiture Option (if applicable), or
b) when, in the case of fixed premium policies, the policy is surrendered or
continued under any non-forfeiture option; or
3. if the policy matures or terminates; or
4. on policy anniversary nearest age 40 of the Insured, or when the maximum
number of options have been exercised, whichever is sooner.
INCONTESTABILITY -- In applying the Incontestability provision of the policy to
this rider, the "date of issue" will be the date this rider is signed by us.
CONTINUATION -- This rider may be continued on a new policy other than the one
issued under this rider subject to the following rules: 1. The "maximum amount
per option" must be less than or equal to the amount for this rider. 2. No
additional option dates will become available because of the change in
insurance. 3. The rates will be determined according to the original issue age
for this policy.
CANCELLATION -- Upon written request by the owner of the policy, this rider may
be cancelled on any premium due date.
NO DIVIDENDS ARE PAYABLE -- This rider does not participate in our profits or
surplus.
CONSIDERATION -- We have issued this rider in consideration of the application
and payment of the premiums. A copy of the application is attached to the
policy. In the case of flexible premium policies one-twelfth of the annual
premium for the rider will be paid in the manner specified in the policy. In the
case of fixed premium policies, the annual premium for this rider is shown in
the policy data and is payable as provided by this policy. In either case, no
premium for this rider will be payable after this rider terminates.
RIDER DATE -- The rider date of this rider will be the policy date of the policy
unless a different rider date is shown here.
<PAGE>
Signed for the Company at Los Angeles, California, and effective on the date the
policy is issued unless a different effective date is shown here.
Executive Vice President, General Counsel President and CEO
And Corporate Secretary
1-071 11-186 PAGE 2
<PAGE>
OPTION FOR ADDITIONAL INSURANCE
ENDORSEMENT
<PAGE>
Transamerica Occidental Life Insurance Company has issued this endorsement as a
part of the policy to which it is attached ("the policy"). There is no premium
payable for this endorsement.
At the request of the Owner to exercise an option under this endorsement, we
will issue additional insurance if all the following conditions are met:
1. The option date must be the 1st, 2nd and/or 3rd policy anniversary.
2. The Owner must make a written request to exercise this option within 31 days
before or after the chosen option date.
3. On the chosen option date, the policy must be in force and the Insured must
then be living.
4. The Minimum Initial Premium for the additional insurance must be paid.
5. If the monthly deductions for the policy are being waived under a
disability benefit on an option date, this option will not be available.
6. The maximum amount of insurance available under this endorsement will be the
lesser of:
a. The original face amount; or
b. $100,000
7. Exercising an option under this endorsement is available only on policies
with issue ages 0 to 50.
General Provisions
1. The new policy will be dated and effective on the chosen option date.
2. Subject to 4. Below, any part of the maximum amount of insurance under this
endorsement will be available for issue on any of the option dates, but the
total amount issued on all such dates may not exceed the maximum amount
under this endorsement.
3. We will issue to the Owner a new policy of the same type as the policy for
the additional insurance amount. The monthly deduction for the new policy
shall be at our then-current rate for such insurance at the time this
option is exercised. The new policy shall be issued at the class of risk of
the policy at the Insured's attained age.
4. The face amount of the new policy may not be less than our published minimum
for the insurance. The new policy shall not contain this endorsement.
5. The incontestability period in the new policy shall continue from the date
of issue of the policy and will not start anew. This means that the new
policy will be contestable for one year if this option is exercised on the
first policy anniversary, but will not be contestable if this option is
exercised on the 2nd and/or 3rd policy anniversary. The suicide period in
the new policy, however, will start anew on the chosen option date.
6. Unless the Owner requests that it not be included, any waiver provision
rider on the policy will also be included on the new policy. Any other
riders on the policy will not automatically be on the new policy, but they
will be added to the new policy provided the Insured gives us satisfactory
evidence of insurability.
<PAGE>
Signed for the Company at Los Angeles, California, on the date of issue of this
policy.
Executive Vice President, General Counsel President
And Corporate Secretary
1-006 47-191
<PAGE>
Request to exercise the Option for Additional Insurance:
I wish to exercise the Option for Additional Insurance for Policy No. .
I understand that the additional insurance will begin when the Minimum Initial
Premium is paid. Please send the necessary application to:
Name
Street
City State Zip
Owner's Signature Date
Mail to Transamerica Occidental Life Insurance Company, Box 512101 Terminal
Annex, Los Angeles, California 90051-9986, or to the agent from whom you
purchased your insurance.
1-006 47-191
<PAGE>
TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY
OPTION FOR ADDITIONAL INSURANCE
ENDORSEMENT
<PAGE>
Transamerica Occidental Life Insurance Company has issued this endorsement as a
part of the policy to which it is attached ("the policy"). There is no premium
payable for this endorsement.
At the request of the Owner to exercise an option under this endorsement, we
will issue additional insurance if all the following conditions are met:
1. The option date must be the 1st, 2nd and/or 3rd policy anniversary.
2. The Owner must make a written request to exercise this option within 31 days
before or after the chosen option date.
3. If this option is exercised, we will forward an application and
authorization. The Insured must sign the authorization and provide answers,
satisfactory to us, to the following questions:
a) Is the Insured now so disabled by sickness or injury as to be unable to
perform any of the duties of his/her normal job?
b) Within the past five years, has the Insured had high blood pressure,
heart disease, diabetes, or cancer?
4. On the chosen option date, the policy must be in force and the Insured must
then be living.
5. The Minimum Initial Premium for the additional insurance must be paid.
6. If the monthly deductions for the policy are being waived under a
disability benefit on an option date, this option will not be available.
7. The maximum amount of insurance available under this endorsement will be the
lesser of:
a. The original face amount; or
b. $100,000
General Provisions
1. The new policy will be dated and effective on the chosen option date.
2. Subject to 4. below, any part of the maximum amount of insurance under this
endorsement will be available for issue on any of the option dates, but the
total amount issued on all such dates may not exceed the maximum amount
under this endorsement.
3. We will issue to the Owner a new policy of the same type as the policy for
the additional insurance amount. The monthly deduction for the new policy
shall be at our then-current rate for such insurance at the time this
option is exercised. The new policy shall be issued at the class of risk of
the policy at the Insured's attained age.
4. The face amount of the new policy may not be less than our published minimum
for the insurance. The new policy shall not contain this endorsement.
5. The incontestability and suicide periods in the new policy will start anew on
the chosen option date.
6. Unless the Owner requests that it not be included, any waiver provision
rider on the policy will also be included on the new policy, provided the
Insured is not over 55 when this option is exercised. Any other riders on
the policy will not automatically be on the new policy, but they will be
added to the new policy provided the Insured gives us satisfactory evidence
of insurability.
<PAGE>
Signed for Transamerica Occidental Life Insurance Company at Los Angeles,
California, and effective on the date of issue of the policy to which this
endorsement is attached unless a different date is shown here.
Executive Vice President, General Counsel President
And Corporate Secretary
1-006 11-100
Request to exercise the Option for Additional Insurance:
I, the Owner, wish to exercise the Option for Additional Insurance for Policy
No. I understand that the additional insurance will be effective the later of
the specified policy anniversary or when the Minimum Initial Premium is paid.
Please send the necessary application to:
Name
Street
City State Zip
Owner's Signature Date
Mail to Transamerica Occidental Life Insurance Company, Box 512101 Terminal
Annex, Los Angeles, California 90051-9986, or to the agent from whom you
purchased your insurance.
1-006 11-100
