<PAGE> 1
EXHIBIT 99.1(5)(b)
ReliaStar Life of New York
1000 Woodbury Road, Suite 102
Woodbury, NY 11797
--------------------------------------------------------------------------------
A Life Insurance Illustration using
SELECT*LIFE NY II
A Variable Universal Life Insurance Policy
(Standard Form #86-025)
ReliaStar Life Insurance Company of New York
Designed for:
James Doe
Prepared by:
Reliastar Agent
[RELIASTAR LOGO]
--------------------------------------------------------------------------------
BA-4-V 12/08/2000 11:55 AM
Page 1 of 11
<PAGE> 2
ReliaStar Life of New York
SELECT*LIFE NY II 1000 Woodbury Road, Suite 102
A Variable Universal Life Insurance Policy Woodbury, NY 11797
________________________________________________________________________________
POLICY ILLUSTRATION
Variable Account
The purpose of this illustration is to show how the performance of the
underlying sub-accounts could affect the policy cash value and death benefit
assuming the current policy costs continue. This illustration is hypothetical
and may not be used to project or predict investment results.
Premiums are paid at the beginning of the year. The cash value and death
benefit are shown as of the end of each policy year.
Prepared for:
James Doe
Male 40 Preferred No Tobacco
Initial Total Face Amount: $100,000
Initial Death Benefit Option: A (Level)
Annual Premium: $1,462.00
<TABLE>
<CAPTION>
------------------------------CURRENT POLICY COSTS-------------------------
0.00% Gross Hypothetical Return 10.00% Gross Hypothetical Return
(-1.19% Net Return) (8.81% Net Return)
---------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
End Accum- Cash Accum- Cash
End of Yr Premium ulation Surrender Death ulation Surrender Death
of Yr Age Outlay Value Value Benefit Value Value Benefit
----- ----- ------- ------- --------- ------- ------- --------- -------
1 41 1,462 938 235 100,000 1,053 350 100,000
2 42 1,462 1,853 1,229 100,000 2,187 1,562 100,000
3 43 1,462 2,746 2,200 100,000 3,408 2,861 100,000
4 44 1,462 3,620 3,152 100,000 4,727 4,259 100,000
5 45 1,462 4,476 4,086 100,000 6,155 5,765 100,000
------
7,310
6 46 1,462 5,315 5,003 100,000 7,702 7,389 100,000
7 47 1,462 6,137 5,902 100,000 9,377 9,142 100,000
8 48 1,462 6,940 6,784 100,000 11,191 11,035 100,000
9 49 1,462 7,724 7,645 100,000 13,156 13,078 100,000
10 50 1,462 8,486 8,486 100,000 15,283 15,283 100,000
------
14,620
11 51 1,462 9,556 9,556 100,000 17,934 17,934 100,000
12 52 1,462 10,595 10,595 100,000 20,803 20,803 100,000
13 53 1,462 11,602 11,602 100,000 23,909 23,909 100,000
14 54 1,462 12,576 12,576 100,000 27,273 27,273 100,000
15 55 1,462 13,519 13,519 100,000 30,922 30,922 100,000
------
21,930
16 56 1,462 14,431 14,431 100,000 34,883 34,883 100,000
17 57 1,462 15,311 15,311 100,000 39,184 39,184 100,000
18 58 1,462 16,157 16,157 100,000 43,858 43,858 100,000
19 59 1,462 16,969 16,969 100,000 48,940 48,940 100,000
20 60 1,462 17,744 17,744 100,000 54,470 54,470 100,000
------
29,240
</TABLE>
________________________________________________________________________________
This illustration is not complete without all pages.
$100,000 Sel*Life NY II for James Doe Presented by: Reliastar Agent
Version M3 2.6.4 12/08/2000 11:55 AM
State of Issue: New York Page 2 of 11
<PAGE> 3
ReliaStar Life of New York
SELECT*LIFE NY II 1000 Woodbury Road, Suite 102
A Variable Universal Life Insurance Policy Woodbury, NY 11797
________________________________________________________________________________
<TABLE>
<CAPTION>
------------------------------CURRENT POLICY COSTS-------------------------
0.00% Gross Hypothetical Return 10.00% Gross Hypothetical Return
(-1.19% Net Return) (8.81% Net Return)
---------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
End Accum- Cash Accum- Cash
End of Yr Premium ulation Surrender Death ulation Surrender Death
of Yr Age Outlay Value Value Benefit Value Value Benefit
----- ----- ------- ------- --------- ------- ------- --------- -------
21 61 1,462 18,476 18,476 100,000 60,489 60,489 100,000
22 62 1,462 19,164 19,164 100,000 67,046 67,046 100,000
23 63 1,462 19,806 19,806 100,000 74,199 74,199 100,000
24 64 1,462 20,398 20,398 100,000 82,008 82,008 101,690
25 65 1,462 20,938 20,938 100,000 90,506 90,506 110,418
------
36,550
26 66 1,462 21,417 21,417 100,000 99,735 99,735 119,683
27 67 1,462 21,847 21,847 100,000 109,756 109,756 130,610
28 68 1,462 22,228 22,228 100,000 120,636 120,636 142,351
29 69 1,462 22,552 22,552 100,000 132,448 132,448 154,965
30 70 1,462 22,812 22,812 100,000 145,272 145,272 168,516
------
43,860
31 71 1,462 23,009 23,009 100,000 159,196 159,196 183,076
32 72 1,462 23,130 23,130 100,000 174,333 174,333 196,997
33 73 1,462 23,164 23,164 100,000 190,797 190,797 211,785
34 74 1,462 23,114 23,114 100,000 208,715 208,715 227,499
35 75 1,462 22,964 22,964 100,000 228,226 228,226 244,202
------
51,170
36 76 1,462 22,672 22,672 100,000 249,484 249,484 261,958
37 77 1,462 22,206 22,206 100,000 272,560 272,560 286,189
38 78 1,462 21,547 21,547 100,000 297,605 297,605 312,486
39 79 1,462 20,646 20,646 100,000 324,775 324,775 341,015
40 80 1,462 19,491 19,491 100,000 354,246 354,246 371,958
------
58,480
41 81 1,462 18,056 18,056 100,000 386,203 386,203 405,514
42 82 1,462 16,288 16,288 100,000 420,843 420,843 441,886
43 83 1,462 14,131 14,131 100,000 458,375 458,375 481,295
44 84 1,462 11,523 11,523 100,000 499,025 499,025 523,977
45 85 1,462 8,362 8,362 100,000 543,023 543,023 570,174
------
65,790
46 86 1,462 4,474 4,474 100,000 590,598 590,598 620,129
*47 87 1,462 0 0 0 641,994 641,994 674,094
48 88 1,462 0 0 0 697,449 697,449 732,322
49 89 1,462 0 0 0 757,213 757,213 795,075
50 90 1,462 0 0 0 821,544 821,544 862,622
------
73,100
</TABLE>
________________________________________________________________________________
This illustration is not complete without all pages.
$100,000 Sel*Life NY II for James Doe Presented by: Reliastar Agent
Version M3 2.6.4 12/08/2000 11:55 AM
State of Issue: New York Page 3 of 11
<PAGE> 4
ReliaStar Life of New York
SELECT*LIFE NY II 1000 Woodbury Road, Suite 102
A Variable Universal Life Insurance Policy Woodbury, NY 11797
________________________________________________________________________________
<TABLE>
<CAPTION>
------------------------------CURRENT POLICY COSTS-------------------------
0.00% Gross Hypothetical Return 10.00% Gross Hypothetical Return
(-1.19% Net Return) (8.81% Net Return)
---------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
End Accum- Cash Accum- Cash
End of Yr Premium ulation Surrender Death ulation Surrender Death
of Yr Age Outlay Value Value Benefit Value Value Benefit
----- ----- ------- ------- --------- ------- --------- --------- ---------
51 91 1,462 0 0 0 890,693 890,693 935,228
52 92 1,462 0 0 0 966,094 966,094 1,004,738
53 93 1,462 0 0 0 1,048,668 1,048,668 1,080,129
54 94 1,462 0 0 0 1,139,453 1,139,453 1,162,242
55 95 1,462 0 0 0 1,239,687 1,239,687 1,252,084
------
80,410
56 96 1,462 0 0 0 1,349,889 1,349,889 1,349,890
57 97 1,462 0 0 0 1,469,761 1,469,761 1,469,761
58 98 1,462 0 0 0 1,600,149 1,600,149 1,600,150
59 99 1,462 0 0 0 1,741,979 1,741,979 1,741,979
60 100 1,462 0 0 0 1,896,252 1,896,252 1,896,252
------
87,720
</TABLE>
*Year 47, Month 11
Based on the current costs and 0% hypothetical rate of return illustrated, the
policy would lapse and cannot be illustrated. Additional premiums would be
required to continue the coverage.
________________________________________________________________________________
This illustration is not complete without all pages.
$100,000 Sel*Life NY II for James Doe Presented by: Reliastar Agent
Version M3 2.6.4 12/08/2000 11:55 AM
State of Issue: New York Page 4 of 11
<PAGE> 5
ReliaStar Life of New York
SELECT*LIFE NY II 1000 Woodbury Road, Suite 102
A Variable Universal Life Insurance Policy Woodbury, NY 11797
________________________________________________________________________________
POLICY ILLUSTRATION
Variable Account
The purpose of this illustration is to show how the performance of the
underlying sub-accounts could affect the policy cash value and death benefit
assuming the maximum policy costs were charged. This illustration is
hypothetical and may not be used to project or predict investment results.
Premiums are paid at the beginning of the year. The cash value and death
benefit are shown as of the end of each policy year.
Prepared for:
James Doe
Male 40 Preferred No Tobacco
Initial Total Face Amount: $100,000
Initial Death Benefit Option: A (Level)
Annual Premium: $1,462.00
<TABLE>
<CAPTION>
-------------------------MAXIMUM GUARANTEED POLICY COSTS------------------
0.00% Gross Hypothetical Return 10.00% Gross Hypothetical Return
(-1.39% Net Return) (8.61% Net Return)
--------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
End Accum- Cash Accum- Cash
End of Yr Premium ulation Surrender Death ulation Surrender Death
of Yr Age Outlay Value Value Benefit Value Value Benefit
----- ----- ------- ------- --------- ------- ------- --------- -------
1 41 1,462 692 0 100,000 793 90 100,000
2 42 1,462 1,358 734 100,000 1,638 1,013 100,000
3 43 1,462 2,000 1,453 100,000 2,538 1,992 100,000
4 44 1,462 2,614 2,145 100,000 3,498 3,029 100,000
5 45 1,462 3,201 2,810 100,000 4,521 4,131 100,000
------
7,310
6 46 1,462 3,758 3,446 100,000 5,611 5,298 100,000
7 47 1,462 4,284 4,049 100,000 6,771 6,537 100,000
8 48 1,462 4,777 4,620 100,000 8,008 7,852 100,000
9 49 1,462 5,236 5,157 100,000 9,236 9,248 100,000
10 50 1,462 5,657 5,657 100,000 10,731 10,731 100,000
------
14,620
11 51 1,462 6,376 6,376 100,000 12,582 12,582 100,000
12 52 1,462 7,048 7,048 100,000 14,562 14,562 100,000
13 53 1,462 7,667 7,667 100,000 16,678 16,678 100,000
14 54 1,462 8,230 8,230 100,000 18,940 18,940 100,000
15 55 1,462 8,729 8,729 100,000 21,357 21,357 100,000
------
21,930
16 56 1,462 9,158 8,158 100,000 23,940 23,940 100,000
17 57 1,462 9,512 9,512 100,000 26,703 26,703 100,000
18 58 1,462 9,787 9,787 100,000 29,665 29,665 100,000
19 59 1,462 9,978 9,978 100,000 32,843 32,843 100,000
20 60 1,462 10,074 10,074 100,000 36,258 36,258 100,000
------
29,240
</TABLE>
________________________________________________________________________________
This illustration is not complete without all pages.
$100,000 Sel*Life NY II for James Doe Presented by: Reliastar Agent
Version M3 2.6.4 12/08/2000 11:55 AM
State of Issue: New York Page 5 of 11
<PAGE> 6
ReliaStar Life of New York
SELECT*LIFE NY II 1000 Woodbury Road, Suite 102
A Variable Universal Life Insurance Policy Woodbury, NY 11797
________________________________________________________________________________
<TABLE>
<CAPTION>
------------------------MAXIMUM GUARANTEED POLICY COSTS-------------------
0.00% Gross Hypothetical Return 10.00% Gross Hypothetical Return
(-1.39% Net Return) (8.61% Net Return)
---------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
End Accum- Cash Accum- Cash
End of Yr Premium ulation Surrender Death ulation Surrender Death
of Yr Age Outlay Value Value Benefit Value Value Benefit
----- ----- ------- ------- --------- ------- --------- --------- ---------
21 61 1,462 10,065 10,065 100,000 39,933 39,933 100,000
22 62 1,462 9,939 9,939 100,000 43,894 43,894 100,000
23 63 1,462 9,680 9,680 100,000 48,171 48,171 100,000
24 64 1,462 9,267 9,267 100,000 52,798 52,798 100,000
25 65 1,462 8,679 8,679 100,000 57,819 57,819 100,000
------
36,550
26 66 1,462 7,892 7,892 100,000 63,288 63,288 100,000
27 67 1,462 6,887 6,887 100,000 69,272 69,272 100,000
28 68 1,462 5,639 5,639 100,000 75,852 75,852 100,000
29 69 1,462 4,121 4,121 100,000 83,128 83,128 100,000
30 70 1,462 2,294 2,294 100,000 91,159 91,159 105,745
------
43,860
31 71 1,462 106 106 100,000 99,829 99,829 114,804
*32 72 1,462 0 0 100,000 109,208 109,208 123,406
33 73 1,462 0 0 0 119,387 119,387 132,520
34 74 1,462 0 0 0 130,441 130,441 142,181
35 75 1,462 0 0 0 142,476 142,476 152,449
------
51,170
36 76 1,462 0 0 0 155,618 155,618 163,399
37 77 1,462 0 0 0 169,793 169,793 178,283
38 78 1,462 0 0 0 185,075 185,075 194,329
39 79 1,462 0 0 0 201,540 201,540 211,618
40 80 1,462 0 0 0 219,269 219,269 230,233
------
58,480
41 81 1,462 0 0 0 238,342 238,342 250,260
42 82 1,462 0 0 0 258,840 258,840 271,782
43 83 1,462 0 0 0 280,839 280,839 294,881
44 84 1,462 0 0 0 304,414 304,414 319,635
45 85 1,462 0 0 0 329,642 329,642 346,125
------
65,790
46 86 1,462 0 0 0 356,601 356,601 374,432
47 87 1,462 0 0 0 385,373 385,373 404,642
48 88 1,462 0 0 0 416,039 416,039 436,841
49 89 1,462 0 0 0 448,687 448,687 471,121
50 90 1,462 0 0 0 483,399 483,399 507,569
------
73,100
</TABLE>
________________________________________________________________________________
This illustration is not complete without all pages.
$100,000 Sel*Life NY II for James Doe Presented by: Reliastar Agent
Version M3 2.6.4 12/08/2000 11:55 AM
State of Issue: New York Page 6 of 11
<PAGE> 7
ReliaStar Life of New York
SELECT*LIFE NY II 1000 Woodbury Road, Suite 102
A Variable Universal Life Insurance Policy Woodbury, NY 11797
________________________________________________________________________________
<TABLE>
<CAPTION>
------------------------MAXIMUM GUARANTEED POLICY COSTS-------------------
0.00% Gross Hypothetical Return 10.00% Gross Hypothetical Return
(-1.39% Net Return) (8.61% Net Return)
---------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
End Accum- Cash Accum- Cash
End of Yr Premium ulation Surrender Death ulation Surrender Death
of Yr Age Outlay Value Value Benefit Value Value Benefit
----- ----- ------- ------- --------- ------- --------- --------- ---------
51 91 1,462 0 0 0 520,249 520,249 546,262
52 92 1,462 0 0 0 560,780 560,780 583,212
53 93 1,462 0 0 0 605,625 605,625 623,795
54 94 1,462 0 0 0 655,566 655,566 668,677
55 95 1,462 0 0 0 771,588 711,588 718,705
------
80,410
56 96 1,462 0 0 0 773,857 773,857 773,858
57 97 1,462 0 0 0 841,454 841,454 841,454
58 98 1,462 0 0 0 914,834 914,834 914,835
59 99 1,462 0 0 0 994,494 994,494 994,494
60 100 1,462 0 0 0 1,080,969 1,080,969 1,080,970
------
87,720
</TABLE>
*Year 32, Month 7
Based on the maximum guaranteed costs and 0% hypothetical rate of return
illustrated, the policy would lapse and cannot be illustrated. Additional
premiums would be required to continue the coverage.
________________________________________________________________________________
This illustration is not complete without all pages.
$100,000 Sel*Life NY II for James Doe Presented by: Reliastar Agent
Version M3 2.6.4 12/08/2000 11:55 AM
State of Issue: New York Page 7 of 11
<PAGE> 8
ReliaStar Life of New York
SELECT*LIFE NY II 1000 Woodbury Road, Suite 102
A Variable Universal Life Insurance Policy Woodbury, NY 11797
--------------------------------------------------------------------------------
VALUABLE INFORMATION ABOUT YOUR ILLUSTRATION
This is an illustration, not a contract, and must be preceded or accompanied by
a current Prospectus.
This illustration does not recognize that, because of inflation, a dollar in
the future has less value than a dollar today.
The values illustrated comply with the Internal Revenue Code definition of life
insurance.
GROSS HYPOTHETICAL RETURNS. The gross hypothetical returns shown are
illustrative only and should not be deemed a representation of past or future
rates of return. No representation may be made by your agent or ReliaStar Life
Insurance Company of New York that these hypothetical rates of return can be
achieved or sustained over any period of time. The death benefits and cash
surrender values for a policy may be different from those shown, even if the
actual rates of return averaged the hypothetical rate of return illustrated over
a period of years but fluctuated above or below that average at any time during
the period.
NET ANNUAL RETURN. The net rate illustrated reflects a reduction from the gross
rate to cover ReliaStar Life Insurance Company of New York's variable
accumulation value charge and portfolio operating expenses. The variable
accumulation value charge on an annual basis is equal to 0.40% of the Variable
Account assets for current costs and 0.60% for the maximum guaranteed costs. An
average portfolio operating expense of 0.79% is deducted from the gross return.
The actual portfolio expense deducted would vary based on the premium allocation
specified.
SUB-ACCOUNT ALLOCATION. This illustration assumes that the net premiums (after
expense deductions) have been allocated to the Variable Account. Select*Life NY
II offers the policy owner the opportunity to select those sub-accounts that
most clearly reflect their own tolerance for risk. Sub-accounts and their
allocations are selected initially and can be changed or transferred between the
sub-accounts of the policy without creating a taxable event. Currently, there is
no charge on the first 24 transfers in a policy year, but there is a charge of
$25.00 for each subsequent transfer. We reserve the right to limit transfers to
twelve per policy year and charge $25.00 for transfers in excess of twelve per
policy year.
FIXED ACCOUNT. A portion of premiums and accumulation values may also be
allocated to the Fixed Account. The Fixed Account is an interest paying account
that offers a guarantee of both principal and interest at a minimum annual rate
of 4% on amounts credited to the account. ReliaStar Life Insurance Company of
New York has complete ownership and control of all of the assets of the Fixed
Account. For current interest crediting rates on the Fixed Account, ask your
Registered Representative.
MINIMUM MONTHLY PREMIUM. A basic minimum monthly premium of $65.00 is required
to issue the policy and to maintain the base policy Basic Death Benefit
Guarantee. This basic minimum premium will change if increases or decreases are
made in any of the policy benefits.
DEATH BENEFIT GUARANTEE. The basic death benefit guarantee is in effect for 5
policy years provided basic minimum premiums (net of policy loans and
withdrawals) are paid. The basic death benefit guarantee prevents the policy
from lapsing even if the cash surrender value is not sufficient to cover the
monthly deduction due. The basic death benefit guarantee, while in effect,
provides for payment of the policy death benefit regardless of sub-account
performance. An Extended Death Benefit Guarantee for 33 policy years is in
effect provided the Extended Death Benefit minimum monthly premiums (net of
policy loans and withdrawals) are paid. The Extended Death Benefit minimum
monthly premium is $121.83. Please see the Prospectus for a full explanation of
this provision.
DEDUCTIONS AND CHARGES. A premium expense charge is deducted from each premium
paid. The accumulation value of the policy is subject to several charges: a
monthly amount charge, a monthly administration charge, a variable accumulation
value charge, and the cost of insurance for the base policy and any riders.
Surrender charges are applicable for the first 10 years and the first 10 years
following any requested increase in the face amount.
--------------------------------------------------------------------------------
This illustration is not complete without all pages.
$100,000 Sel*Life NY II for James Doe Presented by: Reliastar Agent
Version M3 2.6.4 12/08/2000 11:55 AM
State of Issue: New York Page 8 of 11
<PAGE> 9
ReliaStar Life of New York
SELECT*LIFE NY II 100 Woodbury Road, Suite 102
A Variable Universal Life Insurance Policy Woodbury, NY 11797
--------------------------------------------------------------------------------
TAXATION. Tax laws are complex and change frequently. Changes in premium
payments from those illustrated or other changes made to the illustrated policy
after issue may result in classification as a Modified Endowment Contract
(MEC). Distributions from a Modified Endowment Contract, including loans, are
taxable as income in the year received to the extent that the accumulation
value of the policy prior to the distribution exceeds the total premiums paid.
In addition, distributions may be subject to an additional 10% income tax
penalty if taken before age 59-1/2. For complete information on how
distributions from this policy may affect your personal tax situation, always
consult your professional tax advisor.
ISSUER. Select*Life NY II is a product of ReliaStar Life Insurance Company of
New York located at 1000 Woodbury Road, Suite 102, Woodbury, NY 11797. The
general distributor is Washington Square Securities, Inc., an affiliated
company, member NASD/SIPC, located at 20 Washington Avenue South, Minneapolis,
MN 55401 (612-372-5507). Form #86-025.
PREMIUM LIMITS SUMMARY.
<TABLE>
<S> <C>
Minimum First Year Annual Premium: $816.00
Initial Guideline Level Premium: $1,679.03
Initial Guideline Single Premium: $18,971.14
Initial MEC 7-pay Premium: $4,438.10
</TABLE>
--------------------------------------------------------------------------------
This illustration is not complete without all pages.
$100,000 Sel*Life NY II for James Doe Presented by: Reliastar Agent
Version M3 2.6.4 12/08/2000 11:55 AM
State of Issue: New York Page 9 of 11
<PAGE> 10
ReliaStar Life of New York
SELECT*LIFE NY II 1000 Woodbury Road, Suite 102
A Variable Universal Life Insurance Policy Woodbury, NY 11797
________________________________________________________________________________
ILLUSTRATION SUMMARY AND DISCLOSURE
Variable Account
This page summarizes information from the previous ledger pages and outlines
some important policy provisions. Review the information presented below. If
acceptable, sign, date, and return this illustration, along with the
application for insurance, to ReliaStar Life Insurance Company of New York.
Prepared for:
James Doe
Male 40 Preferred No Tobacco
Initial Total Face Amount: $100,000
Initial Death Benefit Options: A (Level)
Annual Premium: $1,462.00
This summary is based on the premium outlay in the policy illustration. The
cash value and death benefit are shown as of the end of the year.
<TABLE>
<CAPTION>
____________________________________________________________________________________________________________________
GUARANTEED COSTS CURRENT COSTS
0.00% Gross Annual Return 0.00% Gross Annual Return 12.00% Gross Annual Return
(-1.39% Net Return) (-1.19% Net Return) (8.81% Net Return)
____________________________________________________________________________________________________________________
<S> <C> <C> <C>
Year 10, Age 50
Cash Surrender Value: 10,371 8,986 15,283
Death Benefit: 100,000 100,000 100,000
Year 20, Age 60
Cash Surrender Value: 36,258 17,744 54,470
Death Benefit: 100,000 100,000 100,000
Projected age when
Death Benefit Ends: 71 82 95
____________________________________________________________________________________________________________________
</TABLE>
You may adjust your payment amounts, within limits, to extend or increase the
cash value and death benefit.
I understand that:
PURCHASE OF LIFE INSURANCE. I am buying a flexible premium cash value variable
life insurance policy issued by ReliaStar Life Insurance Company of New York.
RECEIPT OF PROSPECTUS. I received the current Prospectus describing the terms
and operation of the policy and the underlying sub-accounts. I'm keeping the
Prospectus for further reference. I understand the policy has some features
comparable to and others different from a traditional life insurance policy. I
realize this Disclosure Statement highlights some, but not all, of the
important aspects of the policy and that I should examine the Prospectus prior
to purchasing a policy.
INSURANCE PROTECTION. The policy provides insurance protection until age 100, if
the cash surrender value, as explained in the Prospectus, is sufficient to pay
the monthly charges. The policy remains in force during the death benefit
guarantee periods, without regard to the cash surrender value, if on each
monthly anniversary as described in the policy the total premiums paid, less any
partial withdrawals or policy loans, equals or exceeds the total required
premium payments specified in the policy.
SUB-ACCOUNT ALLOCATION. I may allocate a net premium (amount remaining after
expense deductions) among one or more sub-accounts, each of which invests in one
of the available portfolios. Each portfolio has a different investment
objective, as described in the current Prospectus. In allocating net premiums to
a sub-account, the investment performance of the underlying portfolios I select
will impact the policy accumulation value and may impact the death benefit.
Thus, the investment risk for those amounts is mine, and no minimum accumulation
value in any sub-account(s) is guaranteed. I may also allocate net premiums to a
Fixed Account, which the Company guarantees both as to principal and interest at
a minimum annual rate of 4.0%.
_______________________________________________________________________________
This illustration is not complete without all pages.
$100,000 Sel*Life NY II for James Doe Presented by: Reliastar Agent
Version M3 2.6.4 12/08/2000 11:55 AM
State of Issue: New York Page 10 of 11
<PAGE> 11
ReliaStar Life of New York
SELECT*LIFE NY II 1000 Woodbury Road, Suite 102
A Variable Universal Life Insurance Policy Woodbury, NY 11797
________________________________________________________________________________
SELECTED PORTFOLIO. The sub-accounts I select have varying portfolio operating
expenses. Changes to the selected sub-accounts and the allocation percentages
will have an impact on the policy cash values. This illustration assumes the
average portfolio expense for all underlying portfolios is deducted:
ILLUSTRATIONS. The illustrations in the Prospectus present hypothetical
investment results and those presented by the Company's representative will
utilize hypothetical and/or historical investment results. Neither hypothetical
nor historical investment returns are guaranteed. The values set forth are
illustrative only and are not intended to predict actual performance. They are
intended to help explain how the policy operates and are not deemed to represent
future investment results. Actual investment results may be more or less and
depend on a number of factors, as explained in the Prospectus.
CHARGES AND DEDUCTIONS. As described in the Prospectus, there are (a) charges
made against each premium payment and (b) monthly deductions against the
accumulation value. If I surrender the policy or allow it to lapse during the
first 10 years after issue or an increase, a surrender charge will be imposed.
LOANS AND WITHDRAWALS. Policy loans and partial cash withdrawals are available,
subject to certain limits and charges as explained in the Prospectus. If, at any
time, the amount of the policy loan exceeds the cash surrender value, the grace
period goes into effect and the Company may lapse the policy. Policy loans and
partial withdrawals may cause the death benefit guarantees to terminate.
TAX MATTERS. The Company does not provide legal or tax advice in reference to
this life insurance policy. I acknowledge that the section in the Prospectus
"Federal Tax Matters", is not intended to be a complete description of the tax
status of the policy.
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Applicant or Policy Owner Date
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Date of Prospectus Prospectus Form Number
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Reliastar Agent Date
________________________________________________________________________________
This illustration is not complete without all pages.
$100,000 Sel*Life NY II for James Doe Presented by: Reliastar Agent
Version M3 2.6.4 12/08/2000 11:55 AM
State of Issue: New York Page 11 of 11
