<PAGE>
HARTFORD LIFE INSURANCE COMPANY
Home Office Address:
P.O. BOX 2999:
HARTFORD, CONNECTICUT 06104-2999
(A stock insurance company)
ADMINISTRATIVE OFFICE ADDRESS:
NATIONAL SERVICE CENTER
P.O. BOX 59179
MINNEAPOLIS, MINNESOTA 55459
Will pay the Death Proceeds to the Beneficiary, upon receipt at Our National
Service Center in Minneapolis, Minnesota, of due proof of the Insured's death
while the Policy was in force.
Signed for the Company
LYNDA GODKIN THOMAS M. MARRA
Lynda Godkin, SECRETARY Thomas M. Marra, PRESIDENT
READ YOUR POLICY CAREFULLY
This is a legal contract between You and Us
RIGHT TO EXAMINE POLICY
WE WANT YOU TO BE SATISFIED WITH THE POLICY YOU HAVE PURCHASED. WE URGE YOU
TO EXAMINE IT CLOSELY. IF, FOR ANY REASON YOU ARE NOT SATISFIED, YOU MAY
DELIVER OR MAIL THE POLICY TO US OR TO THE AGENT FROM WHOM IT WAS PURCHASED
ANYTIME DURING YOUR FREE LOOK PERIOD. YOUR FREE LOOK PERIOD BEGINS ON THE
DAY YOU RECEIVE YOUR POLICY AND ENDS TEN DAYS AFTER YOU RECEIVE IT. IN SUCH
AN EVENT, THE POLICY WILL BE RESCINDED AND WE WILL PAY AN AMOUNT EQUAL TO THE
GREATER OF THE PREMIUMS PAID FOR THE POLICY LESS ANY INDEBTEDNESS OR THE SUM
OF: I) THE ACCOUNT VALUE LESS ANY INDEBTEDNESS, ON THE DATE THE RETURNED
POLICY IS RECEIVED BY US OR TO THE AGENT FROM WHOM IT WAS PURCHASED; AND, II)
ANY DEDUCTIONS UNDER THE POLICY OR CHARGES ASSOCIATED WITH THE SEPARATE
ACCOUNT.
CASH SURRENDER VALUE PAYABLE ON THE SCHEDULED MATURITY DATE,
UNLESS EXTENDED BY ELECTION OF OWNER
DEATH PROCEEDS PAYABLE AT DEATH OF INSURED AS DESCRIBED
IN THE DEATH BENEFIT SECTION
ADJUSTABLE DEATH BENEFIT
PREMIUMS PAYABLE AS SHOWN ON PAGE 3
NON-PARTICIPATING
THE PORTIONS OF THE ACCOUNT VALUES PROVIDED BY THIS CONTRACT THAT ARE IN THE
SUB-ACCOUNTS ARE BASED ON THE INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT.
THEY ARE VARIABLE AND MAY INCREASE OR DECREASE DEPENDING ON THE INVESTMENT
EXPERIENCE OF THE SEPARATE ACCOUNT. THE AMOUNT AND DURATION OF THE DEATH
BENEFIT MAY BE FIXED OR MAY INCREASE OR DECREASE DEPENDING ON THE INVESTMENT
EXPERIENCE OF THAT SEPARATE ACCOUNT. THE NO LAPSE GUARANTEE IS SUBJECT TO
THE CONDITIONS DESCRIBED ON PAGE 15.
FLEXIBLE PREMIUM
VARIABLE LIFE INSURANCE POLICY
[LOGO]
HL-15486(00)(NY) Printed in U.S.A.
<PAGE>
TABLE OF CONTENTS
Page
Policy Specifications 3
Definitions 5
Death Benefit 7
Increases and Decreases in Face Amount 8
Premiums 9
Valuation Provisions 10
Account Value, Cash Value
and Cash Surrender Value 11
Transfers 12
Monthly Deduction Amount 13
Lapse and Policy Grace Period 15
Reinstatement 16
Policy Loans 17
Withdrawals 18
Surrenders 18
Payments By Us 18
Taxation of The Separate Account 18
The Contract 19
Ownership and Beneficiary 21
Termination and Maturity Date 21
Income Settlement Options 22
Any Riders follow page 24
Page 2
HL-15486(00)(NY) Printed in U.S.A.
<PAGE>
HARTFORD LIFE INSURANCE COMPANY
HARTFORD, CONNECTICUT 06104-2999
(A STOCK INSURANCE COMPANY)
(THE "COMPANY")
NATIONAL SERVICE CENTER ADDRESS:
P.O. BOX 59179
MINNEAPOLIS, MINNESOTA 55459
CASH SURRENDER VALUE PAYABLE ON THE SCHEDULED MATURITY DATE,
UNLESS EXTENDED BY ELECTION OF OWNER
DEATH PROCEEDS PAYABLE AT DEATH OF INSURED AS DESCRIBED
IN THE DEATH BENEFIT SECTION
ADJUSTABLE DEATH BENEFIT
PREMIUMS PAYABLE AS SHOWN ON PAGE 3
NON-PARTICIPATING
THE PORTIONS OF THE ACCOUNT VALUES PROVIDED BY THIS CONTRACT THAT ARE IN THE
SUB-ACCOUNTS ARE BASED ON THE INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT.
THEY ARE VARIABLE AND MAY INCREASE OR DECREASE DEPENDING ON THE INVESTMENT
EXPERIENCE OF THAT SEPARATE ACCOUNT. THE AMOUNT AND DURATION OF THE DEATH
BENEFIT MAY BE FIXED OR MAY INCREASE OR DECREASE DEPENDING ON THE INVESTMENT
EXPERIENCE OF THAT SEPARATE ACCOUNT. THE NO LAPSE GUARANTEE IS SUBJECT TO
THE CONDITIONS DESCRIBED ON PAGE 15.
[LOGO]
FLEXIBLE PREMIUM
VARIABLE LIFE INSURANCE POLICY
HL-15486(00)(NY) Printed in U.S.A.
POLICY SPECIFICATIONS
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BASE POLICY INFORMATION
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POLICY: FLEXIBLE PREMIUM VARIABLE LIFE
POLICY NUMBER: VL00001
INSURED: JOHN DOE
ISSUE AGE/SEX: 35, MALE
INSURANCE CLASS: PREFERRED/NON-NICOTINE
OWNER: JOHN DOE
BENEFICIARY: JANE DOE
INITIAL PLANNED PREMIUM: $1,000.00
PAYMENT FREQUENCY: ANNUAL
INITIAL FACE AMOUNT: $100,000
DEATH BENEFIT OPTION: B (RETURN OF ACCOUNT VALUE OPTION)
DEATH BENEFIT OPTION C LIMIT: NOT APPLICABLE
MINIMUM INCREASE IN FACE AMOUNT: $100,000
MINIMUM DECREASE IN FACE AMOUNT: NONE
MINIMUM FACE AMOUNT AFTER DECREASE: $50,000
NO LAPSE GUARANTEE PERIOD: JANUARY 1, 2000 - DECEMBER 31, 2004
MONTHLY NO LAPSE
GUARANTEE PREMIUM: $51.27
POLICY DATE: JANUARY 1, 2000
DATE OF ISSUE: JANUARY 1, 2000
SCHEDULED MATURITY DATE: JANUARY 1, 2060**
ANNUAL FIXED ACCOUNT
MINIMUM CREDITED RATE: 3.5%*
SEPARATE ACCOUNT: [VARIABLE LIFE I]
INITIAL PREMIUM ALLOCATION: [HARTFORD MONEY MARKET FUND]
7702 TEST GUIDELINE PREMIUM TEST
* ANY AMOUNTS IN THE LOAN ACCOUNT WILL BE CREDITED WITH INTEREST AT THIS RATE.
** IT IS POSSIBLE THAT COVERAGE FOR THIS POLICY AND/OR ATTACHED RIDERS WILL
EXPIRE PRIOR TO THE SCHEDULED MATURITY DATE AND/OR THE TERMINATION DATE SHOWN
WHERE PREMIUMS AND INVESTMENT EXPERIENCE ARE INSUFFICIENT TO CONTINUE
COVERAGE TO SUCH DATE. COVERAGE MAY ALSO BE AFFECTED BY CHANGES IN THE
MONTHLY DEDUCTION AMOUNT, POLICY LOANS, THE COST OF ANY ADDITIONAL BENEFIT
RIDERS AND THE DEATH BENEFIT OPTION. THE MONTHLY DEDUCTION AMOUNT INCLUDES
COST OF INSURANCE CHARGES AND OTHER EXPENSE CHARGES. INTEREST RATES CREDITED
TO THE VALUES IN THE FIXED ACCOUNT IN EXCESS OF THE FIXED ACCOUNT MINIMUM
CREDITED RATE ARE NOT GUARANTEED AND ARE SUBJECT TO CHANGE. VARIATIONS IN
CREDITED INTEREST RATES, INVESTMENT EXPERIENCE AND MONTHLY DEDUCTION AMOUNTS
MAY REQUIRE ADDITIONAL PREMIUMS TO BE PAID OR MAY CAUSE THE ACCOUNT VALUES TO
BE LESS THAN THOSE SHOWN IN THE ILLUSTRATION.
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POLICY NUMBER: VL0000001
POLICY SPECIFICATIONS
POLICY CHARGES
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DEDUCTIONS FROM PREMIUM PAYMENTS
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TYPE OF POLICY PERCENT OF
CHARGE YEARS PREMIUMS PAID
------ ----- -------------
GUARANTEED MAXIMUM ALL 6.00%
SALES CHARGES
TAX CHARGE ALL [1.75%]*
* THE TAX PERCENTAGE RATE DEPENDS UPON THE RATE ASSESSED BY YOUR STATE OR
MUNICIPALITY OF RESIDENCE. IF YOUR STATE OR MUNICIPALITY OF RESIDENCE CHANGES
AND/OR IF YOUR RESIDENCE STATE OR MUNICIPALITY CHANGES ITS TAX RATE, THE TAX
RATE WILL CHANGE TO EQUAL THAT NEW RATE. THE TAX RATE FOR RESIDENTS OF NEW
YORK WILL NOT BE CHANGED WITHOUT THE APPROVAL OF THE SUPERINTENDENT OF
INSURANCE OF THE STATE WHERE THE POLICY IS ISSUED FOR DELIVERY.
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GUARANTEED MAXIMUM DEDUCTIONS FROM ACCOUNT VALUE
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TYPE OF POLICY CHARGE OR
CHARGE YEARS PERCENT OF VALUE
------ ----- ----------------
MONTHLY ADMINISTRATIVE ALL $10.00 PER MONTH
CHARGE
MORTALITY AND EXPENSE
RISK RATES
ACCUMULATED VALUE 1-10 0.0667% PER MONTH (0.80% PER
MORTALITY AND EXPENSE YEAR) OF THE ACCUMULATED
RISK RATE VALUE IN THE SUB-ACCOUNTS.
11-20 0.0417% PER MONTH (0.50%) PER
YEAR) OF THE ACCUMULATED
VALUES IN THE SUB-ACCOUNTS.
21+ 0.0333% PER MONTH (0.40%) PER
YEAR) OF THE ACCUMULATED
VALUES IN THE SUB-ACCOUNTS.
FACE AMOUNT MORTALITY 1-5 $.25 PER MONTH PER $1,000 OF
AND EXPENSE RISK RATE PER INITIAL FACE AMOUNT.
$1,000
6+ 0
FACE AMOUNT INCREASE $.50 PER MONTH, PER $1000 OF
FEE THE INCREASED AMOUNT, FOR THE
FIRST 12 MONTHS FOLLOWING THE
INCREASE.
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POLICY NUMBER: VL0000001
POLICY SPECIFICATIONS
POLICY CHARGES
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TRANSFER CHARGE
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ALL POLICY YEARS $00.00 FOR THE FIRST TRANSFER IN ANY CALENDAR MONTH.
ALL POLICY YEARS $25.00 PER TRANSFER IN EXCESS OF 1 PER CALENDAR
MONTH.
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MAXIMUM SURRENDER CHARGES
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POLICY SURRENDER POLICY SURRENDER
YEAR CHARGE YEAR CHARGE
1 1,200.00 6 634.00
2 1,114.00 7 634.00
3 1,028.00 8 598.00
4 934.00 9 512.00
5 634.00 10 0.00
SURRENDER CHARGES WILL BE REDUCED AS THE RESULT OF ANY PRIOR SURRENDER CHARGES
ASSESSED.
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<PAGE>
POLICY NUMBER: VL0000001
POLICY SPECIFICATIONS
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SCHEDULED FACE AMOUNT INCREASES
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DATE OF INCREASE SCHEDULED INCREASE AMOUNT
JANUARY 1, 2001 $75,000
JANUARY 1, 2002 $75,000
JANUARY 1, 2003 $75,000
JANUARY 1, 2004 $75,000
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Page 3C
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<PAGE>
POLICY NUMBER: VL0000001
POLICY SPECIFICATIONS
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TABLE OF MINIMUM DEATH BENEFIT PERCENTAGES
AND MONTHLY MAXIMUM COST OF INSURANCE RATES PER $1,000
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MINIMUM MAXIMUM COST MINIMUM MAXIMUM COST
ATTAINED DEATH BENEFIT OF INSURANCE ATTAINED DEATH BENEFIT OF INSURANCE
AGE PERCENTAGES RATE AGE PERCENTAGES RATE
35 250.00 0.180833 65 120.00 2.218333
36 250.00 0.193333 66 119.00 2.427500
37 250.00 0.207500 67 118.00 2.649167
38 250.00 0.223333 68 117.00 2.887500
39 250.00 0.241667 69 116.00 3.150833
40 250.00 0.262500 70 115.00 3.447500
41 243.00 0.285000 71 113.00 3.785833
42 236.00 0.309167 72 111.00 4.173333
43 229.00 0.335833 73 109.00 4.611667
44 222.00 0.364167 74 107.00 5.091667
45 215.00 0.394167 75 105.00 5.604167
46 209.00 0.426667 76 105.00 6.141667
47 203.00 0.460833 77 105.00 6.697500
48 197.00 0.497500 78 105.00 7.276667
49 191.00 0.538333 79 105.00 7.896667
50 185.00 0.583333 80 105.00 8.578333
51 178.00 0.635833 81 105.00 9.340833
52 171.00 0.694167 82 105.00 10.200833
53 164.00 0.760833 83 105.00 11.153333
54 157.00 0.834167 84 105.00 12.176667
55 150.00 0.913333 85 105.00 13.248333
56 146.00 0.997500 86 105.00 14.350833
57 142.00 1.086667 87 105.00 15.477500
58 138.00 1.181667 88 105.00 16.627500
59 134.00 1.285000 89 105.00 17.807500
60 130.00 1.400000 90 105.00 19.035833
61 128.00 1.530000 91 104.00 20.342500
62 126.00 1.676667 92 103.00 21.785833
63 124.00 1.840833 93 102.00 23.510833
64 122.00 2.022500 94 101.00 25.830833
THE MINIMUM DEATH BENEFIT PERCENTAGES ARE DETERMINED TO COMPLY WITH SECTION
7702 OF THE INTERNAL REVENUE CODE, OR YOUR REQUESTED PERCENTAGES, IF GREATER.
THE MAXIMUM COST OF INSURANCE RATES DO NOT EXCEED THE COST OF INSURANCE RATES
BASED ON THE 1980 COMMISSIONERS STANDARD ORDINARY, MALE OR FEMALE MORTALITY
TABLE, AGE LAST BIRTHDAY. THE MAXIMUM COST OF INSURANCE RATES HAVE BEEN
ADJUSTED TO REFLECT ANY SPECIAL CLASS RATING.
Page 3D
15486(3D)(NY) Printed in U.S.A.
<PAGE>
DEFINITIONS The definitions in this section apply to the following
words and phrases whenever and wherever they appear in
the Policy.
ACCOUNT VALUE: the total of all amounts in the Fixed
Account, Loan Account and Sub-Accounts.
ACCUMULATION UNIT: an accounting unit used to calculate
the value of a Sub-Account.
ATTAINED AGE: the Issue Age plus the number of completed
Policy Years.
CASH SURRENDER VALUE: the Cash Value less all
Indebtedness.
CASH VALUE: the Account Value less any applicable
Surrender Charges.
COMPANY, WE, US, OUR: the Company referred to on the
first page of the Policy.
CUMULATIVE NO LAPSE GUARANTEE PREMIUM: the premium
required to maintain the No Lapse Guarantee. On the
Policy Date, the Cumulative No Lapse Guarantee Premium is
the Monthly No Lapse Guarantee Premium shown on Page 3.
On each Monthly Activity Date thereafter, the Cumulative
No Lapse Premium is: (a) the Cumulative No Lapse
Guarantee Premium on the previous Monthly Activity Date;
plus (b) the current Monthly No Lapse Guarantee Premium.
DATE OF ISSUE: the date shown on Page 3 from which
Suicide and Incontestability provisions are measured.
The date may be different from the Policy Date.
DEATH BENEFIT: the amount used to calculate the Death
Proceeds. The Death Benefit on the Policy Date is
determined by the Death Benefit Option You select on Your
application. Thereafter, it may change in accordance
with the terms of the Death Benefit Option provision, the
Minimum Death Benefit provision and the No Lapse
Guarantee provision.
DEATH BENEFIT OPTION: the Death Benefit Option in effect
determines how the Death Benefit is calculated. The
three Death Benefit Options provided are described in the
Death Benefit section.
DEATH PROCEEDS: the amount which We will pay on the
death of the Insured.
DOLLAR COST AVERAGING: systematic transfers from one
account to any other available account.
FACE AMOUNT: an amount We use to determine the Death
Benefit. On the Policy Date, the Face Amount equals the
Initial Face Amount shown on Page 3. Thereafter, it may
change in accordance with the terms of the Increases and
Decreases in Face Amount provision the Death Benefit
Option Changes provision, the No Lapse Guarantee
provision and the Withdrawals provision.
FIXED ACCOUNT: part of the Company's General Account to
which all or a portion of the Account Value may be
allocated.
FUNDS: the registered open-end management companies in
which assets of the Separate Account may be invested.
GENERAL ACCOUNT: all Company assets other than those
allocated to Separate Accounts.
Page 5
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<PAGE>
DEFINITIONS IN WRITING: in a written form satisfactory to Us.
(CONTINUED)
INDEBTEDNESS: all loans taken on the Policy, plus any
interest due or accrued minus any loan repayments.
INTERNAL REVENUE CODE: Internal Revenue Code of 1986, as
amended.
ISSUE AGE: as of the Policy Date, an Insured's age on
his/her last birthday.
LOAN ACCOUNT: an account established for any amounts
transferred from the Fixed Account and Sub-Accounts as a
result of loans. The amounts in the Loan Account are
credited with interest and are not subject to the
investment experience of any Sub-Accounts.
MONTHLY ACTIVITY DATE: the Policy Date and the same date
in each succeeding month as the Policy Date. However,
whenever the Monthly Activity Date falls on a date other
than a Valuation Day, the Monthly Activity Date will be
deemed to be the next Valuation Day.
NET AMOUNT AT RISK: the Net Amount at Risk is determined
by subtracting the Account Value from the Policy's Death
Benefit. If the Face Amount has been increased from the
initial Face Amount, the Net Amount at Risk is first
allocated to the most recent increase and then,
successively to each prior increase.
NET PREMIUM: the amount of premium credited to the
Account Value. It is the premium paid minus the
deductions from premium shown on Page 3A.
We can use sales loads that are lower than the sales
loads shown on Page 3A. Sales loads will be determined
on each Policy Anniversary based on future expectations
for such factors as mortality, expenses, interest,
persistency and taxes. Sales loads will be reviewed no
more often than once a year, nor less than every 5 years.
Any change We make will be on a uniform basis for
Insureds of the same Issue Age, sex and insurance class
and whose coverage has been in force for the same length
of time. No change in sales loads will occur on account
of deterioration of the Insured's health.
Any change in sales loads will be determined in
accordance with the procedures and standards on file with
the Insurance Department where this Policy is delivered.
PLANNED PREMIUM: the amount that the Owner intends to
pay. The Initial Planned Premium is shown on Page 3.
POLICY ANNIVERSARY: an anniversary of the Policy Date.
POLICY DATE: the date shown on Page 3 from which Policy
Anniversaries and Policy Years are determined. This is
the date the Policy goes into effect.
POLICY GRACE PERIOD: the 61 day period between the day
Your Policy goes into default and the day on which Your
Policy terminates.
POLICY YEARS: years as measured from the Policy Date.
Page 6
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<PAGE>
DEFINITIONS PRO RATA BASIS: an allocation method based on the
(CONTINUED) proportion of the Account Value in the Fixed
Account and each Sub-Account.
SCHEDULED MATURITY DATE: the date, shown on Page 3, on
which the Policy will mature, in accordance with the
Termination and Maturity Date provision.
SEPARATE ACCOUNT: an account, as specified on Page 3,
which has been established by Us to separate the assets
funding the variable benefits for the class of contracts
to which the Policy belongs from the other assets of the
Company.
SUB-ACCOUNTS: the subdivisions of the Separate Account.
SURRENDER CHARGE: a charge that may be assessed if You
surrender the Policy or You request a Policy change that
results in a Face Amount decrease.
VALUATION DAY: the date on which a Sub-Account is
valued. This occurs everyday We are open and the New
York Stock Exchange is open for trading.
VALUATION PERIOD: the period of time between the close
of business on successive Valuation Days.
YOU, YOUR: the Owner of the Policy.
DEATH BENEFIT GENERAL
Upon receipt of due proof of the Insured's death, We will
pay the Death Proceeds to the Beneficiary.
DEATH PROCEEDS
Death Proceeds equal the Death Benefit described below
less Indebtedness and less any due and unpaid Monthly
Deduction Amounts occurring during a Policy Grace Period.
However, if the Insured dies after We receive a request
In Writing from You to surrender the Policy, the Cash
Surrender Value will be paid in lieu of the Death
Proceeds.
The Death Benefit is the greater of:
(a) the Death Benefit provided by the Death Benefit
Option chosen; and
(b) the Minimum Death Benefit Percentage applicable as of
the date of death, multiplied by the Account Value (as of
the receipt of proof of death) increased by the Monthly
Deduction Amounts taken after the date of the Insured's
death and before We receive due proof of death.
DEATH BENEFIT OPTIONS
You have three Death Benefit Options.
1. Under Option A (Level Option), the Death Benefit is
the Face Amount as of the date of death.
2. Under Option B (Return of Account Value Option), the
Death Benefit is the Face Amount as of the date of death,
plus the Account Value (as of the receipt of proof of
death) increased by the Monthly Deduction Amounts taken
after the date of the Insured's death and before We
receive due proof of death.
3. Under Option C (Return of Premium Option), the Death
Benefit is the Face Amount as of the date of death, plus
the lesser of (a) the sum of the premiums paid; or (b)
the Death Benefit Option C Limit shown on Page 3.
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<PAGE>
DEATH BENEIT DEATH BENEFIT OPTION CHANGES
(CONTINUED) You may change Your Death Benefit Option, subject to the
conditions described here. You must notify Us In Writing
of the change. Such change will be effective on the
Monthly Activity Date following the date We receive the
request.
You may change Option C (Return of Premium Option) or
Option B (Return of Account Value Option) to Option A
(Level Option). If You do, the Face Amount will become
that amount available as a Death Benefit immediately
prior to the option change.
You may change Option A (Level Option) to Option B
(Return of Account Value Option). If You do, the Face
Amount will become that amount available as a Death
Benefit immediately prior to the option change, reduced
by the then current Account Value. Any resulting
decrease in the Face Amount may be subject to a partial
Surrender Charge as described in the Decreases in Face
Amount provision.
MINIMUM DEATH BENEFIT
We will automatically increase the Death Benefit so that
it will never be less than the Account Value multiplied
by the Minimum Death Benefit Percentage for the then
current Policy Year. The Table of Minimum Death Benefit
Percentages is shown on Page 3D. This is to ensure that:
(a) the Policy continues to qualify as life insurance under
the Internal Revenue Code; or
(b) the Policy maintains the relationship between the
Account Value and the Death Benefit You selected on Your
application, if greater.
INCREASES AND GENERAL
DECREASES IN At any time after the first Policy Year, You may make a
FACE AMOUNT request In Writing to change the Face Amount. The minimum
amount by which the Face Amount can be increased or
decreased is shown on Page 3.
We reserve the right to limit You to one increase or
decrease in any 12 month period.
SCHEDULED INCREASES IN FACE AMOUNT
We will increase the Face Amount automatically by the
amounts shown on Page 3C. These scheduled increases will
continue until You request to discontinue the increases
or until You request to decrease the Face Amount of Your
Policy. Decreases in the Face Amount as a result of a
withdrawal will not affect Your scheduled increases.
Scheduled increases in the Face Amount are not subject to
the Face Amount Increase Fee.
UNSCHEDULED INCREASES IN FACE AMOUNT
All requests to increase the Face Amount must be applied
for on a new application and accompanied by the Policy.
All requests will be subject to evidence of insurability
satisfactory to Us. Any increase approved by Us will be
effective on the Monthly Activity Date shown on the new
Policy specifications page, provided that the Monthly
Deduction Amount for the first month after the effective
date of the increase is made. A Face Amount Increase Fee
is assessed on the first twelve Monthly activity dates
beginning on the effective date of each increase. The
Face Amount Increase Fee will not exceed the amount shown
on Page 3A.
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<PAGE>
INCREASES AND DECREASES IN FACE AMOUNT
DECREASES IN A decrease in the Face Amount will be effective on the
FACE AMOUNT Monthly Activity Date following the date We receive Your
(CONTINUED) request. The remaining Face Amount must not be less than
the minimum Face Amount shown on Page 3. If during the
Surrender Charge Period, You decrease Your Face Amount to
an amount lower than it has ever been, a partial
Surrender Charge will be assessed.
The Surrender Charge assessed will be:
(a) the Surrender Charge applicable to the then current
Policy Year, if any; multiplied by
(b) the percentage described below.
The percentage will be determined by:
(i) subtracting the new Face Amount from the lowest
previous Face Amount; and
(ii) dividing that difference by the lowest previous Face
Amount.
The Surrender Charge assessed will be deducted from Your
Account Value on the Monthly Activity Date on which the
decrease becomes effective. We will also reduce the
Surrender Charges applicable to future Policy Years and
provide You a revised schedule of Maximum Surrender
Charges.
PREMIUMS GENERAL
No insurance is effective until We receive premiums
sufficient to cover the Monthly Deduction Amount on the
Policy Date, subject to the terms of the application's
conditional receipt. After the first premium has been
paid, subsequent premiums can be paid at any time.
Checks must be made payable to the Company shown on the
first page of the Policy.
Checks may be sent to either:
(a) Us at the address shown on the premium notice; or
(b) Our authorized agent in exchange for a receipt signed by
Our President or Secretary and countersigned by such
agent.
We will apply any amount received under the Policy as a
premium unless it is clearly marked otherwise. The
premium will be applied on the date We receive it at the
address shown on the premium notice.
PLANNED PREMIUM PAYMENTS
We will send You a premium notice for the Planned Premium
payment. The notices may be sent at 12, 6, or 3 month
intervals. The Initial Planned Premium payment and
payment frequency You selected are shown on Page 3. You
may change the Planned Premium payment shown on the
premium notices subject to Our premium limitations.
FLEXIBLE PREMIUMS
After the first premium has been paid, Your subsequent
premium payments are flexible. The actual amount and
frequency of payment will affect the Account Value and
could affect the amount and duration of insurance
provided by the Policy. You may pay additional premiums
at any time prior to the Scheduled Maturity Date subject
to Our Premium Limitations.
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<PAGE>
PREMIUMS PREMIUM LIMITATIONS
(CONTINUED) You may pay premiums at any time prior to the Scheduled
Maturity Date subject to the following limitations:
(a) the minimum premium that We will accept is $50 or the
amount required to keep the Policy in force.
(b) if premiums are received which would cause the Policy
to fail to meet the definition of a life insurance
contract in accordance with the Internal Revenue Code, We
reserve the right to refund the excess premium payments.
Such refunds and interest thereon will be made within 60
days after the end of a Policy Year.
(c) We reserve the right to require evidence of
insurability for any premium payment that results in an
increase in the Death Benefit greater than the amount of
the premium.
(d) any premium received in excess of $1,000,000 is
subject to Our approval.
INITIAL PREMIUM ALLOCATION
The initial Net Premium and any additional Net Premiums
received by Us prior to the end of the free look period
as described in the Right to Examine Policy Provision,
will be allocated as shown on Page 3 on the later of:
(a) the Policy Date; and
(b) the date We receive the premium.
The accumulated values of these amounts will then be
allocated to the Fixed Account and Sub-Accounts according
to the premium allocation You specified in the
application on the later of:
(a) 10 days after You receive the Policy; or
(b) the date We receive the final requirement to put the
Policy in force.
SUBSEQUENT PREMIUM ALLOCATIONS
You may change how Your premiums are allocated by
notifying Us In Writing. Subsequent Net Premiums will be
allocated to the Fixed Account and Sub-Accounts according
to Your most recent instructions as long as:
(a) the total number of active Sub-Accounts does not
exceed 9; and
(b) the percentage You allocate to each Sub-Account is in
whole percentages.
If We receive a premium with a premium allocation
instruction that does not comply with the above rules, We
will allocate the Net Premium on a Pro Rata Basis.
VALUATION SUB-ACCOUNT ACCUMULATION UNITS
PROVISIONS Amounts allocated to each Sub-Account increase the number
of Accumulation Units in each Sub-Account. The number of
Accumulation Units added to each Sub-Account is
determined by dividing the amount allocated to the
Sub-Account by the dollar value of one Accumulation Unit
for such Sub-Account.
Amounts taken from each Sub-Account decrease the number
of Accumulation Units in each Sub-Account. The number of
Accumulation Units subtracted from each Sub-Account is
determined by dividing the amount taken from the
Sub-Account by the dollar value of one Accumulation Unit
for such Sub-Account.
The number of Your Accumulation Units will not be
affected by any subsequent change in the value of the
units. The Accumulation Unit Values in each Sub-Account
may increase or decrease daily as described below.
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<PAGE>
VALUATION SUB-ACCOUNT ACCUMULATION UNIT VALUE
PROVISIONS The Accumulation Unit Value for each Sub-Account will
(CONTINUED) vary to reflect the investment experience of the
applicable Fund and will be determined on each
Valuation Day by multiplying the Accumulation Unit Value
of the particular Sub-Account on the preceding Valuation
Day by a Net Investment Factor for that Sub-Account for
the Valuation Period then ended. The Net Investment
Factor for each of the Sub-Accounts is equal to the net
asset value per share of the corresponding Fund at the
end of the Valuation Period (plus the per share amount of
any dividend or capital gain distributions paid by that
Fund in the Valuation Period then ended) divided by the
net asset value per share of the corresponding Fund at
the beginning of the Valuation Period.
EMERGENCY PROCEDURE
If the New York Stock Exchange is closed (except for
holidays or weekends) or trading is restricted due to an
existing emergency as defined by the Securities and
Exchange Commission so that We cannot value the
Sub-Accounts, We may postpone all transactions which
require valuation of the Sub-Accounts until valuation is
possible. Any provision of the Policy which specifies a
Valuation Day will be superseded by the emergency
procedure.
FIXED ACCOUNT
We will credit interest to amounts in the Fixed Account
on a monthly basis at rates We determine. The Annual
Fixed Account Minimum Credited Rate is shown on Page 3.
We may credit interest rates greater than the Annual
Fixed Account Minimum Credited Rate to the Fixed Account.
Such additional amounts of interest will be
nonforfeitable from the effective date of their
crediting. The interest credited will reflect the timing
of amounts added to or withdrawn from the Fixed Account.
Rates will be determined from time to time based on Our
expectations as to interest, mortality, expenses,
persistency and taxes.
ACCOUNT VALUE, ACCOUNT VALUE
CASH VALUE Your Account Value on the Policy Date equals the initial
AND CASH Net Premium less the Monthly Deduction Amount for the
SURRENDER VALUE first Policy month.
On each subsequent Monthly Activity Date, Your Account
Value equals:
(a) the sum of Your Accumulated Values in the Fixed
Account and Sub-Accounts; plus
(b) the value of Your Loan Account, if any; minus,
(c) the appropriate Monthly Deduction Amount.
On each Valuation Day (other than a Monthly Activity
Date), Your Account Value equals:
(a) the sum of Your Accumulated Values in the Fixed
Account and Sub-Accounts; plus
(b) the value of Your Loan Account, if any.
ACCUMULATED VALUE - FIXED ACCOUNT
Your Accumulated Value in the Fixed Account equals:
(a) the Net Premiums allocated to it; plus
(b) amounts transferred to it from the Sub-Accounts or
the Loan Account; plus
(c) interest credited to it; minus
(d) amounts transferred out of it to the Sub-Accounts or
the Loan Account; minus
(e) any transfer charges or Surrender Charges that have
been taken from it; minus
(f) any Monthly Deduction Amounts taken from it; minus
(g) any withdrawals taken from it.
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ACCOUNT VALUE, ACCUMULATED VALUE - SUB-ACCOUNTS
CASH VALUE Your Accumulated Value in any Sub-Account equals:
AND CASH (a) the number of Your Accumulation Units in that
SURRENDER VALUE Sub-Account on the Valuation Day; multiplied by
(CONTINUED) (b) that Sub-Account's Accumulation Unit Value on the
Valuation Day.
The number of Accumulation Units in any Sub-Account is
increased when:
(a) Net Premiums are allocated to it; or
(b) amounts are transferred to it from other
Sub-Accounts, the Fixed Account or the Loan Account.
The number of Accumulation Units in any Sub-Account is
decreased when:
(a) amounts are transferred out of it to other
Sub-Accounts, the Fixed Account or the Loan Account; or
(b) any transfer charges or Surrender Charges have been
taken from it; or
(c) any Monthly Deduction Amounts are taken from it; or
(d) any withdrawals are taken from it.
CASH VALUE
Your Cash Value is equal to the Account Value less any
applicable Surrender Charges. The Surrender Charges and
the Policy Years during which they will be applied are
shown on Page 3B.
CASH SURRENDER VALUE
Your Cash Surrender Value is equal to Your Cash Value
minus the Indebtedness, if any.
TRANSFERS AMOUNT AND FREQUENCY OF TRANSFERS
Upon request and as long as the Policy is in effect, You
may transfer amounts among the Fixed Account and
Sub-Accounts.
We reserve the right to limit the number and frequency of
transfers. One transfer per calendar month is allowed
without charge. Each additional transfer is assessed a
charge of $25.00. Transfers related to Dollar Cost
Averaging are not included for the purposes of this limit
nor are they subject to a charge. All transfers are
subject to a minimum of $25.00 and a maximum of
$2,000,000. There are no restrictions on the size of
remaining balances
DOLLAR COST AVERAGING
From time to time, We may offer and You may enroll in a
Dollar Cost Averaging program. Prior to enrollment, You
may obtain information on the available programs from Us.
You may terminate participation in the program at any
time by calling or writing Us. In such an event, any
non-transferred balances will be allocated to the other
accounts according to Your instructions.
RESTRICTIONS ON TRANSFERS
Transfers from the Fixed Account (other than those
allowed under a Dollar Cost Averaging program) are
subject to the following:
(a) the transfer must occur during the 30 day period
following each Policy Anniversary; and
(b) the maximum amount transferred in any Policy Year
will be the greater of $1,000 or 25% of the Accumulated
Value in the Fixed Account on the date of transfer.
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<PAGE>
TRANSERS TRANSFERS TO THE FIXED ACCOUNT
(CONTINUED) You may transfer all amounts in the Sub-Accounts to the
Fixed Account and apply the Cash Surrender Value to
purchase a non-variable Paid-Up Life Insurance Policy, as
long as the Policy is in effect. The amount of the
non-variable Paid-Up Life Insurance is the amount that
can be purchased by the net single premium at the then
attained age of the Insured based on the Annual Fixed
Account Minimum Credited Rate and Maximum Cost of
Insurance Rates guaranteed in the contract. Subsequent
Cash Values of the non-variable Paid-Up Life Insurance
are based on the 1980 Commissioners Standard Ordinary
Male or Female Mortality Table, age last birthday using
the Monthly Maximum Cost of Insurance and the Annual
Fixed Account Minimum Credited Rate. The Paid-Up Life
Insurance Policy is not subject to the Monthly
Administrative Charge.
At any time this policy is in force You may elect to
transfer Accumulated Values in the Sub-Accounts to the
Fixed Account if a material change is made in the
investment policy of the Separate Account and You object
to that change. At any time during the first 18 months
from the Date of Issue and while this Policy is in force,
You may elect to transfer Accumulated Values in the Sub
Accounts to the Fixed Account. Transfers made under
these situations will not be subject to any transfer
charge; nor will they be included in the total number of
transfers for the purpose of determining the
applicability of any future transfer charge. All other
transfers to the Fixed Account are subject to the charge
and frequency restrictions noted in the Amount and
Frequency of Transfers provision
TRANSFER CHARGE
After a transfer has occurred, the Transfer Charge, as
specified on Page 3B, if any, will be deducted on a Pro
Rata Basis.
MONTHLY GENERAL
DEDUCTION On each Monthly Activity Date, We will deduct an amount
AMOUNT from Your Account Value to pay for the benefits provided
by the Policy. This amount is called the Monthly
Deduction Amount and equals:
(a) the Cost of Insurance; plus
(b) the Monthly Administrative Charge; plus
(c)the Mortality and Expense Risk Charge; plus
(d) the Face Amount Increase Fee, if any; plus
(e) the charges for additional benefits provided by rider,
if any.
The Monthly Deduction Amount will be taken on a Pro Rata
Basis from the Fixed Account and Sub-Accounts on each
Monthly Activity Date.
COST OF INSURANCE
The Cost of Insurance for any Monthly Activity Date is
equal to:
(a) the Cost of Insurance Rate per $1,000; multiplied by
(b) the Net Amount at Risk; divided by
(c) $1,000.
On any Monthly Activity Date, the Net Amount At Risk
equals the Death Benefit less the Account Value on that
date prior to assessing the Monthly Deduction Amount.
COST OF INSURANCE RATE
The Cost of Insurance Rate is based on the then current
Policy Year as well as the Initial Face Amount, sex,
Issue Age, and insurance class of the Insured shown on
Page 3.
The Cost of Insurance Rates will not exceed those in the
Table of Monthly Maximum Cost of Insurance Rates shown on
Page 3D. Part of the Cost of Insurance charges is used
to recover acquisition expenses arising from the issuance
of the Policy. The expense recovery component is higher
in the early Policy Years.
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<PAGE>
MONTHLY We can use Cost of Insurance Rates that are lower than
DEDUCTION the Monthly Maximum Cost of Insurance Rates shown on Page 3D.
AMOUNT Rates will be determined on each Policy Anniversary based on
(CONTINUED) Our future expectations of such factors as mortality,
expenses, interest, persistency and taxes. Rates on
in-force policies will be reviewed no more than once a
year, nor less than once every five years. Any change We
make will be on a uniform basis for Insureds of the same
Issue Age, sex, insurance class, Initial Face Amount, and
whose coverage has been in force for the same length of
time. Upon providing satisfactory evidence to Us, You
may change the insurance class to a more favorable class.
Future Cost of Insurance charges will be based on the
more favorable class and all other contract terms and
provisions will remain as established at issue. No
change in insurance class or cost will occur on account
of deterioration of the Insured's health.
Any change in policy cost factors will be determined in
accordance with the procedures and standards on file with
the Insurance Superintendent of New York.
MONTHLY ADMINISTRATIVE CHARGE
The Monthly Administrative Charge will not exceed the
amounts shown on Page 3A.
The Monthly Administrative Charge will be determined on
each Policy Anniversary based upon changes in future
expectations as to mortality, expenses, interest,
persistency and taxes. Charges on in-force policies will
be reviewed no more often than once every five years.
Any change We make will be on a uniform basis for
Insureds of the same Issue Age, sex, and insurance class
and whose coverage has been in-force for the same length
of time.
Any change in the Monthly Administrative Charge will be
determined in accordance with the procedures and
standards on file with the Insurance Department.
MORTALITY AND EXPENSE RISK CHARGE
The Mortality and Expense Risk Charge for any Monthly
Activity Date is equal to the sum of (a) and (b) where
(a) equals:
(i) the monthly Accumulated Value Mortality and Expense
Risk Rate; multiplied by
(ii) the sum of Your Accumulated Values in the
Sub-Accounts on the Monthly Activity Date, prior to
assessing the Monthly Deduction Amount.
and
(b) equals:
(i) the monthly Mortality and Expense Risk Rate per
$1,000; multiplied by
(ii) the lower of the Initial Face Amount or the current
Face Amount; divided by
(iii) $1,000.
Each month the Mortality and Expense Risk Rates will not
exceed those shown on Page 3A.
Mortality and Expense Risk Charges will be determined on
each Policy Anniversary based upon changes in future
expectations as to mortality, expenses, interest,
persistency and taxes. Mortality and Risk Charges on
in-force policies will be reviewed no more than once a
year. Any change We make will be on a uniform basis for
Insureds of the same Issue Age, sex, and insurance class
and whose coverage has been in-force for the same length
of time.
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<PAGE>
MONTHLY Any change in the Mortality and Expense Risk Charges will
DEDUCTION be determined in accordance with the procedures and standards
AMOUNT on file with the Insurance Superintendent of New York.
(CONTINUED)
FACE AMOUNT INCREASE FEE
The Face Amount Increase Fee will not exceed the amount
shown on Page 3A.
LAPSE AND POLICY GRACE PERIOD
POLICY During the first three Policy Years, the Policy will go
GRACE PERIOD into default on any Monthly Activity Date on which the
Account Value less Indebtedness is not sufficient to
cover the Monthly Deduction Amount.
During the fourth Policy Year and thereafter, the Policy
will go into default on any Monthly Activity Date if the
Cash Surrender Value is not sufficient to cover the
Monthly Deduction Amount.
If the Policy goes into default, We will send You a lapse
notice warning You that the Policy is in danger of
terminating. That lapse notice will tell You the minimum
premium required to keep the Policy from terminating.
This minimum premium equals the amount to pay three
Monthly Deduction Amounts as of the day the Policy Grace
Period began. That notice will be mailed both to You at
your last known address and to any assignee of record at
lease 30 days, but no more than 45 days before the end of
the Policy Grace Period.
We will keep the Policy inforce for the 61 day period
following the date Your Policy goes into default. We
call that period the Policy Grace Period. However, if We
have not received the required premiums (specified in
Your lapse notice) by the end of the Policy Grace Period,
the Policy will terminate unless the No Lapse Guarantee
is in effect (see the No Lapse Guarantee provision which
follows).
The Policy will be in default if total Indebtedness
equals or exceeds the Cash Value on any Monthly Activity
Date. We will advise You of the amount required to repay
or reinstate such indebtedness. If such payment is not
made by the end of the Policy Grace Period, the Policy
will terminate without value.
If the Insured dies during the Policy Grace Period, We
will pay the Death Proceeds.
NO LAPSE GUARANTEE
The Policy will remain in force at the end of the Policy
Grace Period as long as the No Lapse Guarantee is
available, as described below.
This Policy provides a No Lapse Guarantee subject to the
conditions described below to Insureds with an Issue Age
of 79 or below as long as:
(a) the Policy is in the No Lapse Guarantee Period; and
(b) on each Monthly Activity Date during that period, the
cumulative premiums paid into the Policy, less
Indebtedness and less withdrawals from the Policy, equal
or exceed the Cumulative No Lapse Guarantee Premium.
The No Lapse Guarantee Period is shown on Page 3.
Page 15
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<PAGE>
LAPSE AND If the No Lapse Guarantee is available and You fail to
POLICY pay the required premium as defined in Your lapse notice by
GRACE PERIOD the end of the Policy Grace Period, the No Lapse Guarantee
(CONTINUED) will then go into effect. The Policy will remain in force,
however:
(a) the Death Benefit Option becomes Level;
(b) all riders will terminate,
(c) any future scheduled increases in the Face Amount
will be canceled.
The No Lapse Guarantee will remain in effect on each
subsequent Monthly Activity Date provided:
(a) the Policy remains in default; and
(b) the No Lapse Guarantee is available.
While the No Lapse Guarantee is in effect, We guarantee
that Your Account Value will never be less than zero.
If during the No Lapse Guarantee Period, there is any
increase or decrease in the Face Amount, or any change in
rider coverage or a change in insurance class, a new
monthly No Lapse Guarantee Premium will be calculated.
We will send You a notice of the new Monthly No Lapse
Guarantee Premium, which will be used in calculating the
Cumulative No Lapse Guarantee Premium in subsequent
months.
NO LAPSE GUARANTEE GRACE PERIOD
If, on each Monthly Activity Date during the No Lapse
Guarantee Period, the cumulative premiums paid into the
Policy, less Indebtedness and less withdrawals from the
Policy, do not equal or exceed the Cumulative No Lapse
Guarantee Premium on that date, a No Lapse Guarantee
Grace Period of 61 days will begin. We will mail You and
any assignee a notice. That notice will warn You that
You are in danger of losing the No Lapse Guarantee and
will tell You the amount of premium You need to pay to
continue the No Lapse Guarantee.
The No Lapse Guarantee will be removed from the Policy if
the required premium is not paid by the end of the No
Lapse Guarantee Grace Period. You will receive a written
notification of the change and the No Lapse Guarantee
will never again be available or in effect on the Policy.
REINSTATEMENT Unless the Policy has been surrendered for its Cash
Surrender Value, the Policy may be reinstated prior to
the Scheduled Maturity Date provided:
(a) You make Your request In Writing within five years
from the Termination Date;
(b) satisfactory evidence of insurability is submitted;
(c) any Indebtedness at the time of termination must be
repaid or carried over to the reinstated Policy; and
(d) You pay sufficient premium to:
(i) cover all Monthly Deduction Amounts that are due and
unpaid during the Policy Grace Period; and
(ii) keep the Policy in force for 3 months after the date
of reinstatement.
The Account Value on the reinstatement date will equal:
(a) the Cash Value at the time of termination; plus (b)
Net Premiums attributable to premiums paid at the time of
reinstatement; minus
(c) the Monthly Deduction Amounts that were due and
unpaid during the Policy Grace Period; plus
(d) the Surrender Charge at the time of reinstatement.
The Surrender Charge will be based on the duration from
the original Policy Date as though the Policy had never
lapsed.
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<PAGE>
POLICY LOANS GENERAL
At any time while the Policy is in force, You may borrow
against the Policy by assigning it as sole security to
Us. We may defer granting a loan, except to pay premiums
to Us, for the period permitted by law but not more than
six months. Any loan amount secured by transfers from
the Sub-Accounts are subject to the Separate Account
deferral provisions. We recommend consultation with a
Tax Advisor prior to taking a loan.
LOAN AMOUNTS
Any new loan taken together with any existing
Indebtedness may not exceed 90% of the Cash Value on the
date We grant a loan. The minimum loan amount that We
will allow is $500.
Unless you specify otherwise, all loan amounts will be
transferred from the Fixed Account and the Sub-Accounts
to the Loan Account on a Pro Rata Basis.
If total Indebtedness equals or exceeds the Cash Value on
any Monthly Activity Date, the Policy will then go into
default. See the Lapse and Policy Grace Period provision
for details.
CREDITED INTEREST
Any amounts in the Loan Account will be credited with
interest at a rate equal to the Annual Fixed Account
Minimum Credited Rate shown on Page 3.
PREFERRED INDEBTEDNESS
If, any time after the 10th Policy Anniversary, the
Account Value exceeds the total of all premiums paid
since issue, a portion of Your Indebtedness may qualify
as preferred. Preferred Indebtedness is charged a lower
interest rate than the non-preferred Indebtedness, if
any. (Refer to the Interest Charged on Indebtedness
provision for details.) The maximum amount of Preferred
Indebtedness is the amount by which the Account Value
exceeds the total premiums paid and is determined on each
Monthly Activity Date.
LOAN REPAYMENTS
All or part of a loan may be repaid at any time that:
(a) the Policy is in force; and
(b) the Insured is alive.
However, each repayment must be at least the lesser of
$50 or the Indebtedness and clearly identified In Writing
as a loan repayment. Otherwise, it will be considered a
premium payment.
The amount of a loan repayment will be deducted from the
Loan Account and will be allocated among the Fixed
Account and Sub-Accounts in the same percentage as
premiums are allocated.
INTEREST CHARGED ON INDEBTEDNESS
The table below shows the interest rates We will charge
on Your Indebtedness.
-------------------------------------------------------------
DURING POLICY PORTION OF INTEREST RATE CHARGED
YEARS INDEBTEDNESS EQUALS THE FIXED
ACCOUNT MINIMUM
CREDITED RATE PLUS:
-------------------------------------------------------------
1-10 All 2%
-------------------------------------------------------------
11 and later Preferred 0%
Non-Preferred 0.25%
-------------------------------------------------------------
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<PAGE>
POLICY LOANS Because the interest charged on Indebtedness may exceed the
(CONTINUED) rate credited to the Loan Account, the Indebtedness may grow
faster than the Loan Account. If this happens, any
difference between the value of the Loan Account and the
Indebtedness will be transferred on each Monthly Activity
Date from the Fixed Account and Sub-Accounts to the Loan
Account on a Pro Rata Basis.
WITHDRAWALS GENERAL
You may request a withdrawal In Writing. The minimum
withdrawal allowed is $500. The maximum withdrawal is
the Cash Surrender Value less $1,000. A charge of up to
$10 may be assessed for each withdrawal. One withdrawal
per calendar month is allowed. Unless specified
otherwise, the withdrawal will be deducted on a Pro Rata
Basis.
If the Death Benefit Option then in effect is Option A
(Level Option) or Option C (Return of Premium Option),
the Face Amount will be reduced by the amount equal to
the reduction in the Account Value resulting from the
withdrawal. If the Death Benefit Option then in effect
is Option B (Return of Account Value), the Face Amount
will not be reduced.
Any withdrawal that causes the Face Amount to fall below
the lowest previous Face Amount will be subject to a
partial Surrender Charge. Refer to the Decreases in Face
Amount provision for an explanation of the applicable
partial Surrender Charge.
SURRENDERS GENERAL
While the Policy is in force, You may surrender the
Policy to Us. The Policy, and additional benefits
provided by rider, are then canceled as of the day We
receive Your request In Writing or the date You request
the surrender, whichever is later. We will then pay You
the Cash Surrender Value as of that date.
A detailed statement of the method of computation of cash
surrender values and other nonforfeiture benefits is on
file with the Insurance Superintendent of New York.
PAYMENTS GENERAL
BY US We will pay Death Proceeds, Cash Surrender Values,
withdrawals and loan amounts attributable to the
Sub-Accounts within 7 days after We receive all the
information needed to process the payment unless:
(a) the New York Stock Exchange is closed on other than
customary weekend and holiday closings or trading on the
New York Stock Exchange is restricted as determined by
the Securities and Exchange Commission (SEC); or
(b) an emergency exists, as determined by the SEC, as a
result of which disposal of securities is not reasonably
practicable to determine the value of the Sub-Accounts.
DEFERRAL OF PAYMENTS FROM THE FIXED ACCOUNT
We may defer payment of any Cash Surrender Values,
withdrawals and loan amounts which are not attributable
to the Sub-Accounts for up to six months from the date of
the request except to pay premiums to Us. If We defer
payment for more than 10 days, We will pay interest at
the rate We declare under Settlement Option 1 -- Interest
Income.
TAXATION OF THE GENERAL
SEPARATE ACCOUNT We do not expect to incur any federal, state or local
income tax on the earnings or realized capital gains
attributable to the Separate Account. Based upon these
expectations, no charge is being made to the Separate
Account for federal, state or local income taxes. If We
incur income taxes attributable to the Separate Account
or determine that such taxes will be incurred, We may
assess a charge for taxes against the Policy in the
future, subject to approval by the Insurance
Superintendent of New York.
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<PAGE>
THE CONTRACT ENTIRE CONTRACT
The Policy, the attached copy of the initial application,
any applications for reinstatement, all subsequent
applications to change the Policy, any endorsements or
riders and all additional Policy information sections
added to the Policy are the entire contract. The
contract is made in consideration of the application and
the payment of the initial premium. We will not use any
statement to cancel the Policy or to defend a claim under
it, unless that statement is contained in an attached
written application. All statements in the application
will be deemed representations and not warranties.
INTERPRETATION OF POLICY TERMS AND CONDITIONS
We have full discretion and authority to determine
eligibility for benefits and to construe and interpret
all terms and provisions of the Policy.
CONTRACT MODIFICATION
The only way this contract may be modified is by a
written agreement signed by Our President, or one of Our
Vice Presidents, Secretaries or Assistant Secretaries.
FUND MODIFICATION
We reserve the right, subject to any applicable law, to
make certain changes, including the right to add,
eliminate or substitute any investment options offered
under the Policy.
NON-PARTICIPATION
The Policy is non-participating. It does not share in
Our surplus earnings, so You will receive no Policy
dividends under it.
MISSTATEMENT OF AGE AND/OR SEX
If on the date of death:
(a) the Issue Age of the Insured is understated; or
(b) the sex of the Insured is incorrectly stated such
that it resulted in lower Costs of Insurance, the Death
Benefit will be reduced to the Death Benefit that would
have been provided by the last Cost of Insurance charge
at the correct Issue Age and/or sex.
If on the date of death:
(a) the Issue Age of the Insured is overstated; or
(b) the sex of the Insured is incorrectly stated such
that it resulted in higher Costs of Insurance, the Death
Benefit will be adjusted by the return of all excess
Costs of Insurance prior to the date of the Insured's
death.
SUICIDE
If, within two years from the Date of Issue, the Insured
dies by suicide, Our liability will be limited to the
premiums paid less Indebtedness and less any withdrawals.
If, within two years from the effective date of any
increase in the Face Amount for which evidence of
insurability was obtained, the Insured dies by suicide,
Our liability with respect to such increase, will be
limited to the Cost of Insurance for the increase.
INCONTESTABILITY
We cannot contest the Policy after it has been in force,
during the Insured's lifetime, for two years from its
Date of Issue, except for non-payment of premium.
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<PAGE>
THE CONTRACT Any increase in the Face Amount for which evidence of
(CONTINUED) insurability was obtained, will be incontestable only
after the increase has been in force, during the
Insured's lifetime, for two years from the effective date
of the increase.
The Policy may not be contested for more than two years
after the reinstatement date. Any contest We make after
the Policy is reinstated will be limited to the material
misrepresentations in the evidence of insurability
provided to Us in the request for reinstatement.
However, the provision will not affect Our right to
contest any statement in the original application or a
different reinstatement request which was made during the
Insured's lifetime for two years from the Date of Issue
of the Policy or a subsequent reinstatement date.
APPEALING DENIAL OF CLAIM
On any denied claim, You or Your representative may
appeal to the Company for a full and fair review. You
may:
(a) request a review upon written application within 60
days of receipt of a claim denial;
(b) review pertinent documents; and
(c) submit issues and comments In Writing.
SEPARATE ACCOUNTS
We will have exclusive and absolute ownership and control
of the assets of Our Separate Accounts. The assets of a
Fund will be available to cover the liabilities of Our
General Account only to the extent that those assets
exceed the liabilities of that Separate Account. Such
assets will not be chargeable with liabilities arising
out of any other business that We may conduct. The
assets of a Fund will be valued on each Valuation Day.
Realized and unrealized gains and losses from the assets
of each Fund are credited or charged to against such Fund
without regard to Our other income, gains and losses.
Our determination of the value of an Accumulation Unit by
the method described in the Policy will be conclusive.
CHANGE IN THE OPERATION OF THE SEPARATE ACCOUNT
At Our election and subject to any necessary vote by
persons having the right to give instructions on the
voting of Fund shares held by the Sub-Accounts, the
Separate Account may be operated as a management company
under the Investment Company Act of 1940 or any form
permitted by law, may be deregistered under the
Investment Company Act of 1940 in the event registration
is no longer required, or may be combined with one or
more Separate Accounts.
VOTING RIGHTS
We will notify You of any Fund shareholder's meetings at
which the shares held for Your Sub-Account may be voted.
We will also send proxy materials and instructions for
You to vote the shares held for Your Sub-Account. We
will arrange for the handling and tallying of proxies
received from the Owners. We will vote the Fund shares
held by Us in accordance with the instructions received
from the Owners. You may attend any meeting, where
shares held for Your benefit may be voted.
In the event that You give no instructions or leave the
manner of voting discretionary, We will vote such shares
of the appropriate Fund in the same proportion as shares
of that Fund for which instructions have been received.
Also, We will vote the Fund shares in this proportionate
manner which are held by Us for Our own account.
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<PAGE>
THE CONTRACT ANNUAL REPORT
(CONTINUED) We will send You a report at least once each Policy Year
showing:
(a) the current Account Value, Cash Surrender Value and
Face Amount;
(b) the premiums paid, Monthly Deduction Amounts and
loans since the last report;
(c) the amount of any Indebtedness; and
(d) any other information required by the Insurance
Superintendent of New York.
OWNERSHIP AND CHANGE OF OWNER OR BENEFICIARY
BENEFICIARY The Owner and Beneficiary will be those named in the
application until You change them. To change the Owner
or Beneficiary, notify Us In Writing while the Insured is
alive. After We receive written notice, the change will
be effective as of the date You signed such notice,
whether or not of the Insured is living when We receive
it. However, the change will be subject to any payment
We made or actions We may have taken before We received
the request.
ASSIGNMENT
You may assign the Policy. Until You notify Us In
Writing, no assignment will be effective against Us. We
are not responsible for the validity of any assignment.
OWNER'S RIGHTS
While the Insured is alive and no Beneficiary is
irrevocably named, You may:
(a) exercise all the rights and options that the Policy
provides or that We permit;
(b) assign the Policy; and
(c) agree with Us to any change to the Policy.
NO NAMED BENEFICIARY
If no named Beneficiary survives the Insured, then,
unless the Policy provides otherwise:
(a) You will be the Beneficiary; or
(b) if You are the Insured, Your estate will be the
Beneficiary.
TERMINATION AND TERMINATION
MATURITY DATE The Policy will terminate upon the earliest of the
following events:
(a) the Scheduled Maturity Date of the Policy; or
(b) the surrender of the Policy; or
(c) the end of the Policy Grace Period during which
premiums sufficient for the required deductions are not
paid, provided the No Lapse Guarantee is not available;
or
(d) the end of the No Lapse Guarantee Period, provided
the No Lapse Guarantee is available and in effect;
(e) or the end of the No Lapse Guarantee Grace Period
during which premiums sufficient to maintain the No Lapse
Guarantee are not paid; provided the No Lapse Guarantee
is available and in effect; or
(f) the date We receive notification In Writing of the
death of the Insured. In this event, Your Death Benefit
will increase by any Monthly Deduction Amounts taken
after the date of the Insured's death and before We
receive due proof of death.
SCHEDULED MATURITY DATE
The Scheduled Maturity Date is the last date on which You
may elect to pay premium. Unless You elect to continue
the Policy beyond this date, the Policy will terminate
and any Cash Surrender Value will be paid to You.
If elected, the Policy may continue in force after the
Scheduled Maturity Date subject to the following
conditions:
(a) the Policy must be in force on the Scheduled Maturity
Date;
(b) the Owner including any assignee of record must agree
In Writing to this continuation.
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<PAGE>
TERMINATION AND If any of the above conditions are not met, the Policy,
MATURITY DATE if still in force, will terminate on the Scheduled Maturity
(CONTINUED) Date.
After the Scheduled Maturity Date:
(a) the Death Benefit will be reduced to the Account
Value;
(b) the Account Value, if any will continue to be valued
as described in the Account Value, Cash Value and Cash
Surrender Value provision;
(c) any loans that are in effect on the Scheduled
Maturity Date will continue to accrue interest and become
part of any Indebtedness;
(d) loans and withdrawals will continue to be available;
(e) no future Monthly Deduction Amounts will be deducted
from Your Account Value;
(f) no further premiums will be accepted.
All additional benefits provided by rider will deem to
have terminated at the Scheduled Maturity Date.
THIS POLICY MAY NOT QUALIFY AS LIFE INSURANCE AFTER THE
INSURED'S ATTAINED AGE 100 UNDER FEDERAL TAX LAW AND MAY
BE SUBJECT TO ADVERSE TAX CONSEQUENCES. YOUR TAX ADVISOR
SHOULD BE CONSULTED BEFORE YOU CHOOSE TO CONTINUE THE
POLICY BEYOND AGE 100.
INCOME AVAILABILITY
SETTLEMENT All or parts of the proceeds of the Policy may, instead
OPTIONS of being paid in one sum, be left with Us under any one or
a combination of the following options, subject to Our
minimum amount requirements on the date of election.
We will pay interest of at least 3% per year (or higher,
if required by state law) on the Death Proceeds from the
date of the Insured's death to the date payment is made
or an Income Settlement Option is elected. The rate will
always be at least the rate of interest payable under
Option 1 -- Interest Income. These proceeds are then no
longer subject to the investment experience of a Separate
Account.
If any payee is a corporation, partnership, association,
assignee, or fiduciary, an option may be chosen only with
Our consent. Option 4 is not available to any payee
whose age exceeds 90.
DESCRIPTION OF TABLES
The options shown below and on the next page are based on
interest at a guaranteed rate of 3% per year. Payments
under Option 4 are based on mortality according to the
1983a Individual Annuity Mortality Table, with ages set
back one year.
We may pay or credit excess interest of such amount and
in such manner as We determine.
DEATH OF PAYEE
If the payee dies while receiving payments under one of
the options below, We will pay the following:
(a) Any principal and accrued interest remaining unpaid
under Option 1 or 2.
(b) The value of remaining unpaid guaranteed payments, if
any, under Option 3 or 4, commuted using interest of 3%
per year.
Any such amount will be paid in one sum to the payee's
estate.
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<PAGE>
INCOME OTHER OPTIONS
SETTLEMENT To convert the monthly payments shown in the tables for
OPTIONS Options 3 and 4 to quarterly, semi-annual or annual payments,
(CONTINUED) multiply by the following factors:
PAYMENT INTERVAL FACTOR
Quarterly 2.99
Semi-annual 5.96
Annual 11.84
Other options may be arranged with Our consent.
OPTION 1 - INTEREST INCOME
Payments of interest at the rate We declare, but not less
than 3% per year, on the amount left under this option.
OPTION 2 - INCOME OF FIXED AMOUNT
Equal payments of the amount chosen until the amount left
under this option, with interest of not less than 3% per
year, is exhausted. The final payment will be for the
balance only.
OPTION 3 - INCOME FOR FIXED PERIOD
Payments, determined from the table below, are guaranteed
for the number of years chosen. The first payment will
be due on the date proceeds are applied under this option.
MONTHLY PAYMENTS MONTHLY PAYMENTS
NUMBER PER $1,000 OF NUMBER PER $1,000 OF
OF YEARS PROCEEDS OF YEARS PROCEEDS
1 $84.47 10 $9.61
2 42.86 15 6.87
3 28.99 20 5.51
4 22.06 25 4.71
5 17.91 30 4.18
OPTION 4 - LIFE INCOME
Payments, determined from the table shown below for the
option elected, are based on the payee's sex and age
nearest birthday on the day the first payment becomes
due. The first payment will be due on the date proceeds
are applied under this option. The Life Income available
are:
(a) Payments only while the payee is alive.
(b) Payment guaranteed for 10 years; then continuing
while the payee is alive.
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<PAGE>
INCOME
SETTLEMENT
OPTIONS
(CONTINUED)
MONTHLY PAYMENTS PER $1,000 OF PROCEEDS
<TABLE>
<CAPTION>
OPTION 4A OPTION 4B OPTION 4A OPTION 4B
PAYEE'S LIFE ONLY 10 YRS. CERTAIN PAYEE'S LIFE ONLY 10 YRS. CERTAIN
AGE MALE FEMALE MALE FEMALE AGE MALE FEMALE MALE FEMALE
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
20 $3.02 $2.92 $3.01 $2.92 68 $6.51 $5.68 $6.12 $5.50
25 3.12 3.00 3.12 3.00 69 6.74 5.85 6.28 5.65
30 3.25 3.10 3.24 3.10 70 6.98 6.04 6.44 5.80
35 3.41 3.23 3.40 3.23 71 7.24 6.25 6.61 5.97
40 3.61 3.39 3.60 3.38 72 7.51 6.47 6.79 6.14
45 3.87 3.59 3.85 3.58 73 7.81 6.72 6.96 6.32
50 4.19 3.85 4.15 3.83 74 8.12 6.98 7.14 6.50
51 4.27 3.91 4.22 3.89 75 8.46 7.26 7.32 6.69
52 4.35 3.97 4.30 3.95 76 8.83 7.57 7.50 6.89
53 4.43 4.03 4.37 4.01 77 9.22 7.90 7.68 7.09
54 4.51 4.10 4.45 4.08 78 9.64 8.27 7.85 7.29
55 4.61 4.18 4.54 4.15 79 10.09 8.66 8.02 7.50
56 4.70 4.25 4.63 4.22 80 10.57 9.08 8.18 7.70
57 4.80 4.34 4.72 4.30 81 11.08 9.54 8.33 7.89
58 4.91 4.42 4.82 4.38 82 11.63 10.04 8.48 8.08
59 5.03 4.52 4.92 4.47 83 12.22 10.59 8.62 8.27
60 5.15 4.62 5.03 4.56 84 12.84 11.18 8.75 8.44
61 5.28 4.72 5.15 4.66 85 13.50 11.81 8.86 8.60
62 5.43 4.83 5.27 4.76 86 14.19 12.50 8.97 8.74
63 5.58 4.95 5.39 4.87 87 14.93 13.24 9.07 8.87
64 5.74 5.08 5.53 4.98 88 15.71 14.04 9.16 8.99
65 5.91 5.21 5.67 5.10 89 16.53 14.89 9.24 9.09
66 6.10 5.36 5.81 5.23 90 17.40 15.79 9.31 9.18
67 6.30 5.51 5.96 5.36
</TABLE>
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15486(23/24)(NY) Printed in U.S.A.
