CG VARIABLE LIFE INSURANCE SEPARATE ACCOUNT A
S-6EL24, 1995-07-11
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<PAGE>   1
                      SECURITIES AND EXCHANGE COMMISSION
                           Washington, D.C.  20549
                                      
                                   FORM S-6
                                      
                    FOR REGISTRATION UNDER THE SECURITIES
                         ACT OF 1933 OF SECURITIES OF
                            UNIT INVESTMENT TRUSTS
                          REGISTERED ON FORM N-8B-2
                                      
                CG VARIABLE LIFE INSURANCE SEPARATE ACCOUNT A
           -------------------------------------------------------
                          (Exact Name of Registrant)
                                      
                  CONNECTICUT GENERAL LIFE INSURANCE COMPANY
           -------------------------------------------------------
                             (Name of Depositor)

            900 Cottage Grove Road, Bloomfield, Connecticut 06002
           -------------------------------------------------------
             (Address of Depositor's Principal Executive Offices)

               Depositor's Telephone Number, including Area Code
                                 (203) 726-6000

<TABLE>
<S>                                                  <C>
Jerold H. Rosenblum, Esquire                              Copy to:
Connecticut General Life Insurance Company           Michael James, Esquire
Two Liberty Place                                    Two Liberty Place
47th Floor                                           47th Floor
Philadelphia, PA 19192-2475                          Philadelphia, PA 19192-2475
(Name and Address of Agent for Service)         
                                                     Michael Berenson, Esquire
                                                     Suite 400 East
                                                     1025 Thomas Jefferson St., N.W.
                                                     Washington, D.C.  20007-0805
</TABLE>

          Approximate date of proposed public offering:  Continuous

  Indefinite Number of Units of Interest in Variable Life Insurance Contracts
  ---------------------------------------------------------------------------
               (Title and Amount of Securities Being Registered)

An indefinite amount of the securities being offered by the Registration
Statement is being registered pursuant to Rule 24f-2 under the Investment
Company Act of 1940.  The initial registration fee of $500 has been paid with
this declaration.

The registrant amends this Registration Statement of such date or dates as may
be necessary to delay its effective date until the registrant shall file a
further amendment which specifically states that this registration statement
shall thereafter become effective in accordance with Section 8(a) of the
Securities Act of 1933 or until the registration statement shall become
effective on such date as the Commission, acting pursuant to said Section 8(a)
may determine.

It is proposed that this filing will become effective:

__________ immediately upon filing pursuant to paragraph (b) of Rule 485
__________ on _______, pursuant to paragraph (b) of Rule 485
__________ 60 days after filing pursuant to paragraph (a) of Rule 485
__________ on _______, pursuant to paragraph (a) of Rule 485
<PAGE>   2
                       CROSS REFERENCE TO ITEMS REQUIRED

                                 BY FORM N-8B-2
<TABLE>
<CAPTION>
   N-8B-2 Item                      Caption in Prospectus
   -----------                      ---------------------
<S>                                 <C>
        1                           Cover Page; The Separate Account and the 
                                    Fund Accounts

        2                           Cover Page; The Company

        3                           Not Applicable

        4                           Distribution of Policies

        5                           The Separate Account and The Fund Accounts

        6                           Not Applicable

        7                           Not Applicable

        8                           Financial Statements

        9                           Legal Proceedings

       10                           Highlights; Full Surrender; Partial 
                                    Surrender; Right-to-Examine Period; 
                                    Conversion; Transfers; The Separate Account
                                    and the Fund Accounts; Voting Rights; 
                                    Lapse; Right to Take Action Regarding
                                    the Separate Account; Premium Payments

       11                           The Separate Account and The Fund Accounts;
                                    The Funds

       12                           Cover Page; The Separate Account and The 
                                    Fund Accounts; The Funds

       13                           Cover Page; Highlights; Charges and Fees

       14                           Highlights; Eligibility

       15                           Premium Payments; Charges and Fees

       16                           The Funds

       17                           Surrender, Lapse, and Reinstatement; 
                                    Transfers; Right to Examine Period; 
                                    Certificate Loans

       18                           Tax Matters

       19                           Reports to Certificateholders
</TABLE>
<PAGE>   3
<TABLE>
<CAPTION>
   N-8B-2 Item                     Caption in Prospectus
   -----------                     ---------------------
<S>                                 <C>
       20                           Not Applicable

       21                           Certificate Loans

       22                           Not Applicable

       23                           Not Applicable

       24                           Incontestability; Suicide; Misstatement 
                                    of Age

       25                           The Company

       26                           Fund Participation Agreements

       27                           The Company

       28                           Directors and Officers

       29                           The Company

       30                           Not Applicable

       31                           Not Applicable

       32                           Not Applicable

       33                           Not Applicable

       34                           Not Applicable

       35                           The Company

       36                           Not Applicable

       37                           Not Applicable

       38                           Distribution of Policies

       39                           Distribution of Policies

       40                           Not Applicable

       41                           Distribution of Policies

       42                           Not Applicable

       43                           Not Applicable

       44                           The Separate Account and The Fund Accounts;
                                    Certificate Values; The Funds; Charges and 
                                    Fees
</TABLE>
<PAGE>   4
<TABLE>
<CAPTION>               
    N-8B-2 Item                    Caption in Prospectus
    -----------                    ---------------------
       <S>                          <C>
       45                           Not Applicable

       46                           The Separate Account and The Fund Accounts;
                                    Certificate Values; The Funds; Surrender, 
                                    Lapse and Reinstatement; Charges and Fees

       47                           Premium Payments; The Funds

       48                           Not Applicable

       49                           Not Applicable

       50                           Not Applicable

       51                           Cover Page; Highlights; Eligibility; 
                                    Coverage Amount; Termination, Continuation,
                                    and Conversion; Premium Payments

       52                           The Funds; Substitution or Elimination of 
                                    Securities

       53                           Tax Matters

       54                           Not Applicable

       55                           Not Applicable

       56                           Not Applicable

       57                           Not Applicable

       58                           Not Applicable

       59                           Financial Statements
</TABLE>
<PAGE>   5
A REGISTRATION STATEMENT RELATING TO THESE SECURITIES HAS BEEN FILED WITH THE
SECURITIES AND EXCHANGE COMMISSION BUT HAS NOT YET BEEN EFFECTIVE.  THESE
SECURITIES MAY NOT BE SOLD NOR MAY OFFERS TO BUY BE ACCEPTED PRIOR TO THE TIME
THE REGISTRATION STATEMENT BECOMES EFFECTIVE.  THIS COMMUNICATION SHALL NOT
CONSTITUTE AN OFFER TO SELL OR A SOLICITATION OF AN OFFER TO BUY, NOR SHALL
THERE BE ANY SALE OF THESE SECURITIES IN ANY STATE IN WHICH SUCH OFFER,
SOLICITATION, OR SALE WOULD BE UNLAWFUL PRIOR TO REGISTRATION QUALIFICATION
UNDER THE SECURITIES LAWS OF ANY SUCH STATE.



                  SUBJECT TO COMPLETION, DATED JULY 11, 1995




CONNECTICUT GENERAL LIFE INSURANCE COMPANY

CG VARIABLE LIFE INSURANCE SEPARATE ACCOUNT A

                 HOME OFFICE LOCATION:
                 900 COTTAGE GROVE ROAD
                 HARTFORD, CT 06152

                 MAILING ADDRESS:
                 CIGNA COMPANIES
                 GROUP VARIABLE CUSTOMER SERVICE CENTER
                 95 HIGHLAND AVENUE
                 BETHLEHEM, PA   18017-9077
                 (800)(828-3485)
- --------------------------------------------------------------------------------

               THE GROUP VARIABLE UNIVERSAL LIFE INSURANCE POLICY
- --------------------------------------------------------------------------------

                 This prospectus describes a group variable universal life
insurance contract ("Policy") offered by Connecticut General Life Insurance
Company ("the Company").  The Policy is a group master contract entered into
between a Group Policyholder (an employer or a union) and the Company. Certain
Employees (employees or union members) as agreed upon between the Group
Policyholder and the Company, may become insured under the Policy. Employees
who become insured under the Policy will receive a Certificate of Insurance
("Certificate") describing their rights under the Policy. Employees may obtain
life insurance coverage for their spouses and dependent children as well.

This Policy is intended to provide life insurance benefits.  It provides for a
death benefit, flexible premium payments, a choice of underlying funding
options for the accumulation of cash value,  and a choice of additional benefit
options.  Its cash value will, and the death benefit may, vary with the
investment performance of the underlying funding options selected. Certificate
Cash Values may be used to continue the Certificate in force, may be borrowed
within certain limits, and may be fully or partially surrendered.  No sales
loads are charged under this Policy.

                 The Company offers seven variable funding vehicles
("Funds")under the Policy through the Separate Account.  Each Fund is a
portfolio of a diversified open-end management investment company (commonly
called a mutual fund) and each Fund has a different investment objective:

                 o  CIGNA Variable Products Money Market Fund
                 o  Fidelity VIP II Investment Grade Bond Portfolio
                 o  Fidelity VIP II Asset Manager Portfolio
                 o  CIGNA Variable Products Index Fund
                 o  Fidelity VIP Equity-Income Portfolio
                 o  Twentieth Century TCI Growth Fund
                 o  Fidelity VIP Overseas Portfolio
<PAGE>   6
                 The fixed interest option offered under the Policy is the
Fixed Account.  Amounts held in the Fixed Account are guaranteed and will earn
a minimum interest rate of 4% per year.  Unless specifically mentioned, this
prospectus only describes the variable investment options.

                 It may not be advantageous to replace existing insurance or
supplement an existing variable universal life insurance policy with coverage
under the Policy.  This entire Prospectus, and those of the Funds, should be
read carefully to understand the Policy being offered.

THIS PROSPECTUS IS VALID ONLY WHEN ACCOMPANIED BY THE CURRENT PROSPECTUSES OF
THE MUTUAL FUNDS AVAILABLE AS FUNDING OPTIONS FOR THE POLICIES OFFERED BY THIS
PROSPECTUS.  ALL PROSPECTUSES SHOULD BE RETAINED FOR FUTURE REFERENCE.

THESE SECURITIES HAVE NOT BEEN APPROVED OR DISAPPROVED BY THE SECURITIES AND
EXCHANGE COMMISSION, NOR HAS THE COMMISSION PASSED UPON THE ACCURACY OR
ADEQUACY OF THIS PROSPECTUS.  ANY REPRESENTATION TO THE CONTRARY IS A CRIMINAL
OFFENSE.

THIS PROSPECTUS DOES NOT CONSTITUTE AN OFFER OF, OR SOLICITATION OF AN OFFER TO
ACQUIRE, ANY INTEREST OR PARTICIPATION IN THE GROUP VARIABLE UNIVERSAL LIFE
INSURANCE POLICIES OFFERED BY THIS PROSPECTUS IN ANY JURISDICTION TO ANYONE TO
WHOM IT IS UNLAWFUL TO MAKE SUCH AN OFFER OR SOLICITATION IN SUCH JURISDICTION.


                     PROSPECTUS DATED: [                 ]
<PAGE>   7
                               TABLE OF CONTENTS

<TABLE>
<CAPTION>
                                                                                                                    Page
<S>                                                                                                                   <C>
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      4
Highlights  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      8
    Initial Choices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      8
    Death Benefit Amount  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      8
    Amount of Premium Payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      9
    Selection of Funding Vehicles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      9
    Charges and Fees  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      9
The Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     11
The Separate Account and The Fund Accounts  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     11
The Funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     12
    Fund Annual Expenses  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     15
    Investment Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     16
    Substitution or Elimination of Funds  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     17
    Fund Participation Agreements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     17
Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     17
Coverage Amounts  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     18
    Amounts of Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     18
    Guaranteed Issue Amounts  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     18
    Changes in Coverage Amounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     18
    Automatic Increase Feature  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     19
Effective Dates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     20
Right To Examine Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     20
Death Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     20
    Amount of Death Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     20
    Payment of Death Benefit  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     21
Premium Payments  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     22
    Premium Payments  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     22
    Premium Increases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     23
    Allocation of Net Premium Payments  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     23
Certificate Values  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     24
    Cash Value  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     24
    Variable Accumulation Unit Value  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     26
    Transfers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     26
    Net Cash Value  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     28
Charges and Fees  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     28
    Premium Load  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     28
    Monthly Deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     28
    Transaction Fees for Excess Transfers and Surrenders  . . . . . . . . . . . . . . . . . . . . . . . . . . . .     30
    Mortality and Expense Risk Charge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     30
Certificate Loans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     31
Surrender, Lapse, and Reinstatement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     32
    Full Surrenders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     32
    Partial Surrenders  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     32
    Lapse of a Certificate  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     33
    Reinstatement of a Lapsed Certificate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     33
Termination, Continuation, and Conversion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     33
    Policy Termination  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     33
</TABLE>





2
<PAGE>   8
<TABLE>
<S>                                                                                                                   <C>
    Termination of Individual Coverage  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     33
    Continuation  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     34
    Conversion  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     34
Additional Coverage Riders  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     35
    Accidental Death, Dismemberment, and Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     35
    Waiver of Cost of Life Insurance  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     35
    Paid-Up Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     36
    Advanced Payment Benefit  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     36
    Seat Belt Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     38
Other Policy Provisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     38
    Deferral of Payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     38
    Fixed Benefit Policy Exchange . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     38
    Certificate Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     39
    Beneficiary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     39
    Assignment  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     40
    Incontestability  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     40
    Misstatement of Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     40
    Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     40
State Variation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     41
Non-Participating Policies  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     41
Dollar Cost Averaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     41
Tax Matters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     42
    Policy Proceeds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     42
    Taxation of the Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     44
    Section 848 Charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     44
    Other Considerations  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     45
Other Matters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     45
    Voting Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     45
    Directors and Officers  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     47
    Distribution of Policies  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     48
    Other Contracts Issued by the Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     48
    Right to Take Actions Regarding the Separate Account  . . . . . . . . . . . . . . . . . . . . . . . . . . . .     49
    State Regulation  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     49
    Reports to Certificate Owners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     50
    Advertisements  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     50
    Legal Proceedings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     50
    Experts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     51
    Registration Statement  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     51
    Financial Statements  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     51
    Illustrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     52
</TABLE>





                                                                               3
<PAGE>   9
    DEFINITIONS

                 CASH VALUE: The sum of the Fixed Account Value, the Fund
                 Account Values and the Loan Account Value.

                 CERTIFICATE:  The document given to a person insured under the
                 Policy as evidence of that person's rights and obligations
                 under the Policy.

                 CERTIFICATE EFFECTIVE DATE: The date on which the Certificate
                 becomes effective, as shown in the Coverage Verification
                 Pages.

                 CODE: The Internal Revenue Code of 1986, as amended.

                 CORRIDOR DEATH BENEFIT: The Death Benefit calculated as a
                 percentage of the Cash Value rather than by reference to the
                 Coverage Amount to satisfy the Internal Revenue Service
                 definition of life insurance.

                 COST OF INSURANCE: The portion of the Monthly Deduction
                 attributable to the life insurance coverage, not including
                 riders, supplemental benefits or monthly administrative fees.

                 COVERAGE AMOUNT:  The amount of life insurance benefit
                 selected by the Owner upon application and changed from time
                 to time by the Owner as described in this Prospectus.

                 CURRENT OUTSTANDING LOAN BALANCE:  The Loan Balance plus all
                 interest accrued but not yet paid.

                 CUSTOMER SERVICE CENTER: The office of the Company to which
                 Premium Payments should be sent, notices given and any
                 customer service requests made.  Unless otherwise stated in
                 the Coverage Verification Pages of the Certificate, the
                 mailing address of the Customer Service center is:  CIGNA
                 Companies, Group Variable Customer Service Center, 95 Highland
                 Avenue, Bethlehem, PA 18017-9077

                 DEATH BENEFIT: The amount payable to the beneficiary upon the
                 death of the Insured. The Death Benefit is reduced by any
                 advanced payment benefit made under the Certificate and any
                 amounts due the Company under the Certificate.

                 FIXED ACCOUNT: The account under which principal is





4
<PAGE>   10
                 guaranteed and interest is credited at a rate of not less than
                 4% per year.  Fixed Account assets are general assets of the
                 Company held in the Company's General Account.

                 FIXED ACCOUNT VALUE: The portion of the Cash Value, other than
                 the Loan Account Value, held in the Company's General Account.

                 FUND ACCOUNT:  An Account, the value of which varies based on
                 the net investment performance of a specific Fund, as
                 described herein. Fund Account assets are held in the Separate
                 Account and are not guaranteed.

                 FUND ACCOUNT VALUE:  The Cash Value portion which is
                 determined by multiplying the number of Variable Accumulation
                 Units in the Fund Account by the current Variable Accumulation
                 Unit Value.

                 FUND(S): One or more of CIGNA Variable Products Money Market
                 Fund, Fidelity VIP II Investment Grade Bond Portfolio,
                 Fidelity VIP II Asset Manager Portfolio, CIGNA Variable
                 Products Index Fund, Fidelity VIP Equity-Income Portfolio,
                 Twentieth Century TCI Growth Fund and Fidelity VIP Overseas
                 Portfolio.

                 Each Fund is an open-end management investment company, or a
                 portfolio of an open-end management investment company, whose
                 investment performance is used in determining the investment
                 performance of a Fund Account under the Policy.

                 GENERAL ACCOUNT: The Company's general asset account, in
                 which, along with other assets of the Company, the assets
                 supporting the non-variable portion of the Policy are held.

                 GRACE PERIOD: The period after the Certificate's Net Cash
                 Value becomes insufficient to cover a due but unpaid Monthly
                 Deduction during which the Owner may keep the Certificate in
                 force by paying the required premium.

                 INSURED: The person whose life is insured in the Certificate.

                 LOAN ACCOUNT VALUE: A portion of the Cash Value equal to the
                 sum of all unpaid Certificate loans, plus all unpaid interest
                 added to the Loan Balance





                                                                               5
<PAGE>   11
                 as provided for in the Policy, less repayments on loans, plus
                 interest which accrues daily on the Loan Account.

                 LOAN BALANCE:   The sum of all loans under the Certificate
                 less any loan repayments, plus all unpaid interest added to
                 the Loan Balance as provided for in the Policy.

                 MONTHLY DEDUCTION: The monthly deduction made from the Net
                 Cash Value; this deduction includes the cost of insurance, 
                 monthly administrative fees and charges for supplemental
                 riders or benefits, if applicable.

                 NET CASH VALUE: The Cash Value less the Current Outstanding
                 Loan Balance.

                 NET PREMIUM PAYMENT: The portion of a premium payment, after
                 deduction of the premium load, available for allocation to the
                 Fixed Account and the Fund Accounts.

                 OWNER: The Owner of a Certificate under a Policy on the
                 Certificate Effective Date will be the person designated as
                 Owner in the Coverage Verification Pages.  If no person is
                 designated as Owner, the Insured will be the Owner.

                 POLICY:  The group life insurance contract described in this
                 Prospectus, under which flexible premium payments are
                 permitted and the death benefit and contract values may vary
                 with the investment performance of the funding option(s)
                 selected.

                 POLICY ANNIVERSARY DATE:   The Policy Anniversary Date stated
                 in the Coverage Verification Pages of the Certificate.

                 POLICY YEAR: Each twelve-month period, beginning on the Policy
                 Anniversary Date, during which the Policy is in effect.

                 RELATED FUND: The Fund whose investment performance is the
                 basis for determining the investment performance of a specific
                 Fund Account.

                 SEPARATE ACCOUNT: CG Variable Life Insurance





6
<PAGE>   12
                 Separate Account A. Separate Account assets are kept separate
                 from the general assets of the Company and are not, except to
                 the extent that they exceed Separate Account liabilities,
                 chargeable with the general liabilities of the Company.

                 VALUATION DAY: Every day on which Variable Accumulation Units
                 are valued; any day on which the New York Stock Exchange is
                 open, except any day on which trading on the Exchange is
                 restricted, or on which an emergency exists, as determined by
                 the Securities and Exchange Commission, so that valuation or
                 disposal of securities is not practicable.

                 VALUATION PERIOD: The period consisting of one or more days,
                 from one Valuation Time to the next succeeding Valuation Time.

                 VALUATION TIME: The time of the close of the New York Stock
                 Exchange (currently 4:00 p.m. New York time) on a Valuation
                 Day. All actions which are to be performed on a Valuation Day
                 will be performed as of the Valuation Time.

                 VARIABLE ACCUMULATION UNIT: A unit of measure used to
                 calculate the value of a Fund Account.





                                                                               7
<PAGE>   13
HIGHLIGHTS
                 The Policy is a group variable universal life insurance
                 policy. The Policy will be sold to Group Policyholders
                 (employers and unions) to make available life insurance
                 coverage for their Employees (employees of the employer or
                 members of the union). Employees who purchase coverage on
                 their own lives will receive a Certificate of Insurance under
                 the Policy. Employees may also purchase a Certificate of
                 Insurance under the Policy on the lives of their spouses. Term
                 life insurance coverage on the lives of the dependent children
                 of the Employee may be added as an additional benefit to the
                 Certificate of Insurance on the Employee or the Certificate of
                 Insurance on the spouse (but not both).

                 Each Certificate may accumulate Cash Value on a fixed or a
                 variable basis or on a combination of fixed and variable
                 bases. (See Eligibility Section)

                 The Policy's provisions may vary from state to state as
                 required by state law.

                 INITIAL CHOICES TO BE MADE

                 When purchasing a Certificate under a Policy, the Owner makes
                 three important choices:

                 1)  Selecting the initial Coverage Amount;
                 2)  Selecting the amount of premium payments to make; and
                 3)  Selecting how Net Premium Payments will be allocated among
                     the available funding options.

                 (See Coverage Amount and Premium Payment Sections)

                 DEATH BENEFIT AMOUNT

                 At the time of purchase, the Certificate Owner (also called
                 the "Owner" in this Prospectus) must choose the initial
                 Coverage Amount.  The Coverage Amount may be changed from time
                 to time by the Owner.  The Death Benefit will be the Coverage
                 Amount plus the Net Cash Value less any amounts due the
                 Company under the Certificate.  The Death Benefit will be
                 reduced by the amount of any Advanced Payment Benefit made 
                 under the Policy.  The amount payable will be determined 
                 as of the date of the Insured's death based on investment 
                 performance and any changes made by the Owner. (See Death 
                 Benefit Section)





8
<PAGE>   14
                 AMOUNT OF PREMIUM PAYMENT

                 At the time of purchase, the Owner must also choose the amount
                 of premium to be paid.  The Owner may vary premium payments to
                 some extent and still keep the Certificate in force.  Premium
                 reminder notices will be sent for premiums required to
                 continue the Certificate in force.  If the Certificate lapses
                 it may be reinstated. (See "Reinstatement of a Lapsed
                 Certificate".)

                 SELECTION OF FUNDING VEHICLE(S)

                 The Owner must choose how to allocate Net Premium Payments.
                 Net Premium Payments may be allocated, in any combination, to
                 one or more Fund Accounts, each of which varies in value based
                 on the performance of a particular Fund, and to the Fixed
                 Account. Allocations to any Fund Account or to the Fixed
                 Account must be in 5% increments.  (See Allocation of Net
                 Premium Payments Section)

                 Fund Account Values are not guaranteed and will vary with the
                 investment performance of the specific Fund underlying that
                 Fund Account.

                 CHARGES AND FEES

                 There is no sales load.

                 There is a premium load on all premium payments which will not
                 exceed 5.00%. Currently the premium load is 3.00% which is
                 made up of 2.50% for state premium taxes and 0.50% for the
                 additional federal income tax burden under Section 848 of the
                 Code relating to the tax treatment of deferred acquisition
                 costs.

                 Monthly deductions are made for the cost of insurance and any
                 additional benefits.

                 Monthly deductions are also made for administrative expenses.
                 The administrative charge is comprised of two fixed dollar
                 monthly fees, the sum of which will not exceed $6.00 per
                 month. The first fixed dollar monthly fee, which will not
                 exceed $5.00 per month, will be charged to each Certificate
                 under the Policy. The second fixed dollar monthly fee, which
                 will not exceed $3.00 per month,  will be charged, in addition
                 to the first fee, to Certificates which have accumulated Cash
                 Value in any Fund Account. The second fixed dollar





                                                                               9
<PAGE>   15
                 monthly fee will be waived for Certificates under which the
                 Net Cash Value is greater than $10,000.

                 Daily charges to the Fund Accounts are made for the mortality
                 and expense risks.  The mortality and expense risk charge may
                 vary up to an annual rate of 0.90%.  It is currently at the
                 annual rate of 0.45%.

                 Investment results for each Fund Account are affected by each
                 Fund's daily charge for management fees; these charges vary by
                 Fund and are shown at page 15 of this Prospectus.

                 A transaction fee of $25 is imposed for full surrenders,
                 partial surrenders and for transfers in excess of 12 per
                 Policy Year.  The Company reserves the right to waive this fee
                 in some circumstances.

                 Interest is charged on Certificate loans at an effective
                 annual rate of 8%.  Interest is credited to funds securing the
                 loan at an effective annual rate of no less than 6%.

                 In certain instances, the Company may reduce monthly
                 administrative fees and/or waive certain transaction fees in
                 the sale of Policies to certain groups. 

                 Costs for sales, administration, and mortality generally vary
                 with the size and stability of the group among other factors.
                 The Company takes all these factors into account when reducing
                 charges. To qualify for reduced charges, a group or similar
                 arrangement must meet certain requirements, including our
                 requirements for size and ease of administration.

                 The Company will make any reductions according to its rules in
                 effect when an application or enrollment form for a Policy is
                 approved. The Company may change these rules from time to
                 time. Any variation in the monthly administrative fees or
                 transaction fees will reflect differences in costs or services
                 and will not be unfairly discriminatory.





10
<PAGE>   16
THE COMPANY
                 The Company is a stock life insurance company incorporated in
                 Connecticut in 1865.  Its Home Office mailing address is
                 Hartford, Connecticut 06152, Telephone (203) 726-6000.  It has
                 obtained authorization to do business in fifty states, the
                 District of Columbia and Puerto Rico.  The Company issues
                 group and individual life and health insurance policies and
                 annuities.  The Company has various wholly-owned subsidiaries
                 which are generally engaged in the insurance business.  The
                 Company is an indirect wholly-owned subsidiary of CIGNA
                 Corporation, Philadelphia, Pennsylvania.

                 The Company markets the Policies through independent insurance
                 brokers, general agents, and registered representatives of
                 broker-dealers who are members of the National Association of
                 Securities Dealers, Inc.


THE SEPARATE
ACCOUNT AND THE
FUND ACCOUNTS
                 Cash Value invested in the Fund Accounts of a Certificate
                 under the Policy is held in the Separate Account. The Separate
                 Account, CG Variable Life Insurance Separate Account A, was
                 established pursuant to a May 22, 1995 resolution of the Board
                 of Directors of the Company.  Under Connecticut insurance law,
                 the income, gains or losses of the Separate Account are
                 credited without regard to the other income, gains or losses
                 of the Company.  The Company serves as the custodian of the
                 assets of the Separate Account.  These assets are held for the
                 Policies. The Separate Account cannot be charged with
                 liabilities of the Company other than liabilities under the
                 Policies or under other Policies whose variable values and
                 benefits are supported by the Separate Account, except to the
                 extent that the Separate Account assets exceed the reserves
                 and other contract liabilities of the Separate Account. All
                 obligations arising under the Policies are general corporate
                 liabilities of the Company.  Separate Account assets are
                 invested in shares of Funds.

                 Owners who allocate Net Premium Payments, or transfer funds
                 from another account, into a Fund Account receive Variable
                 Accumulation Units of the





                                                                              11
<PAGE>   17
                 Related Fund valued at the current Variable Accumulation Unit
                 Value for that Fund.  Variable Accumulation Unit Values for a
                 Fund vary each Valuation Day based on the investment
                 performance of the Related Fund. Any and all distributions
                 made by any Fund with respect to shares held by the Separate
                 Account will be reinvested in additional shares of the Fund at
                 net asset value.

                 Deductions, transfers, and surrenders from Fund Accounts will, 
                 in effect, be made by surrendering Variable Accumulation Units 
                 of the Related Fund at the then current Variable Accumulation 
                 Unit Value.

                 The Separate Account is registered with the Securities and
                 Exchange Commission ("Commission") as a unit investment trust
                 under the Investment Company Act of 1940 (the "Act").  Such
                 registration does not involve supervision of the Separate
                 Account or the Company's management of investment practices or
                 policies by the Commission.  The Company does not guarantee
                 the Separate Account's investment performance or the
                 performance of the Certificates' Fund Accounts.

                 The Company has other separate accounts registered as unit
                 investment trusts with the Commission for the purpose of
                 funding the Company's variable annuity contracts and other
                 variable life insurance contracts.

THE FUNDS
                 Each of the Fund Accounts under a Certificate is supported
                 solely by the shares of one of the Funds available as funding
                 vehicles under the Policies.  Each of the Funds is a portfolio
                 of a trust or a corporation which is registered as an
                 open-end, diversified management investment company under the
                 Act (an "Investment Company").

                 The Investment Companies and their investment advisers and
                 distributors are:

                 Fidelity's Equity-Income Portfolio and Fidelity's Overseas
                 Portfolio are portfolios of the Variable Insurance Products
                 Fund; and, Fidelity's Asset Manager Portfolio and Fidelity's
                 Investment Grade Bond Portfolio are portfolios of the Variable
                 Insurance Products Fund II.

                 Fidelity Management & Research Company, 82





12
<PAGE>   18
                 Devonshire Street, Boston, Massachusetts, is the investment
                 adviser to Variable Insurance Products Fund and Variable
                 Insurance Products Fund II. These funds are distributed by
                 Fidelity Distributors Corporation, 82 Devonshire Street,
                 Boston, Massachusetts, 02103.

                 TCI Growth is a portfolio of TCI Portfolios, Inc.

                 Investors Research Corporation, Twentieth Century Tower, 4500
                 Main Street, Kansas City, Missouri, 64111 is the investment
                 adviser to TCI Portfolios, Inc. which is distributed by TCI
                 Portfolios, Inc., 4500 Main Street, P.O. Box 419385, Kansas
                 City, Mo., 64141-6385.

                 CIGNA Companion Fund and CIGNA Money Market Fund are
                 portfolios of CIGNA Variable Products Group.

                 CIGNA Investments, Inc.,900 Cottage Grove Road, Bloomfield,
                 Connecticut, 06152-2215, is the investment adviser to CIGNA
                 Variable Products Group, which is distributed by CIGNA
                 Financial Advisors, Inc., 900 Cottage Grove Road, Bloomfield,
                 Ct. 06152

                 The investment advisory fees charged the Funds by their
                 advisers are shown on page 15 of this Prospectus.

                 There follows a brief description of the investment objective
                 of each Fund.  There can be no assurance that any of the
                 stated investment objectives will be achieved.


                 CIGNA MONEY MARKET FUND

                 The fund seeks to earn a high level of current income while
                 maintaining a stable share price by investing in high-
                 quality, short-term money market securities of different
                 types. It stresses income, preservation of capital, and
                 liquidity, and does not seek the higher yields or capital
                 appreciation that more aggressive investments may provide. The
                 fund's yield will vary from day to day and generally reflects
                 current short-term interest rates and other market conditions.

                 FIDELITY INVESTMENT GRADE BOND PORTFOLIO

                 The fund seeks high current income by investing





                                                                              13
<PAGE>   19
                 primarily in fixed-income obligations of all types. The fund
                 invests at least 65% of its assets in investment-grade, fixed
                 income securities such as bonds, notes and debentures, and
                 maintains a dollar-weighted average maturity of ten years or
                 less. Because the fund invests in fixed income securities, its
                 share price is related to changes in interest rates. The fund
                 may use various investment techniques to hedge the fund's
                 risks, but there is no guarantee that these strategies will
                 work as intended. With its focus on medium- to high-quality
                 investments and intermediate maturity, the fund has a moderate
                 risk level and yield potential.

                 FIDELITY ASSET MANAGER PORTFOLIO

                 The fund seeks high total return with reduced risk over the
                 long term. The fund seeks to achieve its investment objective
                 by allocating its assets among stocks, bonds, short-term and
                 other investments of U.S. and foreign issuers. The fund
                 spreads its assets among all three asset classes moderating
                 both its risk and return potential.  Because the fund can
                 invest in bonds and short-term instruments, its returns may
                 not be as high as a fund that invests only in stocks.

                 CIGNA INDEX FUND

                 The fund seeks to match the total return of the S&P 500 while
                 keeping expenses low. The S&P is made up of 500 common stocks,
                 most of which trade on the New York Stock Exchange. The fund's
                 composition may not always be identical to that of the S&P
                 500. Because the fund seeks to track, rather than exceed, the
                 performance of the S&P 500, it is not managed in the same
                 manner as other mutual funds. It should not be expected to
                 achieve the potentially greater results that could be 
                 obtained by a fund that aggressively seeks growth.

                 FIDELITY EQUITY-INCOME PORTFOLIO

                 The fund seeks reasonable income by investing primarily in
                 income-producing securities. It will normally have 65% of its
                 assets invested in such securities. The balance will tend to
                 be invested in debt obligations many of which are expected to
                 be convertible into common stock.The fund seeks to achieve a
                 yield that beats that of the S&P 500.  The fund does have the
                 flexibility to invest the





14
<PAGE>   20
                 balance in all types of securities, including bonds of varying
                 quality. The fund is designed for those who want some income
                 from equity and bond investments, but also want to be invested
                 in the stock market for its long-term growth potential.

                 TWENTIETH CENTURY TCI GROWTH

                 The investment objective of TCI Growth is capital growth. The
                 fund will seek to achieve its investment objective by
                 investing primarily in common stocks that are considered by
                 management to have better-than-average prospects for
                 appreciation. It may purchase securities only of companies
                 that have a record of at least three years' continuous
                 operation.

                 FIDELITY OVERSEAS PORTFOLIO

                 The fund seeks long-term growth of capital by investing
                 primarily in securities of issuers whose principal activities
                 are outside of the U.S. The fund normally invests at least 65%
                 of its total assets in securities of issuers from at least
                 three different countries outside of North America. The fund
                 expects to invest a majority of its assets in equity
                 securities, but may also invest in debt securities of any
                 quality. The fund may invest in the securities of any issuer,
                 including companies and other business organizations, as well
                 as governments and government agencies. It is important to
                 note that investments in foreign securities involve risks in
                 addition to those of U.S. investments. The performance of the
                 fund depends upon currency values, the political and
                 regulatory environment, and overall economic factors in the
                 countries in which the fund invests.

                 FUND ANNUAL EXPENSES
                 (as a percentage of Fund average net assets)

                 The management fees for each Fund are based on a percentage of
                 that Fund's assets under management.  The fees below represent
                 the amounts payable to the investment adviser of each of the
                 Funds on an annual basis as of the date of this Prospectus,
                 plus other expenses.





                                                                              15
<PAGE>   21
<TABLE>
<CAPTION>
                                                                                                     TOTAL
                                                             MANAGEMENT             OTHER            ANNUAL
                                                                FEES               EXPENSES         EXPENSES
                 <S>                                             <C>                     <C>           <C>
                 CIGNA Money Market Fund                          .35%                   .35%           .70%
                 (1)

                 Fidelity Investment Grade
                 Bond Portfolio                                   .46%                   .21%           .67%

                 Fidelity Asset Manager
                 Portfolio  (2)                                   .72%                   .08%           .80%

                 CIGNA Index Fund                                 .35%                   .40%           .75%

                 Fidelity Equity-Income
                 Portfolio   (2)                                  .52%                   .06%           .58%

                 TCI Growth                                      1.00%                   .00%          1.00%

                 Fidelity Overseas
                 Portfolio                                        .77%                   .15%           .92%
</TABLE>


                 (1)     The expenses shown here include a cap on other
                         expenses of .35%.  Without this cap, it is estimated
                         that total annual expenses would be ___________.

                 (2)     A portion of the brokerage commissions the portfolio
                         was paid was used to reduce its expenses. Without this
                         reduction, "Total Annual Expenses" would have been
                         .81% for Asset Manager and .60% for Equity-Income.

                 The purpose of the above Table is to assist the Certificate
                 Owner in understanding the various Fund costs and expenses
                 that a Certificate Owner will incur, directly or indirectly.
                 For additional information, see the Funds in this Prospectus
                 and the discussion in each Fund's prospectus.

                 INVESTMENT RISK

                 There is no assurance that the investment objective of any of
                 the Funds will be met.  A Certificate Owner bears the complete
                 investment risk for those portions of his Cash Value allocated
                 to a Fund Account.  Each of the Fund





16
<PAGE>   22
                 Accounts involves inherent investment risk, and such risk
                 varies significantly among the Fund Accounts.  Certificate
                 Owners should read each Fund's prospectus carefully and
                 understand the Fund Accounts' relative degrees of risk before
                 making or changing investment choices.  Additional Funds may,
                 from time to time, be made available as investments to
                 underlie the Policies.  However, the right to make such
                 selections will be limited by the terms and conditions imposed
                 on such transactions by the Company.

                 SUBSTITUTION OR ELIMINATION OF FUNDS

                 If the shares of any Fund should no longer be available for
                 investment by the Separate Account or if, in the judgment of
                 the Company, further investment in such shares should become
                 inappropriate in view of the purpose of the investment
                 objectives of the Policies or the Separate Account, the
                 Company may substitute shares of another Fund or eliminate
                 such Fund from the Separate Account.  No substitution or
                 elimination of securities supporting any Fund Account may take
                 place without prior approval of the Commission and under such
                 requirements as it may impose and notification to Group
                 Policyholders and Owners.

                 FUND PARTICIPATION AGREEMENTS

                 The Company has entered into agreements with the various
                 Investment Companies and their advisers or distributors
                 through which the Company makes the Funds available under the
                 Policies and performs certain administrative services.  In
                 some cases, the advisers or distributors may compensate the
                 Company for such services.

ELIGIBILITY
                 The Policies will be sold to Group Policyholders (employers
                 and unions) who wish to make variable universal life insurance
                 coverage available to all or a portion of their Employees
                 (employees of employers and members of unions) and retirees,
                 and their families. Employees may apply for coverage under the
                 Policy within policy limits and subject to certain
                 requirements to provide evidence of good health.

                 Employees may also apply for variable universal life insurance
                 coverage on their spouses and for





                                                                              17
<PAGE>   23
                 term life insurance coverage on their children. Depending upon
                 the coverage selected by the Group Policyholder, Employees may
                 be able to continue their coverage upon retirement, leave of
                 absence, and/or termination of employment. Spouses may be able
                 to continue coverage upon divorce, or death of the Employee.


COVERAGE AMOUNTS


                 AMOUNTS OF COVERAGE

                 Coverage Amounts for Employees will be in multiples of the
                 Employee's annual compensation and will be selected by the
                 Employee at the time of enrollment. The minimum Coverage
                 Amount for Insured Employees is $10,000. The minimum Coverage
                 Amount for spouses is the lesser of $10,000 or 50% of the
                 Employee selected amount. The maximum Coverage Amount will be
                 agreed upon by the Group Policyholder and the Company but
                 shall not be more than the lesser of ten times annual
                 compensation or a fixed dollar maximum.

                 Coverage for spouses will be in $10,000 increments up to 50%
                 of the Employee selected amount.

                 Maximum Coverage Amounts are subject to limitation by state
                 law and may vary from state to state.

                 GUARANTEED ISSUE AMOUNTS

                 Employees will be able to purchase insurance on themselves and
                 their spouses in amounts up to a guaranteed issue amount
                 without providing evidence of good health. The guaranteed
                 issue amount will be agreed upon between the Group
                 Policyholder and the Company before coverage under the Policy
                 is offered to Employees. Employees and their spouses will be
                 required to provide evidence of good health for amounts of
                 insurance in excess of the guaranteed issue amount, for any
                 increases in coverage, or if they enroll after the Policy
                 Effective Date, or more than 30 days after becoming eligible
                 after the Policy Effective Date.

                 CHANGES IN COVERAGE AMOUNTS

                 Changes in the Coverage Amount of a Certificate can be made by
                 submitting a written request to the





18
<PAGE>   24
                 Customer Service Center in a form satisfactory to the Company.

                 Increases in an Employee's Coverage Amount may be applied for
                 based on an increase in the Employees' annual compensation or
                 a higher multiple of the Employee's compensation.  Increases
                 in the Coverage Amount for a spouse or child may be applied
                 for at any time.

                 Changes in the Coverage Amount are subject to the following
                 conditions:
 
                 *       Satisfactory evidence of good health and a
                         supplemental application will be required for an
                         increase in the Coverage Amount.

                 *       No decrease may reduce the Coverage Amount to less
                         than $10,000 (for spouses, 50% of the Employee
                         Coverage Amount if the Employee Coverage Amount is
                         less than $20,000).

                 *       No decrease may reduce the Coverage Amount below the
                         minimum required to maintain the Policy's or the
                         Certificate's status under the Code as a life
                         insurance contract.

                 *       If the Automatic Increase Feature is available on the
                         Policy and the Employee has elected it, the Coverage
                         Amount for an Insured Employee will be increased on
                         the Policy Anniversary Date to maintain his elected
                         multiple of annual compensation.  Evidence of good
                         health will not be required for increases in Coverage
                         Amount through the Automatic Increase Feature.

                 AUTOMATIC INCREASE FEATURE

                 If the Group Policyholder has elected to have this feature
                 offered on the Policy, and the Employee has elected this
                 feature, the Employee's Coverage Amount will be increased on
                 each Policy Anniversary Date in order to maintain his elected
                 multiple of annual compensation. Evidence of good health will
                 not be required for this increase in Coverage Amount. The
                 amount of the increase may be subject to a dollar and/or
                 percentage limit.








                                                                              19
<PAGE>   25
EFFECTIVE DATES

                 Coverage, for applicants who apply within 31 days of becoming
                 eligible, up to the guaranteed issue amounts will become
                 effective either when the applicant becomes eligible or when
                 the completed application is received. For applicants who
                 apply later, and for amounts in excess of the guaranteed issue
                 amount, coverage will become effective when the Company agrees
                 in writing to insure the applicant.

                 For Employees not in active service, the effective date of
                 coverage will be delayed until the return to active service.
                 For spouses who are disabled or for spouses and children who
                 are hospitalized or confined at home under medical care, the
                 effective date of coverage will be delayed until all such
                 conditions have ended. If the conditions delaying the
                 effective date are not resolved within 90 days of the original
                 application date, a new application and new evidence of good
                 health will be required.

RIGHT TO EXAMINE

                 A Certificate may be returned for cancellation and a full
                 refund of premium within 30 days after the Certificate is
                 received, unless otherwise stipulated by state law
                 requirements.  Any premium payment made prior to the
                 expiration of the 30 day Right to Examine period will be held
                 in the Fixed Account and not allocated to the Separate Account
                 even if the Certificate Owner may have so directed until three
                 business days following the expiration of the Right-
                 to-Examine period.  If the Certificate is returned for
                 cancellation in a timely fashion, the refund of premiums paid,
                 without interest, will usually occur within seven days of
                 notice of cancellation, although a refund of premiums paid by
                 check may be delayed until the check clears the bank upon
                 which it is drawn.  Any refund will be reduced by partial
                 surrenders or loans plus interest accrued.

DEATH BENEFIT

                 AMOUNT OF DEATH BENEFIT

                 The Death Benefit will be the greater of the Coverage Amount
                 (an amount selected by the Owner, and subject to change by the
                 Owner from time to





20
<PAGE>   26
                 time, with certain restrictions), plus the Net Cash Value, or
                 the Corridor Death Benefit.  The Death Benefit varies,
                 increasing or decreasing over time, depending on the amount of
                 premium paid and the investment performance of the Fund
                 Accounts and the Fixed Account.  The Death Benefit will be
                 reduced by any amount paid under the Advanced Payment Benefit 
                 Rider.

                 PAYMENT OF DEATH BENEFIT

                 The Death Benefit under the Certificate will be paid in a lump
                 sum within seven days after receipt at the Customer Service
                 Center of due proof of the Insured's death (a certified copy
                 of the death certificate) plus such other documentation as the
                 Company may require as proof of a covered claim under the
                 Certificate.  Payment of the Death Benefit may be delayed if 
                 the Certificate is being contested.

                 The Death Benefit under the Certificate at any time must be at
                 least the following "Corridor Percentage" of the Cash Value
                 based on the Insured's attained age:

<TABLE>
<CAPTION>
                   INSURED'S              CORRIDOR              INSURED'S                CORRIDOR
                 ATTAINED AGE            PERCENTAGE           ATTAINED AGE              PERCENTAGE
                 ------------            ----------           ------------              ----------
                     <S>                    <C>                     <C>                    <C>
                     0-40                   250%                    70                     115%
                      41                    243                     71                     113
                      42                    236                     72                     111
                      43                    229                     73                     109
                      44                    222                     74                     107
                                            ---                     --                     ---

                      45                    215                     75                     105
                      46                    209                     76                     105
                      47                    203                     77                     105
                      48                    197                     78                     105
                      49                    191                     79                     105
                                            ---                     --                     ---

                      50                    185                     80                     105
                      51                    178                     81                     105
                      52                    171                     82                     105
                      53                    164                     83                     105
                      54                    157                     84                     105
                                            ---                     --                     ---

                      55                    150                     85                     105
                      56                    146                     86                     105
                      57                    142                     87                     105
</TABLE>





                                                                              21
<PAGE>   27
<TABLE>
                      <S>                   <C>                     <C>                    <C>
                      58                    138                     88                     105
                      59                    134                     89                     105
                                            ---                     --                     ---

                      60                    130                     90                     105
                      61                    128                     91                     104
                      62                    126                     92                     103
                      63                    124                     93                     102
                      64                    122                     94                     101
                                            ---                     --                     ---

                      65                    120                     95                     100
                      66                    119                     96                     100
                      67                    118                     97                     100
                      68                    117                     98                     100
                      69                    116                     99                     100
                                            ---                     --                     ---
</TABLE>




PREMIUM PAYMENTS

                 PREMIUM PAYMENTS

                 The Certificates provide for flexible premium payments.
                 Premium payments are payable at the frequency and in the
                 amount selected by the Certificate Owner.  The initial premium
                 payment is due on the Certificate Effective Date.  Premiums
                 may be paid on a periodic basis (for Insured Employees,
                 periodic premium payments are ordinarily made through payroll
                 deduction; for other Eligible Classes, periodic billing may be
                 available) or on a lump sum basis.  The minimum payment
                 required is the amount necessary to maintain a positive Net
                 Cash Value.  After the initial premium payment, each
                 subsequent lump sum premium payment must be at least $25.  The
                 Company reserves the right to decline a premium payment.

                 All premium payments, whether periodic or on a lump sum basis,
                 will be deemed received when actually received by the Company
                 at its Customer Service Center; or,if such premium payment is
                 made by payroll deduction, such premium payment will be deemed
                 received when the Company has confirmed receipt of a wire
                 transfer into a bank account maintained by the Company for
                 receipt of premium from Group Policyholders under these
                 Policies.  Such a wire transfer must be preceded, by 2
                 business days,by a reconciliation statement identifying the
                 Group Policyholder, the Certificate number, the Owner and the
                 amount of premium received for each Certificate.





22
<PAGE>   28
                 The Certificate Owner may elect to increase, decrease or
                 change the frequency or amount of premium payments.

                 Payment of periodic premium or lump sum premium in any amount
                 will not guarantee that the Certificate will remain in force.
                 Conversely, failure to pay periodic premium or lump sum
                 premium  will not necessarily cause a Certificate to lapse.

                 PREMIUM INCREASES

                 At any time, the Owner may increase periodic premium payment
                 amounts or make lump sum premium payments, but:

                 *      Evidence of good health may be required if the
                        additional premium or the new periodic premium payment
                        would require the Company to increase the Coverage
                        Amount.  If satisfactory evidence of good health is
                        requested and not provided, the increase in premium
                        will be refunded without interest and without
                        participation of such amounts in any Fund Account.

                 *      In no event may the total of all premium payments
                        exceed the then-current maximum premium limitations
                        established by federal law for a Certificate to qualify
                        as a life insurance contract.  If, at any time, a
                        premium payment would result in total premiums
                        exceeding such maximum premium limitation, the Company
                        will only accept that portion of the premium payment
                        which will make total premiums equal the maximum.  Any
                        part of the premium in excess of that amount will be
                        returned or applied as otherwise agreed and no further
                        premium payments will be accepted until allowed by the
                        then-current maximum premium limitations prescribed by
                        law.

                 *      If there is any Current Outstanding Loan Balance, any
                        lump sum premium payments will be used first as a loan
                        repayment with any excess applied as an additional Net
                        Premium Payment unless otherwise agreed between the
                        Owner and the Company.

                 ALLOCATION OF NET PREMIUM PAYMENTS

                 At the time of purchase of the Certificate, the





                                                                              23
<PAGE>   29
                 Owner must decide how to allocate Net Premium Payments among
                 the Fund Accounts and the Fixed Account.  Allocation to any
                 one Fund Account or to the Fixed Account must be in increments
                 of 5% of the Net Premium Payment.  The portion of any Net
                 Premium Payment allocated to a Fund Account will be used to
                 purchase Variable Accumulation Units whose value varies based
                 on the investment performance of the Related Fund. The number
                 of Variable Accumulation Units credited to the Fund Account
                 for any single purchase is determined by dividing the amount
                 of the Net Premium Payment being allocated to that Fund
                 Account by the value of the Variable Accumulation Unit for
                 that Fund Account.

                 During the Right-to-Examine period, any Net Premium Payment
                 will be allocated to the Fixed Account, and interest credited
                 from the later of Certificate Effective Date or the date the
                 Net Premium Payment was received.  The Company will allocate
                 the Net Premium Payments received during the Right to Examine
                 Period directly to the Fund Account(s) selected by the Owner
                 within three days after expiration of the Right-to-Examine
                 period.

                 Unless the Company is directed otherwise by the Certificate
                 Owner, subsequent Net Premium Payments will be allocated on
                 the same basis as the most recent Net Premium Payment.  Such
                 allocation will occur as of the Valuation Day during which the
                 payment is received.

                 The allocation for future premium payments may be changed at
                 any time free of charge.  Any new allocation will be applied
                 to premium payments beginning no later than one week after the
                 Company receives the notice of the new allocation.  Any new
                 allocation must allocate to any single Fund Account or the
                 Fixed Account in increments of 5% of the Net Premium Payment.

CERTIFICATE VALUES

                 CASH VALUE

                 The Cash Value of the Certificate is the sum of the Fixed
                 Account Value, the Fund Account Values, and the Loan Account
                 Value.

                 The Loan Account Value is described under the Certificate Loan
                 Provisions section of this Prospectus.





24
<PAGE>   30
                 The Fixed Account Value is the sum of: a) the Fixed Account
                 Value at the end of the preceding day, minus b) charges or
                 fees charged to the Fixed Account and transfers and surrenders
                 out of the Fixed Account during that day, plus c) interest on 
                 the difference between a and b, plus d) the sum of all 
                 transfers into the Fixed Account during that day and all net 
                 premium allocated to the Fixed Account during that day.

                 The Fund Account Value is the product of the number of
                 Variable Accumulation Units in that Fund Account and the
                 Variable Accumulation Unit Value for that Fund Account.

                 Variable Accumulation Units are added to a Fund Account when
                 Net Premium Payments are allocated to the Fund Account or
                 funds are transferred into the Fund Account from another Fund
                 Account, the Fixed Account, or the Loan Account.  Variable
                 Accumulation Units are deducted from a Fund Account when funds
                 are transferred out of the Fund Account to another Fund
                 Account, the Fixed Account, or the Loan Account. Variable
                 Accumulation Units are also deducted from the Fund Account
                 when funds are transferred out of the Fund Account for
                 surrender or partial surrender. Variable Accumulation Units
                 will also be deducted from the Fund Account when funds are
                 withdrawn from the Fund Account for the Monthly Deductions,
                 transaction fees, or other charges which are charged to a Fund
                 Account as provided for in the Policy.

                 The number of Variable Accumulation Units to be added to or
                 deducted from a Fund Account is determined by dividing the
                 dollar amount to be credited to or charged against the Fund
                 Account by the Variable Accumulation Unit Value of Variable
                 Accumulation Units for that Fund Account during the Valuation
                 Period in which the credit or charge will occur.

                 The Variable Accumulation Unit Value for a Fund Account is
                 maintained by the Company and changes from Valuation Period to
                 Valuation Period based on the investment performance of the
                 Related Fund, the mortality and expense risk charge, and any
                 charges to the Fund Account for taxes resulting from the
                 operation of the Separate Account. (See Variable Accumulation
                 Unit Value below.)





                                                                              25
<PAGE>   31
                 The Fixed Account Value is guaranteed; but, there is no
                 assurance that the sum of the Fund Account Values of the
                 Certificate will equal or exceed the Net Premium Payments
                 allocated to the Fund Accounts.

                 Each Certificate Owner will be advised at least annually as to
                 the number of Variable Accumulation Units which remain
                 credited to the Certificate, the current Variable Accumulation
                 Unit values, the Fund Account Values, the Fixed Account Value
                 and the Loan Account Value.

                 VARIABLE ACCUMULATION UNIT VALUE

                 The value of a Variable Accumulation Unit for any Valuation
                 Period is determined by multiplying the value of that Variable
                 Accumulation Unit for the immediately preceding Valuation
                 Period by the Net Investment Factor for the current period for
                 the appropriate Fund Account.  The Net Investment Factor is
                 determined separately for each Fund Account by dividing (a) by
                 (b) and subtracting (c) from the result, where (a) equals the
                 net asset value per share of the Related Fund at the end of a
                 Valuation Period plus the per share amount of any distribution
                 declared by the Fund if the "ex-dividend" date is during the
                 Valuation Period plus or minus the Fund Account's
                 proportionate share of taxes or provisions for taxes, if any,
                 attributable to the operation of the Separate Account during
                 the Valuation Period; (b) equals the net asset value per share
                 of the Related Fund  at the beginning of that Valuation
                 Period, and (c) is the daily charge for mortality and expense
                 risk multiplied by the number of days in the Valuation Period.


                 TRANSFERS

                 While the Certificate is in force, values may, at any time, be
                 transferred ($250 minimum) from one Fund Account to another,
                 or from the Fund Accounts to the Fixed Account.  Within the 30
                 days after each Policy Anniversary, the Owner may also
                 transfer a portion of the Fixed Account Value to one or more
                 Fund Accounts.   The cumulative amount of any transfers from
                 the Fixed Account within any such 30-day period cannot exceed
                 25% of the Fixed Account Value.  The Company may further limit
                 transfers from the Fixed Account at any time. Transfers will
                 be effective as of the Valuation Day





26
<PAGE>   32
                 during which the request is received in good order at the 
                 Customer Service Center.

                 Subject to the above restrictions, up to 12 transfers may be
                 made in any Policy Year without charge, and any value
                 remaining in the Fixed Account or a Fund Account after a
                 transfer must be at least $250. Any transfer made which causes
                 the remaining aggregate value of Variable Accumulation Units
                 for a Fund Account to be less than $250 will result in those
                 remaining Variable Accumulation Units being transferred as
                 part of the requested transfer.

                 Transfers may be made in writing (or by telephone if telephone
                 transactions have been previously authorized in writing).  To
                 make a telephone transfer, the Certificate Owner must call the
                 Customer Service Center and provide, as identification, his
                 Certificate number, his Social Security number, and his
                 personal identification number.  A customer service
                 representative will then, upon ascertaining that telephone
                 transfers are authorized for that Certificate, take the
                 transfer request, which will be processed as of the next close
                 of business and confirmed within five business days.  The
                 Company disclaims all liability for losses resulting from
                 unauthorized or fraudulent telephone transactions, but
                 acknowledges that if it does not follow these procedures,
                 which it believes to be reasonable, it may be liable for such
                 losses.

                 Any transfers among the Fund Accounts or from a Fund Account
                 to the Fixed Account will result in the crediting and
                 cancellation of Variable Accumulation Units based on the
                 Variable Accumulation Unit values next determined after a
                 written request is received at the Customer Service Center.
                 The Certificate Owner should carefully consider current market
                 conditions and each Fund's investment policies and related
                 risks before allocating money to the Fund Accounts.  See pages
                 12-16 of this Prospectus and the prospectuses of the Funds.





                                                                              27
<PAGE>   33

                 NET CASH VALUE

                 The Net Cash Value is the Cash Value of the Certificate minus
                 the Current Outstanding Loan Balance.


CHARGES AND FEES


                 PREMIUM LOAD

                 A deduction of 3.0% of each premium payment will be made to
                 cover the premium load.  This load consists of 2.50% for state
                 premium taxes and 0.50% for federal income taxes. The load may
                 be changed from time to time but may not exceed 5%.

                 MONTHLY DEDUCTIONS

                 A Monthly Deduction is made from the Net Cash Value for
                 administrative expenses.  The monthly administrative fee will
                 be comprised of two fixed dollar monthly fees, the sum of
                 which is guaranteed not to exceed $6.00 per month.  The first
                 fixed dollar monthly fee, which will not exceed $5.00 per
                 month, will be charged to each Certificate.  The second fixed
                 dollar monthly fee, which will not exceed $3.00 per month,
                 will be charged, in addition to the first, to Certificates
                 which have accumulated Cash Value in any Fund Account. The
                 second fixed dollar monthly fee will be waived for any
                 Certificate whose Net Cash Value is greater than $10,000.

                 This charge is for items such as premium billing and
                 collection, Certificate value calculation, confirmations and
                 periodic reports; and it will not exceed the Company's costs.

                 In certain instances, the Company may reduce monthly
                 administrative fees and/or waive certain transaction fees in
                 the sale of Policies to certain groups.

                 Costs for sales, administration, and mortality generally vary
                 with the size and stability of the group among other factors.
                 The Company takes all these factors into account when reducing
                 charges.





28
<PAGE>   34
                 To qualify for reduced charges, a group or similar arrangement
                 must meet certain requirements, including our requirements for
                 size and ease of administration.

                 The Company will make any reductions according to its rules in
                 effect when an application or enrollment form for a Policy is
                 approved. The Company may change these rules from time to
                 time. Any variation in the monthly administrative fees or
                 transaction fees will reflect differences in costs or services
                 and will not be unfairly discriminatory.

                 A Monthly Deduction is also made from the Net Cash Value for
                 the Cost of Insurance and any charges for additional benefits
                 or coverages. The Cost of Insurance is determined by
                 multiplying the Coverage Amount by the applicable Cost of
                 Insurance Rate as determined by the Company.  The Cost of
                 Insurance Rate depends on the attained age, type of benefit,
                 size and type of group, gender mix of the group, expectations
                 of participation, Eligible Class of Insured, experience
                 and persistency, federal and state taxes, rating classes,
                 expectations of future mortality, whether premiums are paid
                 directly to the Company or through payroll deduction, and the
                 current Coverage Amount.

                 The Guaranteed Maximum Cost of Insurance Rates, per $10,000 of
                 Net Amount at Risk, for standard risks are set forth in the
                 following Table based on 150% of the 1980 Commissioners
                 Standard Ordinary Male Mortality Tables, Age Last Birthday.



<TABLE>
<CAPTION>
   ATTAINED AGE                      ATTAINED AGE                      ATTAINED AGE
       LAST           MONTHLY            LAST           MONTHLY            LAST           MONTHLY
     BIRTHDAY           RATE           BIRTHDAY           RATE           BIRTHDAY           RATE
     --------           ----           --------           ----           --------           ----
       <S>              <C>              <C>             <C>               <C>            <C>
                                         45               5.92             75              87.89
       16               1.99             46               6.41             76              96.76
       17               2.15             47               6.93             77             106.02
       18               2.27             48               7.48             78             115.76
       19               2.35             49               8.10             79             126.29

       20               2.37             50               8.78             80             138.01
       21               2.37             51               9.57             81             151.28
       22               2.35             52              10.45             82             166.45
       23               2.30             53              11.46             83             183.54
       24               2.25             54              12.58             84             202.21
</TABLE>





                                                                              29
<PAGE>   35
<TABLE>
       <S>              <C>              <C>             <C>               <C>           <C>
       25               2.19             55              13.78             85             222.14
       26               2.15             56              15.06             86             243.05
       27               2.14             57              16.42             87             264.86
       28               2.12             58              17.86             88             287.59
       29               2.15             59              19.44             89             311.42

       30               2.19             60              21.20             90             336.81
       31               2.25             61              23.20             91             364.47
       32               2.34             62              25.45             92             395.85
       33               2.44             63              27.98             93             434.54
       34               2.56             64              30.79             94             488.72

       35               2.71             65              33.82             95             575.26
       36               2.90             66              37.08             96             732.95
       37               3.11             67              40.53             97            1061.50
       38               3.35             68              44.27             98            1508.68
       39               3.63             69              48.41             99            1508.68

       40               3.94             70              53.10
       41               4.28             71              58.48
       42               4.64             72              64.67
       43               5.04             73              71.72
       44               5.47             74              79.51
</TABLE>




        The Monthly Deductions are deducted from the Fixed Account and each
        Fund Account in the proportion that the value of such account bears to
        the sum of the Fixed Account Value and the Fund Account Values.  For
        the Fund Accounts, deductions are accomplished by decreasing the number
        of Variable Accumulation Units in the Fund Account.  The Monthly
        Deductions are due on the first day of each month.

        TRANSACTION FEE FOR EXCESS TRANSFERS AND SURRENDERS

        There will be a $25 transaction fee for each transfer between funding
        options in excess of 12 during any Policy Year.  The Company reserves
        the right to waive this fee in some situations. Upon surrender of a
        Certificate, or a partial surrender, a transaction fee of $25 will be
        charged.

        MORTALITY AND EXPENSE RISK CHARGE

        For mortality and expense risks, a daily deduction, currently
        equivalent to .45% per year is made from amounts held in the Fund
        Accounts.  This deduction may be changed by the Company from time to
        time; but, it is guaranteed not to exceed .90% per year.

        The mortality risk the Company assumes is that the group of





30
<PAGE>   36
        lives insured under the Policies may, on average, live for shorter
        periods of time than the Company estimated. The expense risk the
        Company assumes is that its costs of issuing and administering Policies
        may be more than the Company estimated.

        If these charges are insufficient to cover actual costs and assumed
        risks, the loss will fall on the Company. Conversely, if the charge
        proves more than sufficient, any excess will be added to the Company's
        surplus and may be used for any proper purpose.

CERTIFICATE LOANS

        If the Certificate is in force and has an accumulated Net Cash Value,
        the Company will grant a loan to the Owner of the Certificate using the
        Certificate's Cash Value as security for the loan. The minimum loan
        amount is $250. A Certificate loan requires that a loan agreement be
        executed and that the Certificate be assigned to the Company.  The loan
        may be for any amount up to 90% of the Net Cash Value at the time of
        the loan.  Further, the Company will not grant a loan which would
        require that the Loan Account Value be greater than 90% of the Cash
        Value. Interest will accrue on the Loan at an annual rate of 8% and
        will be due on the Policy Anniversary Date or upon surrender or upon
        termination of the Certificate. Interest not paid within 30 days of
        coming due, will be added to the Loan Balance as of the date on which 
        it became due. Funds equaling the change in the amount of the Loan 
        Balance will, from time to time as the Loan Balance changes, be 
        transferred from the Fund Accounts and the Fixed Account to the Loan
        Account. If Certificate values are held in more than one funding
        option, withdrawals from each funding option will be made
        proportionately from the values in each funding option at the time of
        the transfer, unless the Company is instructed otherwise in writing at
        the Customer Service Center.

        In the event of surrender, lapse, death of the Insured, or any other
        event resulting in termination of the Certificate, the Loan Account
        Value will revert to the Company in repayment of the Current
        Outstanding Loan Balance.  To the extent that the Current Outstanding 
        Loan Balance exceeds the Loan Account Value, such excess will reduce 
        the payment of any proceeds under the Certificate or the Cash Value.

        The Company will credit interest on the Loan Account Value at a rate
        which will be not less than 6%.

        Upon repayment of all or any portion of a loan, and corresponding
        reduction of the Loan Balance, funds in the Loan Account in excess of
        the Loan Balance will be





                                                                              31
<PAGE>   37
        transferred to the funding options according to current Net Premium 
        Payment allocations.

        A Certificate loan, whether or not repaid, will affect the proceeds
        payable upon the Insured's death and the Cash Value because the
        investment results of the Fund Accounts or the Fixed Account will apply
        only to the non-loaned portion of the Cash Value.  The longer a loan is
        outstanding, the greater the effect is likely to be. Depending on the
        investment results of the Fund Accounts or the Fixed Account while the
        loan is outstanding, the effect could be favorable or unfavorable.

SURRENDERS,
LAPSE, AND
REINSTATEMENT


        FULL SURRENDERS

        A full surrender may be made at any time while the Certificate is in
        force. The Company will pay the Net Cash Value (less the transaction
        fee and any other amounts due the Company) next computed after
        receiving the Owner's written request at the Customer Service Center in
        a form satisfactory to the Company along with the return of the
        Certificate. A transaction fee of $25 is charged.



        PARTIAL SURRENDERS

        A partial surrender may be made at any time by written request to the
        Customer Service Center while the Certificate is in force. A $25
        transaction fee is charged.

        The amount of a partial surrender may not exceed 90% of the Net Cash
        Value at the end of the Valuation Period in which the election would
        become effective, and may not be less than $250.

        A partial surrender will reduce the Cash Value and the Death Benefit,
        but it will not reduce the Coverage Amount.

        If, at the time of a partial surrender, the Net Cash Value is
        attributable to more than one funding option, the $25 transaction
        charge and the amount paid upon the surrender will be taken
        proportionately from the values in each funding option, unless the
        Certificate Owner and the Company agree otherwise.





32
<PAGE>   38
        LAPSE OF A CERTIFICATE

        A lapse occurs if a Monthly Deduction due under the Certificate is
        greater than the Net Cash Value and no payment to cover the Monthly
        Deduction is made within the Grace Period.  The Company will send the
        Owner a lapse notice at least 61 days before the Grace Period expires.

        REINSTATEMENT OF A LAPSED CERTIFICATE

        If the Certificate lapses, the Owner can apply, in writing, for
        reinstatement at any time prior to three years after the date of lapse.
        The Coverage Amount of the reinstated Certificate will be the same as
        the Coverage Amount of the Certificate at the time of lapse. To
        reinstate a Certificate, the Company will require satisfactory evidence
        of good health (at the Owner's expense) and an amount sufficient to pay
        for the current Monthly Deduction plus one  additional Monthly
        Deduction, plus repayment of any Current Outstanding Loan Balance and
        any interest accrued from the date of lapse.

        Reinstatement will be effective on the date the Company approves the
        reinstatement and will be subject to new incontestability and suicide
        periods.


TERMINATION,
CONTINUATION,AND
CONVERSION


        POLICY TERMINATION

        Either the Group Policyholder or the Company may terminate the Policy
        upon 60 days prior notice to the other party. Upon Policy termination,
        individual coverage will be affected as set forth below.

        TERMINATION OF INDIVIDUAL COVERAGE

        Coverage for an Insured under the Policy will terminate upon lapse or
        surrender of the Insured's Certificate, or upon the death of the
        Insured. Coverage for an Insured under the Policy will also terminate
        upon termination of the Policy or upon loss of eligibility of the
        Insured unless the Policy expressly provides for continuation of the
        Insured's coverage.

        Term insurance coverage for an insured dependent child will terminate
        upon termination of the Certificate under which the child is covered,
        or upon the loss of eligibility of the child, or when the Certificate
        Owner terminates the child





                                                                              33
<PAGE>   39
        coverage, or upon the Child electing to purchase group variable
        universal life insurance under the Policy as provided for in the
        Policy, or upon the death of the child.

        CONTINUATION

        The circumstances in which the Employees or spouses may continue
        coverage after Policy termination or loss of eligibility will be
        determined by the Group Policyholder in advance of the Policy being
        issued.  For loss of eligibility the following options are available to
        the Group Policyholder. For Employees, the Group Policyholder may
        select continuation upon retirement, leave of absence, and termination
        of employment. For spouses, the Group Policyholder may select
        continuation upon termination of the Employee's employment, death of
        the Employee, and divorce of the spouse and the Employee. For Employees
        on leave of absence, the Group Policyholder may select continuation
        upon retirement, return to active service, or termination of
        employment. Child term coverage may continue if the Certificate upon
        which the term coverage was elected continues.

        For termination of the Policy, the Group Policyholder may elect to
        allow continuation if the Insured Employee or spouse is not eligible
        for coverage under a successor plan.

        If continuation is not available to the Insured as described above, and
        the Insured has a Net Cash Value of $250 or greater, coverage under the
        Policy will continue for the Insured.

        CONVERSION

        If the Insured's coverage terminates because the Insured is no longer a
        member of an Eligible Class under the Policy, and continuation is not
        provided for under the Policy, the insured may convert the amount of
        his insurance coverage which is terminating.

        If the Insured's coverage terminates because of Policy termination, and
        continuation is not provided for under the Policy, and if the Insured
        has been covered under the Policy for at least three years, the Insured
        may convert up to $10,000 of the life insurance coverage which is
        terminating.

        Such conversions may be to any form of life insurance coverage then
        offered by the Company except that the coverage may not be term
        insurance and it may not contain disability or other supplemental
        benefits. Evidence of good health will not be required for such
        conversion. Such





34
<PAGE>   40
        conversions must be applied for within 31 days of termination of
        coverage.

        No conversion is available for lapsed or surrendered coverage or for
        coverage which the Insured is eligible to replace under another group
        life insurance contract.


ADDITIONAL
COVERAGE
RIDERS

        Each of the following optional benefit riders is available for Group
        Policyholder selection. Where indicated, the Employee will be able to
        choose whether or not he wishes to purchase the coverage provided by
        the rider. An additional cost of insurance will be charged as a part of
        the Monthly Deduction for each coverage rider which is in effect for
        the Certificate.

        ACCIDENTAL DEATH, DISMEMBERMENT, AND INJURY

        The Group Policyholder may select one of three Accident Benefit Riders
        which provide additional benefits in the event of death or injury
        resulting from accident within 90 days of the accident.

        The first rider provides an additional death benefit equal to the
        Coverage Amount.

        The second rider provides, in addition to the benefit provided by the
        first rider, additional benefits if the insured suffers, as a result of
        accident, loss of a hand, loss of a foot, loss of the sight in one eye,
        loss of the thumb and index finger of the same hand, or any combination
        thereof.  The benefit for any covered loss under this rider is a
        percentage of the Coverage Amount under the Policy. The maximum amount
        that will be paid, in aggregate, for all losses under the rider, 
        resulting from any one accident, is an amount equal to the Coverage 
        Amount.

        The third rider provides, in addition to the benefits provided under
        the second rider above, benefits if the insured suffers, as a result of
        accident, loss of speech, loss of hearing, quadriplegia, paraplegia, or
        hemiplegia. The benefit for any covered loss under this rider is a
        percentage of the Coverage Amount under the Policy. The maximum amount
        that will be paid, in aggregate, for all losses under this rider,
        resulting from any one accident, is an amount equal to the Coverage 
        Amount.

        WAIVER OF COST OF LIFE INSURANCE

        The Group Policyholder may elect for coverage under this





                                                                              35
<PAGE>   41
        optional benefit rider to apply for all Insured Employee Certificates
        or to be available to be elected or declined by the Employee. Under
        this optional benefit rider, if the Insured Employee becomes totally
        disabled before age 60, the cost of life insurance coverage, the
        monthly administrative fee for the Employee's Certificate, and the cost
        of child term coverage provided under the Employee's Certificate will
        be waived while the Employee remains continuously and totally disabled
        following a waiting period of 6 to 12 months. The waiting period will
        be agreed upon between the Group Policyholder and the Company before
        coverage under this Rider is offered to employees. While the
        specifically identified charges are being waived under this rider, the
        Owner may continue to pay premiums which will accumulate as Cash Value
        subject to the terms and conditions of the Policy.

        The Insured must submit proof of continuing Total Disability as
        reasonably required by the Company. The Coverage Amount may not be
        increased while the cost of insurance is being waived; and, the cost of
        insurance for spouse coverage, retiree coverage and any optional
        benefits or features is not waived under this rider. Child coverage may
        not be added after the disability has begun.  Coverage under this rider
        terminates at age 65.

        PAID-UP INSURANCE

        If elected by the Group Policyholder, all Certificate Owners will be
        covered by this rider.

        Under this optional benefit rider, the Owner may use all or any portion
        of his Net Cash Value to purchase a policy of Paid- Up insurance in an
        amount not to exceed the Coverage Amount in force for the Insured at
        the time of purchase. Such coverage is provided under a separate policy
        but the premium for such coverage shall be calculated by using the
        maximum cost of insurance for the Policy and the minimum interest rate
        guarantee for the Fixed Account. No evidence of good health will be
        required for such coverage.

        ADVANCED PAYMENT BENEFIT

        If elected by the Group Policyholder, this coverage is available to be
        elected or declined by the Certificate Owner. This coverage is
        available for insured employees, former employees,  spouses, former
        spouses, retirees and leave of absence employees.

        Under this rider, the Company will pay one of three types of benefit.

        The three types of benefit are:





36
<PAGE>   42
        1.        Terminal Illness Benefit. The Company will pay up to 60% of
                  the Insured's Coverage Amount upon receipt of due proof,
                  acceptable to the Company, that the Insured has a terminal
                  illness. Such proof comprises a written diagnosis by two
                  unaffiliated physicians stating that the Insured has less
                  than 12 months to live, and supportive evidence satisfactory
                  to the Company including but not limited to radiological,
                  histological, and laboratory reports. Payment will be made in
                  a lump sum.

        2.        Nursing Care and Custodial Care Facility Benefit. The Company
                  will pay up to 60% of the Insured's Coverage Amount upon
                  receipt of due proof, acceptable to the Company, that the
                  Insured:

                                        *    has an Impairment, as determined
                                             by the Company;

                                        *    is confined to a Nursing Care or
                                             Custodial Facility (registered as
                                             a bed patient on a 24 hour basis)
                                             due to the Impairment;

                                        *    provides the Company with written
                                             certification from two
                                             unaffiliated Physicians that the
                                             Insured is expected to remain in
                                             the Nursing Care or Custodial
                                             Care Facility for the rest of his
                                             life; and,

                                        *    has satisfied the deductible 
                                             waiting period.

                                        The deductible waiting period is 90
                                        consecutive days. Payment may be made
                                        on a lump sum basis or on a periodic
                                        basis at 2% per month until thirty
                                        monthly payments have been made.
                                        Impairment is specifically defined in
                                        the rider and generally means the
                                        Insured is totally disabled and unable
                                        to function without human assistance
                                        or supervision.

                  3.                    Specified Disease Benefit. The Company
                                        will pay up to 60% of the Insured's
                                        Coverage Amount upon receipt of due
                                        proof, acceptable to the Company, that
                                        the Insured has a Specified Disease.
                                        Specified Disease means life
                                        threatening cancer, heart attack,
                                        renal failure, stroke, specified organ
                                        transplant, or acquired immune
                                        deficiency syndrome. Such diseases are
                                        further defined in the rider. Due
                                        proof comprises a written diagnosis
                                        and prognosis by a licensed physician
                                        certifying the existence of the
                                        disease, and supportive evidence
                                        satisfactory to the Company





                                                                              37
<PAGE>   43
                                        including but not limited to
                                        radiological, histological, or
                                        laboratory reports. Payment will be
                                        made in a lump sum.



                 The Owner may make a claim for only one of the three benefits
                 described above. Once a benefit has been paid under this rider
                 for an Insured, no further benefits will be paid for that
                 Insured under this rider.  The Death Benefit for the Insured
                 will be reduced by the amount paid under this rider for the
                 Insured.

                 SEAT BELT BENEFIT RIDER

                 Under this optional benefit rider, the Company will pay an
                 additional 10% of the Insured's Coverage Amount (up to a
                 maximum of $10,000) if the Insured dies as a result of an
                 accident while driving or riding in a private passenger car
                 and properly wearing his seat belt. Proper use of the seat
                 belt must be certified in the official accident report.





OTHER
POLICY
PROVISIONS

                 DEFERRAL OF PAYMENT

                 Payment of the surrendered amount from the Fund Accounts may
                 be postponed when the New York Stock Exchange is closed and
                 for such other periods as the Commission may require.  Payment
                 from the Fixed Account may be deferred up to six months at the
                 Company's option.  If the Company exercises its right to defer
                 such payments from the Fixed Account interest will be added as
                 required by law.

                 FIXED BENEFIT POLICY EXCHANGE


                 Where required by state law, the Owner may, within eighteen
                 months of the Certificate Effective Date, exchange his
                 Certificate for a Certificate of insurance under a group
                 flexible premium life insurance policy issued by the Company
                 ("Exchange Policy"). The date of issue and the age at issue of





38
<PAGE>   44
                 the Certificate under the Exchange Policy shall be the same as
                 for the Certificate under the Policy. Additional coverage and
                 riders elected by the Owner under the Policy will be provided
                 on the Exchange Policy to the extent available. Premium rates
                 will be those in effect under the Exchange Policy at the time
                 of exchange for the class of eligible persons into which the
                 Insured falls. Cash Values will be equitably adjusted under
                 the Exchange Policy.


                 CERTIFICATE OWNER

                 While the Insured is living, all rights in this Certificate
                 are vested in the Certificate Owner named in the application,
                 or as subsequently changed, subject to assignment, if any.

                 If the Certificate Owner, other than the Insured, dies before
                 the Insured, the Certificate Owner's rights in this
                 Certificate belong to the Certificate Owner's estate.

                 BENEFICIARY

                 The Beneficiary(ies) shall be as named in the application, or
                 as subsequently changed.

                 The Certificate Owner may name a new Beneficiary while the
                 Insured is living.  Any change must be in a written form
                 satisfactory to the Company and recorded at the Customer
                 Service Center.  Once recorded, the change will be effective
                 as of the date signed; however, the change will not affect any
                 payment made or action taken by the Company before it was
                 recorded.

                 If any Beneficiary predeceases the Insured, that Beneficiary's
                 interest passes to any surviving Beneficiary(ies), unless
                 otherwise provided.  Multiple Beneficiaries will be paid in
                 equal shares, unless otherwise provided.  If no designated
                 Beneficiary survives the Insured, or if no Beneficiary has
                 been designated, the death proceeds shall be paid to the first
                 surviving class of the Insured's spouse, the Insured's
                 children, the Insured's parents or the Insured's siblings.  If
                 no member of any of the above classes survives the Insured,
                 the proceeds will be paid to the Insured's estate.





                                                                              39
<PAGE>   45
                 ASSIGNMENT

                 While the Insured is living, the Certificate Owner may assign
                 his rights in the Certificate.  The assignment must be in
                 writing in a form acceptable to the Company, signed by the
                 Certificate Owner and recorded at the Customer Service Center.
                 No assignment will affect any payment made or action taken by
                 the Company before it was recorded.  The Company is not
                 responsible for any assignment not submitted for recording,
                 nor is the Company responsible for the sufficiency or validity
                 of any assignment.  The assignment will be subject to all
                 terms and conditions of the Policy.

                 INCONTESTABILITY

                 The Company will not contest payment of the death proceeds
                 based on the initial Coverage Amount after the Certificate has
                 been in force during the Insured's lifetime for two years from
                 the Certificate Effective Date.  For any increase in Coverage
                 Amount, the Company will not contest payment of the death
                 proceeds based on such an increase after it has been in force
                 during the Insured's lifetime for two years from its effective
                 date.

                 MISSTATEMENT OF AGE

                 If the age of the Insured has been misstated, the affected
                 benefits will be adjusted to the amounts which the cost of
                 insurance deducted from the Cash Value would have purchased at
                 the correct age.

                 SUICIDE

                 If the Insured dies by suicide, while sane or insane, within
                 two years from the Certificate Effective Date, the Company
                 will pay no more than the sum of the premiums paid, less any
                 partial surrenders, less the sum of any loans plus accrued
                 interest. If the Insured dies by suicide, while sane or
                 insane, within two years from the date an application is
                 accepted for an increase in the Coverage Amount, the Company
                 will pay no more than a refund of the monthly charges for the
                 cost of such additional coverage.





40
<PAGE>   46
STATE
VARIATIONS

                 Certain benefits and other policy terms may vary from state to
                 state due to the requirements of state law.

NONPARTICIPATING
POLICIES

                 These are nonparticipating Policies on which no dividends are
                 payable. These Policies do not share in the profits or surplus
                 earnings of the Company.
DOLLAR COST
AVERAGING

                 Dollar Cost Averaging is a program which, if elected, enables
                 a Certificate Owner to systematically reallocate specified
                 dollar amounts from the Money Market Fund Account to the other
                 Fund Accounts at regular intervals.  By allocating an
                 identified sum on a regularly scheduled basis as opposed to
                 reallocating the total amount at one particular time, a
                 Certificate Owner may be less susceptible to the impact of
                 market fluctuations.

                 Dollar Cost Averaging may be selected by establishing a Money
                 Market Fund Account Value of at least $3,000.  The minimum
                 transfer amount is $250.  All Dollar Cost Averaging transfers
                 will be made effective the first processing day following the
                 first of the month (or the next Valuation Day, if later).
                 Election of this arrangement may occur at any time by properly
                 completing the Dollar Cost Averaging election form, returning
                 it to the Company so it is received by the tenth of the month,
                 to be effective the following month, and ensuring that
                 sufficient value is in the Money Market Fund Account.

                 Dollar Cost Averaging will terminate when any of the following
                 occurs: (1) the number of designated transfers has been
                 completed; (2) the Money Market Fund Account Value is
                 insufficient to complete the next transfer; (3) the Owner
                 requests termination in writing and such writing is received
                 by the tenth of the month in order to cancel the transfer
                 scheduled to take effect the following month; or (4) the
                 Certificate is lapsed, surrendered or otherwise terminated.

                 There is currently no charge for Dollar Cost Averaging;
                 however, Dollar Cost Averaging transfers are counted among the
                 twelve free transfers per Policy Year.  The Company reserves
                 the right to





                                                                              41
<PAGE>   47
                 charge for this program.  In the event there are additional
                 transfers, a transfer fee will be charged.  The Company does
                 not intend to profit from any such charge.

                 The main objective of Dollar Cost Averaging is to shield
                 investments from short term price fluctuations. Since the same
                 dollar amount is transferred to a Fund Account with each
                 transfer, more Variable Accumulation Units are purchased if
                 the Variable Accumulation Unit Value is low, and fewer
                 Variable Accumulation Units are purchased if the Variable
                 Accumulation Unit Value is high. Therefore, a lower than
                 average cost per unit may be achieved over the long term. This
                 plan of investing allows investors to take advantage of market
                 fluctuations but does not assure a profit or protect against a
                 loss in declining markets.


TAX MATTERS

                 POLICY PROCEEDS

                 Section 7702 of the Code provides that if certain tests are
                 met, a Policy will be treated as a life insurance policy for
                 federal tax purposes.  The Company will monitor compliance
                 with these tests.  The Policy should thus receive the same
                 federal income tax treatment as fixed benefit life insurance.
                 As a result, the death proceeds payable under a Policy are
                 excludable from gross income of the Beneficiary under Section
                 101 of the Code.

                 Section 7702A of the Code defines modified endowment contracts
                 as those policies issued or materially changed on or after
                 June 21, 1988 on which the total premiums paid during the
                 first seven years exceed the amount that would have been paid
                 if the policy provided for paid up benefits after seven level
                 annual premiums.  The Code provides for taxation of
                 surrenders, partial surrenders, loans, collateral assignments
                 and other pre-death distributions from modified endowment
                 contracts in the same way annuities are taxed, i.e., they are
                 taxable to the extent the cash value of the policy exceeds, at
                 the time of distribution, the premiums paid into the policy.
                 A 10% tax penalty generally applies to the taxable portion of
                 such distributions unless the Policy Owner is over age 59 1/2
                 or disabled.





42
<PAGE>   48
                 The Certificates under the Policies offered by this Prospectus
                 may or may not be issued as modified endowment contracts.  The
                 Company will monitor premiums paid and will notify the
                 Certificate Owner when the Certificate's non-modified
                 endowment contract status is in jeopardy.  If a Policy is not
                 a modified endowment contract, a cash distribution during the
                 first 15 years after a policy is issued which causes a
                 reduction in death benefits may still become fully or
                 partially taxable to the Owner pursuant to Section 7702(f)(7)
                 of the Code.  The Certificate Owner should carefully consider
                 this potential effect and seek further information before
                 initiating any changes in the terms of the Certificate.  Under
                 certain conditions, a Certificate may become a modified
                 endowment contract as a result of a material change or a
                 reduction in benefits as defined by Section 7702A(c) of the
                 Code.

                 In addition to meeting the tests required under Section 7702
                 and Section 7702A, Section 817(h) of the Code requires that
                 the investments of separate accounts such as the Separate
                 Account be adequately diversified.  Regulations issued by the
                 Secretary of the Treasury set the standards for measuring the
                 adequacy of this diversification.  A variable life insurance
                 policy not adequately diversified under these regulations
                 would not be treated as life insurance under Section 7702 of
                 the Code.  To be adequately diversified, each Fund Account of
                 the Separate Account must meet certain tests.  The Company
                 believes the Separate Account investments meet the applicable
                 diversification standards.

                 Should the Secretary of the Treasury issue additional rules or
                 regulations limiting the number of funds, transfers between
                 funds, exchanges of funds or changes in investment objectives
                 of funds such that the Policy would no longer qualify as life
                 insurance under Section 7702 of the Code, the Company will
                 take whatever steps are available to allow the Policies to
                 continue to qualify as life insurance under Section 7702.

                 The Company will monitor compliance with these regulations
                 and, to the extent necessary, will change the objectives or
                 assets of the Separate Account investments to remain in
                 compliance.

                 A total surrender or termination of the Certificate by lapse
                 may have adverse tax consequences.  If the





                                                                              43
<PAGE>   49
                 amount received by the Certificate Owner plus total
                 Certificate indebtedness exceeds the premiums paid into the
                 Certificate, the excess will generally be treated as taxable
                 income, regardless of whether or not the Certificate is a
                 modified endowment contract.

                 Federal estate and state and local estate, inheritance and
                 other tax consequences of ownership or receipt of Certificate
                 proceeds depend on the circumstances of each Certificate Owner
                 or Beneficiary. The Owner should consult a professional tax
                 adviser to determine the tax consequences of purchasing or
                 making transactions under the Policy.

                 TAXATION OF THE COMPANY

                 The Company is taxed as a life insurance company under the
                 Code.  Since the Separate Account is not a separate entity
                 from the Company and its operations form a part of the
                 Company, it will not be taxed separately as a "regulated
                 investment company" under Sub-chapter M of the Code.
                 Investment income and realized capital gains on the assets of
                 the Separate Account are reinvested and taken into account in
                 determining the value of Variable Accumulation Units.

                 The Company does not initially expect to incur any Federal
                 income tax liability that would be chargeable to the Separate
                 Account.  Based upon these expectations, no charge is
                 currently being made against the Separate Account for federal
                 income taxes.  If, however, the Company determines that on a
                 separate company basis such taxes may be incurred, it reserves
                 the right to assess a charge for such taxes against the
                 Separate Account.

                 The Company may also incur state and local taxes in addition
                 to premium taxes in several states.  At present, these taxes
                 are not significant.  If they increase, however, additional
                 charges for such taxes may be made.

                 SECTION 848 CHARGES

                 The current 3.0% premium load is assessed to cover state taxes
                 and federal income tax liabilities incurred by the Company.
                 This load is made up of 2.50% for state taxes and 0.50% for
                 the additional federal income tax burden under Section 848 of
                 the





44
<PAGE>   50
                 Code relating to the tax treatment of deferred acquisition
                 costs.  The 0.50% charge for federal income tax liabilities is
                 reasonable in relation to the Company's increased taxes under
                 this Section of the Code.  The premium load may be changed
                 from time to time by the Company, but it may be no 
                 greater than 5.0%.

                 OTHER CONSIDERATIONS

                 The foregoing discussion is general and is not intended as tax
                 advice.  Counsel and other competent advisers should be
                 consulted for more complete information.  This discussion is
                 based on the Company's understanding of Federal income tax
                 laws as they are currently interpreted by the Internal Revenue
                 Service.  No representation is made as to the likelihood of
                 continuation of these current laws and interpretations.

OTHER MATTERS

                 VOTING RIGHTS

                 In accordance with its view of presently applicable law, the
                 Company will vote the shares of each Fund held in the Separate
                 Account at meetings of the shareholders of the particular Fund
                 in accordance with written instructions received from persons
                 having Variable Accumulation Units of the Fund.  The Company
                 will vote shares for which it has not received instructions,
                 as well as shares attributable to it, in the same proportion
                 as it votes shares for which it has received instructions.
                 The Funds do not hold regular meetings of shareholders.

                 If, however, the Act or any regulation thereunder is amended
                 or if the present interpretation thereof should change, and as
                 a result the Company determines that it is permitted to vote
                 the Fund shares in its own right, it may elect to do so.

                 The number of votes which a Certificate Owner has the right to
                 instruct will be calculated separately for each Fund. This
                 number will be determined by calculating the proportion of the
                 Certificate Owner's Cash Value in the Fund Account to
                 the amount of the Separate Account's investment in the Related
                 Fund and multiplying that proportion by the number of votes the
                 Separate Account has in the Fund. In determining the number of
                 votes, fractional shares will be recognized. The number of
                 votes that a Certificate Owner has the right to





                                                                              45
<PAGE>   51
                 instruct will be determined as of the date coincident with the
                 date established by the Fund for determining shareholders
                 eligible to vote at the meeting of the Fund, but not more than
                 60 days before the meeting of the Fund.  Voting instructions
                 will be solicited by written communication at least 14 days
                 prior to such meeting of the Fund.  Each person having a
                 voting interest in the Fund will receive appropriate proxy
                 materials and reports.

                 The Company will vote the Fund shares as to which no timely
                 instructions are received in proportion to the voting
                 instructions from others with an interest in the particular
                 Fund Account. Voting instructions to abstain on any item to be
                 voted upon will be applied to reduce the votes eligible to be
                 cast by the Company.

                 The Company may, if required by State insurance regulatory
                 authorities, disregard voting instructions if the instructions
                 require that the shares be voted so as to cause a change in
                 the sub-classification or investment objectives of the Fund or
                 to approve or disapprove an investment advisory contract for a
                 Fund. A change would be disapproved only if the proposed
                 change is contrary to state law or prohibited by state
                 regulatory authorities or the Company determines that the
                 change would have an adverse effect on the Separate Account in
                 that the proposed investment policy for a Fund may result in
                 overly speculative or unsound investments. In the event the
                 Company does disregard voting instructions, a summary of that
                 action and the reasons for such action will be included in the
                 next annual report to Certificate Owners.

                 The Funds' shares are issued and redeemed only in connection
                 with variable annuity contracts and variable life insurance
                 policies issued through separate accounts of the Company and
                 other life insurance companies.  The Funds do not foresee any
                 disadvantage to Certificate Owners arising out of the fact
                 that shares may be made available to separate accounts which
                 are used in connection with both variable annuity and variable
                 life insurance products.  Nevertheless, the Funds' Boards
                 intend to monitor events in order to identify any material
                 irreconcilable conflicts which may possibly arise and to
                 determine what action, if any, should be taken in response
                 thereto.  If such a conflict were to occur, one of the
                 separate accounts might





46
<PAGE>   52
                 withdraw its investment in a Fund.  This might force a Fund to
                 sell portfolio securities at disadvantageous prices.

                 DIRECTORS AND OFFICERS OF THE COMPANY

                 The following persons are Directors and officers of the
                 Company.  The address of each is 900 Cottage Grove Road,
                 Hartford, CT 06152 and each has been employed by the Company
                 for more than five years except Mr. Jones, Mr.  Alexander and
                 Dr. Schaffer. Prior to April, 1994, Mr. Jones was employed by
                 NAC RE Corporation.  Prior to December 1994, Mr. Alexander was
                 employed by E.I. DuPont De Nemour as Director, Human
                 Resources.  Prior to May 1993, Dr.  Schaffer was Vice
                 President, Professional Affairs, Aetna Health Plans, Aetna
                 Life & Casualty and until 1990 was Vice President, Quality
                 Management, Humana, Inc.

<TABLE>
<CAPTION>
                                                                           POSITIONS AND OFFICES
                 NAME AND ADDRESS                                          WITH THE COMPANY
                 ----------------                                          ----------------
                 <S>                      <C>
                 Thomas C. Jones          President
                                          (Principal Executive Officer)

                 James T. Kohan           Vice President and Actuary (Principal Financial Officer)

                 Robert Moose             Vice President
                                          (Principal Accounting
                                          Officer)

                 David C. Kopp            Corporate Secretary

                 Andrew G. Helming        Secretary

                 Stephen C. Stachelek     Treasurer

                 Harold W. Albert         Director

                 S. Tyrone Alexander      Director and Senior Vice Pesident

                 Martin A. Brennan        Director and Senior Vice President

                 Robert W. Burgess        Director

                 John G. Day              Director and Chief Counsel

                 R. Chris Doerr           Director, Senior Vice
</TABLE>





                                                                              47
<PAGE>   53
<TABLE>
                 <S>                      <C>
                                          President and Chief Financial Officer

                 Lawrence P. English      Director and Chairman of the Board

                 Joseph M. Fitzgerald     Director and Senior Vice President

                 Arthur C. Reeds, III     Director and Senior Vice President

                 Patricia L. Rowland      Director and Senior Vice President

                 W. Allen
                  Schaffer, M.D.          Director and Senior Vice President
</TABLE>


                 DISTRIBUTION OF POLICIES

                 The Policies will be sold by licensed insurance agents in
                 those states where the Policies may lawfully be sold.  Such
                 agents will be registered representatives of broker-dealers
                 registered under the Securities Exchange Act of 1934 who are
                 members of the National Association of Securities Dealers,
                 Inc. (NASD).  The Policies will be distributed by the
                 Company's principal underwriter, CIGNA Financial Advisors,
                 Inc. ("CFA"), whose address is the same as the Company's.  CFA
                 is a Connecticut corporation organized in 1967, and is the
                 principal underwriter for the Company's other registered
                 separate accounts.

                 Gross first year commissions paid by the Company, including
                 expense reimbursement allowances, on the sale of these
                 Policies are not more than 20% of premium payments.  Gross
                 renewal commissions paid by the Company will not exceed 15%
                 of premium payments.

                 OTHER CONTRACTS ISSUED BY THE COMPANY

                 The Company does presently and will, from time to time, offer
                 other variable annuity contracts and variable life insurance
                 policies with benefits which vary in accordance with the
                 investment experience of a separate account of the Company.







48
<PAGE>   54
                 RIGHT TO TAKE ACTIONS REGARDING THE SEPARATE
                 ACCOUNT

                 The Company reserves the right to take certain actions in
                 connection with Separate Account operations. These actions
                 will be taken in accordance with applicable laws (including
                 obtaining any required regulatory approvals).

                 Specifically, the Company reserves the right to:

                 o       add, combine, or remove any Fund Account,
                 o       create new separate accounts,
                 o       combine the Separate Account with one or more other
                         separate accounts,
                 o       operate the Separate Account as a management
                         investment company under the Act or in any other form
                         permitted by law,
                 o       deregister the Separate Account under the Act,
                 o       manage the Separate Account under the direction of a
                         committee or discharge such committee at any time,
                 o       transfer any assets in any Fund Account to another
                         Fund Account, or to one or more separate accounts or
                         to the Company's general account, and
                 o       to take any actions necessary to comply with, or to
                         obtain and continue any exemptions from, the Act.


                 STATE REGULATION

                 The Company is subject to the laws of Connecticut governing
                 insurance companies and to regulation by the Connecticut
                 Insurance Department.  An annual statement in a prescribed
                 form is filed with the Insurance Department each year covering
                 the operation of the Company for the preceding year and its
                 financial condition as of the end of such year.  Regulation by
                 the Insurance Department includes periodic examination to
                 determine the Company's contract liabilities and reserves so
                 that the Insurance Department may certify the items are
                 correct.  The Company's books and accounts are subject to
                 review by the Insurance Department at all times and a full
                 examination of its operations is conducted periodically by the
                 National Association of Insurance Commissioners.  Such
                 regulation does not, however, involve any supervision of
                 management or investment practices or policies. A blanket bond
                 for $10 million covers all of the officers and employees of
                 the Company.





                                                                              49
<PAGE>   55
                 REPORTS TO CERTIFICATE OWNERS

                 The Company maintains Policy records and will mail to each
                 Certificate Owner, at the last known address of record, an
                 annual statement showing the amount of the current Death
                 Benefit, the Cash Value, and Net Cash Value, premiums paid and
                 monthly charges deducted since the last report, the amounts
                 invested in the Fixed Account, in each Fund Account, and any
                 Loan Account Value.

                 Certificate Owners will also be sent annual reports containing
                 financial statements for the Separate Account as required by
                 the 1940 Act.

                 In addition, Certificate Owners will receive periodic
                 statements of significant transactions, such as changes in
                 Coverage Amount, changes in net premium payment allocation,
                 transfers among Fund Accounts, premium payments, loans, loan
                 repayments, reinstatement and termination.

                 ADVERTISING

                 The Company is rated by independent financial rating services,
                 including Moody's, Standard & Poor's, Duff & Phelps and A.M.
                 Best Company.  The purpose of these ratings is to reflect the
                 financial strength or claims-paying ability of the Company.
                 The ratings are not intended to reflect the investment
                 experience or financial strength of the Separate Account.  The
                 Company may advertise these ratings from time to time.
                 Furthermore, the Company may occasionally include in
                 advertisements comparisons of currently taxable and tax
                 deferred investment programs, based on selected tax brackets,
                 or discussions of alternative investment vehicles and general
                 economic conditions.

                 LEGAL PROCEEDINGS

                 There are no material legal or administrative proceedings
                 pending or known to be contemplated, other than ordinary
                 routine litigation incidental to the business, to which the
                 Company and the Separate Account are party, or to which any of
                 their property is subject.  The principal underwriter, CFA, is
                 not engaged in any material litigation of any nature.







50
<PAGE>   56
                 EXPERTS

                 Actuarial opinions regarding Deferred Acquisition Cost Tax
                 (DAC Tax) and Mortality and Expense Risk Charges (M&E Charges)
                 referred to in this Registration Statement have been rendered
                 by Benjamin Clement, FSA, MAAA as stated in the opinion filed
                 as an Exhibit to the Registration Statement given on the 
                 authority of Mr. Clement as an expert in actuarial matters. 
                 Legal matters involving the federal securities laws have been
                 reviewed by Jorden, Burt & Berenson, Washington, D.C.

                 Legal matters in connection with the Policies described herein
                 are being passed upon by Jerold H. Rosenblum, Esq., Chief
                 Counsel, CIGNA Group Insurance, 1601 Chestnut Street,
                 Philadelphia, PA  19102 in the opinion filed as an Exhibit to
                 the Registration Statement given on his authority as an expert
                 in these matters.

                 The consolidated financial statements of Connecticut General
                 Life Insurance Company as of December 31, 1994 and 1993 and
                 for each of the three years in the period ended December 31,
                 1994 included in this Prospectus have been so included in
                 reliance on the report of Price Waterhouse LLP, independent
                 accountants, given on the authority of said firm as experts in
                 auditing and accounting.

                 REGISTRATION STATEMENT

                 A Registration Statement has been filed with the Securities
                 and Exchange Commission under the Securities Act of 1933, as
                 amended, with respect to the Policies offered hereby.  This
                 Prospectus does not contain all the information set forth in
                 the Registration Statement and amendments thereto and exhibits
                 filed as a part thereof, to all of which reference is hereby
                 made for further information concerning the Separate Account,
                 the Company, and the Policies offered hereby.  Statements
                 contained in this Prospectus as to the content of Policies and
                 other legal instruments are summaries.  For a complete
                 statement of the terms thereof, reference is made to such
                 instruments as filed.

                 FINANCIAL STATEMENTS

                 There follow consolidated balance sheets of the Company and
                 its subsidiaries as of December 31, 1994 and 1993 and related
                 consolidated statements of income and retained earnings and
                 cash flows for





                                                                              51
<PAGE>   57
                 the years ended December 31, 1994, 1993, and 1992.

                 The most current financial statements of the Company are those
                 as of the end of the most recent fiscal year.  The Company
                 does not prepare financial statements more often than annually
                 and believes that any incremental benefit to prospective
                 Certificate Owners that may result from preparing and
                 delivering more current financial statements, though
                 unaudited, does not justify the additional cost that would be
                 incurred.  In addition, the Company represents that there have
                 been no adverse changes in the financial condition or
                 operations of the Company between the end of 1994 and the date
                 of this Prospectus.


                 These financial statements should be considered only as
                 bearing upon the ability of the Company to meet its
                 obligations under the Policies.  No financial statements of
                 the Separate Account are included, because as of the date of
                 this Prospectus the Separate Account had not yet commenced
                 operations.

                 ILLUSTRATIONS

                 Illustrations of hypothetical investment performance under the
                 Policies will be filed by amendment.





52
<PAGE>   58
                                    PART II

                     INFORMATION NOT REQUIRED IN PROSPECTUS

                          UNDERTAKING TO FILE REPORTS


         Subject to the terms and conditions of Section 15(d) of the Securities
Exchange Act of 1934, the undersigned registrant hereby undertakes to file with
the Securities and Exchange Commission such supplementary and periodic
information, documents, and reports as may be prescribed by any rule or
regulation of the Commission heretofore or hereafter duly adopted pursuant to
authority conferred in that section.

                              RULE 484 UNDERTAKING


         The following provisions regarding the Indemnification of Directors
and Officers of the Registrant are applicable:

         Connecticut Law: Except where an applicable insurance policy is
procured, Connecticut General Statutes ("C.G.S.") Section 33-320a is the sole
source of indemnification rights for directors and officers of Connecticut
corporations and for persons who may be deemed to be controlling persons by
reason of their status as a shareholder, director, officer, employee or agent
of a Connecticut corporation.  Under C.G.S. Section 33-320a, a corporation
shall indemnify any director or officer who was or is a party, or was
threatened to be made a party, to any threatened, pending or completed action,
suit or proceeding, whether civil, criminal, administrative or investigative
(hereinafter referred to as "proceeding") by virtue of the fact that he or the
person whose
<PAGE>   59
legal representative he is: (i) is or was a director or officer of the
corporation; (ii) while a director or an officer of the corporation, is or was
serving at the request of the corporation as a director, officer, partner,
trustee, employee or agent of another foreign or domestic corporation,
partnership, joint venture, trust or other enterprise (hereinafter referred to
as "enterprise"), other than an employee benefit plan or trust; or (iii) while
a director or an officer of the corporation, is or was a director or officer
serving at the request of the corporation as a fiduciary of an employee benefit
plan or trust maintained for the benefit of employees of the corporation or any
other enterprise, against "covered expenditures" if (and only if) his conduct
met the applicable statutory eligibility standard.  The types of expenditures
which are covered and the statutory eligibility standard vary according to the
type of proceeding to which the director or officer is or was a party or was
threatened to be made a party.

         According to C.G.S. Section 33-320a, in non-derivative proceedings
other than ones brought in connection with an alleged claim based upon the
purchase or sale by a director or officer of securities of the corporation or
of another enterprise, which the director or officer serves or served at the
request of the corporation, the corporation shall indemnify a director or
officer against judgments, fines, penalties, amounts paid in settlement and
reasonable expenses, including attorney's fees, actually incurred by him in
connection with the proceeding, or any appeal therein, IF
<PAGE>   60
AND ONLY IF he acted (i) in good faith and (ii) in a manner he reasonably
believed to be in the best interests of the corporation or, in the case of a
person serving as a fiduciary of any employee benefit plan or trust, in a
manner he reasonably believed to be in the best interests of the corporation or
in the best interest of the participants and beneficiaries of such employee
benefit plan or trust and consistent with the provisions of such employee
benefit plan or trust.  However, where the proceeding brought is criminal in
nature, C.G.S. Section 33-320a requires that the director or officer must
satisfy the additional condition that he had no reasonable cause to believe
that his conduct was unlawful in order to be indemnified.  A director or
officer also will be entitled to indemnification as described above if (i) he
is successful on the merits in the defense of any non-derivative proceeding
brought against him or (ii) a court shall have determined that in view of all
the circumstances he is fairly and reasonably entitled to be indemnified.  The
decision about whether the director or officer qualifies for indemnification
under C.G.S. Section 33-320a may be made (i) in writing by a majority of those
members of the board of directors who were not parties to the proceeding in
question, (ii) in writing by independent legal counsel selected by a consent in
writing signed by a majority of those directors who were not parties to the
proceeding, or (iii) by the shareholders of the corporation at a special or
annual meeting by an affirmative vote of at least a majority of the voting
power of shares not owned by parties to the proceeding.  A director or officer
also may apply to a court of competent jurisdiction for indemnification even
though
<PAGE>   61
he previously applied to the board, independent legal counsel or the
shareholders and his application for indemnification was rejected.

         For purposes of C.G.S. Section 33-320a, the termination of any
proceeding by judgment, order, settlement, conviction or upon a plea of nolo
contendere or its equivalent shall not create, of itself, a presumption that
the director or officer did not act in good faith or in a manner which that
director or officer did not believe reasonably to be in the best interests of
the corporation or of the participants and beneficiaries of an employee benefit
plan or trust and consistent with the provisions of such plan or trust.
Likewise, the termination of a criminal act or proceeding shall not create, of
itself, a presumption that the director or officer had reasonable cause to
believe that his conduct was unlawful.

         In non-derivative proceedings based on the purchase or sale of
securities of the corporation or of another enterprise, which the director or
officer serves or served at the request of the corporation, C.G.S. Section
33-320a provides that the corporation shall indemnify the director or officer
only after a court shall have determined upon application that in view of all
the circumstances, the director or officer is fairly and reasonably entitled to
be indemnified.  Furthermore, the expenditures for which the director or
officer shall be indemnified shall be only such amount as the court determines
to be appropriate.
<PAGE>   62
         Pursuant to C.G.S. Section 33-320a, where a director or officer was or
is a party or was threatened to be made a party to a derivative proceeding, the
corporation shall indemnify him against expenses, including attorneys' fees,
actually and reasonably incurred by him in connection with the proceeding or
any appeal therein, in relation to matters as to which he is finally adjudged
not to have breached his duty to the corporation.  The corporation also shall
indemnify a director or officer where the court determines that, in view of all
the circumstances, such person is fairly and reasonably entitled to be
indemnified; however, in such a situation, the individual shall be indemnified
only for such amount as the court determines to be appropriate.  Furthermore,
the statute provides that the corporation shall not indemnify a director or
officer for amounts paid to the corporation, to a plaintiff or to counsel for a
plaintiff in settling or otherwise disposing of a threatened or pending action,
with or without court approval, or for expenses incurred in defending a
threatened action or a pending action which is settled or otherwise disposed of
without court approval.

         C.G.S. Section 33-320a also provides that expenses incurred in
defending a proceeding may be paid by the corporation in advance of the final
disposition of such proceeding upon authorization of the board of directors,
provided said expenses are indemnifiable under the statute and the director or
officer agrees to repay such amount if he is later found not entitled to
indemnification by the corporation.
<PAGE>   63
         Lastly, C.G.S. Section 33-320a is intended to be an exclusive statute.
A corporation established under Connecticut statute cannot indemnify a director
or officer (other than a director or officer who is or was serving at the
request of the corporation as a director, officer, partner, trustee, employee
or agent of another enterprise), to an extent either greater or less than that
authorized by the statute, and any provision in the certificate of
incorporation, the by-laws, a shareholder or director resolution, or agreement
or otherwise that is inconsistent with the statute is invalid.  Notwithstanding
the above, C.G.S. Section 33-320a specifically authorizes a corporation to
procure insurance providing greater indemnification rights than those set out
in the statute the premium cost of which may be shared with the director or
officer on such basis as may be agreed upon.

         The directors and officers may also be covered by an errors and
omissions or other insurance policies.

         The Bylaws of CIGNA Corporation provide that any person who at any
time serves as a director or officer of the Company or any majority owned
ultimate subsidiary of CIGNA Corporation shall be indemnified or reimbursed
against and for any and all claims for which they become subject by reason of
such service.

         Insofar as indemnification for liability arising under the Securities
Act of 1933 (the "Act") may be permitted to directors, officers and controlling
persons of the registrant pursuant to the foregoing provisions, or otherwise,
the registrant has been advised
<PAGE>   64
that in the opinion of the Securities and Exchange Commission such
indemnification is against public policy as expressed in the Act and is,
therefore, unenforceable.  In the event that a claim for indemnification
against such liabilities (other than the payment by the registrant of expenses
incurred or paid by a director, officer or controlling person of the registrant
in the successful defense of any action, suit or proceeding) is asserted by
such director, officer or controlling person in connection with the securities
being registered, the registrant will, unless in the opinion of its counsel the
matter has been settled by controlling precedent, submit to a court of
appropriate jurisdiction the question whether such indemnification by it is
against public policy as expressed in the Act and will be governed by the final
adjudication of such issue.

            REPRESENTATIONS, DESCRIPTION AND UNDERTAKING PURSUANT TO

                PARAGRAPH (b)(13)(iii)(F) of RULE 6e-3(T) UNDER

                       THE INVESTMENT COMPANY ACT OF 1940


         Registrant makes the following representations:

                 1.       Rule 6e-3(T)(b)(13)(iii)(F) is being relied upon.

                 2.       The level of the mortality and expense risk charge is
                          reasonable in relation to the risks assumed by the
                          life insurer under the contract.

                 3.       The Company has concluded that there is a reasonable
                          likelihood that the distribution financing
                          arrangement of the CG Variable Life Insurance
                          Separate Account A (the "Separate Account") will
                          benefit the Separate Account and the Owners.

                 4.       The Separate Account is organized as a unit
                          investment trust which will invest only in management
                          companies which have undertaken to have
<PAGE>   65
                          a board of directors, a majority of whom are not
                          interested persons of the Company, to formulate and
                          approve any plan under Rule 12b-1 to finance
                          distribution expenses.

         The methodology used to support the representation made in paragraph
(2) above was based on analysis of the policies including the level of other
expense charges, uncertainties in terms of expense and mortality factors, and
policy guarantees.  The Company will maintain and make available to the
Commission on request, memoranda setting forth the basis for the
representations in paragraphs (2) and (3) above.
                           
         In connection with the Policies, the Company is relying on paragraph
(B) of Rule 6e-3(T)(b)(13)(iv).

                       CONTENTS OF REGISTRATION STATEMENT


         This Registration Statement is comprised of the following documents:

         The Facing Sheet.

         The Prospectus consisting of 52 pages.

         The undertaking to file reports.

         The signatures.

         Powers of Attorney.

         Written consents of the following persons:

                 1.       Price Waterhouse LLP - to be filed by amendment

                 2.       Counsel opining as to the legality of securities
                          being registered - to be filed by amendment

                 3.       Benjamin Clement, Actuary - to be filed by amendment

                 4.       Jorden Burt & Berenson - to be filed by amendment

         The following Exhibits:

         1.      The following Exhibits correspond to those required
                 by Paragraph A of the instructions as to Exhibits in
<PAGE>   66
                 Form N-8B-2:

                 A.       (1)     Resolution of Board of Directors of
                                  Connecticut General Life Insurance Company
                                  establishing the Separate Account.

                          (2)     Not Applicable.

                          (3)     Distributing contracts:

                                  (a)      Distribution Agreement betweeen
                                           Connecticut General Life Insurance
                                           Company and CIGNA Financial
                                           Advisors, Inc. - to be filed by
                                           amendment.

                                  (b)      Form of Dealer Agreement - to be 
                                           filed by amendment.

                                  (c)      Not Applicable.

                          (4)     Not Applicable.

                          (5)     Group Variable Universal Life Insurance
                                  Policy 

                          (6)     (a)      Certificate of Incorporation of 
                                           Connecticut General Life Insurance 
                                           Company - to be filed by amendment.

                                  (b)      By-laws of Connecticut General Life
                                           Insurance Company - to be filed by
                                           amendment.

                          (7)     Not Applicable.

                          (8)     Participation Agreements between Separate
                                  Account and underlying Investment Companies -
                                  to be filed by amendment.

                          (9)     Not Applicable.

                          (10)    Form of Application for Group Variable 
                                  Universal Life Insurance Policy.

                          (11)    Memorandum describing Connecticut General
                                  Life Insurance Company's issuance, transfer,
                                  and redemption procedures for the Policy - to
                                  be filed by amendment.

                 B.       (1)     Not Applicable.

                          (2)     Not Applicable.

                 C.       Not Applicable.
<PAGE>   67
         2.      Opinion of Counsel as to the legality of the securities being
                 registered - to be filed by amendment.

         3.      Not Applicable.

         4.      Not Applicable.

         5.      Opinion and Consent of Benjamin Clement as to actuarial
                 matters pertaining to the securities being registered - to be
                 filed by amendment.

         6.      Consent of Price Waterhouse LLP - to be filed by amendment.

         7.      Consent of counsel opining as to the legality of the
                 securities being registered - see Exhibit 2.

         8.      Opinion and consent of Jorden Burt & Berenson - to be filed by
                 amendment.
<PAGE>   68


                                   SIGNATURES



         Pursuant to the requirements of the Investment Company Act of 1940,
the Registrant has caused this notification of registration to be duly signed
on its behalf by the undersigned, thereunto duly authorized, in the City of
Philadelphia in the State of Pennsylvania on the 11th day of July, 1995.




                                           CG VARIABLE LIFE INSURANCE SEPARATE
                                               ACCOUNT A of
                                           CONNECTICUT GENERAL LIFE INSURANCE
                                               COMPANY,
                                           Registrant

                                           By: Connecticut General Life 
                                                    Insurance Company
                                               Depositor

                                           By:     
                                               ----------------------------


                                           CONNECTICUT GENERAL LIFE INSURANCE
                                               COMPANY,
                                           Depositor

                                           By:     
                                               ----------------------------



Attest: 
        ---------------------

Title: 
       ----------------------
<PAGE>   69
                              POWER OF ATTORNEY

We, the undersigned directors and officers of Connecticut General Life
Insurance Company, hereby severally constitute and appoint David C. Kopp and
Jerold H. Rosenblum, and each of them individually, our true and lawful
attorneys, with full power to them and each of them to sign for us, and in our
names and in the capacities indicated below, any and all Registration
Statements on Form N-8B-2 or S-6 on behalf of the Company in the name of one of
its Separate Accounts filed with the Securities and Exchange Commission under
the Securities Act of 1933, and such other documentation as may be required to
obtain the necessary approvals of state and federal regulators for the
registration and issuance of products from the Separate Account, hereby
ratifying and confirming our signatures as they may be signed by our attorneys
to said Registration Statements and documentation.

WITNESS our hands and common seal on this ________ day of _____________, 1995.

<TABLE>                             
<CAPTION>                           
Signature                             Title
- ---------                             -----
<S>                                   <C>
/s/ THOMAS C. JONES
- -----------------------               President (Principal Executive Officer) 
Thomas C. Jones                                                               

/s/ JAMES T. KOHAN
- -----------------------               Vice President and Actuary (Principal   
James T. Kohan                        Financial Officer)                      
                                                                              
/s/ ROBERT MOOSE
- -----------------------               Vice President                          
Robert Moose                          (Principal Accounting Officer)          
                                                                              
/s/ HAROLD W. ALBERT
- -----------------------               Director                                
Harold W. Albert                                                              

/s/ S. TYRONE ALEXANDER
- -----------------------               Director                                
S. Tyrone Alexander                                                           

/s/ MARTIN A. BRENNAN
- -----------------------               Director                                
Martin A. Brennan                                                             

/s/ ROBERT W. BURGESS
- -----------------------               Director                                
Robert W. Burgess                                                             
</TABLE>                              
<PAGE>   70
POWER OF ATTORNEY                   
PAGE 2                              
                                    
<TABLE>                             
<S>                                      <C>
/s/ JOHN G. DAY
- ---------------------------              Director 
John G. Day                                    

/s/ R. CHRIS DOERR
- ---------------------------              Director 
R. Chris Doerr                                 

/s/ LAWRENCE P. ENGLISH
- ---------------------------              Director 
Lawrence P. English                            

/s/ JOSEPH M. FITZGERALD
- ---------------------------              Director 
Joseph M. Fitzgerald                           

/s/ ARTHUR C. REEDS, III
- ---------------------------              Director 
Arthur C. Reeds, III                           

/s/ PATRICIA L. ROWLAND
- ---------------------------              Director 
Patricia L. Rowland                            

/s/ W. ALLEN SCHAFFER, M.D.
- ---------------------------              Director 
W. Allen Schaffer, M.D.                        
</TABLE>                                
                                        

<PAGE>   1
                                                                  EXHIBIT A(1)

                            SECRETARY'S CERTIFICATE

                   CONNECTICUT GENERAL LIFE INSURANCE COMPANY

The following is certified to be a true and correct copy of certain resolutions
adopted by the Board of Directors of Connecticut General Life Insurance Company
at a meeting held on May 22, 1995, a quorum being present; and such resolutions
remain in full force and effect as of the date of certification, not having
been amended, modified or rescinded since the date of its adoption.

        Establishment of CG Variable Life Insurance Separate Account A

         WHEREAS, Section 38a-433 of the Connecticut Insurance Laws permits a
         domestic life insurance company to establish one or more separate
         accounts; and

         WHEREAS, it is desired that the Company create such a separate account
         to house certain of its variable life insurance products;

         NOW, THEREFORE, BE IT RESOLVED: The a separate account referred to
         herein as "CG Variable Life Insurance Separate Account A" is hereby
         established.

         FURTHER RESOLVED: That the assets of CG Variable Life Insurance
         Separate Account A shall be derived solely from (a) the sale of
         variable life insurance products, (b) funds corresponding to dividend
         accumulation with respect to investment of such assets, and (c)
         advances made by the Company in connection with the operation of CG
         Variable Life Insurance Separate Account A.

         FURTHER RESOLVED: That this Company shall maintain in CG Variable Life
         Insurance Separate Account A assets with a fair market value at least
         equal to the statutory valuation reserves for the variable life
         insurance policies.

         FURTHER RESOLVED: That the officers of the Company be, and each of
         them hereby is, authorized in his or her discretion, as the Company
         may deem appropriate from time to time, in accordance with applicable
         laws and regulations (a) to divide CG Variable Life Insurance Separate
         Account A into divisions and subdivisions, with each division or
         subdivision investing in shares of designated classes of designated
         investment companies or other appropriate securities, (b) to modify
         or eliminate any such divisions or subdivisions, (c) to designate
         further any division or subdivision thereof and (d) to change the
         designation of CG Variable Life Insurance Separate Account A to
         another designation.

                                       1
<PAGE>   2
         FURTHER RESOLVED: That the officers of the Company be, and each of
         them hereby is, authorized to invest cash from the Company's general
         account in CG Variable Life Insurance Separate Account A or in any
         division or subdivision thereof as may be deemed necessary or
         appropriate to facilitate the commencement of the operations of CG
         Variable Life Insurance Separate Account A or to meet any minimum
         capital requirements under the Investment Company Act of 1940 and to
         transfer cash or securities from time to time between the Company's
         general account and CG Variable Life Insurance Separate Account A as
         deemed necessary or appropriate so long as such transfers are not
         prohibited by law and are consistent with the terms of the variable
         life insurance policies issued by the Company providing for
         allocations to CG Variable Life Insurance Separate Account A.

         FURTHER RESOLVED: That the income, gains, and losses (whether or not
         realized) from assets allocated to CG Variable Life Insurance Separate
         Account A shall, in accordance with any variable life insurance
         policies issued by the Company providing for allocations to CG
         Variable Life Insurance Separate Account A, be credited to or charged
         against CG Variable Life Insurance Separate Account A without regard
         to the other income, gains, or losses of the Company.

         FURTHER RESOLVED: That authority is hereby delegated to the President
         of the Company to adopt procedures regarding, among other things,
         criteria by which the Company shall afford a pass-through of voting
         rights to the owners of variable life insurance policies providing for
         allocation to CG Variable Life Insurance Separate Account A with
         respect to the shares of any investment companies which are held in CG
         Variable Life Insurance Separate Account A.

         FURTHER RESOLVED: That the officers of the Company be, and each of
         them hereby is, authorized and directed to prepare and execute any
         necessary agreements to enable CG Variable Life Insurance Separate
         Account A to invest or reinvest the assets of CG Variable Life
         Insurance Separate Account A in securities issued by investment
         companies registered under the Investment Company Act of 1940 or other
         appropriate securities as the officers of the Company may designate
         pursuant to the provisions of the variable life insurance policies
         providing for allocations to CG Variable Life Insurance Separate
         Account A.



                                       2
<PAGE>   3
         FURTHER RESOLVED: That the Company may register under the Securities
         Act of 1933 variable life insurance policies, or units of interest
         thereunder, under which amounts will be allocated by the Company to CG
         Variable Life Insurance Separate Account A to support reserves for
         such policies and, in connection therewith, the officers of the
         Company be, and each of them hereby is, authorized, to prepare,
         execute and file with the Securities and Exchange Commission, in the
         name and on behalf of the Company, registration statements under the
         Securities Act of 1933, including prospectuses, supplements, exhibits
         and other documents relating thereto, and amendments to the foregoing,
         in such form as the officer executing the same may deem necessary or
         appropriate.

         FURTHER RESOLVED: That the officers of the Company be, and each of
         them hereby is, authorized to take all actions necessary to register
         CG Variable Life Insurance Separate Account A as a unit investment
         trust under the Investment Company Act of 1940 and to take such
         related actions as they deem necessary and appropriate to carry out
         the foregoing.

         FURTHER RESOLVED: That the officers of the Company be, and each of them
         hereby is, authorized to prepare, execute and file with the Securities
         and Exchange Commission, applications and amendments thereto for such
         exemptions from or orders under the Investment Company Act of 1940 and
         the Securities Act of 1933, and to request from the Securities and
         Exchange Commission no action and interpretative letters as they may
         from time to time deem necessary or desirable.

         FURTHER RESOLVED: That the officers of the Company be, and each of
         them hereby is, authorized to prepare, execute and file all periodic
         reports required under the Investment Company Act of 1940 and the
         Securities Exchange Act of 1934.

         FURTHER RESOLVED: That the Chief Counsel of the Company, or the person
         as is designated by him from time to time, is hereby appointed as
         agent for service under any such registration statement and is duly
         authorized to receive communications and notices from the Securities
         and Exchange Commission with respect thereto, and to exercise powers
         given to such agent by the Securities Act of 1933 and the Rules
         thereunder and any other necessary Act.



                                       3
<PAGE>   4
         FURTHER RESOLVED: That the officers of the Company be, and each
         of them hereby is, authorized to effect in the name and on behalf of
         the Company, all such registrations, filings and qualifications under
         blue sky or other applicable securities laws and regulations and under
         insurance securities laws and insurance laws and regulations of such
         states and other jurisdictions as they may deem necessary or
         appropriate, with respect to the Company, and with respect to any
         variable life insurance policies under which amounts will be allocated
         by the Company to CG Variable Life Insurance Separate Account A to
         support reserves for such policies; such authorization shall include
         registration, filing and qualification of the Company and of said
         policies, as well as registration, filing and qualification of
         officers, employees and agents of the Company as brokers, dealers,
         agents, salespersons, or otherwise; and such authorization shall also
         include, in connection therewith, authority to prepare, execute,
         acknowledge and file all such applications, applications for
         exemptions, certificates, affidavits, covenants, consents to service
         of process and other instruments, and to take all such action as the
         officer executing the same or taking such action may deem necessary or
         desirable.

         FURTHER RESOLVED: That the officers of the Company be, and each of
         them hereby is, authorized to execute and deliver all such documents
         and papers and to do or cause to be done all such acts and things as
         they may deem necessary or desirable to carry out the foregoing
         resolutions and the intent and purpose thereof.


   Dated:  May 22, 1995                         /s/ DAVID C. KOPP
         -------------------------------       --------------------------
                                               David C. Kopp
                                               Corporate Secretary



(SEAL)

                                       4

<PAGE>   1
                                  Mailing Address:  Hartford, Connecticut 06152 
                                     Home Office:  Bloomfield, Connecticut


                   CONNECTICUT GENERAL LIFE INSURANCE COMPANY
                     (REFERRED TO HEREIN AS "THE COMPANY")


POLICYHOLDER:    [ABC COMPANY]

ADDRESS:                  [123 MAIN STREET
                          YOUR STATE, USA]
                                                     
POLICY                    POLICY                      POLICY
NUMBER:  [XXXXX]          EFFECTIVE DATE:  [X/X/XX]   ANNIVERSARY DATE: [X/X]

This group Policy contains the terms under which the Company agrees to insure
certain persons and pay benefits.

The Company and the Policyholder have agreed to all the terms of this group
Policy.

                              INSURING AGREEMENTS

The group Policy is issued to the Policyholder in consideration of its
application, subject to payment of the required premium in accordance with
agreed terms.  The Company agrees to insure eligible persons as described in
the Certificate of Insurance and the Policy Schedule for the benefits provided
in, and subject to the terms, conditions and limitations set forth in the
Policy, the Certificate of Insurance, and the Policy Schedule under which such
person is eligible.  The Certificate(s) are included in and made a part of this
group Policy.

An Employee will become eligible and insured in accordance with the terms of
the Eligibility and Effective Date of Insurance sections of the Certificate.

ALL BENEFITS AND VALUES PROVIDED BY THE POLICY WHEN BASED ON THE INVESTMENT
EXPERIENCE OF THE FUND ACCOUNTS ARE VARIABLE AND NOT GUARANTEED AS TO DOLLAR
AMOUNT.

This Policy is issued in the state of [Your State] and shall be governed by its
laws.


 /s/ DAVID C. KOPP                                          /s/ THOMAS C. JONES
- -------------------                                         --------------------
Corporate Secretary                                             PRESIDENT


                 GROUP VARIABLE UNIVERSAL LIFE INSURANCE POLICY
<PAGE>   2
                               TABLE OF CONTENTS


<TABLE>                                                                         
         <S>                                                                                   <C>
         The Schedule                                                                                       Page
                 Policy Schedule                                                                               3
                 All Other Schedule Sections                                                         Certificate
                                                                                
         Definitions                                                                                 Certificate
                                                                                
         Eligibility                                                                                 Certificate
                                                                                
         Effective Date of Insurance                                                                 Certificate
                                                                                
         Life Insurance Death Benefit                                                                Certificate
                                                                                
         Premium Payments                                                                      5 and Certificate
                                                                                
         Fund Account Provisions                                                                     Certificate
                                                                                
         Certificate Value Provisions                                                                Certificate
                                                                                
         Surrenders, Loan and Reinstatement Provisions                                               Certificate
                                                                                
         Termination Provisions                                                                      Certificate
                                                                                
         Continuation Provisions                                                                     Certificate
                                                                                
         Conversion Provisions                                                                       Certificate
                                                                                
         Table of Guaranteed Maximum Monthly Cost of Insurance Rates                                 Certificate
                                                                                
         Ownership and Assignment Provisions                                                         Certificate
                                                                                
         Beneficiary Provisions                                                                      Certificate
                                                                                
         General Provisions                                                                    6 and Certificate
                                                                                
         [Accelerated Payment Benefit                                                                     Rider]
                                                                                
         [Paid-Up Life Insurance Option                                                                   Rider]
                                                                                
         [Seat Belt Benefit                                                                               Rider]
                                                                                
         [Supplemental Accidental Death Benefit                                                           Rider]
                                                                                
         [Supplemental Accidental Death and Dismemberment Benefit                                         Rider]
                                                                                
         [Supplemental Accidental Death, Dismemberment,                         
                 Loss of Sight, Speech and Hearing; or Paralysis Benefit                                  Rider]
                                                                                
         [Waiver of Cost of Life Insurance During Total Disability                                        Rider]
</TABLE>                                                                        





                                       2
<PAGE>   3
                                POLICY SCHEDULE


POLICYHOLDER:    [ABC COMPANY]

EMPLOYER:        [ABC COMPANY]

CLASSES OF ELIGIBLE EMPLOYEES:

<TABLE>
<S>                                                                             <C>
LIFE INSURANCE BENEFITS                                                          
    FOR EMPLOYEE                                                                 
         MAXIMUM GUARANTEED ISSUE:                                                           [$40,000]
         MAXIMUM ISSUE:                                                                           [$!]
         [AUTOMATIC INCREASE FEATURE:                                           [Optional/Automatic] ]
                                                                                 
    [FOR SPOUSE:                                                                 
         MAXIMUM GUARANTEED ISSUE:                                                           [$20,000]
         MAXIMUM ISSUE:                                                                         [$!] ]
                                                                                 
    [FOR DEPENDENT CHILD(REN) TERM INSURANCE:                                    
         MAXIMUM ISSUE:                                                                         [$!] ]
                                                                                 
ADDITIONAL BENEFITS:                                                                    EFFECTIVE DATE
                                                                                 
[Accelerated Payment Benefit Rider                                                           XX/XX/XX]
[Paid-up Insurance Option Rider                                                              XX/XX/XX]
[Seat Belt Benefit Rider                                                                     XX/XX/XX]
[Supplemental Accidental Death Benefit Rider                                                 XX/XX/XX]
[Supplemental Accidental Death & Dismemberment Benefit Rider                                 XX/XX/XX]
[Supplemental Accidental Death, Dismemberment, Loss of Sight,                    
 Speech & Hearing; or Paralysis Benefit Rider                                                XX/XX/XX]
[Waiver of Cost of Life Insurance During Total Disability Rider                              XX/XX/XX]
</TABLE>                                                                        





                                       3
<PAGE>   4
AVAILABLE FUNDS

<TABLE>
<CAPTION>
FUND GROUPS                                FUNDS
<S>                                        <C>
Fund Manager A                             Fidelity VIP II Investment Grade Bond Portfolio
                                           Fidelity VIP Equity-Income Portfolio
                                           Fidelity VIP II Asset Manager Portfolio
                                           Fidelity VIP Overseas Portfolio

Fund Manager B                             TCI Growth

Fund Manager C                             CIGNA Variable Products Money Market Fund
                                           CIGNA Variable Products Index Fund
</TABLE>





The Separate Account for the Policy is CG Variable Life Insurance Separate
Account A - A Connecticut General Life Insurance Company separate investment
account established on May 22, 1995.





                                       4
<PAGE>   5
                               PREMIUM PROVISIONS

PAYMENT OF POLICY PREMIUM.  The total premium payable by the Policyholder under
the Policy will be the sum of all amounts payroll deducted as Premium for the
Policy each month and payroll deduction services for collection of all premium
contributed by Employees.  The first premium will be due on the Policy
Effective Date.  After that, premiums will be due on the first day of each
month, unless the Policyholder and the Company agree on some other method of
premium payment from time to time.  The premiums are payable at the designated
Customer Service Center and will be deemed received only when an accurate
reconciliation is received, two business days prior to the receipt of the
premium, and the premium is actually received at the Customer Service Center or
when wire transferred into a bank account established by the Company for
receipt of premium under this Policy.

If any premium is not paid when due, the Policy will be cancelled as of the
date the premium is due, except as provided in the Grace Period section.

GRACE PERIOD.  A Grace Period of 61 days will be granted for the payment of the
payroll deducted premium under the Policy.  The Policy will be in force during
that Grace Period.  If such premium is not paid in the Grace Period, the Policy
will cease at the end of that period.  The Policy will cease before that date
if the Policyholder gives written notice of cancellation in advance to the
Company.  When the Policy ceases, the Policyholder will be liable to the
Company for all premiums past due.





                                       5
<PAGE>   6
                               GENERAL PROVISIONS

ENTIRE CONTRACT.  The entire contract will be made up of the Policy, the
application of the Policyholder, a copy of which is attached to the Policy, the
Certificate(s), the Coverage Verification Pages, any Policy or Certificate
riders, and the applications, if any, of the Insureds.

POLICY CHANGES.  Changes may be made in the Policy only by amendment, signed by
the Policyholder and by the Company acting through its President or Director.
No agent may change or waive any terms of the Policy.

INSURANCE DATA.  The Policyholder will give the Company all of the data that it
needs to calculate the premium and all other data that it may reasonably
require.  Failure of the Policyholder to give this data will not void or
discontinue an Insured's insurance.  The Company has the right to examine the
Policyholder's records relative to these benefits at any reasonable time while
the Policy is in effect, and maintains this right until all rights and
obligations under the Policy are finally fulfilled.

STATEMENTS NOT WARRANTIES.  All statements made by the Policyholder or by an
applicant will, in the absence of fraud, be deemed representations and not
warranties.  No statement made by the Policyholder or by the applicant to
obtain insurance will be used to void or reduce the insurance unless it is made
in writing, and is signed by the Policyholder or the applicant and a copy is
sent to the Policyholder, the applicant or his Beneficiary.

CLERICAL ERROR.  An Insured's coverage will not be affected by error or delay
in keeping records of insurance under this Policy.  If such an error or delay
is found, the premium will be adjusted fairly.

CERTIFICATES.  The Company will issue a Certificate to each Owner.  The
Certificate will show the benefits provided under this Policy.  It will set
forth any changes in benefits due to age and to whom benefits will be paid.

CONFORMITY WITH STATE STATUTES.   Any provision of this Policy which, as of its
effective date, is in conflict with the laws of the state where it is
delivered, is amended to conform to the minimum requirements of such laws.





                                       6
<PAGE>   7
                                   Mailing Address:  Hartford, Connecticut 06152
                                           Home Office:  Bloomfield, Connecticut

CONNECTICUT   GENERAL  LIFE  INSURANCE  COMPANY ("the Company") certifies that
it insures the person(s) named in the Coverage Verification Pages attached to
this Certificate for the benefits provided by the Group Variable Universal Life
Insurance Policy No.  [XXXXXX-X] (the "Policy") issued to the [ABC Company] as
indicated in the Coverage Verification Pages.

NOTICE:   This Certificate does not apply to any Insured unless the Coverage
          Verification Pages showing the Insured's name, eligibility class, and
          the Certificate Effective Date are attached.

[EMPLOYER: ABC Company ]
POLICYHOLDER: [ABC Company ]
POLICY EFFECTIVE DATE: [XX/XX/XX]

This Certificate is included in and made a part of the Policy.  It describes
the main features of the insurance.

This Certificate takes the place of any other issued to the Insured on a prior
date which described the insurance.

                            30-DAY RIGHT TO EXAMINE

If the Owner is not satisfied with this Certificate for any reason, it may be
returned to the Company within 30 days after receipt.  During this time, any
premium paid will be placed in the Fixed Account, and if the Certificate is so
returned, it will be deemed void from the Certificate Issue Date and the
Company will return any premium that has been paid, less any loans, interest
accrued and partial surrenders made during the Right to Examine period. If the
Certificate is not returned during the Right to Examine period, all premiums
will be allocated within three days of the end of the Right to Examine period
as provided for in the Allocation of Net Premium Payments provision.

The amount of insurance payable upon the death of the Insured will be
determined as provided in the Life Insurance Benefit provisions of the
Certificate.

THE BENEFITS AND VALUES PROVIDED BY THE POLICY WHEN BASED ON THE INVESTMENT
EXPERIENCE OF THE FUND ACCOUNTS ARE VARIABLE AND ARE NOT GUARANTEED AS TO
DOLLAR AMOUNT.  LOANS MAY NOT EXCEED 90% OF THE NET CASH VALUE.


 /s/ DAVID C. KOPP                                          /s/ THOMAS C. JONES
- -------------------                                         --------------------
Corporate Secretary                                             PRESIDENT


                             CERTIFICATE OF GROUP
                              VARIABLE UNIVERSAL
                                LIFE INSURANCE
<PAGE>   8
                               TABLE OF CONTENTS
<TABLE>
<CAPTION>
                                                                                     PAGE
                                                                                     ----
<S>                                                                                  <C>
CERTIFICATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           1
DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           4
SCHEDULE OF BENEFITS ("THE SCHEDULE") . . . . . . . . . . . . . . . . . . . .           8
         Guaranteed Issue Amount  . . . . . . . . . . . . . . . . . . . . . .           9
         Amounts Exceeding the Guaranteed Issue Amount  . . . . . . . . . . .          10
         Maximum and Minimum Amounts of Coverage  . . . . . . . . . . . . . .          10
CHANGES IN COVERAGE AMOUNT  . . . . . . . . . . . . . . . . . . . . . . . . .          11
         Automatic Increase Feature . . . . . . . . . . . . . . . . . . . . .          11
         Increases in Coverage Amount . . . . . . . . . . . . . . . . . . . .          11
         Decreases in Coverage Amount . . . . . . . . . . . . . . . . . . . .          12
         Premiums Held Pending Acceptance of Coverage Amount  . . . . . . . .          12
         Maximums and Minimums  . . . . . . . . . . . . . . . . . . . . . . .          12
         Increase Due to Minimum Death Benefit Provisions . . . . . . . . . .          13
ELIGIBILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          14
EFFECTIVE DATE OF INSURANCE . . . . . . . . . . . . . . . . . . . . . . . . .          16
LIFE INSURANCE BENEFIT  . . . . . . . . . . . . . . . . . . . . . . . . . . .          19
PREMIUM PAYMENTS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          21
         Premiums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          21
         Allocation of Net Premium Payments . . . . . . . . . . . . . . . . .          21
         Limits on Allocation of Net Premium Payments . . . . . . . . . . . .          21
         Interruptions of Premium Payments  . . . . . . . . . . . . . . . . .          22
         Grace Period for Insured . . . . . . . . . . . . . . . . . . . . . .          22
FUND ACCOUNT PROVISIONS . . . . . . . . . . . . . . . . . . . . . . . . . . .          23
         Separate Account and Fund Accounts . . . . . . . . . . . . . . . . .          23
         Investment Risk  . . . . . . . . . . . . . . . . . . . . . . . . . .          23
         Investment of the Fund Account Assets  . . . . . . . . . . . . . . .          24
         Substitution or Elimination of Securities  . . . . . . . . . . . . .          24
         Transfer Privilege . . . . . . . . . . . . . . . . . . . . . . . . .          24
         Limits on Transfers  . . . . . . . . . . . . . . . . . . . . . . . .          25
CERTIFICATE VALUE PROVISIONS  . . . . . . . . . . . . . . . . . . . . . . . .          26
         Cash Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          26
         Fixed Account Value  . . . . . . . . . . . . . . . . . . . . . . . .          26
         Loan Account Value . . . . . . . . . . . . . . . . . . . . . . . . .          26
         Fund Account Value . . . . . . . . . . . . . . . . . . . . . . . . .          26
         Crediting and Cancelling Variable Accumulation Units . . . . . . . .          27
         Variable Accumulation Unit Value . . . . . . . . . . . . . . . . . .          27
         Net Investment Factor  . . . . . . . . . . . . . . . . . . . . . . .          27
         Monthly Cost of Insurance Rates  . . . . . . . . . . . . . . . . . .          28
         Monthly Deduction  . . . . . . . . . . . . . . . . . . . . . . . . .          28
         Net Cash Value . . . . . . . . . . . . . . . . . . . . . . . . . . .          29
         Lapse (Insufficient Net Cash Value)  . . . . . . . . . . . . . . . .          29
         Basis of Computations  . . . . . . . . . . . . . . . . . . . . . . .          29
SURRENDERS, LOANS AND REINSTATEMENT PROVISIONS  . . . . . . . . . . . . . . .          30
TERMINATION PROVISIONS  . . . . . . . . . . . . . . . . . . . . . . . . . . .          33
CONTINUATION PROVISIONS . . . . . . . . . . . . . . . . . . . . . . . . . . .          34
CONVERSION PROVISIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . .          36
TABLE OF GUARANTEED MAXIMUM MONTHLY COST OF INSURANCE   . . . . . . . . . . .          37
OWNERSHIP AND ASSIGNMENT PROVISIONS . . . . . . . . . . . . . . . . . . . . .          39
BENEFICIARY PROVISIONS  . . . . . . . . . . . . . . . . . . . . . . . . . . .          40
GENERAL PROVISIONS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          41
</TABLE>                                                            





                                       2
<PAGE>   9
                              EXPLANATION OF TERMS

You will find terms starting with capital letters throughout your Certificate
and the Coverage Verification Pages.  To help you understand your benefits, the
location of the definition of these terms is indicated in the Table of
Contents, or the definition is provided in the Definitions section of this
Certificate.  The male pronoun, whenever used, includes the female pronoun.


                                  THE SCHEDULE

The Schedule is a brief outline of the amounts of coverage available upon
initial enrollment.  For a full description of each benefit, refer to the
appropriate section listed in the Table of Contents.





                                       3
<PAGE>   10
DEFINITIONS

ACTIVE SERVICE
    An Employee will be considered in Active Service with the Employer on a day
    which is one of the Employer's scheduled work days if he is performing in
    the usual way all of the regular duties of his work for the Employer.  Such
    service can occur at one of the Employer's places of business or at some
    location to which the Employer's business requires him to travel.  An
    Employee will be deemed in Active Service on a day which is not one of the
    Employer's scheduled work days only if he was in Active Service on the
    preceding scheduled work day.

ANNUAL COMPENSATION
    An Insured Employee's rate of pay as reported by the Employer.  It does not
    include [overtime, bonus, additional compensation, or pay for more than 40
    hours in a week.]  A Retiree's Annual Compensation will be his rate of pay
    in effect immediately prior to retirement.  A Leave of Absence Employee's
    Annual Compensation will be his rate of pay in effect immediately prior to
    going on a Leave of Absence.

ATTAINED AGE
    An Insured's age on his last birthday either prior to or on the same date
    as the Policy Effective Date or the Policy Anniversary Date, whichever is
    later.

CASH VALUE
    Cash Value is the sum of the Fixed Account Value, the Fund Account Values,
    and the Loan Account Value.

CERTIFICATE EFFECTIVE DATE
    The Certificate Effective Date is the date this Certificate becomes
    effective, as shown in the Coverage Verification Pages.

CURRENT OUTSTANDING LOAN BALANCE
    The Loan Balance plus all interest accrued but not yet paid.

[DEPENDENT CHILD
    The unmarried Child of an Employee who is:
    a)   at least 15 days of age, but less than [19] years old; or
    b)   [19] or more years old, but less than [25] years, and enrolled in a
         school as a full-time student and primarily supported by the Employee;
         or
    c)   [19] or more years old, primarily supported by the Employee, and
         incapable of self-sustaining employment by reason of mental or
         physical handicap.  Proof of the Child's condition and dependence must
         be submitted to the Company within 31 days after the date the Child
         ceases to qualify as a Dependent under a) or b) above.  During the
         next two years, the Company may, from time to time, require proof of
         the continuation of such condition and dependence.  After that, the
         Company may require proof no more than once a year.

    The term "Child" means a Child born to, legally adopted by, or under the
    legal guardianship of  the Employee.  It also means a stepchild of the
    Employee living with the Employee.]





                                       4
<PAGE>   11
DEFINITIONS


EMPLOYEE
    An Employee of the Employer in one of the Classes of Eligible Employees
    described in the Classes of Eligible Persons provisions.  [The term does
    not include Employees who are part-time or temporary or who normally work
    less than [30] hours a week for the Employer.]





                                       5
<PAGE>   12
DEFINITIONS (CONTINUED)

EMPLOYER
    The Employer is shown on the first page of this Certificate and is the
    group Policyholder.

FIXED ACCOUNT
    The account which provides for a guaranteed minimum interest rate of not
    less than 4% per year.  Fixed Account assets are general assets of the
    Company and are distinguishable from those allocated to a separate account
    of the Company.

[FORMER INSURED DEPENDENT CHILD
    An Insured Dependent Child who: (a) no longer qualifies as a Dependent
    Child, and who has elected to continue his insurance under the Policy; or
    (b) is at least 22 years of age and has elected to be insured as a Former
    Insured Dependent Child instead of being insured as an Insured Dependent
    Child.]

FORMER INSURED EMPLOYEE
    An Insured Employee who no longer qualifies as such and who has elected to
    continue his insurance under the Policy.

[FORMER INSURED SPOUSE
    An Insured Spouse  who: (a) no longer qualifies as such and who has elected
    to continue his insurance under the Policy; or (b) a Spouse of a Former
    Insured Employee who has elected to be insured under the Policy on or after
    the date the Insured Employee becomes a Former Insured Employee.]

FUND ACCOUNT
    An account, the value of which varies based on the net investment
    performance of a specific Fund, as described in the Fund Account
    Provisions. Assets in a Fund Account are not guaranteed.

FUND ACCOUNT VALUE
    The Cash Value portion which is determined by multiplying the number of
    Variable Accumulation Units in the Fund Account by the current Variable
    Accumulation Unit Value.

FUNDS
    One or more of CIGNA Money Market Fund, Fidelity Investment Grade Bond
    Portfolio, Fidelity Asset Manager Portfolio, CIGNA Index Fund, Fidelity
    Equity-Income Portfolio, TCI Growth, Fidelity Overseas Portfolio.

    Each Fund is an open-end management investment company, or a portfolio of
    an open-end management investment company, whose investment performance is
    used in determining the investment performance of a Fund Account under the
    Policy.

GENERAL ACCOUNT
    The Company's general asset account in which along with other assets of
    the Company, assets supporting the non-variable portion of the Policy are
    held.

GUARANTEED ISSUE AMOUNT
    The Coverage Amount that an Insured may purchase without satisfying the
    Insurability Requirement.  The Maximum Guaranteed Issue Amount for each
    Class of Insureds is specified in The Schedule.  The Company reserves the
    right to change this amount from time to time.





                                       6
<PAGE>   13
DEFINITIONS (CONTINUED)


INSURABILITY REQUIREMENT
    The requirement that an eligible person submit evidence of good health
    acceptable to the Company in order to be insured.  The Company may require
    that the eligible person provide such evidence at his own expense.
    Further, the Company may require different evidence of good health for
    different amounts of insurance.

INSURED
    A person who is eligible for insurance in one of the Eligible Classes under
    the Policy, who has elected the insurance, and for whom premium has been
    paid and whose coverage has not ceased.

LAPSE
    The Insured's coverage ends due to insufficient Net Cash Value (See Lapse
    section).  The insurance will remain in force, subject to the terms and
    conditions of the Policy, until the Net Cash Value is insufficient to cover
    the Monthly Deduction, as provided in the Lapse and Grace Period for
    Insured provisions.

[LIFE STATUS CHANGE
    A Life Status Change is defined as any of the following events:
         -  marriage, legal separation, annulment, or divorce;
         -  death of Employee's Spouse or Dependent Child;
         -  birth, adoption or legal guardianship of a child;
         -  stepchild living with the Employee; or
         -  purchase of a primary home.]

LOAN ACCOUNT
    The account in which assets securing a Loan against the Certificate are
    held after transfer out of the Fixed Account and the Fund Accounts.  The
    Loan Account assets are general assets of the Company and are
    distinguishable from those allocated to a separate account of the Company
    and to the Fixed Account.

LOAN BALANCE
    The sum of all loans granted under the Certificate less any loan repayments
    plus all unpaid interest added to the Loan Balance as provided for in the
    Certificate Loan provisions.

MONTHLY ADMINISTRATIVE FEES
    Two fixed monthly charges to the Certificate representing the Company's
    cost of administering the Certificates. These charges are set forth in the
    Coverage Verification Pages.

MONTHLY DEDUCTION
    The Monthly Deduction means monthly charges made to the Cash Value; these
    charges include the cost of insurance, the monthly administrative fees,
    and charges for any supplemental riders or benefits (see Monthly Deduction
    section).





                                       7
<PAGE>   14
DEFINITIONS (CONTINUED)


NET CASH VALUE
    The Net Cash Value means the Cash Value minus any Current Outstanding Loan
    Balance (see Certificate Value Provisions).

NET PREMIUM PAYMENT
    The amount of a premium payment, less the premium load for taxes shown in
    the Coverage Verification Pages.  The Net Premium Payment is the amount
    available for allocation to the Fixed Account and the Fund Accounts.

OWNER
    The owner of a Certificate under a Policy on the Certificate Effective Date
    is the person designated as Owner in the Coverage Verification Pages. If no
    person is designated as the Owner, the Insured will be the Owner.

PAID-UP INSURANCE
    A life insurance policy issued by the Company or an affiliate of the
    Company under which no further premiums are payable but under which the
    insurance coverage continues in effect.  For purposes of determining the
    Guaranteed Issue Amount and the Maximum Amount of Insurance under this
    Certificate, Paid-up Insurance shall mean Paid-up Insurance purchased under
    the Policy or a Replaced Policy.

POLICY ANNIVERSARY DATE
    The Policy Anniversary Date as stated on the Coverage Verification Pages.





                                       8
<PAGE>   15
DEFINITIONS (CONTINUED)

POLICY EFFECTIVE DATE
    The date the Policy issued to the Policyholder becomes effective.

POLICY YEAR
    The period starting on a Policy Anniversary Date and continuing to the next
    Policy Anniversary Date.  The initial Policy Year may be less than 12
    months.

RELATED FUND
    The Fund whose investment performance is the basis for a specific Fund
    Account's investment performance.

REPLACED POLICY
    Any policy of group universal life insurance or group variable
    universal life insurance issued by the Company or an affiliate of
    the Company to the Employer, or to a trust to which the Employer
    subscribes, which policy is discontinued, or sponsorship of which policy is
    discontinued, within 90 days of the Policy Effective Date of the Policy.

RETIREE
    A former Employee of the Employer who has satisfied the Employer's
    requirements for retirement.

SEPARATE ACCOUNT
    CG Variable Life Insurance Separate Account A established on May 22, 1995.

SPOUSE
    Except for the purpose of eligibility for insurance, the lawful Spouse of
    an Employee, including a Spouse who is legally separated, divorced, or
    widowed.

SUCCESSOR PLAN
    A life insurance plan available through the Employer within 90 days of
    termination of the Policy for which the Insureds are, or will become,
    eligible to obtain similar insurance.

VALUATION DAY
    Every day on which the New York Stock Exchange ("NYSE") is open for
    business, except any day on which trading on the NYSE is restricted, or on
    which an emergency exists, as determined by the Securities and  Exchange
    Commission, so that valuation or disposal of securities is not practicable.

VALUATION PERIOD
    The period of time for which a Fund determines its net asset value; a
    Valuation Period is the period of time between the ends of two consecutive
    Valuation Days.  A Valuation Period may be longer than one day.

VARIABLE ACCUMULATION UNIT
    A unit of measure used in calculating the value of each Fund Account.





                                       9
<PAGE>   16
           -------------------   THE SCHEDULE   -------------------

LIFE INSURANCE

AMOUNTS OF INSURANCE AVAILABLE
   When applying, an applicant may elect a Coverage Amount from the Coverage
   Amounts available for his Eligible Class as set forth in this Schedule.



<TABLE>
<CAPTION>
                 ELIGIBLE CLASS                                              COVERAGE AMOUNT
                 <S>                                                         <C>
                 Insured Employee                                            An amount elected [equal to 1, 2, 3, 4, or 5 times
                                                                             the Employee's  Annual Compensation, rounded to
                                                                             the next higher $10,000, if not already an even
                                                                             multiple of $10,000,].  The sum of the Coverage
                                                                             Amount, the Paid-up Insurance, if any, and any
                                                                             insurance continued or converted under a Replaced
                                                                             Policy may not exceed the lesser of [X] times the
                                                                             Employee's Annual Compensation or [$1,000,000].

                    Maximum Guaranteed Issue Amount                          [$!]


                 [Insured Spouse                                             An amount elected in increments of [$10,000].  The
                                                                             sum of the Coverage Amount, the Paid-up Insurance,
                                                                             if any, and any insurance continued or converted
                                                                             under a Replaced Policy may not exceed [an amount
                                                                             equal to: (a) 3 times the Employee's  Annual
                                                                             Compensation; or (b) $100,000, whichever is less].

                    Maximum Guaranteed Issue Amount                          [$!] ]



                 [Insured Dependent Child                                    [$10,000] ]


                 [Former Insured Dependent Child                             [$50,000] ]


                 Former Insured Employee                                     An amount elected up to  the Insured's last
                                                                             Coverage Amount as an Insured Employee.
</TABLE>





                                       10
<PAGE>   17
           -------------------   THE SCHEDULE   -------------------

LIFE INSURANCE

AMOUNTS OF INSURANCE AVAILABLE (CONTINUED)

<TABLE>
<CAPTION>
                 ELIGIBLE CLASS                                              COVERAGE AMOUNT
                 <S>                                                         <C>
                 [Former Insured Spouse and                                  An amount elected in increments of [$10,000].  The
                    Spouse of a Former Insured Employee                      sum of the Coverage Amount, the Paid-up Insurance,
                                                                             if any, and any insurance continued or converted
                                                                             under a Replaced Policy may not exceed [an amount
                                                                             equal to: (a) 3 times the Employee's  Annual
                                                                             Compensation; or (b) $100,000, whichever is less.]]


                 [Retiree                                                    An amount elected up to the Insured's last
                                                                             Coverage Amount as an Insured Employee.

                    Maximum Guaranteed Issue Amount                          [$!] ]


                 [Leave of Absence Employee                                  An amount elected up to the Insured's last
                                                                             Coverage Amount as an Insured Employee.]
</TABLE>


GUARANTEED ISSUE AMOUNT
   The Guaranteed Issue Amount is the amount of coverage for which the
   applicant may become insured under the Policy without satisfying the
   Insurability Requirement.  The Guaranteed Issue Amount is the Maximum
   Guaranteed Issue Amount shown above less any amount of coverage continued or
   converted under any Replaced Policy.

   For purposes of determining the Guaranteed Issue Amount and the Maximum
   Amount of Coverage, "Replaced Policy" means any policy of group universal
   life insurance or group variable universal life insurance issued by the 
   Company or an affiliate of the Company to the Employer, or to a trust to 
   which the Employer subscribes, which policy is discontinued, or sponsorship 
   of which policy is discontinued, within 90 days of the Policy Effective Date.





                                       11
<PAGE>   18
           -------------------   THE SCHEDULE   -------------------

LIFE INSURANCE (CONTINUED)

AMOUNTS EXCEEDING THE GUARANTEED ISSUE AMOUNT
   If the Coverage Amount initially elected for an Insured is higher than the
   Guaranteed Issue Amount, he will become insured for the amount that exceeds
   the Guaranteed Issue Amount only if he satisfies the Insurability
   Requirement for that amount.  Premiums paid for coverage in excess of the
   Guaranteed Issue Amount prior to written acceptance by the Company will be
   held in the Fixed Account until the excess coverage is accepted or declined.
   If the excess coverage is accepted, the Net Premiums will be allocated as
   provided for in the Allocation of Net Premium Payments provision during 
   the next Valuation Period after the Company accepts the excess coverage.  
   If the coverage is declined, the premiums will be returned without interest
   and less any Partial Surrenders and Loans plus accrued interest.

MAXIMUM AND MINIMUM AMOUNTS OF COVERAGE
   The Coverage Amount for an Insured may not, at any time, be
   less than [$10,000]. The  Coverage Amount for an Insured Spouse or an
   Insured Former Spouse may not be less than [$10,000 or 50% of the Insured
   Employee's Coverage Amount if the Insured Employee's Coverage Amount is less
   than  $20,000]. The sum of the Coverage Amount, any Paid-up Insurance for
   the [Insured Employee, or Former Insured Employee, or Retiree, or a Leave of
   Absence Employee], and any insurance continued or converted under a Replaced
   Policy may not at any time exceed the lesser of [X] times the Employee's
   Annual Compensation or [$1,000,000].  [The sum of the Coverage Amount, any
   Paid-up Insurance for the Insured Spouse, or Former Insured Spouse and any
   insurance continued or converted under a Replaced Policy may not at any time
   exceed an amount equal to:  (a) 3 times the Employee's Annual Compensation;
   or (b) $100,000, whichever is less.  The sum of the Coverage Amount and the
   Paid-up Insurance for a Former Insured Dependent Child may not, at any time,
   exceed $50,000. ]





                                       12
<PAGE>   19
CHANGES IN COVERAGE AMOUNT

[AUTOMATIC INCREASE FEATURE
   If an Insured Employee is covered for the Automatic Increase Feature:
      -   his Coverage Amount will be increased on the Policy Anniversary Date
          in order to maintain his elected multiple of his Annual Compensation;
      -   he will not be required to satisfy the Insurability Requirement for
          the increased amount, provided he is in Active Service; and
      -   the increase amount will be limited to [$,%!] per increase.

   When an eligible Employee becomes insured, he [will/may elect to] be
   enrolled for the Automatic Increase Feature [unless it is rejected.]

   If an Insured Employee is not enrolled for the Automatic Increase Feature
   when he first becomes insured, or if the feature is elected and later
   revoked, the feature may be elected at a later date.  If the feature is
   elected at a later date, the Insured Employee must satisfy the Insurability
   Requirement before he is enrolled for the feature.

   [For purposes of the Automatic Increase Feature, Annual Compensation does
   not include commissions.] ]

INCREASES IN COVERAGE AMOUNT
   On any date while an Insured is covered, the Owner may elect to:
      -   increase the Coverage Amount based on a higher multiple of the
          Insured Employee's Annual Compensation; or 
      -   increase the Insured Employee's Coverage Amount based on an increase
          in his Annual Compensation[; or 
      -   increase the Coverage Amount of an Insured Spouse, Insured Dependent
          Child, Former Insured Dependent Child, Former Insured
          Employee, Former Insured Spouse, or Retiree].

   However, the Insured will become covered for the elected higher Coverage
   Amount only if he satisfies the Insurability Requirement for that amount
   [unless the Insurability Requirement is otherwise not applicable under the
   Automatic Increase Feature].  The effective date of the increase will be the
   day the Company agrees in writing to accept the Insured for the higher
   Coverage Amount.

   [Within 31 days following a Life Status Change, an election may be made to
   increase the Insured Employee's Coverage Amount by [one times the Employee's
   Annual Compensation], without evidence of insurability. ]





                                       13
<PAGE>   20
CHANGES IN COVERAGE AMOUNT

INCREASES IN COVERAGE AMOUNT (CONTINUED)
   [The Guaranteed Issue Amount applies only to initial enrollment.  Unless an
   increase in coverage is exempted from the Insurability Requirement under the
   Automatic Increase Feature or, in the case of an increase of [one times the
   Employee's Annual Compensation] within 31 days following a Life Status
   Change, that increase in coverage will require evidence of insurability
   acceptable to the Company, regardless of whether the proposed new Coverage
   Amount exceeds the Guaranteed Issue Amount, if any. ]

   If an Insured Employee is not in Active Service on the date he would
   otherwise become insured for an increased Coverage Amount, he will become
   insured for the increase on the date he returns to Active Service.  If he
   does not return to Active Service within 90 days from the date the Company
   agrees in writing to accept him for the higher Coverage Amount, he must
   again satisfy the Insurability Requirement.

   If, on the date [an Insured Spouse, Former Insured Employee, Former Insured
   Spouse, Former Insured Dependent Child, or Retiree] would otherwise become
   insured for an increased Coverage Amount:  (a) he is hospitalized; and/or
   (b) he is unable to engage in the normal activities of a person of the same
   age and sex, he will become insured for the increase on the day after the
   conditions described under (a) and/or (b) have ended.  If all of these
   conditions have not ended within 90 days from the date the Company agrees in
   writing to accept him for the higher Coverage Amount, he must again satisfy
   the Insurability Requirement.

DECREASES IN COVERAGE AMOUNT
   The Owner may decrease the Coverage Amount at any time by notifying the
   Company.  The decrease in Coverage Amount will become effective on the first
   of the month after written notice has been received by the Company.  The
   Company may refuse any decrease in an Insured's Coverage Amount if the
   Company has determined that such change would adversely affect the Policy's
   or the Certificate's qualification as a life insurance contract under the
   Internal Revenue Code.  Decreases in the Coverage Amount will apply first to
   the most recent increase in Coverage Amount, then to successively earlier
   increases, then to the initially elected Coverage Amount.

PREMIUMS HELD PENDING ACCEPTANCE OF COVERAGE AMOUNT
   Premiums paid for any amount of coverage for which the Insurability
   Requirement must be satisfied will be held in the Fixed Account until the
   coverage is accepted or declined by the Company in writing.  If the coverage
   is accepted, the Net Premium Payment will be allocated as provided for in
   the Allocation of premium payments provision.  If the coverage is declined,
   the premium for that coverage will be returned without interest and less any
   partial surrenders and loans plus accrued interest.

MAXIMUMS AND MINIMUMS
   All changes in Coverage Amounts are subject to the Maximum and Minimum
   Coverage Amounts as set forth in The Schedule.





                                       14
<PAGE>   21
CHANGES IN COVERAGE AMOUNT (CONTINUED)

INCREASES DUE TO MINIMUM DEATH BENEFIT PROVISIONS
   If the Cash Value increases solely as a result of increases in Variable
   Accumulation Unit Value and/or interest credited to the Fixed Account, and
   the Company determines that, as a result of such increase, the Death Benefit
   must be increased to preserve the qualification of the Policy and the
   Certificate as life insurance under the Internal Revenue Code, evidence of
   insurability shall not be required for such increase.

   If, however, the Cash Value increases for any other reason, and the Company
   determines that as a result of such increase, the Death Benefit must be
   increased to preserve the qualification of the Policy or the Certificate as
   life insurance under the Internal Revenue Code, evidence of insurability
   will be required for such increase.

   In any event, the Owner may decline the increase of the Coverage Amount if
   he withdraws at least an amount of Cash Value which the Company determines
   will avoid having the Policy or Certificate fail to qualify as life
   insurance under the Internal Revenue Code for the foreseeable future.





                                       15
<PAGE>   22
ELIGIBILITY

ELIGIBLE CLASSES
   A person may be insured under only one of the Eligible Classes shown below,
   even though he may be eligible under more than one Class.

   INSURED EMPLOYEE
   Each Employee of the Employer in one of the Classes of Eligible Employees
   shown below will become eligible to be insured as an Insured Employee on the
   later of:
      -   the Policy Effective Date; or
      -   the date he becomes an Employee of the Employer in one of the Classes
          of Eligible Employees.

      CLASSES OF ELIGIBLE EMPLOYEES
       [Each Employee]

   [INSURED SPOUSE
   Each Spouse of an eligible Employee will become eligible to be insured as an
   Insured Spouse on the later of: 
      -   the date the Employee becomes eligible himself; or 
      -   the date the person becomes a Spouse of an eligible Employee;

   provided the Spouse is less than [65] years of age on that date.

   For the purpose of eligibility, the Spouse must be a lawful Spouse and not
   legally separated from the Employee. ]

   [INSURED DEPENDENT CHILD
   An Insured, other than an Insured Dependent Child or Former Insured
   Dependent Child, is eligible to elect coverage for his Dependent Child(ren)
   on the later of the date such Insured:
      -   elects coverage for himself; or
      -   acquires a Dependent Child.

   In no event will a Dependent Child be eligible to become insured under two
   Certificates at the same time.]

   [FORMER INSURED DEPENDENT CHILD
   An Insured Dependent Child whose coverage under the Policy would otherwise
   cease because he no longer qualifies as a Dependent Child will become
   eligible to be insured as a Former Insured Dependent Child on the date he
   ceases to be an Insured Dependent Child (see Continuation).

   In addition, an Insured Dependent Child whose insurance as a Dependent Child
   has not yet ceased and who is at least [22] years of age is eligible to be
   insured as a Former Insured Dependent Child.]

   FORMER INSURED EMPLOYEE
   [An Insured Employee or a Leave of Absence Employee] who no longer qualifies
   as such, will become eligible to be insured as a Former Insured Employee on
   the date he ceases to be an Insured Employee [or a Leave of Absence
   Employee], provided he is not eligible under any other Class.





                                       16
<PAGE>   23
ELIGIBILITY

ELIGIBLE CLASSES (CONTINUED)

   [FORMER INSURED SPOUSE
   An Insured Spouse who no longer qualifies as such, will become eligible to
   be insured as a Former Insured Spouse on the date he ceases to be an Insured
   Spouse, provided he is not eligible under any other Class.

   In addition, the Spouse of a Former Insured Employee who is not insured on
   the date the Insured Employee becomes a Former Insured Employee, is eligible
   to be insured as a Former Insured Spouse, provided that the Spouse is less
   than [65] years of age.  For the purpose of eligibility, the Spouse must be
   a lawful Spouse and not legally separated from the Former Insured Employee.]

   [RETIREE
   [A retired Employee of the Employer will be eligible to be insured as a
   Retiree on the Policy Effective Date.]  An Insured Employee or a Leave of
   Absence Employee will be eligible to be insured as a Retiree on the date he
   retires as an Employee of the Employer in accordance with the Employer's
   requirements for retirement.]

   [LEAVE OF ABSENCE EMPLOYEE
   An  Insured  Employee who is on an Employer-approved leave of absence will
   become eligible to be insured as a Leave of Absence Employee on the date the
   Insured Employee's leave of absence is approved by the Employer.]





                                       17
<PAGE>   24
EFFECTIVE DATE OF INSURANCE

[INSURED EMPLOYEE, INSURED SPOUSE, INSURED DEPENDENT CHILD, AND RETIREE]
   If coverage is elected before or within 31 days after the date [an Insured
   Employee, Insured Spouse, Insured Dependent Child, or Retiree] becomes
   eligible, his insurance will become effective, in an amount not to exceed
   the Guaranteed Issue Amount, on the later of: (a) the date he becomes
   eligible; or (b) the date his completed and signed application is received
   by the Company.

   If coverage is elected for [an Insured Employee, an Insured Spouse or a
   Retiree] for an amount in excess of the Guaranteed Issue Amount, he will
   become insured for the amount that exceeds the Guaranteed Issue Amount on
   the date the Company agrees in writing to insure him for that amount.  The
   Company will require him to satisfy the Insurability Requirement before it
   agrees to insure him for the higher amount.

   If coverage is elected more than 31 days after [an Insured Employee, Insured
   Spouse, Insured Dependent Child, or Retiree] becomes eligible, he will
   become insured on the date the Company agrees in writing to insure him.  The
   Company will require him to satisfy the Insurability Requirement before the
   Company agrees to insure him for any amount.

INSURED EMPLOYEE
   If an Employee is not in Active Service on the date his insurance would
   otherwise begin, he will become insured on the date he returns to Active
   Service.  If an Employee does not return to Active Service within 90 days
   from the date the Company receives the completed original application, a new
   application, and new evidence of good health acceptable to the Company will
   be required.

[INSURED SPOUSE
   If, on the date insurance would otherwise become effective, a Spouse:
      1.  is hospitalized; or
      2.  is confined at home under the care of a medical doctor for sickness
          or injury; and/or 
      3.  has had his level of activity significantly reduced so that he 
          requires human supervision or assistance to perform any of the 
          following Activities of Daily Living: (a) mobility; (b) 
          transferring; (c) feeding; (d) dressing; or (e) toileting; which 
          another person of the same age and sex could normally perform; and/or
      4.  is receiving any disability benefits from any source due to any
          sickness or injury;

   his insurance will begin on the day after all of the conditions set forth
   under 1, 2, 3, and 4 (above) have ended.  If all of these conditions have
   not ended within 90 days from the date the Company receives the completed
   original application, a new application and new evidence of good health
   acceptable to the Company will be required.]

[INSURED DEPENDENT CHILD
   If, on the date his insurance would otherwise begin, a Dependent Child:  (a)
   is hospitalized; or (b) is confined at home under the care of a medical
   doctor for sickness or injury, his insurance will begin on the day after all
   of the conditions described under (a) or (b) have ended.  If all of these
   conditions have not ended within 90 days from the date the Company receives
   the completed original application, a new application and new evidence of
   good health acceptable to the Company will be required.]





                                       18
<PAGE>   25
EFFECTIVE DATE OF INSURANCE

[INSURED DEPENDENT CHILD (CONTINUED)
   If coverage for a Dependent Child is in force and the Employee acquires
   another Dependent Child, coverage for that Child will become effective on
   the later of: (a) the date the Child is 15 days old; or (b) in the case of
   adoption, the first day of any waiting period prior to the finalization of
   the Child's adoption.  Notice must be given to the Company within 31 days of
   birth or adoption.]

[FORMER INSURED DEPENDENT CHILD
   If an Insured Dependent Child elects to be insured as a Former Insured
   Dependent Child, his insurance will become effective on the date his
   coverage as an Insured Dependent Child ceases, provided the required premium
   is paid to the Company within 15 days of such date.

   If an Insured Dependent Child does not elect to be insured as a Former
   Insured Dependent Child within 90 days after he becomes eligible, he will
   not be eligible to elect this coverage at a later date.

   If, on the date he becomes insured as a Former Insured Dependent Child, he:
   (a) is hospitalized; and/or (b) is confined at home under the care of a
   medical doctor for sickness or injury, he will not be insured for any
   Coverage Amount in excess of his existing Coverage Amount until the day
   after all of the conditions described under (a) and (b) have ended.

   In addition, an Insured Dependent Child, whose insurance as a Dependent
   Child has not yet ceased, has the option to elect to be insured as a Former
   Insured Dependent Child instead of being insured as an Insured Dependent
   Child, provided he is at least [22] years of age.  The Effective Date of
   Insurance for such Former Insured Dependent Child will be the later of: (a)
   the first day of the month after he elects the coverage as a Former Insured
   Dependent Child; or (b) the date the required premium is paid to the
   Company.]

[FORMER INSURED SPOUSE
   For the purpose of determining the Effective Date of Insurance for a Spouse
   who is not insured on the date the Insured Employee becomes a Former Insured
   Employee or a Retiree, and who becomes insured as a Spouse of a Former
   Insured Employee, the provisions shown for an Insured Spouse in the
   Effective Date of Insurance section will apply.]

[RETIREE
   If coverage for a Retiree is elected before or within 31 days after he
   becomes eligible as a Retiree, his insurance will become effective on the
   later of: (a) the date he becomes eligible; or (b) the date the completed
   and signed application is received by the Company.

   If the Owner does not elect to insure the Retiree within 31 days after he
   becomes eligible as a Retiree, the Owner may not elect this coverage at a
   later date.]





                                       19
<PAGE>   26
EFFECTIVE DATE OF INSURANCE (CONTINUED)

[LEAVE OF ABSENCE EMPLOYEE
   The Effective Date of Insurance for a Leave of Absence Employee will be the
   later of: (a) the date the Employer approves his leave of absence; or (b)
   the date the Employee begins his leave of absence, provided the required
   premium is paid directly to the Company within the grace period.

   A Leave of Absence Employee must apply to return to Insured Employee status
   within 31 days of his return to Active Service.  If a Leave of Absence
   Employee applies to return to Insured Employee status more than 31 days
   after his return to Active Service, he must satisfy the Insurability
   Requirement before the Company agrees to insure him.]





                                       20
<PAGE>   27
LIFE INSURANCE BENEFIT

DEATH BENEFIT
   If an Insured dies, the Company will pay the Death Benefit in effect on the
   date of death.  The Death Benefit will be paid in a lump sum to the
   Insured's Beneficiary as soon as due proof of death is received by the
   Company.  The Death Benefit will be an amount equal to the greater of:
      -   the Insured's Coverage Amount on the date of death plus the Net Cash
          Value, if any; or 
      -   an amount that, as determined by the Company, is
          required to preserve the qualification of the Policy as a life 
          insurance policy under the Internal Revenue Code less any Current 
          Outstanding Loan Balance.

   The Death Benefit will be reduced by any accelerated payment benefit
   previously paid under the Policy and by any amounts due the Company under
   the Policy.

   If proceeds are not paid within 30 days of receipt of due proof of death,
   the Company will pay interest from the date of death to the date of payment
   at the rate of [X%] or any other rate required by law.





                                       21
<PAGE>   28
LIFE INSURANCE BENEFIT (CONTINUED)

MINIMUM DEATH BENEFIT
   The Minimum Death Benefit allowable at any time under this Certificate
   ("Minimum Death Benefit") is a percentage of the Cash Value.  The Minimum
   Death Benefit depends on the Attained Age of the Insured and is given in the
   following table:

TABLE OF MINIMUM DEATH BENEFITS

<TABLE>
<CAPTION>
=============================================================================================
      ATTAINED AGE        PERCENTAGE OF CASH         ATTAINED AGE        PERCENTAGE OF CASH
       OF INSURED                VALUE                OF INSURED               VALUE
       <S>                       <C>                   <C>                      <C>
- ---------------------------------------------------------------------------------------------
       40 or less                250%                     61                    128%
- ---------------------------------------------------------------------------------------------
           41                    243%                     62                    126%
- ---------------------------------------------------------------------------------------------
           42                    236%                     63                    124%
- ---------------------------------------------------------------------------------------------
           43                    229%                     64                    122%
- ---------------------------------------------------------------------------------------------
           44                    222%                     65                    120%
- ---------------------------------------------------------------------------------------------
           45                    215%                     66                    119%
- ---------------------------------------------------------------------------------------------
           46                    209%                     67                    118%
- ---------------------------------------------------------------------------------------------
           47                    203%                     68                    117%
- ---------------------------------------------------------------------------------------------
           48                    197%                     69                    116%
- ---------------------------------------------------------------------------------------------
           49                    191%                     70                    115%
- ---------------------------------------------------------------------------------------------
           50                    185%                     71                    113%
- ---------------------------------------------------------------------------------------------
           51                    178%                     72                    111%
- ---------------------------------------------------------------------------------------------
           52                    171%                     73                    109%
- ---------------------------------------------------------------------------------------------
           53                    164%                     74                    107%
- ---------------------------------------------------------------------------------------------
           54                    157%                  75 - 90                  105%
- ---------------------------------------------------------------------------------------------
           55                    150%                     91                    104%
- ---------------------------------------------------------------------------------------------
           56                    146%                     92                    103%
- ---------------------------------------------------------------------------------------------
           57                    142%                     93                    102%
- ---------------------------------------------------------------------------------------------
           58                    138%                     94                    101%
- ---------------------------------------------------------------------------------------------
           59                    134%                  95 - 99                  100%
- ---------------------------------------------------------------------------------------------
           60                    130%
=============================================================================================
</TABLE>

NOTE:  See Increases Due to Minimum Death Benefit Provisions.

The Company reserves the right to reject Cash Value contributions or return
Cash Value to the extent necessary to preserve qualification of the Policy
and/or Certificate as a life insurance contract under the Internal Revenue
Code.





                                       22
<PAGE>   29
PREMIUM PAYMENTS

PREMIUMS
   Premiums may be paid on a periodic or a lump-sum basis.  If the Insured or
   Owner is an Employee, premium payments may be paid through payroll
   deduction.  In all other cases, premiums will be paid directly to the
   Company and will be billed by the Company on a quarterly, semi-annual, or
   annual basis.  Premium shall be considered received under the Policy only
   when actually received by the Company at its own offices or at the offices
   of the Customer Service Center designated in the Coverage Verification
   Pages, and not when received by the Policyholder, Employer, or any other
   agent, broker, or third party administrator. Premiums may not exceed an
   amount that, in the Company's opinion, is required to preserve the
   qualification of the Policy and/or Certificate as a life insurance contract
   under the Internal Revenue Code without regard to the Minimum Death Benefit
   provision, and/or to prevent the Policy and/or Certificate from being
   treated as a Modified Endowment Contract under the Internal Revenue Code.
   (See Qualification under Internal Revenue Code section.)

   The first premium payment will be due on the Certificate Effective Date.
   Lump sum premiums must be at least [$25.00] each.

   Unless otherwise specified by the Owner, if there is any indebtedness, any
   lump sum payments made on the Policy will be used first as a Loan repayment
   with any excess treated as lump sum premium payments.

ALLOCATION OF NET PREMIUM PAYMENTS
   Net premium payments shall be allocated to the Fixed Account and/or to the
   Fund Accounts as directed by the Owner, subject to the Limits on Allocation
   of Net Premium Payments provision set forth below.  The Net Premium Payment
   associated with the initial premium payment will be allocated in accordance
   with the allocation percentages specified in the application, within three
   business days of the later of expiration of the 30-Day Right to Examine
   period, the Effective Date of Coverage, the Company's written acceptance of
   coverage in excess of the Guaranteed Issue amount, or the date the premium
   is actually received by the Company.  Subsequent Net Premium Payments will
   be allocated on the same basis as the most recent previous Net Premium
   Payment unless the Company is otherwise instructed in writing to change the
   allocation percentages.  A change in the allocation percentages may be made
   by telephone if such telephone changes have previously been authorized in
   writing.  The Company will not be legally responsible for: (a) any liability
   if acting in good faith upon any change in allocation instructions given by
   telephone; or (b) for the authenticity of such instructions.  If the Owner
   has not directed the Company as to allocation of Net Premium Payments, all
   Net Premium Payments will be allocated to the Fixed Account.

LIMITS ON ALLOCATION OF NET PREMIUM PAYMENTS
   There is no minimum allocation percentage to the Fixed Account or a Fund
   Account; however, all allocations must be made in 5% increments and in
   aggregate must total 100%.  Premium payments will be allocated net of the
   Premium Load for Taxes specified in the Coverage Verification Pages.





                                       23
<PAGE>   30
PREMIUM PAYMENTS (CONTINUED)

INTERRUPTIONS OF PREMIUM PAYMENTS
   If the Owner ceases to pay (or have paid) the periodic premium payments or
   lump sum premiums, the insurance will remain in force, subject to the terms
   and conditions of the Policy, by continuing to deduct the Monthly Deduction
   from the Cash Value.  The insurance will remain in force, subject to the
   terms and conditions of the Policy, until the Net Cash Value is insufficient
   to cover the Monthly Deduction, as provided in the Lapse and Grace Period
   for Insured provisions.

GRACE PERIOD FOR INSURED
   If the Net Cash Value for any Insured on the date that a Monthly Deduction
   is due is less than the required Monthly Deduction, a Grace Period for
   Insured of at least 61 days will be granted to the Owner to pay a premium
   sufficient to cover the required Monthly Deductions for the next premium
   payment period.  If such premium is not paid within the Grace Period for
   Insured, the coverage will Lapse without value at the end of the Grace
   Period for Insured.

   At least 61 days before the end of the Grace Period for Insured, the Company
   will notify the Owner that there is insufficient Net Cash Value to cover the
   next Monthly Deduction.  Failure to give notice will not extend the Death
   Benefit beyond the grace period.  If the Insured dies during the Grace
   Period for Insured, the Company will deduct any overdue Monthly Deduction
   from the Death Benefit payable.





                                       24
<PAGE>   31
FUND ACCOUNT PROVISIONS

SEPARATE ACCOUNT AND FUND ACCOUNTS
   Assets accumulated by the Company under the Policy and other variable life
   insurance policies on a variable basis are held in the Separate Account
   designated in the Coverage Verification Pages.  The Separate Account was
   established by a resolution of the Company's Board of Directors as a
   separate account under the governing laws of Connecticut, the Company's
   state of domicile, and registered as a unit investment trust under the
   Investment Company Act of 1940 (the "Act").  Under Connecticut law, the
   Separate Account assets (except assets in excess of its reserves and other
   contractual liabilities) cannot be charged with the general liabilities of
   the Company.  The Separate Account assets are owned and controlled
   exclusively by the Company, and the Company is not a trustee with respect to
   these assets.

   The Separate Account's assets are invested in shares of Funds made available 
   as funding vehicles under the Policy.  For each Fund that is offered as a
   funding vehicle, the Company maintains Variable Accumulation Units whose
   values reflect the investment performance of the Fund.

   Each Fund Account Value under this Certificate reflects the aggregate number
   of Variable Accumulation Units for the Related Fund purchased by the Owner.
   Variable Accumulation Units are purchased by the Owner through allocation of
   Net Premium Payments, or transfer of Fixed, Loan, or other Fund Account
   Values to the Fund Account.  Variable Accumulation Units for different Funds
   will have different values due to the differing investment performances of
   the Funds.

   The Company reserves the right to take certain actions in connection with
   the operation of the Separate Account. Any such actions will be taken in
   accordance with applicable laws (including obtaining any required regulatory
   approvals). Specifically, the Company reserves the right to:
          -   add, combine, or remove any Fund Account,
          -   create new Separate Accounts,
          -   combine the Separate Account with one or more other separate
              accounts, 
          -   operate the Separate Account as a management investment
              company under the Act or in any other form permitted by law, 
          -   deregister the Separate Account under the Act, 
          -   manage the Separate Account under the direction of a committee 
              or discharge such committee at any time, 
          -   transfer any assets in any Fund Account to another Fund Account,
              or to one or more separate accounts or to our general account, and
          -   to take any actions necessary to comply with, or to obtain and
              continue any exemptions from, the Act.

   The assets of the Separate Account shall be valued as often as policy
   benefits vary, but no less often than monthly.

INVESTMENT RISK
   Each Fund Account's value is always determined by the number and value of
   the Variable Accumulation Units for the Related Fund held by the Owner under
   the Certificate.  The change in value of the Variable Accumulation Units for
   each Fund is always determined by the Fund's share values, the per share
   mortality and expense charges under the Policy, and the per share charges or
   credits for taxes attributable to the operation of the Separate Account.
   Fund Share values may vary reflecting the risks of changing economic
   conditions and the ability of a Fund's investment adviser to manage that
   Fund and anticipate changes in economic conditions.  The Owner bears the
   entire investment risk of gain or loss of Fund Account assets.





                                       25
<PAGE>   32
FUND ACCOUNT PROVISIONS (CONTINUED)

INVESTMENTS OF THE FUND ACCOUNT ASSETS
   All amounts allocated to a Fund Account will be used to purchase Variable
   Accumulation Units for the Related Fund.  Each Fund is registered and
   regulated under the Act as an open-end management investment company or a
   portfolio of an open-end management investment company.

   All Funds available as funding vehicles under the Policy as of the
   Certificate Effective Date are listed in the application for the Certificate
   and in the Coverage Verification Pages.  The Company may add or delete Funds
   at any time or may change Funds in accordance with the Substitution or
   Elimination of Securities provision.

   Any and all distributions made by a Fund will be reinvested in additional
   shares of that Fund at the then current net asset value.  Deductions by the
   Company from a Fund Account for taxes attributable to operation of the
   Separate Account and for mortality and expense charges will be made by
   redeeming a number of Fund shares at the then current net asset value equal
   in total value to the amount to be deducted.  Such reinvestment and
   deductions will affect the value, but not the number, of the Variable
   Accumulation Units for the Related Fund held by the Owner in the Fund
   Account.

   SUBSTITUTION OR ELIMINATION OF SECURITIES
   Shares of a particular Fund may not always be available for purchase or the
   Company may decide that further investment in a Fund is no longer
   appropriate in view of the purposes of the Separate Account or in view of
   legal, regulatory or federal income tax restrictions.  In such event, shares
   of another registered open-end investment company or unit investment trust
   may be substituted both for Fund shares already purchased and/or for
   purchase in the future, provided that these substitutions meet applicable
   Internal Revenue Service diversification guidelines and any necessary
   regulatory or other approvals of such substitutions have been obtained.  In
   the event of any substitution pursuant to this provision, the Company may
   make appropriate amendment(s) to the Policy to reflect the substitution.





                                       26
<PAGE>   33
FUND ACCOUNT PROVISIONS (CONTINUED)

TRANSFER PRIVILEGE
   At any time while the Policy is in effect, other than during the 30-Day
   Right to Examine period, the Owner may transfer all or part of the Fund
   Account Values to the Fixed Account and/or to one or more of the Fund
   Accounts then available under the Policy.  The Owner may transfer part of
   the Fixed Account Value to one or more Fund Accounts, subject to the
   provisions set forth below.  Transfers may be made in writing, or by
   telephone if telephone transfers have been previously authorized in writing.
   Transfer requests must be received at the Customer Service Center prior to 
   the time of day set forth in the prospectus on a day on which the New York 
   Stock Exchange ("NYSE") is open for business, in order to be processed as 
   of the close of business on the date the request is received; otherwise, the
   transfer will be processed on the next business day the NYSE is open for
   business.  The Company will not be legally responsible for: (a) any
   liability if acting in good faith upon any transfer instructions given by
   telephone; or (b) for the authenticity of such instructions.





                                       27
<PAGE>   34
FUND ACCOUNT PROVISIONS

TRANSFER PRIVILEGE (CONTINUED)
   Transfers involving Fund Accounts will reflect the purchase or cancellation
   of Variable Accumulation Units having an aggregate value equal to the dollar
   amount being transferred to or from a particular Fund Account.  The purchase
   or cancellation of such units shall be made using Variable Accumulation Unit
   Values of the applicable Fund Account determined as of the end of the
   Valuation Period in  which the transfer is effective.  Transfers to the
   Fixed Account will earn interest as specified under the Fixed Account Value
   provision.

   Unless otherwise changed by the Company to be less restrictive, transfers
   shall be subject to the following conditions:  (a) Up to [12] transfers may
   be made during any Policy Year without charge; however, for each transfer in
   excess of [12], a transfer fee as set forth in the Coverage Verification
   Pages will be deducted on a pro rata basis from the Fixed Account and/or
   Fund Accounts from which the transfer is being made; (b) No Partial
   Surrender transaction fee will be imposed as a result of the transfer; (c)
   The amount being transferred may not be less than [$250] unless the entire
   value of a Fund Account is being transferred; (d) The amount being
   transferred may not exceed the Company's maximum amount limit then in
   effect; (e) Transfers among the Fund Accounts or from a Fund Account to the
   Fixed Account can be made at any time; (f) Transfers from the Fixed Account
   are subject to the Limits on Transfers provision as set forth below; (g) Any
   value remaining in the Fixed Account or a Fund Account following a transfer
   may not be less than [$250]; (h) Transfers involving Fund Account(s) shall
   be subject to such additional terms and conditions as may be imposed by the
   Funds.

   Any transfer made which causes the remaining aggregate value of Variable
   Accumulation Units for a Fund Account to be less than $250 will result in
   those remaining Variable Accumulation Units being transferred as a part of
   the requested transfer.

LIMITS ON TRANSFERS
   Transfers from the Fixed Account may only be made during the 30-day period
   following each Policy Anniversary Date and are subject to a maximum
   aggregate annual limit of [25%] of the Fixed Account Value as of that Policy
   Anniversary Date.  Additionally, the Company has the right to limit the
   dollar amount of such transfers.  Additional limitations on transfers are
   set forth in the Transfer Privileges provision.





                                       28
<PAGE>   35
CERTIFICATE VALUE PROVISIONS

CASH VALUE
   The Cash Value at the end of any day (after the NYSE closing time) equals:
          a)  The Fixed Account Value at the end of that day; plus
          b)  The Loan Account Value at the end of that day; plus
          c)  The sum of the Fund Account Values at the end of that day.

FIXED ACCOUNT VALUE
   The Fixed Account Value at the end of the day preceding the Certificate
   Effective Date is zero.

   The Fixed Account Value at the end of any subsequent day equals:
          a)  The Fixed Account Value at the end of the preceding day; plus
          b)  All portions of Net Premium Payments allocated to the Fixed
              Account during that day; plus 
          c)  All amounts transferred into the Fixed Account from Fund Accounts
              or the Loan Account; minus 
          d)  All amounts charged to the Fixed Account during that day to pay 
              all or part of any Monthly Deductions due under this
              Certificate; minus
          e)  All amounts transferred out of the Fixed Account during that day
              for Surrenders, Partial Surrenders, Loans, or Fund Transfers;
              minus
          f)  All amounts charged to the Fixed Account during that day to pay
              all or part of any transaction fees or other charges due under
              this Certificate; plus
          g)  Interest accrued on the sum of a) minus d) minus e) minus f).

   Interest will accrue on the Fixed Account daily at a rate which will be the
   greater of: 
          -   4% effective annual yield (.010746% compounded daily); or 
          -   a rate determined by the Company from time to time.
              Such rate will be established on a prospective basis.

   The rate to be credited will be announced by the Company from time to time.

LOAN ACCOUNT VALUE
   The Loan Account Value will be equal to the sum of all amounts transferred
   into the Loan Account as provided for under this Certificate, plus interest
   credited to the Loan Account daily at a rate which will produce an effective
   annual yield of not less than 6%.

FUND ACCOUNT VALUE
   Each Fund Account Value during any Valuation Period shall be determined by
   multiplying the number of Variable Accumulation Units held in such Fund
   Account under this Certificate at the end of the Valuation Period by the
   Variable Accumulation Unit Value for that Fund Account during the Valuation
   Period.





                                       29
<PAGE>   36
CERTIFICATE VALUE PROVISIONS (CONTINUED)

CREDITING AND CANCELLING VARIABLE ACCUMULATION UNITS
   The number of Variable Accumulation Units in a Fund Account will be
   increased to reflect portions of Net Premium payments allocated to that Fund
   Account and to reflect amounts transferred to that Fund Account from the
   Fixed Account, the Loan Account, or from other Fund Accounts.  The number of
   Variable Accumulation Units in the Fund Account will be decreased to reflect
   portions of the Monthly Deduction, Transaction Fees, or other charges which
   are charged to a Fund Account as provided for in this Certificate.  The
   number of Variable Accumulation Units in a Fund Account will also be
   decreased when funds are transferred out of the Fund Account for Surrenders,
   Partial Surrenders, Loans, Fund Transfers, or such other transfers as are
   provided for in this Certificate.  The number of Variable Accumulation Units
   to be credited or charged to a Fund Account is determined by dividing the
   dollar amount credited or charged to the particular Fund Account by the
   Variable Accumulation Unit Value for the particular Fund Account for the
   Valuation Period during which the change in the number of Variable
   Accumulation Units will occur.

VARIABLE ACCUMULATION UNIT VALUE
   The Variable Accumulation Unit Value for each Fund Account was established
   at $10.00 for the first Valuation Period of the particular Fund Account.
   The Variable Accumulation Unit Value for that Fund Account for any
   subsequent Valuation Period is determined by multiplying the Variable
   Accumulation Unit Value for that Fund Account for the immediately preceding
   Valuation Period by the Net Investment Factor for that Fund Account for the
   current Valuation Period.  The Variable Accumulation Unit Value may
   increase, decrease or remain constant from Valuation Period to Valuation
   Period.

NET INVESTMENT FACTOR
   The Net Investment Factor is an index applied to measure the investment
   performance of a Fund Account from one Valuation Period to the next.  The
   Net Investment Factor may be greater or less than or equal to 1.0;
   therefore, the value of a Variable Accumulation Unit may increase, decrease
   or remain the same.

   The Net Investment Factor for any Fund Account for any Valuation Period is
   determined by dividing (a) by (b) and then subtracting (c) from the result
   where:

   (a) is the net result of:

       (1) the net asset value (as described in the prospectus for the Fund) of
       a share of the Related Fund determined as of the end of the Valuation
       Period; plus

       (2) the per-share amount of any dividend or other distribution declared
       by the Related Fund if the date occurs during the Valuation Period; plus
       or minus

       (3) a per-share credit or charge with respect to any taxes paid or
       reserved for by the Company during the Valuation Period which are
       determined by the Company to be attributable to the operation of the
       Separate Account;





                                       30
<PAGE>   37
CERTIFICATE VALUE PROVISIONS

NET INVESTMENT FACTOR (CONTINUED)
   (b) is the net asset value of a share of the Related Fund determined as of
   the end of the preceding Valuation Period; and

   (c) is the asset charge determined by the Company for the Valuation Period
   to reflect the charges for assuming the mortality and expense risks.

   The asset charge factor for any Valuation Period is equal to the daily asset
   charge rate multiplied by the number of 24-hour periods in the Valuation
   Period multiplied by the Fund Account's value as of the end of the preceding
   Valuation Period.  The daily asset charge rate will be determined annually
   by the Company, but in no event may it exceed the maximum specified in the
   Coverage Verification Pages.

MONTHLY COST OF INSURANCE RATES
   The Monthly Cost of Insurance Rates are based on the Insured's Attained
   Age, the type of benefit, the size and type of group, gender mix of the
   group, expectations of participation, the Eligible Class of Insured,
   experience and persistency of the group, federal and state taxes, rating
   classes, expectations due to future mortality, and whether premiums for that
   Insured are paid directly to the Company or through payroll deductions. 
   Adjustments in the Monthly Cost of Insurance Rates may be made by the
   Company from time to time, but not more than once a year, and will apply to
   Insureds of the same Eligible Class.  Under no circumstances will the
   Monthly Cost of Insurance Rates for Life Insurance ever be greater than
   those shown in the Table of Guaranteed Maximum Life Insurance Rates.  Such
   guaranteed maximum rates are based on 150% of the 1980 Commissioners
   Standard Ordinary Male Mortality Table (age last birthday).

MONTHLY DEDUCTION
   The Monthly Deduction will be due on the first of each calendar month and
   will be deducted from the Fixed Account and the Fund Accounts.  The Monthly
   Deduction will be the sum of: 
   -   the Monthly Cost of Insurance Rate for life insurance, based on the 
       Insured's Attained Age, multiplied by the Coverage Amount on that date; 
       and
   -   the Monthly Cost of Insurance Rate for additional benefits, if any,
       multiplied by the Insured's Coverage Amount for each such additional
       benefit; and
   -   the Monthly Cost of Insurance Rate for all Insured Dependent Children,
       if Dependent Child coverage is elected, multiplied by the Insured
       Dependent Child Coverage Amount; and
   -   the Monthly Administrative Fees as set forth in the Coverage Verification
       Pages.

   The Monthly Administrative Fees may be different for each Eligible Class of
   Insureds.  A Monthly Administrative Fee will be charged to each Certificate.

   An additional Monthly Administrative Fee will be charged to each Certificate
   with an accumulated Cash Value in any Fund Account.  This additional Monthly
   Administrative Fee will be waived for each month in which the Certificates'
   Net Cash Value is greater than $10,000.

   The Monthly Administrative Fees may change from time to time.  The maximum
   amounts of these Monthly Administrative Fees are set forth in the Coverage
   Verification Pages.

   The amount of the Monthly Deduction will be deducted from the Fixed Account
   and each Fund Account in the same proportion that the value of each account
   bears to the sum of the Fixed Account Value and the Fund Account Values as
   of the date on which the deduction is made.





                                       31
<PAGE>   38
CERTIFICATE VALUE PROVISIONS (CONTINUED)

NET CASH VALUE
   The Net Cash Value at the end of any day (after the NYSE closing time)
   equals: 
       a) the Cash Value at the end of that day; minus 
       b) the Current Outstanding Loan Balance at the end of that day.

   The Current Outstanding Loan Balance equals the current Loan Balance plus
   all interest accrued but not paid.

LAPSE (INSUFFICIENT NET CASH VALUE)
   If the Net Cash Value on any date is insufficient to cover any due but
   unpaid Monthly Deduction, the insurance for that person and any riders will
   terminate at the end of the Grace Period for Insured.  This termination will
   be termed a Lapse under the Policy.

BASIS OF COMPUTATIONS
   A detailed statement of the method of computing all values under this
   Certificate will be filed with the insurance department of any jurisdiction
   where required.





                                       32
<PAGE>   39
SURRENDERS, LOANS AND REINSTATEMENT PROVISIONS

SURRENDER
   The Owner may terminate his insurance and Surrender the Certificate at any
   time by submitting a written request in a form acceptable to the Company
   along with his Certificate, including the Coverage Verification Pages.  Upon
   Surrender, the Owner will receive the Net Cash Value as of the date of
   Surrender, less any applicable Surrender fee and less any other amounts due
   the Company under this Certificate.

   The Company will charge a transaction fee as set forth in the Coverage
   Verification Pages for Surrender and the transaction fee will be deducted
   from the amount of the Surrender received by the Owner.

   Payment of the proceeds of a Surrender is subject to the Deferment of
   Payments provision of this Certificate.

PARTIAL SURRENDER
   A Partial Surrender may be elected by the Owner on any day while this
   Certificate is in effect by submitting a signed written request in a form
   satisfactory to the Company. The amount of the Partial Surrender must be at
   least [$250] and may not exceed 90% of the Net Cash Value at the time such
   Partial Surrender is processed by the Company.

   When a Partial Surrender is made, the amount of the Partial Surrender will
   be deducted from the Fixed Account and the Fund Accounts. Unless the Company
   and the Owner agree otherwise, the amount of the Partial Surrender will be
   charged to the Fixed Account and the Fund Accounts in shares that reflect
   the same proportion to the amount of the Partial Surrender as each of such
   accounts bears to the sum of the Fixed Account Value and the Fund Account
   Values.

   The Company will charge a transaction fee as set forth in the Coverage
   Verification Pages for each Partial Surrender and the Company reserves the
   right to limit the number of Partial Surrenders in a 12-month period. The
   transaction fee will be deducted from the amount of the Partial Surrender
   received by the Owner.

   Payment of Partial Surrender amounts is subject to the Deferment of Payments
   provision of this Certificate.

LOAN PROVISIONS
   Provided there is sufficient Net Cash Value as specified below, the Company
   will grant a Loan against an Insured's Cash Value.  The Owner will be
   required to sign a proper Loan agreement, including an Assignment of the
   Certificate to the Company, in a form approved by the Company, and such
   other documents as may be required by the Company at the time. The Insured's
   Cash Value will be the security for the Loan and for any accrued interest
   not yet paid to the Company. The minimum Loan amount is [$250]; however, the
   Company reserves the right to change this amount from time to time.





                                       33
<PAGE>   40
SURRENDERS, LOANS AND REINSTATEMENT PROVISIONS

LOAN PROVISIONS (CONTINUED)
   The Company will not grant a Loan in an amount that exceeds 90% of the Net
   Cash Value at the time the Loan is processed.  Further, the Company will not
   grant a Loan which would require that the Loan Account Value be greater than
   90% of the Cash Value.

   The payment of the Loan amount is subject to the Deferment of Payment
   provisions of this Certificate.

   Interest will accrue daily on the Loan Balance at a rate which will produce
   an effective annual yield of 8%. Accrued Loan interest is due and payable to
   the Company on the Policy Anniversary Date or upon Surrender or termination
   of the Certificate or as otherwise agreed by the Owner and the Company.
   Interest which remains unpaid 30 days after it becomes due and payable will
   be added to the Loan Balance as of the date upon which it was payable.

   The Loan Balance shall equal, at any time, the sum of all Loans granted
   under the Certificate, less any Loan repayments, plus all unpaid interest
   added to the Loan Balance as described above.

   The Current Outstanding Loan Balance shall equal the current Loan Balance
   plus all interest accrued but not yet payable on the Loan Balance.

   Unless otherwise agreed between the Owner and the Company, the amount of any
   such Loan will be transferred into the Loan Account from the Fixed Account
   and each of the Fund Accounts in amounts that reflect the same proportion to
   the amount of the Loan as the value of each of such accounts bears to the
   sum of the Fixed Account Value and the Fund Account Values.  Additional
   amounts will be transferred to the Loan Account as additional  Loans are
   made and as interest is added to the Loan Balance.

   Upon Surrender, payment of the Death Benefit under the Certificate, or
   termination of the Certificate for any other reason, the Loan Account will
   be paid to the Company in repayment of the Current Outstanding Loan Balance.
   To the extent the Current Outstanding Loan Balance exceeds the Loan Account
   Value upon such Surrender, payment of the Death Benefit, or termination for
   any other reason, the excess will be deducted from the Cash Value or reduce 
   the payment of proceeds under the Certificate.

   The Current Outstanding Loan Balance may be repaid in full or in part at any
   time during the lifetime of the Insured; however, the minimum Loan repayment
   amount is [$25.00] or the amount of the Current Outstanding Loan Balance, if
   less. The amount of any Loan repayment will be transferred from the Loan
   Account into the Fixed Account and the Fund Accounts in the proportion in
   which current Net Premium Payments are being allocated to those accounts,
   unless otherwise agreed to in writing by the Owner and the Company.





                                       34
<PAGE>   41
SURRENDERS, LOANS AND REINSTATEMENT PROVISIONS (CONTINUED)

REINSTATEMENT
   If an Insured's coverage has Lapsed, it may be reinstated at any time prior
   to three years after the date of Lapse if: 
   -   the Insured's Certificate has not been Surrendered; and 
   -   a written request for Reinstatement and a new application form are sent
       to the Company; and 
   -   at his own expense, satisfactory evidence of good health is submitted 
       to the Company; and 
   -   premiums are paid equal to two times the Monthly Deduction; and 
   -   the Current Outstanding Loan Balance plus interest accrued from date of 
       Lapse is reinstated if not paid.

   The effective date of the reinstated coverage will be the date the Company
   agrees in writing to accept the Insured.

   If an Insured's coverage Lapses while on an Employer-approved leave of
   absence under the Family and Medical Leave Act, it may be reinstated within
   31 days of returning to Active Service without providing evidence of good
   health.  Reinstatement will be subject to new incontestability and suicide
   periods.





                                       35
<PAGE>   42
TERMINATION PROVISIONS

INDIVIDUAL TERMINATIONS
   The insurance on [an Insured Employee, Insured Spouse, Former Insured
   Employee, Former Insured Spouse, Former Insured Dependent Child, Retiree,
   and Leave of Absence Employee] will cease on the earliest date below:
       -  the date the Policy terminates, if no continuation is specifically
          provided for in the Continuation section of the Policy; or
       -  the date the Insured's coverage Lapses; or
       -  the date the Insured's Certificate is Surrendered; or
       -  the  date the Insured is no longer eligible for the Class in which he
          was insured, if no continuation is specifically provided for in the
          Continuation section of the Policy; or
       -  the date of death of the Insured.

   If the Policy terminates or the Insured ceases to qualify for his Eligible
   Class, and continuation of coverage is not specifically provided for in the
   Continuation Provisions, the Insured's coverage may be converted as provided
   in the Conversion Privilege section.  If the Insured's coverage Lapses or is
   Surrendered, neither Continuation nor Conversion is available.

   [The insurance on an Insured Dependent Child will cease on the earliest date
   below: 
       -  the date of Individual Termination (as described above) of the
          Certificate of Insurance under which the Dependent Child is
          insured; or
       -  the date the Owner terminates the coverage for the Insured Dependent
          Child; or 
       -  the first of the month after the date the Insured Dependent
          Child is no longer eligible for the insurance as a Dependent
          Child; or
       -  the date the Insured Dependent Child becomes the Owner of his own
          Group Variable Universal Life Insurance Certificate; or 
       -  the date of death of the Insured Dependent Child.]

POLICY TERMINATION
   The Employer may terminate the Policy by giving the Company written notice
   60 days before the termination date.  The Company may terminate the Policy
   by giving the Employer written notice 60 days before the termination date.

   The Employer will give written notice of termination to the Owners at least
   31 days before the termination date.  No additional persons will be insured
   under the Policy after the termination date; however, persons insured under
   the Policy on the termination date may continue their coverage as provided
   for in the Continuation section.    All premium payments will then be
   payable directly to the Company.

   Notwithstanding the above, [an Insured Employee, Former Insured Employee,
   Insured Spouse, and Former Insured Spouse] who continues his coverage after
   termination of the Policy may insure his Dependent Child(ren), subject to
   the terms and conditions set forth herein.

   The Employer will furnish all necessary data to the Company, including the
   current addresses for all Insureds, as of 31 days prior to termination, and
   shall continue to provide the Company any information and data which the
   Company reasonably determines it may need to meet its obligations under the
   Policy until such obligations are ended.





                                       36
<PAGE>   43
CONTINUATION PROVISIONS

LOSS OF ELIGIBILITY
   If an Insured Employee ceases to be eligible as an Insured Employee, his
   coverage continues [if any of the following events occurs:
       -  he becomes eligible as a Retiree, in which case he continues as a
          Retiree with up to [$!] of his Coverage Amount or multiple of his
          Annual Compensation; or]
   [   -  he becomes eligible as a Leave of Absence Employee, in which case he
          continues as a Leave of Absence Employee with up to [$!] of his
          Coverage Amount or multiple of his Annual Compensation; or]
       -  he becomes eligible as a Former Insured Employee, in which case he
          continues as a Former Insured Employee with up to [$!] of his
          Coverage Amount or multiple of his Annual Compensation.

   [If an Insured Spouse ceases to be eligible as an Insured Spouse, his
   coverage continues if any of the following events occurs: 
       -  the Employee terminates employment with the Employer, in which case 
          the Insured Spouse continues as a Former Insured Spouse with up to 
          [$!] of his Coverage Amount; or
       -  the Employee dies, in which case the Insured Spouse continues as a
          Former Insured Spouse with up to [$!] of his Coverage Amount; or
       -  the Insured Spouse is no longer married to the Employee, in which
          case the Insured Spouse continues as a Former Insured Spouse with up
          to [$!] of his Coverage Amount.

   [An Insured Dependent Child's coverage continues if the Insured Employee or
   Insured Spouse through whom he became insured is eligible to continue
   coverage.]

   [If a Leave of Absence Employee ceases to be eligible as a Leave of Absence
   Employee, his coverage continues if any of the following events occurs:
       -  he becomes eligible as a Retiree, in which case he continues as a
          Retiree with up to [$!] of his Coverage Amount or multiple of his
          Annual Compensation; or
       -  he becomes eligible as a Former Insured Employee, in which case he
          continues as a Former Insured Employee with up to [$!] of his
          Coverage Amount or multiple of his Annual Compensation; or
       -  he becomes eligible as an Employee, in which case he continues up to
          100% of his Coverage Amount.]





                                       37
<PAGE>   44
CONTINUATION PROVISIONS (CONTINUED)

POLICY TERMINATION
   If the Policy terminates and the Insured Employee is not eligible for
   coverage under a Successor Plan, he continues as a Former Insured Employee,
   with up to [$!] of his Coverage Amount or multiple of his Annual
   Compensation.

   [If the Policy terminates and the Insured Spouse is not eligible for
   coverage under a Successor Plan, he continues as a Former Insured Spouse,
   with up to [$!] of his Coverage Amount.]

   [If the Policy terminates and the Leave of Absence Employee is not eligible
   for coverage under a Successor Plan, he continues as a Former Insured
   Employee, with up to [$!] of his Coverage Amount or multiple of his Annual
   Compensation.]

   If the Policy terminates and [a Former Insured Employee, Former Insured
   Spouse, Former Insured Dependent Child, or Retiree] is not eligible under a
   Successor Plan, [each] continues as an Insured in the same Eligible Class,
   with up to [$!] of his Coverage Amount or multiple of his Annual
   Compensation.

   If the Policy terminates and the Insured is eligible for coverage under a
   Successor Plan, he may not continue coverage under the Policy.

NET CASH VALUE $250 OR GREATER
   If the above Continuation Provisions do not provide for continuation of
   coverage under this Certificate, but the Net Cash Value under this
   Certificate is [$250] or greater, the coverage under this Certificate
   continues.  [An Insured Employee, a Leave of Absence Employee, a Retiree, or
   a Former Insured Employee] will continue as a Former Insured Employee; [an
   Insured Spouse or a Former Insured Spouse will continue as a Former Insured
   Spouse; and a Former Dependent Child will continue as a Former Dependent
   Child.]





                                       38
<PAGE>   45
[CONVERSION PROVISIONS

CONVERSION PRIVILEGE
   If all or part of the Coverage Amount for an Insured ends because the
   Insured ceases to be a member of an Eligible Class, the Owner may convert up
   to the amount of insurance which ends, less any amount which the Insured
   becomes eligible to continue or replace under the Policy or under a
   Successor Plan.

   If coverage for an Insured ends because the Policy terminates and the
   individual has been insured under the Policy for at least three years, the
   Owner may convert up to [$10,000], less any amount  which the Insured
   becomes eligible to continue or replace under the Policy or under a
   Successor Plan.

   To convert, the Owner may apply for any type of life insurance currently
   being issued by the Company at the age and in the amount applied for, except
   that the new insurance may not:
       -  be term insurance; or
       -  contain disability or any other supplemental benefits.

   To apply for conversion insurance, the Owner must, within 31 days after
   coverage under the Policy ends: 
       -  submit an application to the Company; and 
       -  pay the required premium.

   Conversion coverage will become effective on the 31st day after the date
   coverage under the Policy ends, provided: (a) the application has been
   received by the Company; and (b) the required premium has been paid.
   Evidence of insurability will not be required for the converted amount.

   Premium for the conversion insurance will be based on:
       -  the age and class of risk of the Insured; and
       -  the type and amount of coverage issued.

   If the Insured dies during the 31-day conversion period, life insurance
   benefits will be paid under the group Policy, regardless of whether he
   applied for conversion insurance.  If a conversion policy is issued, it will
   replace coverage for that type and amount of insurance from the Policy.

EXTENSION OF CONVERSION PERIOD
   If an Insured is eligible for conversion, and the Owner is not notified of
   this right at least 15 days prior to the end of the 31-day conversion
   period, the conversion period will be extended.  The Owner will have 15 days
   from the date notice is given to apply for conversion insurance.  In no
   event will the conversion period be extended beyond 60 days.  Notice, for
   the purposes of this section, means written notice presented to the Owner by
   the Employer or mailed to the Owner's last known address as reported by the
   Employer.

   If the Insured dies during the extended conversion period, but more than 31
   days after his coverage under the Policy terminates: 
       -  life insurance benefits will not be paid under the Policy; and 
       -  life insurance benefits will be paid under the conversion insurance,
          provided: (a) the Insured's application for conversion insurance has
          been received by the Company; and (b) the required premium has been 
          paid.  ]





                                       39
<PAGE>   46
TABLE OF GUARANTEED MAXIMUM MONTHLY COST OF INSURANCE
RATES BASED ON 150% OF THE 1980 COMMISSIONERS
STANDARD ORDINARY MALE MORTALITY TABLE

PER $10,000 OF INSURANCE


<TABLE>
<CAPTION>
==========================================================================================================
        Attained Age                Monthly Rate               Attained Age               Monthly Rate
- ----------------------------------------------------------------------------------------------------------
             <S>                     <C>                            <C>                     <C>
             16                      $    1.99                      37                      $    3.11
- ----------------------------------------------------------------------------------------------------------
             17                      $    2.15                      38                      $    3.35
- ----------------------------------------------------------------------------------------------------------
             18                      $    2.27                      39                      $    3.63
- ----------------------------------------------------------------------------------------------------------
             19                      $    2.35                      40                      $    3.94
- ----------------------------------------------------------------------------------------------------------
             20                      $    2.37                      41                      $    4.28
- ----------------------------------------------------------------------------------------------------------
             21                      $    2.37                      42                      $    4.64
- ----------------------------------------------------------------------------------------------------------
             22                      $    2.35                      43                      $    5.04
- ----------------------------------------------------------------------------------------------------------
             23                      $    2.30                      44                      $    5.47
- ----------------------------------------------------------------------------------------------------------
             24                      $    2.25                      45                      $    5.92
- ----------------------------------------------------------------------------------------------------------
             25                      $    2.19                      46                      $    6.41
- ----------------------------------------------------------------------------------------------------------
             26                      $    2.15                      47                      $    6.93
- ----------------------------------------------------------------------------------------------------------
             27                      $    2.14                      48                      $    7.48
- ----------------------------------------------------------------------------------------------------------
             28                      $    2.12                      49                      $    8.10
- ----------------------------------------------------------------------------------------------------------
             29                      $    2.15                      50                      $    8.78
- ----------------------------------------------------------------------------------------------------------
             30                      $    2.19                      51                      $    9.57
- ----------------------------------------------------------------------------------------------------------
             31                      $    2.25                      52                      $   10.45
- ----------------------------------------------------------------------------------------------------------
             32                      $    2.34                      53                      $   11.46
- ----------------------------------------------------------------------------------------------------------
             33                      $    2.44                      54                      $   12.58
- ----------------------------------------------------------------------------------------------------------
             34                      $    2.56                      55                      $   13.78
- ----------------------------------------------------------------------------------------------------------
             35                      $    2.71                      56                      $   15.06
- ----------------------------------------------------------------------------------------------------------
             36                      $    2.90                      57                      $   16.42
==========================================================================================================
</TABLE>





                                       40
<PAGE>   47
TABLE OF GUARANTEED MAXIMUM MONTHLY COST OF INSURANCE
RATES BASED ON 150% OF THE 1980 COMMISSIONERS
STANDARD ORDINARY MALE MORTALITY TABLE

PER $10,000 OF INSURANCE
(CONTINUED)


<TABLE>
<CAPTION>
==========================================================================================================
        Attained Age                Monthly Rate               Attained Age               Monthly Rate
- ----------------------------------------------------------------------------------------------------------
             <S>                     <C>                            <C>                     <C>
             58                      $   17.86                      79                      $  126.29
- ----------------------------------------------------------------------------------------------------------
             59                      $   19.44                      80                      $  138.01
- ----------------------------------------------------------------------------------------------------------
             60                      $   21.20                      81                      $  151.28
- ----------------------------------------------------------------------------------------------------------
             61                      $   23.20                      82                      $  166.45
- ----------------------------------------------------------------------------------------------------------
             62                      $   25.45                      83                      $  183.54
- ----------------------------------------------------------------------------------------------------------
             63                      $   27.98                      84                      $  202.21
- ----------------------------------------------------------------------------------------------------------
             64                      $   30.79                      85                      $  222.14
- ----------------------------------------------------------------------------------------------------------
             65                      $   33.82                      86                      $  243.05
- ----------------------------------------------------------------------------------------------------------
             66                      $   37.08                      87                      $  264.86
- ----------------------------------------------------------------------------------------------------------
             67                      $   40.53                      88                      $  287.59
- ----------------------------------------------------------------------------------------------------------
             68                      $   44.27                      89                      $  311.42
- ----------------------------------------------------------------------------------------------------------
             69                      $   48.41                      90                      $  336.81
- ----------------------------------------------------------------------------------------------------------
             70                      $   53.10                      91                      $  364.47
- ----------------------------------------------------------------------------------------------------------
             71                      $   58.48                      92                      $  395.85
- ----------------------------------------------------------------------------------------------------------
             72                      $   64.67                      93                      $  434.54
- ----------------------------------------------------------------------------------------------------------
             73                      $   71.72                      94                      $  488.72
- ----------------------------------------------------------------------------------------------------------
             74                      $   79.51                      95                      $  575.26
- ----------------------------------------------------------------------------------------------------------
             75                      $   87.89                      96                      $  732.95
- ----------------------------------------------------------------------------------------------------------
             76                      $   96.76                      97                      $ 1061.50
- ----------------------------------------------------------------------------------------------------------
             77                      $  106.02                      98                      $ 1508.68
- ----------------------------------------------------------------------------------------------------------
             78                      $  115.76                      99                      $ 1508.68
==========================================================================================================
</TABLE>





                                       41
<PAGE>   48
OWNERSHIP AND ASSIGNMENT PROVISIONS

OWNER
   Unless otherwise specified on the application or unless Ownership is
   transferred in accordance with the provisions of the Policy:
       -  the [Insured Employee] will be the Owner of the coverage for himself,
          [his Insured Spouse, his Former Insured Spouse, and his Insured
          Dependent Child, if any;]
   [   -  the Former Insured Dependent Child will be the Owner of the coverage
          for himself; and 
       -  the Former Insured Employee, Retiree, and Leave of
          Absence Employee will be the Owner of the coverage for himself, his
          Former Insured Spouse, and his Insured Dependent Child, if any].

RIGHTS OF OWNER
   While an Insured is alive, the Owner may exercise all rights and privileges
   under the Certificate, including the right to:  (a) release or Surrender the
   Certificate to the Company; (b) agree with the Company to any change in the
   Certificate; (c) transfer all rights and privileges to another person; (d)
   change the Beneficiary; and (e) assign his Certificate.

   All rights and privileges of the Owner may be exercised without the consent
   of any designated Beneficiary, unless the Owner has given up the right to
   change the Beneficiary.

   Unless provided otherwise, if the Owner is a person other than the Insured
   and dies before the Insured, all the rights and privileges of the Owner will
   vest in the Owner's executors or administrators.

TRANSFER OF OWNERSHIP
   The Owner may transfer all his rights and privileges by Assignment to a
   third party.  On the effective date of transfer, that third party will
   become the Owner and will have all the rights and privileges of the Owner.
   The Owner may revoke any transfer prior to its effective date.

   Unless provided otherwise, a transfer will not affect the interest of any
   Beneficiary designated prior to the effective date of the transfer.

   A transfer of ownership or a revocation of transfer must be in writing in a
   form satisfactory to the Company and filed with the Company.  A transfer or
   a revocation will take effect on the later of the effective date specified
   by the Owner or the date it is recorded by the Company.  Any payment made or
   any action taken or allowed by the Company before a transfer or a revocation
   is recorded and effective, will be without prejudice to the Company.  The
   Company does not assume responsibility for the validity or sufficiency of
   any Assignment.





                                       42
<PAGE>   49
BENEFICIARY PROVISIONS

BENEFICIARY DESIGNATION
   The Owner may designate a Beneficiary to whom the proceeds will be paid in
   the event of death of the Insured.  Upon the death of an Insured Dependent
   Child, the Coverage Amount will be paid to the Owner of the Certificate
   under which the Insured Dependent Child was covered unless otherwise
   designated by the Owner.

   If a Beneficiary dies before the Insured, that Beneficiary's interest will
   end; such Beneficiary's share will be paid in equal shares to the other
   Beneficiaries, if there are any.  This does not apply if other arrangements
   have been filed with the Company.

   If there is no surviving Beneficiary or the Owner has not designated a
   Beneficiary, benefits will be paid to the first surviving class of the
   following classes of Beneficiaries:
       -  the Insured's Spouse; or
       -  the Insured's Child or Children; or
       -  the Insured's parents; or
       -  the Insured's siblings.

   If there is no surviving member of any of the above classes, the benefits
   will be paid to the Owner or Owner's estate.  If the Beneficiary is a minor
   or is not able to give valid receipt for any payment due him, such payment
   will be made to his legal guardian.

   Payment in the manner described above will release the Company from all
   liability to the extent of any payment made.

CHANGE OF BENEFICIARY
   The Owner may change the Beneficiary at any time without the consent of the
   Beneficiary, unless the Beneficiary designation is irrevocable.  Any change
   must be made in writing in a form satisfactory to the Company and signed by
   the Owner.  Consent of the Beneficiary will not be required to effect any
   changes other than an irrevocable Beneficiary designation.

   No change in Beneficiary will take effect until this form is received by the
   Company.  When this form is received, the change will take effect as of the
   date of the form.  If the Insured dies before the form is received, the
   Company's obligations under the Policy will be satisfied to the extent of
   any payment that was made before receipt of the form.





                                       43
<PAGE>   50
GENERAL PROVISIONS

MISSTATEMENT OF AGE
   If an Insured's age has been misstated, the Company will adjust all benefits
   to the amounts that the cost of insurance deducted would have purchased for
   the correct age, subject to the Qualification Under Internal Revenue Code
   provision.

INCONTESTABILITY
   The Company will not contest the validity of this insurance after it has
   been in force for two years from the date of issue or Reinstatement, except
   for nonpayment of premiums.  No statement made by an Insured as to his
   insurability will be used to contest the validity of the insurance after it
   has been in force prior to the contest for a period of two years during the
   Insured's lifetime.  No statement made by an Insured will be used to contest
   the validity of his coverage unless it is made in writing, signed by him and
   a copy given to him or his Beneficiary.  Any increase in the Coverage Amount
   effective after an Insured first becomes insured or reinstates coverage will
   be incontestable only after such increase has been in force for two years
   during the Insured's lifetime.  The basis for contesting an increase in the
   Coverage Amount will be limited to material misrepresentations made in the
   application for the increase.

ANNUAL CERTIFICATE REPORT
   The Company will send a report to each Owner once a year to be attached to
   the Certificate.  The report will show the current Coverage Amount, the
   Death Benefit, the Cash Value, and any Loan Balance. The report will also
   show interest earned, gains and losses in the Fund Accounts, premiums paid
   and any other information required by applicable laws.

PAYMENT OF PROCEEDS
   Proceeds, as used in the Policy, means an amount payable:
       -  on the date an Owner Surrenders the Certificate; or
       -  upon the death of the Insured.

   The proceeds payable upon receipt of due proof of an Insured's death will be
   as described in the Death Benefit section.  If an Insured dies as a direct
   result of an accidental bodily injury, the proceeds may also include any
   supplemental benefit, if available and elected.

   If an Owner Surrenders the Certificate, the proceeds will be the Net Cash
   Value less any applicable Surrender fee and less any other amounts due the
   Company under this Certificate.  The proceeds are subject to the adjustments
   described in the Policy.

DEFERMENT OF PAYMENTS
   Amounts payable as a result of Loans, Surrenders, Partial Surrenders, or for
   any other reason, will be paid upon receipt  of such documentation as may be
   required by the Company at the time. However, payment of amounts from the
   Fund Accounts may be postponed when the NYSE is closed or when the
   Securities and Exchange Commission (SEC) declares an emergency.
   Additionally, the Company reserves the right to defer the payment of such
   amounts from the Fixed Account for a period not to exceed 6 months from the
   date written request is received by the Company.  During any such deferred
   period, the amount payable will bear interest as required by law.





                                       44
<PAGE>   51
GENERAL PROVISIONS (CONTINUED)

SUICIDE
   If an Insured commits suicide, while sane or insane, within two years from
   the date his insurance becomes effective, his Death Benefit will be limited
   to a refund of the premiums paid, less: (a) any Current Outstanding Loan
   Balance; and (b) the amount of any Partial Surrenders.

   If an Insured commits suicide, while sane or insane, within two years from
   the effective date of any increase in the Insured's Coverage Amount, the
   Death Benefit payment with respect to such increase will be limited to a
   refund of the monthly charges for the cost of the increase.

QUALIFICATION UNDER INTERNAL REVENUE CODE
   The Policy is designed to qualify as a life insurance policy under the
   Internal Revenue Code, as amended, and to never become a Modified Endowment
   Contract, as defined in Section 7702A of the Code.  The Company reserves the
   right to:  (a) limit or decline an Insured's payments; (b) limit or decline
   Coverage Amount changes; (c) amend the Policy and Certificates; (d)
   distribute Cash Value; or (e) take any other action it deems necessary to
   preserve the qualification of the Policy as a life insurance policy under
   the Internal Revenue Code.





                                       45
<PAGE>   52

                           COVERAGE VERIFICATION PAGE

OWNER:   [Mr. John Doe                    GROUP POLICY NUMBER:     [XXXXXXX]
         123 Main Street
         Anywhere, CT 06000]              CERTIFICATE NUMBER: [XX-XXXXXX]

                                          CERTIFICATE EFFECTIVE DATE: [XX/XX/XX]

INSURED:     [John Doe]  ISSUE AGE: [42]  ELIGIBILITY CLASS:  [Insured Employee]

POLICYHOLDER:    [ABC Company]            POLICY EFFECTIVE DATE:  [XX/XX/XX]

EMPLOYER:        [ABC Company]            POLICY ANNIVERSARY DATE:  [XX/XX]
             
LIFE INSURANCE BENEFITS:
Coverage Amount:                                   [$40,000.00]
<TABLE>
<CAPTION>
ADDITIONAL BENEFITS                                                    RIDER EFFECTIVE DATE
<S>                                                                          <C>
[Automatic Increase Feature:                       [Elected/Declined]         XX/XX/XX] 
[Dependent Child(ren) Term Insurance:              [$!]                       XX/XX/XX]
[Accelerated Payment Benefit Rider                                            XX/XX/XX]
[Paid-up Life Insurance Option Rider                                          XX/XX/XX]
[Seat Belt Benefit Rider                                                      XX/XX/XX]
[Supplemental Accidental Death Benefit Rider                                  XX/XX/XX]
[Supplemental Accidental Death & Dismemberment Benefit Rider                  XX/XX/XX]
[Supplemental Accidental Death, Dismemberment, Loss of Sight,                          
Speech & Hearing; or Paralysis Benefit Rider                                  XX/XX/XX]
[Waiver of Cost of Life Insurance During Total Disability Rider               XX/XX/XX]
</TABLE>                                                                   

LOANS, SURRENDERS:
Loan and Surrender information only pertains if you have accumulated a Cash
Value.

MINIMUM LOAN AMOUNT:                  [$250.00]
MINIMUM PARTIAL SURRENDER:            [$250.00]
SURRENDER FEE:                         [$25.00]
PARTIAL SURRENDER FEE:                 [$25.00]


[Beneficiary information may be verified by contacting the Company's Customer
Service Center at 95 Highland Avenue, Bethlehem, PA, 1.800.828.3485.]

THIS COVERAGE IS UNDERWRITTEN BY:   Connecticut General Life Insurance Company.





<PAGE>   53

                     COVERAGE VERIFICATION PAGE (CONTINUED)

EXPENSE CHARGES AND FEES

PREMIUM LOAD FOR TAXES
         A charge of up to 5.0% of each premium payment will be deducted to
         cover applicable state taxes and federal income tax liabilities.  The
         current charge is [3.0%].

MONTHLY ADMINISTRATIVE FEE
         A Monthly Administrative Fee will be charged to each Certificate in an
         amount not to exceed $5.00 per month. The current Monthly
         Administrative Fee to be charged to each Certificate is [$!] per
         month.

         For each Certificate which has accumulated Cash Value in any Fund
         Account, an additional Monthly Administrative Fee will be charged, in
         an amount not to exceed $3.00 per month. The current additional
         Monthly Administrative Fee to be charged to each Certificate which has
         accumulated a Cash Value in any Fund Account is [$!] per month. The
         additional Monthly Administrative Fee for Certificates which have
         accumulated Cash Value in any Fund Account will be waived for any
         month in which the Net Cash Value of the Certificate is greater than
         $10,000.

         The sum of the two Monthly Administrative Fees will not exceed $6.00
         per month.

CHARGES AND FEES ASSOCIATED WITH THE FUND ACCOUNTS
         For mortality and expense risk, an asset charge is deducted from each
         Fund Account at the end of each Valuation Period.  This charge may be
         changed by the Company from time to time, but it is guaranteed not to
         exceed a daily rate which is equivalent to 0.90% annually of the Fund
         Account's Value.  As of the Certificate Effective Date, this charge
         was equal to a daily rate which is equivalent to [.45%] annually.

         In addition, Daily Fund Operating Expenses will be applied by each
         Fund as set forth in the prospectus for the applicable Fund(s).

TRANSACTION FEE
         A transaction fee of [$25] will be charged for each fund transfer in
         excess of [12] transfers made during any Policy Year and to each
         Surrender and Partial Surrender.

CHANGES TO EXPENSES, FEES AND CHARGES
         The Company reserves the right to change the Transaction Fees from
         time to time.  The Company also reserves the right to change the
         Premium Load, the Monthly Administrative Fee, and the charges for
         mortality and expense risk; however, these charges and fees may not
         exceed the maximums set forth above.





<PAGE>   54

                     COVERAGE VERIFICATION PAGE (CONTINUED)



<TABLE>
<CAPTION>
FUND GROUPS                       FUNDS                                 INITIAL ALLOCATION OF
                                                                        NET PREMIUM PAYMENTS
<S>                               <C>                                        <C>
Fund Manager A                    Fidelity VIP II Investment
                                           Grade Bond Portfolio                        %
                                                                             ----------
                                  Fidelity VIP Equity-Income Portfolio                 %
                                                                             ----------
                                  Fidelity VIP II Asset Manager Portfolio              %
                                                                             ----------
                                  Fidelity VIP Overseas Portfolio                      %
                                                                             ----------
Fund Manager B                    TCI Growth                                           %
                                                                             ----------
Fund Manager C                    CIGNA Variable Products
                                            Money Market Fund                          %
                                                                             ----------
                                  CIGNA Variable Products Index Fund                   %
                                                                             ----------

CIGNA FIXED ACCOUNT                                                                    %
                                                                             ----------
                                                       TOTAL                    100%
</TABLE>


NOTE:    Net premium payments also may be allocated to the Fixed Account.

The Separate Account for the Policy is CG Variable Life Insurance Separate
Account A - A Connecticut General Life Insurance Company separate investment
account established on May 22, 1995.


LIMITS ON ALLOCATION OF NET PREMIUM PAYMENTS
         There is no minimum allocation percentage to the Fixed Account or a
         Fund Account; however, all allocations must be made in 5% increments
         and in aggregate must total 100%.  Premium payments will be allocated
         after deduction of the Premium Load.  If no allocation is made by the
         Owner, all net premiums will be allocated to the Fixed Account.

LIMITS ON TRANSFERS FROM THE FIXED ACCOUNT
         A Transfer from the Fixed Account to any or all of the Fund Accounts
         may be made only during the 30-day period following each Policy
         Anniversary Date and is subject to a maximum aggregate annual limit of
         25% of the Fixed Account Value as of the Policy Anniversary Date.
         Additionally, the Company has the right to limit the dollar amount of
         such transfers.  Additional limitations on Transfers are set forth in
         the Transfer Privileges provision.

GUARANTEED MINIMUM INTEREST RATES
         The interest rate used to credit interest on the Fixed Account Value
         will be determined by the Company from time to time, but will never be
         less than an effective annual rate of 4%  (.010746% compounded daily).

         The interest rate used to credit interest on the Loan Account Value
         will be determined by the Company from time to time, but will never be
         less than an effective annual rate of 6%.  (As of the Certificate
         Effective Date, the interest rate used to credit interest on the Loan
         Account Value will be an effective annual rate of x%.)





<PAGE>   55
SUPPLEMENTAL ACCIDENTAL DEATH BENEFIT RIDER

This rider is made a part of the Policy/Certificate to which it is attached.
This rider takes effect on the Policy Effective Date unless a later date is
shown in the Coverage Verification Pages.

BENEFITS
    The Company will pay the Supplemental Accidental Death Benefit, in addition
    to the Life Insurance Death Benefit, to the Beneficiary of the [Insured
    Employee, Insured Spouse, Former Insured Employee, Former Insured Spouse or
    Leave of Absence Employee] who has elected and paid the applicable cost of
    insurance for the Supplemental Accidental Death Benefit, when the Company
    receives due proof of death.  Death must result directly from an accidental
    bodily injury, and independently of all other causes.  Death must occur
    within 90 days of the accident causing the injury and while coverage is in
    force.  The Supplemental Accidental Death Benefit payable will be equal to
    the Insured's Coverage Amount in force on the date of his death.

LIMITATIONS
    Benefits under this rider will not be paid if the accidental death in any
    way results from:
         -   intentionally self-inflicted injury, suicide or any attempt
             thereat, while sane or insane (except in Missouri, while sane);
         -   mental infirmity;
         -   sickness, disease, bodily infirmity, or bacterial or viral
             infection, even if contracted by accident.  This exclusion does
             not apply to bacterial infection that is the natural and
             foreseeable result of an accidental external cut or wound;
         -   declared or undeclared war, an act of war, or service in any
             military force of any country while such country is engaged in
             war;
         -   performing police duty as a member of a military organization;
         -   taking part in the commission of a felony;
         -   voluntary use of any controlled substance, unless prescribed for
             the Insured by his Physician.  The term "controlled substance" is
             defined in Title II of the Federal Comprehensive Drug Abuse
             Prevention and Control Act of 1970, as now or hereafter amended;
             or
         -   travel or flight in any aircraft, except as a passenger on a
             commercial flight, Employer aircraft, or a military air transport
             passenger flight.

TERMINATION
    An Insured's Supplemental Accidental Death Benefit will cease on the
    earliest date below:
         -   the date the Insured's insurance ceases as described in the
             Certificate; or
         -   the last day for which the Insured has paid the required premium
             for this rider; or
         -   the date this rider is cancelled; or
         -   the Policy Anniversary Date that is the same as or next follows
             the retirement date of an Insured Employee; or
         -   the Policy Anniversary Date that is the same as or next follows
             the [65th] birthday of [an Insured Spouse, Former Insured
             Employee, Former Insured Spouse, or Leave of Absence Employee].

    The Insured must notify the Company of the occurrence of any of the above
    events.  If premium is collected for this benefit beyond the date this
    benefit ceases, such premium will be returned and no benefit will be
    payable in the event of death.
<PAGE>   56
TERMINATION (CONTINUED)
    [If an Insured Employee or Former Insured Employee's cost of life insurance
    is waived as described in the Waiver of Cost of Life Insurance During Total
    Disability Rider, his Supplemental Accidental Death Benefit will cease on
    the date his Waiver of Cost of Life Insurance is approved by the Company.
    This rider will be reinstated on the date his Waiver of Cost of Life
    Insurance ceases, provided the required premium is paid to the Company for
    his life insurance and his Supplemental Accidental Death Benefit Rider.]





                   CONNECTICUT GENERAL LIFE INSURANCE COMPANY



 /s/ DAVID C. KOPP                                           /s/ THOMAS C. JONES
 -----------------                                           -------------------
Corporate Secretary                                               PRESIDENT




                                       2
<PAGE>   57
SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT
BENEFIT RIDER

This rider is made a part of the Policy/Certificate to which it is attached.
This rider takes effect on the Policy Effective Date unless a later date is
shown in the Certificate Coverage Verification Pages.

BENEFITS
    The Company will pay the Supplemental Accidental Death and Dismemberment
    Benefit to the Insured's Beneficiary in the event of loss of life, and to
    the Owner in the event of other covered losses, upon receipt of due proof
    that the [Insured Employee, Insured Spouse, Former Insured Employee, Former
    Insured Spouse, or Leave of Absence Employee] has suffered a loss, as shown
    in the Table of Losses and Benefits while insured for the Supplemental
    Accidental Death and Dismemberment Benefit.  The loss must be as a direct
    result of that injury, independent of all other causes.  The loss must
    occur within 90 days after the date of the accident causing the loss.

    The Supplemental Accidental Death and Dismemberment Benefit payable will be
    equal to the Coverage Amount in force on the Insured on the date of the
    loss, multiplied by the percentage shown in the Table of Losses and
    Benefits for such loss.  The maximum that will be paid for all losses
    resulting from injuries received by an Insured in any one accident will be
    his Coverage Amount.

TABLE OF LOSSES AND BENEFITS

<TABLE>
<CAPTION>
   TYPE OF LOSS                                                 % OF COVERAGE AMOUNT
   <S>                                                                     <C>
   Loss of Life                                                            100%
   Loss of Both Hands                                                      100%
   Loss of Both Feet                                                       100%
   Loss of Entire Sight of Both Eyes                                       100%
   Loss of One Hand and One Foot                                           100%
   Loss of One Hand and Entire Sight of One Eye                            100%
   Loss of One Foot and Entire Sight of One Eye                            100%
   Loss of One Hand                                                         50%
   Loss of One Foot                                                         50%
   Loss of Entire Sight of One Eye                                          50%
   Loss of Thumb and Index Finger
              of the Same Hand                                              25%
</TABLE>

   Loss of a hand or foot means complete Severance through or above the wrist
   or ankle joint.  Loss of sight means the total, permanent loss of sight of
   the eye.  The loss of sight must be irrecoverable by natural, surgical or
   artificial means.  Loss of a thumb and index finger means complete Severance
   through or above the metacarpophalangeal joints (the joints between the
   fingers and the hand).

   (In California, loss of a thumb and index finger means loss by complete
   Severance of at least one whole phalanx of each.)  (In South Carolina, the
   complete severance of four whole fingers from one hand equals the loss of
   one hand.) 

   "Severance" means the complete separation and dismemberment of the part 
   from the body.





<PAGE>   58
LIMITATIONS
   Benefits under this rider will not be paid if the loss in any way results
   from:
       -  intentionally self-inflicted injury, suicide or any attempt thereat,
          while sane or insane (except in Missouri while sane);
       -  mental infirmity;
       -  sickness, disease, bodily infirmity, or bacterial or viral infection,
          even if contracted by accident.  This exclusion does not apply to
          bacterial infection that is the natural and foreseeable result of an
          accidental external cut or wound;
       -  declared or undeclared war, an act of war or service in any military
          force of any country while such country is engaged in war;
       -  performing police duty as a member of a military organization;
       -  taking part in the commission of a felony;
       -  voluntary use of any controlled substance, unless prescribed for the
          Insured by his Physician.  The term "controlled substance" is defined
          in Title II of the Federal Comprehensive Drug Abuse Prevention and
          Control Act of 1970, as now or hereafter amended; or
       -  travel or flight in any aircraft, except as a passenger on a
          commercial flight, Employer aircraft, or a military air transport
          passenger flight.

TERMINATION
   [An Insured's] coverage provided by this rider will cease on the earliest
   date below:
       -  the date the insurance ceases, as described in the Certificate; or
       -  the last day for which the Insured has paid the required premium for
          this rider; or
       -  the date this rider is cancelled; or
       -  the Policy Anniversary Date that is the same as or next follows the
          normal retirement date of an Insured Employee; or
       -  the Policy Anniversary Date that is the same as or next follows the
          [65th] birthday of [an Insured Spouse, Former Insured Employee,
          Former Insured Spouse, or Leave of Absence Employee].

   The Insured must notify the Company of the occurrence of any of the above
   events.  If premium is collected for this benefit beyond the date this
   benefit ceases, such premium will be returned and no benefit will be payable
   in the event of loss beyond the termination date.

   [If an Insured Employee or Former Insured Employee's cost of life insurance
   is waived as described in the Waiver of Cost of Life Insurance During Total
   Disability Rider, his Supplemental Accidental Death and Dismemberment
   Benefit will cease on the date his Waiver of Cost of Life Insurance is
   approved by the Company.  This rider will be reinstated on the date his
   Waiver of Cost of Life Insurance ceases, provided the required premium is
   paid to the Company for his life insurance and his Supplemental Accidental
   Death and Dismemberment Benefit Rider.]

                   CONNECTICUT GENERAL LIFE INSURANCE COMPANY



 /s/ DAVID C. KOPP                                           /s/ THOMAS C. JONES
 -----------------                                           -------------------
Corporate Secretary                                               PRESIDENT




                                       2
<PAGE>   59
SUPPLEMENTAL ACCIDENTAL DEATH, DISMEMBERMENT, LOSS OF SIGHT, SPEECH AND
HEARING; OR PARALYSIS BENEFIT RIDER

This rider is made a part of the Policy/Certificate to which it is attached.
This rider takes effect on the Policy Effective Date unless a later date is
shown in the Certificate Coverage Verification Pages.

BENEFITS
    The Company will pay the below scheduled benefit to the Insured's
    Beneficiary in the event of loss of life and to the Owner in the event of
    all other covered losses, upon receipt of due proof that the [Insured
    Employee, Insured Spouse, Former Insured Employee, Former Insured Spouse,
    or Leave of Absence Employee] has  suffered a loss, as shown in the Table
    of Losses and Benefits, while insured for the Supplemental Accidental
    Death, Dismemberment, Loss of Sight, Speech and Hearing; or Paralysis
    Benefit.  The loss must be as a direct result of that injury, independent
    of all other causes.  The loss must occur within 90 days after the date of
    the accident causing the loss.

    The benefit payable will be equal to the Coverage Amount in force on the
    Insured on the date of the loss, multiplied by the percentage shown in the
    Table of Losses and Benefits for such loss.  The maximum that will be paid
    for all losses resulting from injuries received by an Insured in any one
    accident will be his Coverage Amount.

TABLE OF LOSSES AND BENEFITS
<TABLE>
<CAPTION>
   TYPE OF LOSS                                                                % OF COVERAGE AMOUNT
   <S>                                                                                        <C>
   Loss of Life                                                                               100%
   Loss of Both Hands                                                                         100%
   Loss of Both Feet                                                                          100%
   Loss of Entire Sight of Both Eyes                                                          100%
   Loss of One Hand and One Foot                                                              100%
   Loss of One Hand and Entire Sight of One Eye                                               100%
   Loss of One Foot and Entire Sight of One Eye                                               100%
   Loss of Speech and Hearing (both ears)                                                     100%
   Quadriplegia (total Paralysis of both upper and lower limbs)                               100%
   Paraplegia (total Paralysis of both lower limbs)                                            50%
   Loss of One Hand                                                                            50%
   Loss of One Foot                                                                            50%
   Loss of Entire Sight of One Eye                                                             50%
   Loss of Speech                                                                              50%
   Loss of Hearing (both ears)                                                                 50%
   Hemiplegia (total Paralysis of upper and lower limbs on one side of body)                   50%
   Loss of Thumb and Index Finger of the Same Hand                                             25%
</TABLE>

   Loss of a hand or foot means complete Severance through or above the wrist
   or ankle joint.  Loss of sight means the total, permanent loss of sight of
   the eye.  The loss of sight must be irrecoverable by natural, surgical or
   artificial means.  Loss of speech means total, permanent and irrecoverable
   loss of audible communication.  Loss of hearing means total and permanent
   loss of hearing in both ears which cannot be corrected by any means.  Loss
   of a thumb and index finger means complete Severance through or above the
   metacarpophalangeal joints (the joints between the fingers and the hand).





<PAGE>   60
TABLE OF LOSSES AND BENEFITS (CONTINUED)

    (In California, loss of a thumb and index finger means loss by complete
    Severance of at least one whole phalanx of each.)  (In South Carolina, the
    complete Severance of four whole fingers from one hand equals the loss of
    one hand.)

    "Severance" means the complete separation and dismemberment of the part
    from the body.

    "Paralysis" means loss of use, without Severance, of a limb.  This loss
    must be determined by a Physician to be complete and not reversible.

LIMITATIONS
    Benefits under this rider will not be paid if the loss in any way results
    from:

         -   intentionally self-inflicted injury, suicide or any attempt
             thereat, while sane or insane (except in Missouri, while sane);
         -   mental infirmity;
         -   sickness, disease, bodily infirmity, or bacterial or viral
             infection, even if contracted by accident.  This exclusion does
             not apply to bacterial infection that is the natural and
             foreseeable result of an accidental external cut or wound;
         -   declared or undeclared war, an act of war or service in any
             military force of any country while such country is engaged in
             war;
         -   performing police duty as a member of a military organization;
         -   taking part in the commission of a felony;
         -   voluntary use of any controlled substance, unless prescribed for
             the Insured by his Physician.  The term "controlled substance" is
             defined in Title II of the Federal Comprehensive Drug Abuse
             Prevention and Control Act of 1970, as now or hereafter amended;
             or
         -   travel or flight in any aircraft, except as a passenger on a
             commercial flight, Employer aircraft, or a military air transport
             passenger flight.

TERMINATION
    An Insured's coverage provided by this rider will cease on the earliest
    date below:

         -   the date the Insured's insurance ceases, as described in the
             Certificate; or
         -   the last day for which the Insured has paid the required premium
             for this rider; or
         -   the date this rider is cancelled; or
         -   the Policy Anniversary Date that is the same as or next follows
             the normal retirement date of an Insured Employee; or
         -   the Policy Anniversary Date that is the same as or next follows
             the [65th] birthday of [an Insured Spouse, Former
             Insured Employee, Former Insured Spouse, or Leave of Absence
             Employee].

    The Insured must notify the Company of the occurrence of any of the above
    events.  If premium for this benefit is collected beyond the date this
    benefit ceases, such premium will be returned and no benefit will be
    payable in the event of loss beyond the termination date.




                                       2
<PAGE>   61
TERMINATION (CONTINUED)
    [If an Insured Employee or Former Insured Employee's cost of life insurance
    is waived as described in the Waiver of Cost of Life Insurance During Total
    Disability Rider, his Supplemental Accidental Death, Dismemberment, Loss of
    Sight, Speech and Hearing; or Paralysis Benefit will cease on the date his
    Waiver of Cost of Life Insurance is approved by the Company.  This rider
    will be reinstated on the date his Waiver of Cost of Life Insurance ceases,
    provided the required premium is paid to the Company for his life insurance
    and his Supplemental Accidental Death, Dismemberment, Loss of Sight, Speech
    and Hearing; or Paralysis Benefit Rider.]


                   CONNECTICUT GENERAL LIFE INSURANCE COMPANY



 /s/ DAVID C. KOPP                                           /s/ THOMAS C. JONES
 -----------------                                           -------------------
Corporate Secretary                                               PRESIDENT



                                       3

<PAGE>   62
WAIVER OF COST OF LIFE INSURANCE DURING TOTAL DISABILITY RIDER

This rider is made a part of the Policy/Certificate to which it is attached.
This rider takes effect on the Policy Effective Date unless a later date is
shown in the Coverage Verification Pages.

BENEFIT
    If an Insured Employee or Former Insured Employee becomes Totally Disabled
    (as defined) before age 60, his cost of life insurance, the Monthly
    Administrative Fee, and the cost of insurance for his Insured Dependent
    Child(ren)'s life insurance, for whom he has elected coverage and who are
    covered under his Certificate, will be waived while he remains continuously
    Totally Disabled.  In addition, any cost of insurance deducted from his
    Cash Value by the Company for his life insurance under this Certificate and
    the life insurance for his Insured Dependent Child(ren), if any, on or
    after the date he becomes Totally Disabled, will be refunded to the Owner.
    No additional changes in coverage will be allowed after the Waiver is
    approved by the Company.

PROOF OF LOSS
    In order to qualify for the Waiver of Cost of Life Insurance, an Insured
    Employee or Former Insured Employee must submit due proof that he has been
    continuously Totally Disabled for [six] months or more. Such proof must be
    submitted to the Company no later than one year from the date the Insured
    Employee or Former Insured Employee becomes Totally Disabled.  After his
    cost of life insurance and the cost of life insurance for his Insured
    Dependent Child(ren), if any, has been waived for one year, such cost of
    life insurance will be waived for additional  periods of one year if:
         -   he remains continuously Totally Disabled; and
         -   he submits to the Company, during the three months before the end
             of each such one-year period, proof of the continuation of Total
             Disability.

    However, the Insured Employee or Former Insured Employee is required to pay
    his cost of life insurance and the cost of life insurance for his Insured
    Dependent Child(ren), if any, if such cost of life insurance:
         -   was due more than one year before the Company received proof of
             his Total Disability; or
         -   was due but not yet paid if the Insured Employee or Former Insured
             Employee becomes Totally Disabled during a Grace Period for
             Insureds.

DEATH BENEFIT DURING WAIVER OF COST OF LIFE INSURANCE
    If an Insured Employee or Former Insured Employee dies while his cost of
    life insurance is being waived, the Death Benefit will be paid only if the
    Company receives proof, within one year of his death, that his Total
    Disability was continuous from the date we received the last proof of Total
    Disability until the date he died.

    The Death Benefit payable for an Insured Employee, Former Insured Employee,
    or Insured Dependent Child(ren) will be the Coverage Amount determined from
    The Schedule which was in effect on the day before the date the Insured
    Employee or Former Insured Employee became Totally Disabled, plus the Net
    Cash Value.

    The Coverage Amount may not be increased while the cost of life insurance
    is being waived.





<PAGE>   63
TOTAL DISABILITY OR TOTALLY DISABLED
    An Insured Employee or Former Insured Employee will be considered Totally
    Disabled when he is completely unable to engage in any occupation for wage
    or profit because of injury or sickness.

    At any time while an Insured Employee or Former Insured Employee's cost of
    life insurance is being waived, the Company will have the right to require
    proof of his continuing Total Disability and, at its own expense, to have a
    Physician of its choice examine him.  However, after he has been Totally
    Disabled for two years, the Company will require proof no more than once a
    year.

TERMINATION
    This rider will cease for an Insured Employee or Former Insured Employee
    and his Insured Dependent Child(ren) on the earliest of:
         -   the date the Insured Employee or Former Insured Employee is no
             longer Totally Disabled; or
         -   the date the Insured Employee or Former Insured Employee refuses
             to submit to any physical examination required by the Company; or
         -   the last day of any one-year period of Total Disability during
             which the Insured Employee or Former Insured Employee fails to
             give proof of continuous Total Disability; or
         -   the date the Insured Employee or Former Insured Employee attains
             age 65; or
         -   the date the Certificate terminates.

    An Insured Employee or Former Insured Employee whose Waiver of Cost of Life
    Insurance ceases for himself and any Insured Dependent Child(ren) may
    continue this insurance by paying the Monthly Deduction directly to the
    Company, or through payroll deduction for an Insured Employee, or by having
    adequate Cash Value to cover the Monthly Deduction.

    For the purposes of this rider, an Insured Employee or Former Insured
    Employee's cost of life insurance is deemed to include his Monthly
    Administrative Fee.

    This rider does not apply to any supplemental coverage, if elected, nor to
    any insurance for an Insured Spouse, Former Insured Spouse, Former Insured
    Dependent Child(ren), Retiree, or Leave of Absence Employee.


                   CONNECTICUT GENERAL LIFE INSURANCE COMPANY



 /s/ DAVID C. KOPP                                           /s/ THOMAS C. JONES
 -----------------                                           -------------------
Corporate Secretary                                               PRESIDENT




                                       2
<PAGE>   64
PAID-UP INSURANCE OPTION RIDER

This rider is made a part of the Policy/Certificate to which it is attached.
This rider takes effect on the Policy Effective Date unless a later date is
shown in the Certificate Coverage Verification Pages.

ELECTION OF OPTION
    At any time after a Cash Value has accumulated under the Certificate, the
    Owner may elect:
         -   to use a portion of the Net Cash Value to purchase Paid-up
             Insurance; or
         -   to Surrender his Certificate and use all of the Net Cash Value,
             less applicable transaction fees, to purchase Paid-up Insurance.

    Such Paid-up Insurance will be provided under a separate policy of life
    insurance issued by the Company or an affiliate of the Company.  Evidence
    of good health will not be required for such Paid-up Insurance.

    The amount of Paid-up Insurance will be determined by applying the
    amount  Surrendered, less applicable transaction fees, as a single premium,
    using  the guaranteed maximum life insurance rates and the guaranteed
    minimum interest rates at the Insured's then Attained Age.  However, the
    amount of Paid-up Insurance may not exceed an Insured's Coverage Amount in
    force for him on the date of purchase.

    The Paid-up Insurance will be payable as set forth in the payment
    provisions in the Paid-up Insurance Policy.



                   CONNECTICUT GENERAL LIFE INSURANCE COMPANY



 /s/ DAVID C. KOPP                                           /s/ THOMAS C. JONES
 -----------------                                           -------------------
Corporate Secretary                                               PRESIDENT




<PAGE>   65
ACCELERATED PAYMENT BENEFIT RIDER

This rider is made a part of the Policy/Certificate to which it is attached.
This rider takes effect on the Policy Effective Date unless a later date is
shown in the Certificate Coverage Verification Pages.

The effective date of insurance under this rider is subject to the terms and
conditions set forth in the Certificate.

Any benefits paid under the Nursing Care and Custodial Care Facility Benefit,
the Terminal Illness Benefit, or Specified Disease Benefit will reduce the
amount of the Insured's Death Benefit.

This rider has no Cash Value or Loan value.


NOTICE:          BENEFITS WHICH ARE PAID UNDER THIS ACCELERATED PAYMENT BENEFIT
                 INSURANCE RIDER WILL REDUCE THE DEATH BENEFIT UNDER THE LIFE
                 INSURANCE.

                 BENEFITS PAID UNDER THIS ACCELERATED PAYMENT BENEFIT RIDER MAY
                 BE TAXABLE.  IF SO, THE OWNER OR BENEFICIARY MAY INCUR A TAX
                 OBLIGATION.  AS WITH ALL TAX MATTERS, THE OWNER SHOULD CONSULT
                 HIS PERSONAL TAX ADVISOR TO ASSESS THE IMPACT OF THIS BENEFIT.
                 BENEFITS OF THIS RIDER ARE NOT PAYABLE IF THE CERTIFICATE TO
                 WHICH IT IS ATTACHED IS NOT IN FORCE.

                 THIS IS NOT A LONG-TERM CARE BENEFIT.  BENEFITS PAID UNDER
                 THIS RIDER MAY NOT BE SUFFICIENT TO COVER ALL EXPENSES
                 ASSOCIATED WITH A LONG-TERM STAY IN A NURSING CARE OR
                 CUSTODIAL CARE FACILITY.




                         [30-DAY RIGHT TO EXAMINE RIDER

If the Owner is not satisfied with this rider for any reason, it may be
cancelled within 30 days after receipt.  The Company will return any premium
that has been paid.  In that case, the rider will be void as if it had never
been issued. ]





<PAGE>   66
DEFINITIONS

ACTIVITIES OF DAILY LIVING
    The term "Activities of Daily Living" means the following:
<TABLE>
    <S>  <C>                  <C>
    -    MOBILITY:            moving from one place to another.  It means:
                              a)  walking on a level surface, with or without
                                  equipment; or
                              b)  using a wheelchair most or all of the time to
                                  move on a level surface.
                                  
    -    DRESSING:            putting on and taking off all necessary items of
                              clothing. (Clothing includes braces and
                              artificial limbs, if they are usually worn.)
                              
    -    TOILETING:           cleansing self after elimination and adjusting
                              clothing before and after using the toilet.
                              
    -    TRANSFERRING:        moving into or out of a bed, chair, or other seat
                              (e.g., toilet), with or without equipment.
                              
    -    FEEDING:             getting food into the body, by any means, after
                              it has been prepared and made available to the
                              person.
</TABLE>

[COGNITIVE IMPAIRMENT
    An Insured will be considered to have a Cognitive Impairment if he:
    -    is disabled due to Alzheimer's disease or irreversible organic senile
         dementia, as diagnosed by a Physician; and
    -    needs continuous human supervision to function without causing danger
         to himself or others. ]

[CUSTODIAL CARE FACILITY
    The term "Custodial Care Facility" means an institution, or that distinct
    part of an institution, which meets the following requirements:
    -    it is operated under applicable licensing and any other legal
         requirements which apply to its operation; and
    -    it provides for compensation, room and board, and 24-hour Custodial
         Care Services; and
    -    it keeps daily medical records on all patients. ]

[CUSTODIAL CARE SERVICES
    The term "Custodial Care Services" means services which:
    -    provide assistance to an Insured with an Impairment in performing the
         Activities of Daily Living or provide supervision of an Insured with a
         Cognitive Impairment;
    -    are required to be performed by trained personnel; and
    -    are not primarily to treat an injury or a sickness. ]

[FUNCTIONAL IMPAIRMENT
    An Insured will be considered to have a Functional Impairment if he is
    unable to perform two or more Activities of Daily Living without human
    assistance. ]




                                       2
<PAGE>   67
DEFINITIONS (CONTINUED)

HOSPITAL
    The term "Hospital" means:
    -    an institution licensed as a Hospital which:  a) maintains, on its
         premises, all  facilities necessary for medical and surgical
         treatment; b) provides such treatment on an inpatient basis, for
         compensation, under the supervision of a staff of Physicians; and c)
         provides 24-hour service by Registered Graduate Nurses;
    -    an institution which qualifies as a Hospital, a psychiatric Hospital
         or a tuberculosis Hospital, and a provider of services under Medicare,
         if such institution is accredited as a Hospital by the Joint
         Commission on the Accreditation of Hospitals;
    -    an institution which: a) specializes in the treatment of mental
         illness, alcohol or  drug abuse or other related illness; b) provides
         residential treatment programs; and c) is licensed in accordance with
         the laws of the appropriate legally authorized agency;
    -    a free-standing surgical facility; or
    -    an institution which meets any one of the above requirements and is
         owned or operated by the U.S. Government.

[IMPAIRMENT
    The term "Impairment" means a Cognitive or Functional Impairment, as
    defined in this rider. ]

[NURSING CARE FACILITY
    The term "Nursing Care Facility" means an institution, or that distinct
    part of an institution, which meets the following requirements:
    -    it is operated under applicable licensing and any other laws which
         apply to its operation; and
    -    it provides, on an inpatient basis, skilled nursing care or
         intermediate nursing care for injury, sickness or physical
         rehabilitation; and
    -    it is under the full-time supervision of a Physician or a Registered
         Graduate Nurse; and
    -    it maintains a complete daily written record on the condition of, and
         the services actually received by each patient and that record is made
         available to us; and
    -    it provides inpatient nursing care of sick or injured persons who must
         be under the care of a Physician.

    The term "Nursing Care Facility" will not include an institution which is
    primarily a place for the blind, the deaf, the mentally ill or the mentally
    retarded, or a place for the treatment of alcohol or drug abuse. ]

PHYSICIAN
    The term "Physician" means a licensed medical practitioner who is
    practicing within the scope of his or her license and who is licensed to
    prescribe and administer drugs or to perform surgery.

[PRE-EXISTING CONDITION
    The term "Pre-existing Condition" means a disease or condition for which
    the Insured: (a) received medical treatment, care or advice; (b) took
    prescribed drugs or medicines; or (c) consulted a Physician during the 12
    months prior to the effective date of his coverage under the Policy. ]




                                       3
<PAGE>   68
DEFINITIONS (CONTINUED)

[SPECIFIED DISEASE
    The term "Specified Disease" means a person has been diagnosed by a
    Physician as having one of the following diseases or conditions:
    -    Life-Threatening Cancer;  "life-threatening cancer" means any
         malignant disease or neoplasm characterized by abnormal cells that
         grow and spread in an uncontrolled manner.  The term "life-threatening
         cancer" does not include pre-malignant lesions, carcinoma in situ,
         skin cancer other than malignant melanoma, carcinoid of the appendix,
         intraductal non-invasive carcinoma of the breast, stage 1 Hodgkin's
         disease and stage 1 transitional carcinoma of the urinary bladder or
         benign tumors but does include Leukemia and Hodgkin's Disease (other
         than stage 1).  The diagnosis of "cancer" or a malignant tumor must be
         based on criteria established by the American Board of Pathology and
         histopathologic or histocytologic study.

    -    Heart Attack;  "Heart Attack" means acute myocardial infarction caused
         by coronary thrombosis or coronary occlusion diagnosed by a Physician.
         Supporting evidence must include electrocardiographic studies (ECG)
         and appropriate blood and clinical findings.  If such studies are not
         available at the time of the attack, subsequent studies, when
         available, must confirm the episode by the demonstration of changes
         compatible with a heart attack and that were not known to be present
         prior to the episode in question.  The term "heart attack" does not
         include any other diseases or abnormality of the heart or
         cardiovascular system; or associated or intercurrent diseases or
         injuries that may be the cause or result of a heart attack; or any
         other diseases or injuries.

    -    Renal Failure;  "Renal Failure" means the end stage of chronic,
         irreversible failure of both kidneys to function, necessitating
         regular renal dialysis.

    -    Stroke;  "Stroke" means a condition of sudden onset resulting in
         permanent brain damage as a result of a subarachnoid hemorrhage,
         thrombosis, embolism or of a sudden occlusion or spontaneous rupture
         of a blood vessel in the head or neck, including apoplexy or cerebral
         vascular accident.  The term "stroke" does not include transient
         ischemic attacks (TIA), brief episodes of altered brain function due
         to inadequate blood flow to the brain from any cause nor other
         diseases or injuries involving the brain or that may be the cause or
         result of brain damage.

    -    Specified Organ Transplant;  "Specified Organ Transplant" means the
         replacement of a person's heart, liver or lungs with a corresponding
         organ from a human donor.

    -    Acquired Immune Deficiency Syndrome (AIDS).  "AIDS" means a person has
         tested positive for human immunodeficiency virus (HIV) infection and
         has been diagnosed as having a disease indicative of AIDS by a
         Physician using definitive diagnostic methods.  The term "AIDS" does
         include HIV encephalopathy (dementia) and HIV wasting syndrome. ]

[TERMINAL ILLNESS
    A Terminal Illness will be considered to exist if a person has a written
    diagnosis and prognosis by two unaffiliated Physicians that he has 12
    months or less to live. ]




                                       4
<PAGE>   69
[TERMINAL ILLNESS BENEFIT

BENEFIT
    The Company will pay a one-time Terminal Illness Benefit, up to [60%] of
    the Insured's Coverage Amount, when the Company receives verification that
    an Insured has a Terminal Illness. The Terminal Illness Benefit is based on
    the Insured's Coverage Amount under the Policy in effect on the Benefit
    Determination Date.  This benefit is payable in a lump sum.  [An Insured is
    not eligible for payment under this benefit if the Nursing Care and
    Custodial Care Facility Benefit or Specified Disease Benefit has been
    paid.]

BENEFIT DETERMINATION DATE
    The term "Benefit Determination Date" means the date the Company verifies
    that an Insured is terminally ill.  The Terminal Illness Benefit cannot be
    greater than [60%] of the Coverage Amount in effect on the Benefit
    Determination Date.

DETERMINATION OF TERMINAL ILLNESS
    For the purpose of determining the existence of a Terminal Illness, the
    Company will require that the Insured submit the following:
         -   a written diagnosis and prognosis by two unaffiliated Physicians
             licensed to practice in the United States, stating that the
             Insured has 12 months or less to live; and
         -   supportive evidence satisfactory to the Company, including, but
             not limited to, radiological, histological, and laboratory reports
             documenting the Terminal Illness.]




                                       5
<PAGE>   70
[NURSING CARE AND CUSTODIAL CARE FACILITY BENEFIT

BENEFIT
    The Company will pay a one-time Nursing Care and Custodial Care Facility
    Benefit, up to [60%] of the Insured's Coverage Amount.  The Nursing Care
    and Custodial Care Facility Benefit is based on the Insured's Coverage
    Amount in effect under the Policy on the date the Insured satisfies the
    Deductible Waiting Period.  This benefit is payable in a lump sum or in
    equal monthly installments for [30] months.  [An Insured is not eligible
    for payment under this benefit if the Terminal Illness Benefit or Specified
    Disease Benefit has been paid.]

    An Insured becomes eligible for the Nursing Care and Custodial Care
    Facility Benefit provided he:
         -   has an Impairment, as determined by the Company; and
         -   is confined in a Nursing Care or Custodial Care Facility
             (registered as a bed patient on a 24-hour basis), due to the
             Impairment; and
         -   provides the Company with written certification (from two
             unaffiliated Physicians licensed to practice in the United States)
             that the Insured is expected to remain in the Nursing Care or
             Custodial Care Facility for the rest of his life; and
         -   has satisfied the required Deductible Waiting Period.

DEDUCTIBLE WAITING PERIOD
    The Deductible Waiting Period is 90 consecutive days in an Insured's
    lifetime.  The Deductible Waiting Period begins on the date that the
    Company verifies that the Insured has an Impairment and was confined in a
    Nursing Care or Custodial Care Facility (registered as a bed patient on a
    24-hour basis).

    Once the Company verifies that the Insured has an Impairment, the Insured
    must continue to be confined due to the Impairment for each additional day
    needed to satisfy the Deductible Waiting Period.

    All days for which the Insured is confined in a Nursing Care or Custodial
    Care Facility within 90 days prior to the date the Company verifies he has
    an Impairment will be applied to the Deductible Waiting Period.

MONTHLY PAYMENT
    If the Owner elects a Monthly Payment, payment begins on the first day of
    the first month after the date the Insured becomes eligible for such
    payment.  Monthly Payment will end on the earliest of the following:
         -   the date the Owner has received [30] Monthly Payments; or
         -   the date coverage under this rider terminates; or
         -   the date the Insured dies.

    If the Insured dies after the initial payment is made, but before all
    installments are paid, the remaining payments will be paid in accordance
    with the Beneficiary Provisions applicable to the life insurance benefit.

LIMITATIONS
    No Nursing Care and Custodial Care Facility Benefit will be paid for any
    confinement in an institution located outside the United States.]




                                       6
<PAGE>   71
[NURSING CARE AND CUSTODIAL CARE FACILITY BENEFIT (CONTINUED)

EXCLUSIONS
    No benefits are payable under this rider if an Impairment is caused by, or
    a confinement is due to:
    -    alcoholism or drug abuse;
    -    mental illness, other than Cognitive Impairment;
    -    commission of a felony or engaging in an illegal act; or
    -    attempted suicide or intentionally self-inflicted injury, while sane
         or insane. ]




                                       7
<PAGE>   72
[SPECIFIED DISEASE BENEFIT

BENEFIT
    The Company will pay a one-time Specified Disease Benefit, up to [60%] of
    the Insured's Coverage Amount, when the Company receives verification that
    an Insured has a Specified Disease.  The Specified Disease Benefit is based
    on the Insured's Coverage Amount under the Policy in effect on the Benefit
    Determination Date.  This benefit is payable in a lump sum.  An Insured is
    not eligible for payment under this benefit if the Terminal Illness Benefit
    or Nursing Care and Custodial Care Facility Benefit has been paid.

BENEFIT DETERMINATION DATE
    The term "Benefit Determination Date" means the date the Company verifies
    that an Insured has a Specified Disease.  The Specified Disease Benefit
    cannot be greater than [60%] of the Coverage Amount in effect on the
    Benefit Determination Date.

LIMITATION
    The Company will not pay a Specified Disease Benefit for a Pre-existing
    Condition.  This limitation will not apply if:
         -   the Insured:  (a) receives no medical treatment, care or advice;
             (b)  does not take prescribed drugs or medicines; or (c) does not
             consult with a Physician for the disease or condition for 12
             months after the effective date of this insurance; or
         -   the Insured's coverage under the Policy has been effective for 24
             straight months.

DETERMINATION OF SPECIFIED DISEASE
    For the purposes of determining the existence of a Specified Disease, the
    Company will require that the Insured submit the following:
         -   a written diagnosis and prognosis by a Physician licensed to
             practice in the United States certifying the existence of a
             Specified Disease; and
         -   supportive evidence satisfactory to the Company, including but not
             limited to radiological, histological or laboratory reports
             documenting the Specified Disease. ]




                                       8
<PAGE>   73
PREMIUM PROVISIONS

PREMIUM
    The premium for this rider will be included in the Monthly Deduction and
    will be shown in the Certificate Coverage Verification Pages.

[WAIVER OF PREMIUM
    The Monthly Deduction for an Insured and his Insured Dependent Child(ren),
    if any, will be waived for any month for which Monthly Payments are
    payable.]

CHANGE IN PREMIUMS
    Any premiums for insurance under this rider may be changed by the Company
    from time to time with at least 31 days' advance written notice.  Any such
    change will be made on a class basis.

TERMINATION OF INSURANCE UNDER THIS RIDER

The insurance under this rider for [an Insured Employee, Insured Spouse, Former
Insured Employee, Former Insured Spouse, Retiree, or Leave of Absence Employee]
will cease on the earliest of the following dates:

    -    the date the Insured's coverage ends under the Certificate; or
    -    the last day for which the Insured has paid the required premium for
         this rider, subject to the Grace Period for Insured; or
    -    the date [the Terminal Illness Benefit or Specified Disease Benefit]
         becomes payable to an Insured who applied for such benefit[; or
    -    the date that the Lump Sum Payment for the Nursing Care and Custodial
         Care Facility Benefit becomes payable to an Insured who applied for
         such benefit; or]
[   -    the date that the Monthly Payments for the Nursing Care and Custodial
         Care Facility Benefit end for an Insured on whose behalf such benefits
         were paid.]




                                       9
<PAGE>   74
GENERAL PROVISIONS

NOTICE OF CLAIM
    Written notice of a claim must be given to the Company within 60 days
    after[: 1) the start of the confinement in a Nursing Care or Custodial Care
    Facility; or 2) a diagnosis and prognosis of a Terminal Illness or
    Specified Disease has been made.]  If the notice is not given in that time,
    the claim will not be invalidated or reduced if it is shown that written
    notice was given as soon as was reasonably possible.

CLAIM FORMS
    When the Company receives written notice of a claim, the Company will send
    forms for filing proof of loss.  If the claimant does not get these claim
    forms within 15 days after the Company receives the notice of claim, the
    proof of loss requirements will be met by submitting, within 90 days,
    written proof of the nature and extent of the loss.

PROOF OF LOSS
    Written proof of loss must be given to the Company within 90 days after the
    date of loss.  Failure to furnish proof within 90 days shall not invalidate
    or reduce any claim if it was not reasonably possible to furnish such proof
    within such time.  Such proof must be furnished as soon as reasonably
    possible, but in no event, except in the absence of legal capacity, later
    than one year from the time proof is required.

PAYMENT OF CLAIM
    All benefits under this rider will be paid to the Owner.  If the Insured
    dies prior to the payment of an eligible claim for an Accelerated Benefit,
    the life insurance benefit shall be paid in accordance with the Beneficiary
    Provisions applicable to the life insurance benefit.  Any payment made by
    the Company prior to being advised of the Insured's death shall discharge
    the Company of any obligation to the extent the benefit was paid.

LEGAL ACTION
    No one may sue for payment of claim: a) less than 60 days after due proof
    of loss is furnished; or b) more than three years after the date proof of
    loss is required by the Policy.

RECOVERY OF OVERPAYMENT
    If an overpayment has been made by the Company, the Company has the right,
    at any time, to recover that overpayment from the person to whom or on
    whose behalf it was made.

EXAMINATION
    The Company may require, at its expense, an examination of the Insured and
    a review of the documented evidence by a Physician of its choice.


                   CONNECTICUT GENERAL LIFE INSURANCE COMPANY



 /s/ DAVID C. KOPP                                           /s/ THOMAS C. JONES
 -----------------                                           -------------------
Corporate Secretary                                               PRESIDENT



                                      10
<PAGE>   75
SEAT BELT BENEFIT RIDER

This rider is made a part of the Policy/Certificate to which it is attached.
This rider takes effect on the Policy Effective Date unless a later date is
shown in the Certificate Coverage Verification Pages.

BENEFIT
    The Company will pay a Seat Belt Benefit if an [Insured Employee] dies as a
    result of an accident which occurs:

         -   while covered under the Policy; and
         -   while driving or riding as a passenger in a Private Passenger Car,
             and

             (a)    the car is equipped with seat belts;
             (b)    the seat belt was in actual use and properly fastened at
                    the time of the accident; and
             (c)    the use and position of the seat belt is certified in the
                    official report of the accident.  However, if an official
                    report is not available and it is unclear if the Insured
                    was properly wearing a seat belt, the Company will pay the
                    Limited Seat Belt Benefit.  If such report indicates that a
                    seat belt was not in use, the Company will not pay the Seat
                    Belt Benefit.

    "Private Passenger Car" means a validly registered four-wheel vehicle which
    includes station wagons, jeeps, pick-up trucks, and van-type cars.

    The Seat Belt Benefit will not be paid for an accident which occurs while
    the Insured is participating in a race, speed or endurance test.

    The Seat Belt Benefit is payable to the Insured Employee's designated
    Beneficiary, or if there is none, to the Owner or Owner's estate.  The
    benefit will be equal to the lesser of:

         -   [10%] of the Insured's Coverage Amount, but no less than [$1,000];
             or
         -   [$10,000].

    The Limited Seat Belt Benefit is [$1,000].


                   CONNECTICUT GENERAL LIFE INSURANCE COMPANY



 /s/ DAVID C. KOPP                                           /s/ THOMAS C. JONES
 -----------------                                           -------------------
Corporate Secretary                                               PRESIDENT




<PAGE>   76
                                   Mailing Address:  Hartford, Connecticut 06152
                                        Home Office:  Bloomfield, Connecticut

                   CONNECTICUT GENERAL LIFE INSURANCE COMPANY


                                AMENDATORY RIDER


This rider amends the Policy/Certificate to which it is attached by adding the
following provision:

FIXED BENEFIT EXCHANGE PROVISION
    At any time during the eighteen month period beginning on the Certificate
    Effective Date, the Owner may, without being required to provide evidence
    of good health, exchange his Certificate of Insurance coverage under the
    Policy for a Certificate of Insurance coverage under a group flexible
    premium life insurance policy issued by the Company (the "Exchange
    Policy").  Such coverage under the Exchange Policy will bear the same date
    of issue and the same age at issue as the Certificate under this Policy
    which is exchanged by the Owner.  Premium rates for the Owner under the
    Exchanged Policy will be the premium rates in effect under the Exchange
    Policy on the date of exchange for the class into which the Insured falls
    under the Exchange Policy.  To the extent riders and incidental insurance
    benefits included under the Policy are available under the Exchange Policy,
    the Owner may elect such riders and incidental insurance benefits for his
    Certificate of Insurance coverage under the Exchange Policy.

    Any excess of the accrued premium under the Certificate under this Policy
    over the corresponding accrued premium on the Exchange Policy will be
    either applied as an advance premium or refunded in cash, or added to the
    Cash Value under the Exchange Policy as the Company determines.  Any
    increase or decrease in Cash Value will be reflected in the Cash Value
    under the Exchange Policy.

This rider takes effect on the Policy Effective Date unless a later date is
shown in the Coverage Verification Pages.



                   CONNECTICUT GENERAL LIFE INSURANCE COMPANY


 /s/ DAVID C. KOPP                                           /s/ THOMAS C. JONES
 -----------------                                           -------------------
Corporate Secretary                                               PRESIDENT






<PAGE>   1


                  CONNECTICUT GENERAL LIFE INSURANCE COMPANY
                             HARTFORD, CONNECTICUT
                         (HEREIN CALLED "THE COMPANY ")

          APPLICATION FOR [GROUP VARIABLE UNIVERSAL LIFE INSURANCE]

APPLICATION is hereby made to the Company for group Policy No.XXXXX by [ABC
Company].

This Application is attached to and made a part of the group Policy.

Said group Policy is hereby approved and the terms thereof are hereby accepted
by the Policyholder.

The group Policy will be effective on [XX/XX/XX, provided the minimum
participation requirement is met].

This Application is executed in duplicate; one counterpart being attached to
said group Policy and the other being returned to the Company.

It is agreed that this Application supersedes any previous application for said
group Policy.

                                 [ABC COMPANY]

Signed at [           XYZ State           ]  by
           -------------------------------     --------------------------
                                             (Signature and Title)
On [                      ]                  Witness [                         ]
    ----------------------                            -------------------------
                                             (Licensed Resident Agent where 
                                             required by law)
- --------------------------------------------------------------------------------
                  THIS COPY TO REMAIN ATTACHED TO THE POLICY
XX40046(Rev)
******************************************************************************
                   CONNECTICUT GENERAL LIFE INSURANCE COMPANY
                             HARTFORD, CONNECTICUT
                         (HEREIN CALLED "THE COMPANY ")

           APPLICATION FOR GROUP VARIABLE UNIVERSAL LIFE INSURANCE

APPLICATION is hereby made to the Company for group Policy No.XXXXX by [ABC
Company].

This Application is attached to and made a part of the group Policy.

Said group Policy is hereby approved and the terms thereof are hereby accepted
by the Policyholder.

The group Policy will be effective on [XX/XX/XX, provided the minimum
participation requirement is met].

This Application is executed in duplicate; one counterpart being attached to
said group Policy and the other being returned to the Company.

It is agreed that this Application supersedes any previous application for said
group Policy.

                                 [ABC COMPANY]

Signed at [           XYZ State           ]   by
           -------------------------------      --------------------------------
                                              (Signature and Title)
On [                      ]                   Witness [                        ]
    ----------------------                             ------------------------
                                              (Licensed Resident Agent where 
                                              required by law)
- --------------------------------------------------------------------------------
                   THIS COPY TO BE RETURNED TO THE COMPANY
XX40046(Rev)


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