Common use of Settlement Option Tables Clause in Contracts

Settlement Option Tables. 30 Additional benefits or riders, if any, will be listed in the Schedule. The additional provisions will be inserted in the Policy. SCHEDULE (Effective Date: July 2, 1997) POLICY INFORMATION Policy Number 1000540-001 Stated Death Benefit $100,000.00 Insured XXXX XXX Minimum Stated Death Benefit $ 50,000.00 Owner XXXX XXX Three Year Continuation Period May 1,1998 Ending Date Death Benefit Option Stated Death Benefit Option 1 Three Year Continuation Period Age And Sex 35, Male Minimum Annual Premium $631.62 Premium Class Standard, Non-Smoker Policy Date May 1, 1997 Scheduled Premium $3,000.00 Maturity Date May 15, 2060 Definition of Life Insurance Test: Guideline Premium CUSTOMER SERVICE CENTER: P.O. Box 173763, Denver, Colorado 80217-3763 Coverage may expire prior to the Maturity Date if Scheduled Premiums are paid in a timely manner, coverage may expire prior to the Maturity Date if said premiums are insufficient to continue coverage and the Three Year Continuation has ended. Coverage will also be affected by Partial Withdrawals, Policy Loans, changes in the current cost of insurance rates, the actual credited interest rate for the Guaranteed Interest Division and the investment experience of the Variable Account. FORM 1197 (VUL) - MD PAGE 5 SCHEDULE (CONTINUED) BENEFIT PROFILE ------------------------------------------------------------------------------------------------------------------------------------ Initial Segment Guideline Benefit Issue Age At Effective Annual Target Description Amount Age Maturity Date Date Premium Premium ------------------------------------------------------------------------------------------------------------------------------------ Stated Death Benefit (Segment #1) $100,000.00 35 100 May 1, 1995 $1,288.02 $800.00 ------------------------------------------------------------------------------------------------------------------------------------ Adjustable Term Insurance Rider (Segment #1) $50,000.00 35 100 May 1, 1995 $615,62 $0.00 ------------------------------------------------------------------------------------------------------------------------------------ A coverage segment is a block of Death Benefit coverage. The Stated Death Benefit shown on the schedule page at issue is the initial coverage segment. Additional segments are added to the policy after issue to increase the Death Benefit. Each individual coverage segment added to the policy has its own cost of insurance charges and expense loads as shown in the Schedule. FORM 1197 (VUL) - MD PAGE 5A SCHEDULE (CONTINUED) ALLOCATION OF INITIAL PREMIUM AS SHOWN ON APPLICATION [Xxxxxxxxx & Xxxxxx Limited Maturity Bond] 0 % [Xxxxxxxxx & Xxxxxx Growth ] 0 % [Xxxxxxxxx & Xxxxxx Government Income ] 25 % [Xxxxxxxxx & Xxxxxx Partners] 25 % [Xxxxx American Growth Division] 0 % [Xxxxx American Leveraged AllCap Division] 25 % [Xxxxx American MidCap Growth ] 0 % [Xxxxx American Small Capital] 0 % [Fidelity Asset Manager ] 0 % [Fidelity Growth ] 25 % [Fidelity Overseas ] 0 % [Fidelity Money Market ] 0 % [Fidelity Index 500 ] 0 % [INVESCO Total Return ] 0 % [INVESCO Industrial Income ] 0 % [INVESCO High Yield ] 0 % [INVESCO Utilities ] 0 % [Xxx Xxx Worldwide Balanced ] 0 % [Xxx Xxx Gold and Natural Resources ] 0 % Guaranteed Interest Division 0 % If you elect to invest in a particular Division, at least 1% of your Net Premium must be allocated to that Division provided that the allocation to each Division selected is at least $100. All percentage allocations must be in whole numbers. SCHEDULE (CONTINUED) EXPENSE CHARGES PREMIUM EXPENSE CHARGES (As a Percent of all Premiums): Sales Load: Segment Issue Age Sales Load 0-49 2.25% 50-59 3.25% 60+ 4.25% State And Local Taxes: 2.5% Federal Deferred Acquisition Cost Charge: 1.5% MONTHLY EXPENSE CHARGES: $13.00 per Policy month for the first 36 months $3.00 per Policy month thereafter; plus $0.0125 per thousand of Stated Death Benefit (or Target Death Benefit, if greater), all years. The per thousand charge is limited to $15.00 per Policy month. ANNUAL MORTALITY AND EXPENSE RISK CHARGE (Based on the percentage of assets in each Variable Account Division) Mortality And Expense Risk Charge: 0.75% FORM 1197 (VUL) - MD PAGE 5C SCHEDULE (CONTINUED) SURRENDER CHARGES The maximum Surrender Charges which pertain to the insurance coverages shown in the Schedule are shown in the following table. The total Surrender Charge equals the sum of the Administration Charges and Sales Surrender Charges as described in the Surrender Charges provision. The total Surrender Charge would not exceed the total Maximum Surrender Charge as outlined below. ---------------------------------------- SURRENDERS DURING THE POLICY YEAR TOTAL MAXIMUM ENDING SURRENDER CHARGE ---------------------------------------- 1996 $650.00 ---------------------------------------- 1997 $650.00 ---------------------------------------- 1998 $650.00 ---------------------------------------- 1999 $650.00 ---------------------------------------- 2000 $650.00 ---------------------------------------- 2001 $650.00 ---------------------------------------- 2002 $650.00 ---------------------------------------- 2003 $568.75 ---------------------------------------- 2004 $487.50 ---------------------------------------- 2005 $406.25 ---------------------------------------- 2006 $325.00 ---------------------------------------- 2007 $243.75 ---------------------------------------- 2008 $162.50 ---------------------------------------- 2009 $81.25 ---------------------------------------- 2010 0 ---------------------------------------- SALES SURRENDER CHARGE TABLE -------------------------------------------------------- PERCENTAGE OF - PREMIUMS PAID IN PERCENTAGE OF PERCENTAGE OF EXCESS OF THE PREMIUMS PAID PREMIUMS PAID TARGET PREMIUM IN EXCESS OF 6 UP TO THE AND UP TO 6 TIMES TIMES THE TARGET THE TARGET TARGET PREMIUM PREMIUM PREMIUM -------------------------------------------------------- 25% 5% 0% -------------------------------------------------------- ADMINISTRATION SURRENDER CHARGE TABLE -------------------------------------------------------------- ADMINISTRATIVE SURRENDER SEGMENT CHARGE PER THOUSAND OF ISSUE AGE STATED DEATH BENEFIT -------------------------------------------------------------- 0-39 $2.50 -------------------------------------------------------------- 40-49 $3.50 -------------------------------------------------------------- 50-59 $4.50 -------------------------------------------------------------- 60-69 $5.50 -------------------------------------------------------------- 70 and above $6.50 -------------------------------------------------------------- The Surrender Charge consists of the Sales Surrender Charge and the Administrative Surrender Charge as determined from the above tables for the first 7 Policy years of each segment. Thereafter, the Surrender Charge for the segment decreases at the beginning of each year from the Effective Date of the segment by 12.5% of the Surrender Charge in effect at the end of the 7th Policy year until it reaches zero at the beginning of the 15th Policy year following the segment's Effective Date or the Policy year the Insured reaches age 98, whichever is sooner. FORM 1197 (VUL) - MD PAGE 5D SCHEDULE (CONTINUED) POLICYHOLDER TRANSACTION CHARGES Requests for Illustrations of Benefits and Values: $25 Premium Allocation Changes: $25 for each change over 5 per Policy year Excess Transfer Charge: See the Transfer Provisions section Partial Withdrawal Service Fee: See below POLICY LOANS Policy Loan Interest Rate: 3.75% per year Guaranteed Interest Rate Credited to Loan Division: 3.00% per year Minimum Loan Amount: $100 Maximum Loan Amount: Refer to the Loan Provisions Section PARTIAL WITHDRAWALS Minimum Partial Withdrawal Amount: $100 Maximum Partial Withdrawal Amount: Amount which will leave $500 as the net Cash Value Partial Withdrawal Service Fee: The lesser of $25 or 2% of the amount withdrawn Limit on Partial Withdrawals: One per Policy year GUARANTEED INTEREST DIVISION Guaranteed Interest Rate For Guaranteed Interest Division: 3.00% per year FORM 1197 (VUL) - MD PAGE 5E SCHEDULE (CONTINUED) DEFINITION OF LIFE INSURANCE

Settlement Option Tables. 30 29 Additional benefits or riders, if any, will be listed in the Schedule. The additional provisions will be inserted in the Policy. SCHEDULE (Effective Date: July 2January 1, 19971996) POLICY INFORMATION Policy Number 1000540-001 61000001 Minimum Stated Death Benefit $100,000.00 50,000.00 Insured Mr XXXX XXX Minimum Stated Death Benefit $ 50,000.00 Owner XXXX XXX Three Year Continuation Period May 1,1998 Ending Date Death Benefit Option Stated Death Benefit Option 1 Three Year Continuation Period OPTION 1: GP/CVC LEVEL DB Age And Sex 35, Male Three Year Continuation Period January 1, 1999 Ending Date Premium Class High Band Non-Smoker Three Year Continuation Period $529.00 Minimum Annual Premium $631.62 Premium Class Standard, Non-Smoker Policy Date May January 1, 1997 Scheduled 1996 Planned Premium $3,000.00 1,600.00, Annually Maturity Date May 15January 1, 2060 2061 Definition of Life Insurance Test: Guideline Premium CUSTOMER SERVICE CENTER: [P.O. Box BOX 173763, Denver, Colorado 80217-3763 3763] Coverage may will expire prior to the Maturity Date if Scheduled Premiums are paid in a timely manner, coverage may expire prior to the Maturity Date if said premiums are insufficient to continue coverage and the Three Year Continuation Period has ended. Coverage will also be affected by Partial Withdrawals, Policy Loans, changes in the current cost of insurance rates, the actual credited interest rate for the Guaranteed Interest Division and the investment experience of the Variable Account. FORM Form 1197 (VUL) - MD PAGE MA - 5/97 Page 5 SCHEDULE (CONTINUEDContinued) BENEFIT PROFILE ------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------- Initial Segment Age At Guideline Benefit Issue Age At Maturity Effective Annual Target Description Amount Age Maturity Date Date Premium Premium ------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------- Stated Death Benefit (Segment #1) $100,000.00 35 100 May January 1, 1995 1996 $1,288.02 1,400.80 $800.00 ------------------------------------------------------------------------------------------------------------------------------------ Adjustable Term Insurance Rider (Segment #1) $50,000.00 35 100 May 1, 1995 $615,62 $0.00 ------------------------------------------------------------------------------------------------------------------------------------ A coverage segment is a block of Death Benefit coverage. The Stated Death Benefit shown on the schedule page at issue is the initial coverage segment. Additional segments are added to the policy after issue to increase the Death Benefit. Each individual coverage segment added to the policy has its own cost of insurance charges and expense loads as shown in the Schedule. FORM 941.00 --------------------------------------------------------------------------------------------------------------------- Form 1197 (VUL) - MD PAGE 5/97 Page 5A SCHEDULE (CONTINUED) ALLOCATION OF INITIAL PREMIUM AS SHOWN ON APPLICATION [Xxxxxxxxx & Xxxxxx Limited Maturity BondBond ] 0 50% [Xxxxxxxxx & Xxxxxx Growth ] 0 50% [Xxxxxxxxx & Xxxxxx Government Income ] 25 0% [Xxxxxxxxx & Xxxxxx PartnersPartners ] 25 0% [Xxxxx American Growth Division] 0 0% [Xxxxx American Leveraged AllCap DivisionAll Cap ] 25 0% [Xxxxx American Small Capital ] 0% [Xxxxx American MidCap Growth ] 0 % [Xxxxx American Small Capital] 0 0% [Fidelity Asset Manager ] 0 0% [Fidelity Growth ] 25 0% [Fidelity Overseas ] 0 0% [Fidelity Money Market ] 0 0% [Fidelity Index 500 ] 0 0% [INVESCO Total Return ] 0 0% [INVESCO Industrial Income ] 0 0% [INVESCO High Yield ] 0 0% [INVESCO Utilities ] 0 0% [Xxx Xxx Worldwide Balanced ] 0 0% [Xxx Xxx Gold and Natural Resources ] 0 0% Guaranteed Interest Division 0 ] 0% If you elect to invest in a particular Division, at least 1% of your Net Premium must be allocated to that Division provided that the allocation to each Division selected is at least $100. All percentage allocations must be in whole numbers. SCHEDULE (CONTINUEDContinued) EXPENSE CHARGES PREMIUM EXPENSE CHARGES (As a Percent of all Premiums): Sales Load: Segment Issue Age Sales Load 0-0 - 49 2.25% 50-50 - 59 3.25% 60+ 4.25% State And Local Taxes: [2.5% %] Federal Deferred Acquisition Cost Charge: [1.5% %] We reserve the right to increase or decrease the Premium Expense Charges for taxes due to any change in tax law. We further reserve the right to increase or decrease the Premium Expense Charges for Federal deferred acquisition costs due to any change in the cost to us. MONTHLY EXPENSE CHARGES: $13.00 per Policy month for the first 36 months $3.00 per Policy month thereafter; plus $0.0125 per thousand of Stated Death Benefit (or Target Death Benefit, if greater), all years. The per thousand charge is limited to $15.00 per Policy month. ANNUAL MORTALITY AND EXPENSE RISK CHARGE (Based on the percentage of assets in each Variable Account Division) Mortality And Expense Risk Charge: Charge 0.75% FORM 1197 (VUL) - MD PAGE 5C SCHEDULE (CONTINUED) SURRENDER CHARGES The maximum Surrender Charges which pertain to the insurance coverages shown in the Schedule are shown in the following table. The total Surrender Charge equals the sum of the Administration Charges and Sales Surrender Charges as described This table may change upon any increases and/or decreases in the Surrender Charges provisionPolicy's Stated Death Benefit. The total Surrender Charge would not exceed the total Maximum Surrender Charge as outlined below. ---------------------------------------- -------------------------------------------- SURRENDERS DURING THE POLICY YEAR TOTAL MAXIMUM ENDING SURRENDER CHARGE ---------------------------------------- 1996 $650.00 ---------------------------------------- -------------------------------------------- -------------------------------------------- 1997 $650.00 ---------------------------------------- 720.50 -------------------------------------------- 1998 $650.00 ---------------------------------------- 720.50 -------------------------------------------- 1999 $650.00 ---------------------------------------- 720.50 -------------------------------------------- 2000 $650.00 ---------------------------------------- 720.50 -------------------------------------------- 2001 $650.00 ---------------------------------------- 720.50 -------------------------------------------- 2002 $650.00 ---------------------------------------- 720.50 -------------------------------------------- 2003 $568.75 ---------------------------------------- 720.50 -------------------------------------------- 2004 $487.50 ---------------------------------------- 630.44 -------------------------------------------- 2005 $406.25 ---------------------------------------- 540.38 -------------------------------------------- 2006 $325.00 ---------------------------------------- 450.31 -------------------------------------------- 2007 $243.75 ---------------------------------------- 360.25 -------------------------------------------- 2008 $162.50 ---------------------------------------- 270.19 -------------------------------------------- 2009 $81.25 ---------------------------------------- 180.13 -------------------------------------------- 2010 $90.06 -------------------------------------------- 2011 0 ---------------------------------------- SALES SURRENDER CHARGE TABLE -------------------------------------------------------- PERCENTAGE OF - PREMIUMS PAID IN PERCENTAGE OF PERCENTAGE OF EXCESS OF THE PREMIUMS PAID PREMIUMS PAID TARGET PREMIUM IN EXCESS OF 6 UP TO THE AND UP TO 6 TIMES TIMES THE TARGET THE TARGET TARGET PREMIUM PREMIUM PREMIUM -------------------------------------------------------- 25% 5% 0% -------------------------------------------------------- ADMINISTRATION -------------------------------------------- ADMINISTRATIVE SURRENDER CHARGE TABLE -------------------------------------------------------------- ADMINISTRATIVE SURRENDER SEGMENT CHARGE PER THOUSAND OF ISSUE AGE STATED DEATH BENEFIT -------------------------------------------------------------- 0--------------------------------------------------------------- 0 - 39 $2.50 -------------------------------------------------------------- 40-40 - 49 $3.50 -------------------------------------------------------------- 50-50 - 59 $4.50 -------------------------------------------------------------- 60-60 - 69 $5.50 -------------------------------------------------------------- 70 and above $6.50 -------------------------------------------------------------- The Surrender Charge consists of the Sales Surrender Charge and the Administrative Surrender Charge as determined from the above tables for the first This charge is reduced by 12.5% per year starting 7 Policy years of each after the segment. Thereafter, the Surrender Charge for the segment decreases at the beginning of each year from the 's Effective Date of the segment by 12.5% of the Surrender Charge in effect at the end of the 7th Policy year until it reaches zero at the beginning of the 15th Policy year following the that segment's Effective Date or the Policy year in which the Insured reaches age 98, whichever is soonerearlier. FORM Form 1197 (VUL) - MD PAGE 5/97 Page 5D SCHEDULE (CONTINUED) POLICYHOLDER TRANSACTION CHARGES Requests Request for Illustrations of Benefits and ValuesSales Illustrations: $25 Premium Allocation Changes: $25 for each change over 5 per Policy year Excess Transfer Charge: See the Transfer Provisions section Partial Withdrawal Service Fee: See below POLICY LOANS Policy Loan Interest Rate: 3.75% per year Guaranteed Interest Rate Credited to To Loan Division: 3.00% per year Minimum Loan Amount: $100 Maximum Loan Amount: Refer to See the Loan Provisions Section section. PARTIAL WITHDRAWALS Minimum Partial Withdrawal Amount: $100 Maximum Partial Withdrawal Amount: Amount which will leave $500 as the net Cash Surrender Value Partial Withdrawal Service Fee: The lesser of $25 or 2% of the amount withdrawn Limit on On Partial Withdrawals: One per Policy year GUARANTEED INTEREST DIVISION Guaranteed Interest Rate For Guaranteed Interest Division: 3.00% per year FORM 1197 (VUL) - MD 5/97 PAGE 5E SCHEDULE (CONTINUED) DEFINITION OF LIFE INSURANCEINSURANCE DEATH BENEFIT FACTORS

Settlement Option Tables. 30 29 Additional benefits or riders, if any, will be listed in the Schedule. The additional provisions will be inserted in the Policy. SCHEDULE (Effective Date: July 2May 1, 19971995) POLICY INFORMATION Policy Number 1000540-001 Minimum Stated Death Benefit $100,000.00 50,000.00 Insured XXXX XXX Minimum Stated Death Benefit $ 50,000.00 Owner XXXX XXX Three Year Continuation Period May 1,1998 Ending Date Xxxx Xxx Death Benefit Option Stated Death Benefit Option 1 Three Year Continuation Period Ending Date May 15, 2060 Three Year Continuation Period Age And Sex 35, Male Minimum Annual Premium $631.62 795.00 Premium Class Standard, Standard Non-Smoker Policy Date May 1, 1997 1995 Scheduled Premium $3,000.00 4,500.00 Maturity Date May 15, 2060 Definition of Life Insurance Test: Test Guideline Premium CUSTOMER SERVICE CENTER: P.O. Box 173763, Denver, Colorado 80217-3763 Coverage may will expire prior to the Maturity Date if Scheduled Premiums are paid in a timely manner, coverage may expire prior to the Maturity Date if said premiums are Account Value is insufficient to continue coverage and the Three Three-Year Continuation Period has ended. Coverage will also be affected by Partial Withdrawals, Policy Loans, changes in the current cost of insurance rates, the actual credited interest rate for the Guaranteed Interest Division and the investment experience of the Variable Account. FORM 1197 Form 1195 (VUL) - MD PAGE TX Page 5 SCHEDULE (CONTINUED) BENEFIT PROFILE ------------------------------------------------------------------------------------------------------------------------------------ Initial Segment Age At Guideline Benefit Issue Age At Maturity Effective Annual Target Description Amount Age Maturity Date Date Premium Premium ------------------------------------------------------------------------------------------------------------------------------------ Stated Death Benefit (Segment #1) $100,000.00 35 100 May 1, 1995 $1,288.02 1,335.37 $800.00 3,680.00 ------------------------------------------------------------------------------------------------------------------------------------ Adjustable Term Insurance Rider (Segment #1) $50,000.00 35 100 May 1, 1995 $615,62 620.58 $0.00 ------------------------------------------------------------------------------------------------------------------------------------ A coverage segment is a block of Death Benefit coverage. The Stated Death Benefit shown on the schedule page at issue is the initial coverage segment. Additional segments are added to the policy after issue to increase the Death Benefit. Each individual coverage segment added to the policy has its own cost of insurance charges and expense loads as shown in the Schedule. FORM 1197 Form 1195 (VUL) - MD PAGE Page 5A SCHEDULE (CONTINUED) ALLOCATION OF INITIAL PREMIUM AS SHOWN ON APPLICATION [Xxxxxxxxx & Xxxxxx Limited Maturity Bond] 0 0% [Xxxxxxxxx & Xxxxxx Growth Growth] 0 0% [Xxxxxxxxx & Xxxxxx Government Income Income] 25 25% [Xxxxxxxxx & Xxxxxx Partners] 25 25% [Xxxxx American Growth DivisionGrowth] 0 0% [Xxxxx American Leveraged AllCap DivisionAll Cap] 25 % [Xxxxx American MidCap Growth ] 0 25% [Xxxxx American Small Capital] 0 0% [Xxxxx American MidCap Growth] 0% [Fidelity Asset Manager Manager] 0 0% [Fidelity Growth Growth] 25 25% [Fidelity Overseas Overseas] 0 0% [Fidelity Money Market Market] 0 0% [Fidelity Index 500 500] 0 0% [INVESCO Total Return Return] 0 0% [INVESCO Industrial Income Income] 0 0% [INVESCO High Yield Yield] 0 0% [INVESCO Utilities Utilities] 0 0% [Xxx Xxx Worldwide Balanced Balanced] 0 0% [Xxx Xxx Gold and Natural Resources Resources] 0 0% Guaranteed Interest Division 0 0% If you elect to invest in a particular Division, at least 1% of your Net Premium must be allocated to that Division provided that the minimum allocation to each Division selected is at least $100. All percentage allocations must be in whole numbers. SCHEDULE (CONTINUED) EXPENSE CHARGES PREMIUM EXPENSE CHARGES (As a Percent of all Premiums): Sales Load: Segment Issue Age Sales Load 0PREMIUM PAID PREMIUMS IN UP TO TARGET EXCESS OF TARGET YEARS 1-49 2.255 8% 50-59 3.253% 60YEARS 6+ 4.253% State And Local Taxes3% STATE AND LOCAL TAXES: 2.5% Federal Deferred Acquisition Cost ChargeFEDERAL DEFERRED ACQUISITION COST CHARGE: 1.5% We reserve the right to increase or decrease the Premium Expense Charges for taxes due to any change in tax law. We further reserve the right to increase or decrease the Premium Expense Charges for Federal deferred acquisition costs due to any change in the cost to us. MONTHLY EXPENSE CHARGES: $13.00 15.00 per Policy month for the first 36 60 months $3.00 $ 5.00 per Policy month thereafter; plus $0.0125 .0125 per thousand of Stated Death Benefit (or Target Death Benefit, if greater), all years. The per thousand charge is limited to $15.00 per Policy month. ANNUAL MORTALITY AND EXPENSE RISK CHARGE (Based on the percentage of assets in each Variable Account Division) Mortality And Expense Risk Charge: 0.75% FORM 1197 (VUL) - MD PAGE 5C SCHEDULE (CONTINUED) SURRENDER CHARGES The maximum Surrender Charges which pertain to the insurance coverages shown in the Schedule are shown in the following table. The total Surrender Charge equals the sum of the Administration Charges and Sales Surrender Charges as described in the Surrender Charges provision. The total Surrender Charge would not exceed the total Maximum Surrender Charge as outlined below. ---------------------------------------- SURRENDERS DURING THE POLICY YEAR TOTAL MAXIMUM ENDING SURRENDER CHARGE ---------------------------------------- 1996 $650.00 ---------------------------------------- 1997 $650.00 ---------------------------------------- 1998 $650.00 ---------------------------------------- 1999 $650.00 ---------------------------------------- 2000 $650.00 ---------------------------------------- 2001 $650.00 ---------------------------------------- 2002 $650.00 ---------------------------------------- 2003 $568.75 ---------------------------------------- 2004 $487.50 ---------------------------------------- 2005 $406.25 ---------------------------------------- 2006 $325.00 ---------------------------------------- 2007 $243.75 ---------------------------------------- 2008 $162.50 ---------------------------------------- 2009 $81.25 ---------------------------------------- 2010 0 ---------------------------------------- SALES SURRENDER CHARGE TABLE -------------------------------------------------------- PERCENTAGE OF - PREMIUMS PAID IN PERCENTAGE OF PERCENTAGE OF EXCESS OF THE PREMIUMS PAID PREMIUMS PAID TARGET PREMIUM IN EXCESS OF 6 UP TO THE AND UP TO 6 TIMES TIMES THE TARGET THE TARGET TARGET PREMIUM PREMIUM PREMIUM -------------------------------------------------------- 25% 5% 0% -------------------------------------------------------- ADMINISTRATION SURRENDER CHARGE TABLE -------------------------------------------------------------- ADMINISTRATIVE SURRENDER SEGMENT CHARGE PER THOUSAND OF ISSUE AGE STATED DEATH BENEFIT -------------------------------------------------------------- 0-39 $2.50 -------------------------------------------------------------- 40-49 $3.50 -------------------------------------------------------------- 50-59 $4.50 -------------------------------------------------------------- 60-69 $5.50 -------------------------------------------------------------- 70 and above $6.50 -------------------------------------------------------------- The Surrender Charge consists of the Sales Surrender Charge and the Administrative Surrender Charge as determined from the above tables for the first 7 Policy years of each segment. Thereafter, the Surrender Charge for the segment decreases at the beginning of each year from the Effective Date of the segment by 12.5% of the Surrender Charge in effect at the end of the 7th Policy year until it reaches zero at the beginning of the 15th Policy year following the segment's Effective Date or the Policy year the Insured reaches age 98, whichever is sooner. FORM 1197 (VUL) - MD PAGE 5D SCHEDULE SCHEDULED (CONTINUED) POLICYHOLDER TRANSACTION CHARGES Requests for Illustrations of Benefits and ValuesSales Illustrations: $25 Premium Allocation Changes: $25 for each change over 5 per Policy year Excess Transfer Charge: See the Transfer Provisions section Partial Withdrawal Service Fee: See below POLICY LOANS Policy Loan Interest Rate: 3.75% per year Guaranteed Interest Rate Credited to Loan Division: 3.00% per year Minimum Loan Amount: $100 Maximum Loan Amount: Refer to the Loan Provisions Section PARTIAL WITHDRAWALS Minimum Partial Withdrawal Amount: $100 Maximum Partial Withdrawal Amount: Amount which will leave $500 as the net Cash Value Partial Withdrawal Service Fee: The lesser of $25 or 2% of the amount withdrawn Limit on Partial Withdrawals: One per Policy year GUARANTEED INTEREST DIVISION Guaranteed Interest Rate For Guaranteed Interest Division: 3.00% per year FORM 1197 (VUL) - MD PAGE 5E SCHEDULE (CONTINUED) DEFINITION OF LIFE INSURANCEbelow

Settlement Option Tables. 30 29 Additional benefits or riders, if any, will be listed in the Schedule. The additional provisions will be inserted in the Policy. SCHEDULE (Effective Date: July 2May 1, 19971995) POLICY INFORMATION Policy Number 1000540-001 Stated Death Benefit $100,000.00 Insured XXXX XXX Minimum Stated Death Benefit $ 50,000.00 Owner XXXX XXX Three Year Continuation Period May 1,1998 Ending Date May 1, 1998 Death Benefit Option Stated Death Benefit Option 1 Three Year Continuation Period Age And Sex 35, Male Minimum Annual Premium $631.62 Premium Class Standard, Non-Smoker Policy Date May 1, 1997 1995 Scheduled Premium $3,000.00 Maturity Date May 15, 2060 Definition of Life Insurance Test: Test Guideline Premium CUSTOMER SERVICE CENTER: P.O. Box 173763, Denver, Colorado 80217-80217- 3763 Coverage may expire prior to the Maturity Date if Scheduled Premiums are paid in a timely manner, coverage may expire prior to the Maturity Date if said premiums are insufficient to continue coverage and the Three Year Continuation Guarantee Period has ended. Coverage will also be affected by Partial Withdrawals, Policy Loans, changes in the current cost of insurance rates, the actual credited interest rate for the Guaranteed Interest Division and the investment experience of the Variable Account. FORM 1197 Form 1195 (VUL) - MD PAGE Page 5 SCHEDULE (CONTINUED) BENEFIT PROFILE ------------------------------------------------------------------------------------------------------------------------------------ Initial Segment Age At Guideline Benefit Issue Age At Maturity Effective Annual Target Description Amount Age Maturity Date Date Premium Premium ------------------------------------------------------------------------------------------------------------------------------------ Stated Death Benefit (Segment #1) $100,000.00 35 100 May 1, 1995 $1,288.02 1,335.37 $800.00 3,680.00 ------------------------------------------------------------------------------------------------------------------------------------ Adjustable Term Insurance Rider (Segment #1) $50,000.00 35 100 May 1, 1995 $615,62 $0.00 620.58 (Segment #1) ------------------------------------------------------------------------------------------------------------------------------------ A coverage segment is a block of Death Benefit coverage. The Stated Death Benefit shown on the schedule page at issue is the initial coverage segment. Additional segments are added to the policy after issue to increase the Death Benefit. Each individual coverage segment added to the policy has its own cost of insurance charges and expense loads as shown in the Schedule. FORM 1197 Form 1195 (VUL) - MD PAGE Page 5A SCHEDULE (CONTINUED) ALLOCATION OF INITIAL PREMIUM AS SHOWN ON APPLICATION [Xxxxxxxxx & Xxxxxx Limited Maturity Bond] 0 0% [Xxxxxxxxx & Xxxxxx Growth Growth] 0 0% [Xxxxxxxxx & Xxxxxx Government Income Income] 25 25% [Xxxxxxxxx & Xxxxxx Partners] 25 25% [Xxxxx American Growth DivisionINVESCO High Yield] 0 0% [INVESCO Utilities] 0% [Xxx Xxx Worldwide Balanced] 0% [Xxx Xxx Gold and Natural Resources] 25% [Xxxxx American Leveraged AllCap Division] 25 0% [Xxxxx American Growth Division] 0% [Xxxxx American MidCap Growth Growth] 0 0% [Xxxxx American Small Capital] 0 25% [Fidelity Asset Manager Manager] 0 0% [Fidelity Growth Growth] 25 25% [Fidelity Overseas Overseas] 0 0% [Fidelity Money Market Market] 0 0% [Fidelity Index 500 500] 0 0% [INVESCO Total Return Return] 0 0% [INVESCO Industrial Income Income] 0 % [INVESCO High Yield ] 0 % [INVESCO Utilities ] 0 % [Xxx Xxx Worldwide Balanced ] 0 % [Xxx Xxx Gold and Natural Resources ] 0 0% Guaranteed Interest Division 0 0% If you elect to invest in a particular Division, at least 1% of your Net Premium must be allocated to that Division provided that the minimum allocation to each Division selected is at least $100. All percentage allocations must be in whole numbers. SCHEDULE (CONTINUED) EXPENSE CHARGES PREMIUM EXPENSE CHARGES (As a Percent of all Premiums): Sales Load: Segment Issue Age Sales Load 0PREMIUM PAID PREMIUMS IN UP TO TARGET EXCESS OF TARGET YEARS 1-49 2.255 8% 50-59 3.253% 60YEARS 6+ 4.253% 3% State And and Local Taxes: 2.5% Federal Deferred Acquisition Cost Charge: 1.5% MONTHLY EXPENSE CHARGES: $13.00 15.00 per Policy month for the first 36 60 months $3.00 $ 5.00 per Policy month thereafter; plus $0.0125 per thousand of Stated Death Benefit (or Target Death Benefit, if greater), all years. The per thousand charge is limited to $15.00 per Policy month. ANNUAL MORTALITY AND EXPENSE RISK CHARGE (Based on the percentage of assets in each Variable Account Division) Mortality And Expense Risk Charge: 0.75% FORM 1197 (VUL) - MD PAGE 5C SCHEDULE (CONTINUED) SURRENDER CHARGES The maximum Surrender Charges which pertain to the insurance coverages shown in the Schedule are shown in the following table. The total Surrender Charge equals the sum of the Administration Charges and Sales Surrender Charges as described in the Surrender Charges provision. The total Surrender Charge would not exceed the total Maximum Surrender Charge as outlined below. ---------------------------------------- SURRENDERS DURING THE POLICY YEAR TOTAL MAXIMUM ENDING SURRENDER CHARGE ---------------------------------------- 1996 $650.00 ---------------------------------------- 1997 $650.00 ---------------------------------------- 1998 $650.00 ---------------------------------------- 1999 $650.00 ---------------------------------------- 2000 $650.00 ---------------------------------------- 2001 $650.00 ---------------------------------------- 2002 $650.00 ---------------------------------------- 2003 $568.75 ---------------------------------------- 2004 $487.50 ---------------------------------------- 2005 $406.25 ---------------------------------------- 2006 $325.00 ---------------------------------------- 2007 $243.75 ---------------------------------------- 2008 $162.50 ---------------------------------------- 2009 $81.25 ---------------------------------------- 2010 0 ---------------------------------------- SALES SURRENDER CHARGE TABLE -------------------------------------------------------- PERCENTAGE OF - PREMIUMS PAID IN PERCENTAGE OF PERCENTAGE OF EXCESS OF THE PREMIUMS PAID PREMIUMS PAID TARGET PREMIUM IN EXCESS OF 6 UP TO THE AND UP TO 6 TIMES TIMES THE TARGET THE TARGET TARGET PREMIUM PREMIUM PREMIUM -------------------------------------------------------- 25% 5% 0% -------------------------------------------------------- ADMINISTRATION SURRENDER CHARGE TABLE -------------------------------------------------------------- ADMINISTRATIVE SURRENDER SEGMENT CHARGE PER THOUSAND OF ISSUE AGE STATED DEATH BENEFIT -------------------------------------------------------------- 0-39 $2.50 -------------------------------------------------------------- 40-49 $3.50 -------------------------------------------------------------- 50-59 $4.50 -------------------------------------------------------------- 60-69 $5.50 -------------------------------------------------------------- 70 and above $6.50 -------------------------------------------------------------- The Surrender Charge consists of the Sales Surrender Charge and the Administrative Surrender Charge as determined from the above tables for the first 7 Policy years of each segment. Thereafter, the Surrender Charge for the segment decreases at the beginning of each year from the Effective Date of the segment by 12.5% of the Surrender Charge in effect at the end of the 7th Policy year until it reaches zero at the beginning of the 15th Policy year following the segment's Effective Date or the Policy year the Insured reaches age 98, whichever is sooner. FORM 1197 (VUL) - MD PAGE 5D SCHEDULE (CONTINUED) POLICYHOLDER TRANSACTION CHARGES Requests for Illustrations of Benefits and Values: $25 Premium Allocation Changes: $25 for each change over 5 per Policy year Excess Transfer Charge: See the Transfer Provisions section Partial Withdrawal Service Fee: See below POLICY LOANS Policy Loan Interest Rate: 3.75% per year Guaranteed Interest Rate Credited to Loan Division: 3.00% per year Minimum Loan Amount: $100 Maximum Loan Amount: Refer to the Loan Provisions Section PARTIAL WITHDRAWALS Minimum Partial Withdrawal Amount: $100 Maximum Partial Withdrawal Amount: Amount which will leave $500 as the net Cash Value Partial Withdrawal Service Fee: The lesser of $25 or 2% of the amount withdrawn Limit on Partial Withdrawals: One per Policy year GUARANTEED INTEREST DIVISION Guaranteed Interest Rate For Guaranteed Interest Division: 3.00% per year FORM 1197 (VUL) - MD PAGE 5E SCHEDULE (CONTINUED) DEFINITION OF LIFE INSURANCEplus

Settlement Option Tables. 30 27 Additional benefits or riders, if any, will be listed in the Schedule. The additional provisions will be inserted in the Policypolicy. SCHEDULE (Effective Date: July 2January 1, 19971998) POLICY INFORMATION Policy Number 1000540-001 67000001 Initial Minimum Stated Death Benefit $100,000.00 Insured XXXX XXX Minimum Stated Death Benefit $ 50,000.00 Owner XXXX XXX Three Year Continuation Period May 1,1998 Ending Date Death Benefit Option Stated Death Benefit Option OPTION 1 Three Year Continuation Period Age And Sex 35, Male Minimum Annual Premium $631.62 700.00 Premium Class Standard, Non-Smoker Policy Date May January 1, 1997 1998 Initial Scheduled Premium $3,000.00 1,200.00, Annually Maturity Date May 15January 1, 2060 2063 Definition of Life Insurance Test: Test Guideline Premium/Cash Value Corridor Test [Guarantee Period Annual Premium Guarantee Period Expiration Date ] CUSTOMER SERVICE CENTER: P.O. Box 1737630000 Xxxxxxxx, DenverXxxxxx, Colorado 80217-3763 Xxxxxxxx 00000 Coverage may will expire prior to the Maturity Date if Scheduled Premiums are paid in a timely manner, coverage may expire prior to the Maturity Date if said premiums are insufficient to continue coverage and the Three Year Continuation Guarantee Period has endedexpired. Coverage will also be affected by Partial Withdrawals, Policy Loanspolicy loans, changes in the current cost of insurance rates, the actual credited interest rate for the Guaranteed Interest Division division and the investment experience of the Variable Accountvariable account. FORM 1197 (VUL) - MD PAGE 5 SCHEDULE (CONTINUEDContinued) BENEFIT PROFILE ------------------------------------------------------------------------------------------------------------------------------------ Initial Age At Benefit Segment Maturity Effective Guideline Benefit Annual Segment Description Amount Issue Age At Effective Annual Target Description Amount Age Maturity Date Date Premium Target Premium ------------------------------------------------------------------------------------------------------------------------------------ Stated Death Benefit (Segment #1) $100,000.00 35 100 May January 1, 1995 1998 $1,288.02 1,236.00 $800.00 ------------------------------------------------------------------------------------------------------------------------------------ Adjustable Term Insurance Rider (Segment #1) $50,000.00 35 100 May 1, 1995 $615,62 $0.00 ------------------------------------------------------------------------------------------------------------------------------------ A coverage segment is a block of Death Benefit coverage. The Stated Death Benefit shown on the schedule page at issue is the initial coverage segment. Additional segments are added to the policy after issue to increase the Death Benefit. Each individual coverage segment added to the policy has its own cost of insurance charges and expense loads as shown in the Schedule. FORM 1197 (VUL) - MD PAGE 5A SCHEDULE (CONTINUED) ALLOCATION OF INITIAL PREMIUM AS SHOWN ON APPLICATION [Xxxxxxxxx & Xxxxxx Limited Maturity Bond] 0 % [Xxxxxxxxx & Xxxxxx Growth ] 0 % [Xxxxxxxxx & Xxxxxx Government Income ] 25 % [Xxxxxxxxx & Xxxxxx Partners] 25 % [Xxxxx American Growth Division] 0 % [Xxxxx American Leveraged AllCap Division] 25 % [Xxxxx American MidCap Growth ] 0 % [Xxxxx American Small Capital] 0 % [Fidelity Asset Manager ] 0 % [Fidelity Growth ] 25 % [Fidelity Overseas ] 0 % [Fidelity Money Market ] 0 % [Fidelity Index 500 ] 0 % [INVESCO Total Return ] 0 % [INVESCO Industrial Income ] 0 % [INVESCO High Yield ] 0 % [INVESCO Utilities ] 0 % [Xxx Xxx Worldwide Balanced ] 0 % [Xxx Xxx Gold and Natural Resources ] 0 % Guaranteed Interest Division 0 % If you elect to invest in a particular Division, at least 1% of your Net Premium must be allocated to that Division provided that the allocation to each Division selected is at least $100. All percentage allocations must be in whole numbers. SCHEDULE (CONTINUEDContinued) EXPENSE CHARGES PREMIUM EXPENSE CHARGES (As a Percent of all Premiums): Sales Load: Segment Issue Age Sales Load 0-49 2.25% 50-59 3.25% 60+ 4.25% State And Local Taxes: 2.5% Federal Deferred Acquisition Cost Charge: 1.5% MONTHLY EXPENSE CHARGES: $13.00 per Policy month for the first 36 months $3.00 per Policy month thereafter; plus $0.0125 per thousand of Stated Death Benefit (or Target Death Benefit, if greater), all years. The per thousand charge is limited to $15.00 per Policy month. ANNUAL MORTALITY AND EXPENSE RISK CHARGE (Based on the percentage of assets in each Variable Account Division) Mortality And Expense Risk Charge: 0.75% FORM 1197 (VUL) - MD PAGE 5C SCHEDULE (CONTINUED) SURRENDER CHARGES The maximum Surrender Charges which pertain to the insurance coverages shown in the Schedule are shown in the following table. The total Surrender Charge equals the sum of the Administration Charges and Sales Surrender Charges as described in the Surrender Charges provision. The total Surrender Charge would not exceed the total Maximum Surrender Charge as outlined below. ---------------------------------------- SURRENDERS DURING THE POLICY YEAR TOTAL MAXIMUM ENDING SURRENDER CHARGE ---------------------------------------- 1996 $650.00 ---------------------------------------- 1997 $650.00 ---------------------------------------- 1998 $650.00 ---------------------------------------- 1999 $650.00 ---------------------------------------- 2000 $650.00 ---------------------------------------- 2001 $650.00 ---------------------------------------- 2002 $650.00 ---------------------------------------- 2003 $568.75 ---------------------------------------- 2004 $487.50 ---------------------------------------- 2005 $406.25 ---------------------------------------- 2006 $325.00 ---------------------------------------- 2007 $243.75 ---------------------------------------- 2008 $162.50 ---------------------------------------- 2009 $81.25 ---------------------------------------- 2010 0 ---------------------------------------- SALES SURRENDER CHARGE TABLE -------------------------------------------------------- PERCENTAGE OF - PREMIUMS PAID IN PERCENTAGE OF PERCENTAGE OF EXCESS OF THE PREMIUMS PAID PREMIUMS PAID TARGET PREMIUM IN EXCESS OF 6 UP TO THE AND UP TO 6 TIMES TIMES THE TARGET THE TARGET TARGET PREMIUM PREMIUM PREMIUM -------------------------------------------------------- 25% 5% 0% -------------------------------------------------------- ADMINISTRATION SURRENDER CHARGE TABLE -------------------------------------------------------------- ADMINISTRATIVE SURRENDER SEGMENT CHARGE PER THOUSAND OF ISSUE AGE STATED DEATH BENEFIT -------------------------------------------------------------- 0-39 $2.50 -------------------------------------------------------------- 40-49 $3.50 -------------------------------------------------------------- 50-59 $4.50 -------------------------------------------------------------- 60-69 $5.50 -------------------------------------------------------------- 70 and above $6.50 -------------------------------------------------------------- The Surrender Charge consists of the Sales Surrender Charge and the Administrative Surrender Charge as determined from the above tables for the first 7 Policy years of each segment. Thereafter, the Surrender Charge for the segment decreases at the beginning of each year from the Effective Date of the segment by 12.5% of the Surrender Charge in effect at the end of the 7th Policy year until it reaches zero at the beginning of the 15th Policy year following the segment's Effective Date or the Policy year the Insured reaches age 98, whichever is sooner. FORM 1197 (VUL) - MD PAGE 5D SCHEDULE (CONTINUED) POLICYHOLDER TRANSACTION CHARGES Requests for Illustrations of Benefits and Values: $25 Premium Allocation Changes: $25 for each change over 5 per Policy year Excess Transfer Charge: See the Transfer Provisions section Partial Withdrawal Service Fee: See below POLICY LOANS Policy Loan Interest Rate: 3.75% per year Guaranteed Interest Rate Credited to Loan Division: 3.00% per year Minimum Loan Amount: $100 Maximum Loan Amount: Refer to the Loan Provisions Section PARTIAL WITHDRAWALS Minimum Partial Withdrawal Amount: $100 Maximum Partial Withdrawal Amount: Amount which will leave $500 as the net Cash Value Partial Withdrawal Service Fee: The lesser of $25 or 2% of the amount withdrawn Limit on Partial Withdrawals: One per Policy year GUARANTEED INTEREST DIVISION Guaranteed Interest Rate For Guaranteed Interest Division: 3.00% per year FORM 1197 (VUL) - MD PAGE 5E SCHEDULE (CONTINUED) DEFINITION OF LIFE INSURANCE