ALPINE LIFE INSURANCE COMPANY
Hartford, Connecticut 06104-2999
(a stock insurance company, herein called the "Company")
Will pay the Death Proceeds to the Beneficiary upon receipt of due proof of the
Insured's death while this policy was in force.
Signed for the Company
/s/XXXXX XXXXXX /s/XXXXXXX X. XXXXX
----------------------- ----------------------------
Xxxxx Xxxxxx, SECRETARY Xxxxxxx x. Xxxxx, PRESIDENT
READ YOUR POLICY CAREFULLY
This is a legal contract between You and Us.
RIGHT TO EXAMINE POLICY
We want You to be satisfied with the policy You have purchased. We urge You to
examine it closely. If, for any reason, You are not satisfied, You may deliver
or mail the policy to Us or to the agent from whom it was purchased anytime
during Your free look period. Your free look period begins on the day You
receive Your policy and ends on the latest of: (a) ten days after You receive
it, (b) 45 days after You sign the application, and (c) ten days after We mail
You the Notice of Withdrawal Right. In such event, the policy will be rescinded
and We will pay an amount equal to the greater of the premiums paid for the
policy, less any indebtedness, or the sum of (i) the Account Value, less any
indebtedness, on the date the returned policy is received by Us or the agent
from whom it was purchased and, (ii) any deductions under the policy or by the
Funds for taxes, charges, or fees.
CASH SURRENDER VALUE PAYABLE ON MATURITY DATE
DEATH PROCEEDS PAYABLE AT DEATH
NON-PARTICIPATING
THE DEATH PROCEEDS AND CASH VALUES PROVIDED BY THIS CONTRACT ARE BASED ON THE
INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT. THEY ARE VARIABLE AND NOT
GUARANTEED AS TO A FIXED DOLLAR AMOUNT. SEE PAGE 6 FOR A DESCRIPTION OF THE
DEATH BENEFIT.
MODIFIED SINGLE PREMIUM VARIABLE
LIFE INSURANCE POLICY
VL-ALPINE SAMPLE PRINTED IN U.S.A.
TABLE OF CONTENTS
PAGE
Policy Specifications 3
Definitions 5
Death Benefit 6
Premiums 7
Valuation Provisions 8
Account Value, Cash Value, and Cash Surrender Value 9
Monthly Deduction Amount 10
Annual Maintenance Fee 11
Transfers 11
Termination and Maturity Date 12
Reinstatement 13
Full Surrender 13
Partial Surrenders, Annual Withdrawal Amount, and Surrender Charges 13
Policy Loans 14
Payments by Us 15
Taxation 15
The Contract 16
Ownership and Beneficiary 17
Exchange Option 18
Income Settlement Options 18
VL-ALPINE SAMPLE Page 2 PRINTED IN U.S.A.
POLICY SPECIFICATIONS
DATE OF ISSUE: [JULY 25, 1997] INSURED: [XXXX XXX]
POLICY DATE: [MAY 15, 1997] ISSUE AGE/SEX: [35 MALE]
SCHEDULED
MATURITY DATE: [MAY 15, 2062] INSURANCE CLASS: [PREFERRED]
POLICY NUMBER: [SPVL12345] INITIAL FACE AMOUNT: [$100,000]
OWNER: [XXXX XXX] INITIAL PREMIUM: [$14,500]
BENEFICIARY: [XXXX XXX] INITIAL GUIDELINE PREMIUM PERCENTAGE: [100%]
SEPARATE ACCOUNT: ALPINE LIFE INSURANCE COMPANY
SEPARATE ACCOUNT TWO
SUBACCOUNT FUND
[ADVISERS FUND HARTFORD ADVISERS FUND, INC.
BOND FUND HARTFORD BOND FUND, INC.
CAPITAL APPRECIATION FUND HARTFORD CAPITAL APPRECIATION FUND, INC.
DIVIDEND AND GROWTH FUND HARTFORD DIVIDEND AND GROWTH FUND, INC.
INDEX FUND HARTFORD INDEX FUND, INC.
INTERNATIONAL ADVISERS FUND HARTFORD INTERNATIONAL ADVISERS FUND, INC.
INTERNATIONAL OPPORTUNITIES FUND HARTFORD INTERNATIONAL OPPORTUNITIES FUND, INC.
MIDCAP FUND HARTFORD MIDCAP FUND, INC.
MONEY MARKET FUND HVA MONEY MARKET FUND, INC.
MORTGAGE SECURITIES FUND HARTFORD MORTGAGE SECURITIES FUND, INC.
SMALL COMPANY FUND HARTFORD SMALL COMPANY FUND, INC.
STOCK FUND HARTFORD STOCK FUND, INC.]
OR OTHER FUNDS AS MAY BE MADE AVAILABLE FROM TIME TO TIME.
INITIAL ALLOCATION OF NET PREMIUMS: MONEY MARKET SUBACCOUNT 100%
VL-ALPINE SAMPLE Page 3 PRINTED IN U.S.A.
POLICY SPECIFICATIONS
TABLE OF MINIMUM DEATH BENEFIT PERCENTAGES
AND MONTHLY MAXIMUM COST OF INSURANCE RATES PER $1,000
MINIMUM MAXIMUM MINIMUM MAXIMUM MINIMUM MAXIMUM
DEATH COST OF DEATH COST OF DEATH COST OF
ATT BENEFIT INSURANCE ATT BENEFIT INSURANCE ATT BENEFIT INSURANCE
AGE PERCENT RATE AGE PERCENT RATE AGE PERCENT RATE
35 250.00 0.1442 57 142.00 0.9133 79 106.00 6.0592
36 250.00 0.1817 58 138.00 0.9625 80 105.00 6.6650
37 250.00 0.1983 59 134.00 1.0150 81 105.00 7.3525
38 250.00 0.2175 60 130.00 1.0775 82 105.00 8.1342
39 250.00 0.2383 61 128.00 1.1558 83 105.00 9.0367
40 250.00 0.2633 62 126.00 1.2567 84 105.00 10.0150
41 243.00 0.2900 63 124.00 1.3792 85 105.00 11.0542
42 236.00 0.3167 64 122.00 1.5158 86 105.00 12.1458
43 229.00 0.3433 65 120.00 1.6600 87 105.00 13.2792
44 222.00 0.3700 66 119.00 1.8067 88 105.00 14.4600
45 215.00 0.3983 67 118.00 1.9483 89 105.00 15.6875
46 209.00 0.4275 68 117.00 2.0917 90 105.00 17.0483
47 203.00 0.4575 69 116.00 2.2475 91 104.00 18.5133
48 197.00 0.4900 70 115.00 2.4317 92 103.00 20.1383
49 191.00 0.5258 71 113.00 2.6650 93 103.00 22.0467
50 185.00 0.5642 72 111.00 2.9508 94 103.00 24.6025
51 178.00 0.6050 73 109.00 3.2908 95 102.00 28.4183
52 171.00 0.6517 74 109.00 3.6783 96 102.00 34.4900
53 164.00 0.7033 75 108.00 4.1017 97 101.00 44.7700
54 157.00 0.7558 76 107.00 4.5517 98 101.00 61.9967
55 150.00 0.8100 77 107.00 5.0217 99 101.00 83.3333
56 146.00 0.8633 78 106.00 5.5183
THE MINIMUM BENEFIT PERCENTAGES ARE DETERMINED TO COMPLY WITH SECTION 7702 OF
THE INTERNAL REVENUE CODE.
THE MAXIMUM COST OF INSURANCE RATES DO NOT EXCEED 100% OF THE COST OF INSURANCE
RATES BASED ON THE 1980 COMMISSIONERS STANDARD ORDINARY SMOKER OR NONSMOKER
MORTALITY TABLE, AGE LAST BIRTHDAY.
POLICY LOAN INTEREST RATE: 6.00%
VL-ALPINE SAMPLE Page 4 PRINTED IN U.S.A.
POLICY SPECIFICATIONS
POLICY CHARGES
DEDUCTIONS FROM PREMIUM PAYMENTS
--------------------------------
TYPE OF CHARGE PERCENT OF PREMIUMS PAID
FEDERAL TAX 0.00%
PREMIUM TAX 0.00%
DEDUCTIONS FROM ACCOUNT VALUE
-----------------------------
TYPE OF CHARGE POLICY YEARS CHARGE (IN DOLLARS)
OR PERCENT OF VALUE
ANNUAL MAINTENANCE FEE ALL $30 (1)
FEDERAL TAX ANNUAL RATE 1-10 0.15% (2)
PREMIUM TAX ANNUAL RATE 1-10 0.25% (2)
ADMINISTRATION ANNUAL RATE ALL [0.25%](2)
MORTALITY AND EXPENSE 1-10 0.90% (2)
RISK ANNUAL RATE 11+ 0.50% (2)
(1) THE ANNUAL CONTRACT MAINTENANCE FEE IS A SINGLE CHARGE ON A CONTRACT. IT
IS DEDUCTED PROPORTIONALLY FROM THE INVESTMENT OPTIONS IN USE AT THE TIME
OF THE CHARGE. IT IS APPLIED ONLY IN CASES WHERE THE ACCOUNT VALUE FOR THE
ENTIRE CONTRACT IS LESS THAN $50,000.
(2) CHARGES DEDUCTED MONTHLY BASED ON ACCOUNT VALUE.
UNAMORTIZED TAX CHARGE UPON SURRENDER
AS A PERCENTAGE OF THE AMOUNT SURRENDERED
-----------------------------------------
POLICY YEAR RATE POLICY YEAR RATE
1 2.25% 6 1.00%
2 2.00% 7 0.75%
3 1.75% 8 0.50%
4 1.50% 9 0.25%
5 1.25% 10+ 0.00%
VL-ALPINE SAMPLE Page 4A PRINTED IN U.S.A.
POLICY SPECIFICATIONS
POLICY CHARGES
(ALTERNATE SPEC PAGE - SEE PAGE 11 - TAX EXPENSE CHARGES)
DEDUCTIONS FROM PREMIUM PAYMENTS
--------------------------------
TYPE OF CHARGE PERCENT OF PREMIUMS PAID
FEDERAL TAX 1.5%
PREMIUM TAX 2.5%
DEDUCTIONS FROM ACCOUNT VALUE
-----------------------------
TYPE OF CHARGE POLICY YEARS CHARGE (IN DOLLARS)
OR PERCENT OF VALUE
ANNUAL MAINTENANCE FEE ALL $30 (1)
FEDERAL TAX ANNUAL RATE 1-10 0.00% (2)
PREMIUM TAX ANNUAL RATE 1-10 0.00% (2)
ADMINISTRATION ANNUAL RATE ALL [0.25%] (2)
MORTALITY AND EXPENSE 1-10 0.65% (2)
RISK ANNUAL RATE 11+ 0.50% (2)
(1) THE ANNUAL CONTRACT MAINTENANCE FEE IS A SINGLE CHARGE ON A CONTRACT. IT
IS DEDUCTED PROPORTIONALLY FROM THE INVESTMENT OPTIONS IN USE AT THE TIME
OF THE CHARGE. IT IS APPLIED ONLY IN CASES WHERE THE ACCOUNT VALUE FOR THE
ENTIRE CONTRACT IS LESS THAN $50,000.
(2) CHARGES DEDUCTED MONTHLY BASED ON ACCOUNT VALUE.
UNAMORTIZED TAX CHARGE UPON SURRENDER
AS A PERCENTAGE OF THE AMOUNT SURRENDERED
-----------------------------------------
POLICY YEAR RATE POLICY YEAR RATE
1 0.00% 6 0.00%
2 0.00% 7 0.00%
3 0.00% 8 0.00%
4 0.00% 9 0.00%
5 0.00% 10+ 0.00%
VL-ALPINE SAMPLE Page 4A PRINTED IN U.S.A.
POLICY SPECIFICATIONS
SURRENDER CHARGES
-----------------
POLICY YEAR RATE POLICY YEAR RATE
1 7.5% 6 4.0%
2 7.5% 7 4.0%
3 7.5% 8 2.0%
4 6.0% 9 2.0%
5 6.0% 10+ 0.0%
SURRENDER CHARGE RATE APPLIED AS A PERCENTAGE OF THE LESSER PREMIUM PAYMENTS OR
THE AMOUNT SURRENDERED.
ANNUAL WITHDRAWAL AMOUNT: THE GREATER OF:
(A) 10% OF PREMIUM PAYMENTS PER CONTRACT YEAR
ON A NON-CUMULATIVE BASIS; OR
(B) THE EXCESS OF THE ACCOUNT VALUE OVER
PREMIUM PAID.
VL-ALPINE SAMPLE Page 4B PRINTED IN U.S.A.
DEFINITIONS
The definitions in this section apply to the following words and phrases
whenever and wherever they appear in this policy.
ACCOUNT: any of the Sub-Accounts.
ACCOUNT VALUE: the value of the Sub-Accounts and the Loan Account.
ACCUMULATION UNIT: an accounting unit used to calculate the value of a
Sub-Account.
ANNUITY UNIT: An accounting unit of measure used to calculate the amount of
annuity payments under the variable annuity option.
ATTAINED AGE: the Issue Age plus the number of fully completed Policy Years.
CASH SURRENDER VALUE: the Cash Value less all Indebtedness.
CASH VALUE: the Account Value less any applicable Surrender Charges and tax
charges due upon surrender.
COMPANY, WE, US, OUR: the Company referred to on the first page of this policy.
DATE OF ISSUE: the date shown on Page 3 from which Suicide and Incontestability
provisions are measured.
DEATH PROCEEDS: the amount which We will pay upon the death of the Insured.
FACE AMOUNT: on the Policy Date, the Face Amount equals the Initial Face
Amount. Thereafter it may change in accordance with the terms of the Partial
Withdrawal provision.
FUNDS: the registered open end management investment companies in which the
assets of the Separate Account may be invested.
INDEBTEDNESS: All monies owed to the Company from the Owner. This includes all
outstanding loans on this policy, including any interest due or accrued, and due
and unpaid monthly deduction amount and annual maintenance fee, arising during a
Grace Period.
INITIAL FACE AMOUNT: the amount shown on Page 3.
INSURED: the person whose life is insured under this policy as shown on Page 3.
IN WRITING: in a written form satisfactory to Us.
ISSUE AGE: as of the Policy Date, the Insured's age on his/her last birthday.
LOAN ACCOUNT: an Account established for any amounts transferred from the
Sub-Accounts as a result of loans. The Account is credited with interest and
is not based on the experience of any Separate Account.
VL-ALPINE SAMPLE Page 5 PRINTED IN U.S.A.
DEFINITIONS (CONTINUED)
MONTHLY ACTIVITY DATE: the Policy Date and the same date in each succeeding
month as the Policy Date except that whenever the Monthly Activity Date falls on
a date other than a Valuation Day, the Monthly Activity Date will be deemed the
next Valuation Day.
NET PREMIUM: the premium payments less the applicable charges shown on Page 4A.
OWNER: the Owner of the policy as shown on Page 3.
POLICY ANNIVERSARY: an anniversary of the Policy Date. Similarly, Policy Years
are measured from the Policy Date.
POLICY DATE: the date shown on Page 3 from which Policy Anniversaries and
Policy Years are determined.
POLICY LOAN RATE: the interest rate charged on policy loans.
PREMIUM TAX: the average amount of tax charged by a state or municipal entity
on premium payments.
PRO-RATA BASIS: an allocation method based on the proportion of the Account
Value in each Sub-Account.
SCHEDULED MATURITY DATE: the date, shown on Page 3, on which the policy will
mature.
SEPARATE ACCOUNT: an Account established by Us to separate the assets funding
the variable benefits for the class of contracts to which this policy belongs
from the other assets of the Company. The assets in the Separate Account are
not chargeable with liabilities arising out of any other business that We may
conduct. The Separate Account and the Funds which are the underlying securities
of the Separate Account are listed on Page 3.
SUB-ACCOUNTS: the subdivisions of the Separate Account. These are shown on
Page 3.
VALUATION DAY: the date on which a Sub-Account is valued. This occurs every
day We are open and the New York Stock Exchange is open for trading.
VALUATION PERIOD: the period of time between the close of business on
successive Valuation Days.
YOU, YOUR: the Owner of the policy.
DEATH BENEFIT
GENERAL
On any day the Death Benefit is the greater of:
(a) the Face Amount on date of Insured's death; and
(b) the Minimum Death Benefit described on the following page.
VL-ALPINE SAMPLE Page 6 PRINTED IN U.S.A.
DEATH BENEFIT (CONTINUED)
MINIMUM DEATH BENEFIT
To ensure that the policy continues to qualify as life insurance under the
Internal Revenue Code, We will automatically increase the Death Benefit so that
it will never be less than the appropriate Attained Age percentage of the
Account Value. The Minimum Death Benefit is the Account Value on the date of
death multiplied by the applicable percent shown in the table of Minimum Death
Benefit Percentages on Page 4.
DEATH PROCEEDS
The Death Proceeds are the amount which We will pay on the death of the
Insured. This equals the Death Benefit less any Indebtedness.
PREMIUMS
GENERAL
All premiums are payable either:
(a) to Us at the address shown on the premium notice; or
(b) to Our authorized agent in exchange for a receipt signed by Our President
or Secretary and countersigned by such agent.
Checks should be made payable to the Company.
INITIAL PREMIUM PAYMENTS
You will have the option of setting Your Initial Premium Guideline Percentage at
80%, 90%, or 100% of the Guideline Premium Limitation established by Federal tax
law. The Initial Premium is due on the Policy Date. No insurance is effective
until the Initial Premium is paid. The Initial Premium and the Initial Premium
Guideline Percentage You chose are shown on Page 3.
SUBSEQUENT PREMIUM PAYMENTS
Subject to a $50 minimum, We will accept additional premiums at any time. The
actual amount and frequency of any payments made will affect the Cash Value and
the amount and duration of insurance provided by this policy. Any Subsequent
Premium Payment that results in an increase in the Death Benefit will be
accepted only after We approve evidence of insurability.
VL-ALPINE SAMPLE Page 7 PRINTED IN U.S.A.
PREMIUMS (CONTINUED)
PREMIUM ALLOCATION
The Initial Net Premium will be allocated to the Money Market Sub-Account on the
date We receive the premium, or the Policy Date if it occurs after the date We
receive the premium.
The Accumulated Value in this Money Market Sub-Account will then be allocated to
the Sub-Accounts, in whole percentages according to the premium allocation
specified in the application, on the latest of:
(a) 45 days after the application is signed;
(b) 10 days after We receive the premium;
(c) 10 days after We mail You the Notice of Withdrawal Right; or
(d) the date We receive the final requirement to put the policy in force.
Any additional Premiums, less any applicable charges, received by Us prior to
such date will be allocated to the Money Market Sub-Account.
Upon written request, You may change the premium allocation. Subsequent Net
Premiums will be allocated to the Sub-Accounts according to Your most recent
instructions.
GRACE PERIOD
This policy will terminate 61 days after a Monthly Activity Date on which the
Cash Surrender Value is less than zero. The 61-day period is the Grace Period.
If sufficient premium is not paid by the end of the Grace Period, the policy
will terminate without value. The Company will mail the Owner and any assignee
written notice of the amount of premium that will be required to continue this
policy in force at least 61 days before the end of the Grace Period. The
premium required will be no greater than the amount required to pay three
Monthly Deduction Amounts as of the day the Grace Period began. If that premium
is not paid by the end of the Grace Period, this policy will terminate.
PREMIUM LIMITATION
If premiums are received which would cause the policy to fail to meet the
definition of a life insurance contract in accordance with the Internal Revenue
Code, We will refund the excess premium payments. We will refund such premium
payments and interest thereon within 60 days after the end of a Policy Year.
VALUATION PROVISIONS
SUB-ACCOUNT ACCUMULATION UNITS
Amounts allocated to Sub-Accounts are applied to provide Accumulation Units in
each Sub-Account. The number of Accumulation Units credited to each Sub-Account
is determined by dividing the amount allocated to a Sub-Account by the dollar
value of one Accumulation Unit for such Sub-Account. The number of Your
Accumulation Units will not be affected by any subsequent change in the value of
the units. The Accumulation Unit Values in each Sub-Account may increase or
decrease daily as described on the following page.
VL-ALPINE SAMPLE Page 8 PRINTED IN U.S.A.
VALUATION PROVISIONS (CONTINUED)
SUB-ACCOUNT ACCUMULATION UNIT VALUE
The Accumulation Unit Value for each Sub-Account will vary to reflect the
investment experience of the applicable Fund and will be determined on each
Valuation Day by multiplying the Accumulation Unit Value of the particular
Sub-Account on the preceding Valuation Day by a Net Investment Factor for
that Sub-Account for the Valuation Period then ended. The Net Investment
Factor for each of the Sub-Accounts is equal to the net asset value per share
of the corresponding Fund at the end of the Valuation Period (plus the per
share amount of any dividend or capital gain distributions paid by that Fund
in the Valuation Period then ended) divided by the net asset value per share
of the corresponding Fund at the beginning of the Valuation Period.
EMERGENCY PROCEDURE
If a national stock exchange is closed (except for holidays or weekends) or
trading is restricted due to an existing emergency as defined by the Securities
and Exchange Commission so that We cannot value the Sub-Accounts, We may
postpone all procedures which require valuation of the Sub-Accounts until
valuation is possible. Any provision of this policy which specifies a Valuation
Day will be superseded by the emergency procedure.
ACCOUNT VALUE, CASH VALUE, AND
CASH SURRENDER VALUE
GENERAL
Your Account Value on the Policy Date equals the Initial Net Premium less the
Monthly Deduction Amount for the first policy month as described on Page 4A.
On each subsequent Monthly Activity Date, Your Account Value equals:
(a) the sum of Your Accumulated Values in the Sub-Accounts; plus
(b) the value of Your Loan Account, if any; minus,
(c) the appropriate Monthly Deduction Amount; minus
(d) the Annual Maintenance Fee, if any.
On each Valuation Day (other than a Monthly Activity Date), Your Account Value
equals:
(a) the sum of Your Accumulated Values in the Sub-Accounts; plus
(b) the value of Your Loan Account, if any.
ACCUMULATED VALUE - SUB-ACCOUNTS
Your Accumulated Value in any Sub-Account equals:
(a) the number of Your Accumulation Units in that Sub-Account on the Valuation
Day; multiplied by
(b) that Sub-Account's Accumulation Unit Value on the Valuation Day.
VL-ALPINE SAMPLE Page 9 PRINTED IN U.S.A.
ACCOUNT VALUE, CASH VALUE, AND
CASH SURRENDER VALUE (CONTINUED)
CASH VALUE AND SURRENDER CHARGES
A Surrender Charge and a charge for unpaid tax charges, if applicable, will be
subtracted from the Account Value to determine the Cash Value. These charges
and the Policy Years during which they will be applied are shown on Page 4A.
CASH SURRENDER VALUE
Your Cash Surrender Value is equal to Your Cash Value minus the Indebtedness, if
any. Indebtedness includes all outstanding loans, including any interest due or
accrued, Monthly Deduction Amount, and Annual Maintenance Fee, arising during a
Grace Period.
MONTHLY DEDUCTION AMOUNT
GENERAL
The Monthly Deduction Amount equals:
(a) the Cost of Insurance Charge; plus
(b) the Administrative Charge; plus
(c) the Mortality and Expense Risk Charge; plus
(d) the tax charges, if applicable.
The Monthly Deduction Amount will be taken on a Pro-Rata Basis from the
Sub-Accounts on each Monthly Activity Date.
COST OF INSURANCE CHARGE
The Maximum Cost of Insurance charge for any Monthly Activity Date is equal to:
(a) the Maximum Cost of Insurance rate per $1,000 shown on Page 4; multiplied
by
(b) the coverage amount; divided by
(c) $1,000.
On any Monthly Activity Date the coverage amount equals the Death Benefit less
the Account Value on that date prior to assessing the Monthly Deduction Amount.
We can use Cost of Insurance Charges that are lower than the Maximum Cost of
Insurance Rates shown on Page 4. Charges will be determined based on Our
expectation as to future experience. Any change We make will be on a uniform
basis for Insureds for the same Issue Age, sex, premium band, and insurance
class and whose coverage has been in force for the same length of time. No
change in insurance class or cost will occur on account of deterioration of the
Insured's health.
ADMINISTRATIVE CHARGE
The Administrative Charge for any Monthly Activity Date is equal to:
(a) the Administration Annual Rate divided by 12; multiplied by
(b) the sum of Your Accumulated Values in the Sub-Accounts on the Monthly
Activity Date, prior to assessing the Monthly Deduction Amount.
The Administration Annual Rate is that shown on Page 4A.
VL-ALPINE SAMPLE Page 10 PRINTED IN U.S.A.
MONTHLY DEDUCTION AMOUNT (CONTINUED)
MORTALITY AND EXPENSE RISK CHARGE
The Mortality and Expense Risk Charge for any Monthly Activity Date is equal to:
(a) the Mortality and Expense Risk Annual Rate divided by 12; multiplied by
(b) the sum of Your Accumulated Values in the Sub-Accounts on the Monthly
Activity Date, prior to assessing the Monthly Deduction Amount.
The Mortality and Expense Risk Annual Rate is that shown on Page 4A.
TAX EXPENSE CHARGES
At the time that You applied for this policy, You elected to pay the Federal and
Premium Tax Charges either as a one time payment or amortized over ten years.
If you elected to make a one time payment, the charges will be deducted from
Your premium payment(s) upon receipt by Us. The charges, which are a percentage
of Your premium payment(s), appear on Page 4A under Deductions From Premium
Payments.
If You elected to pay amortized charges, those charges will be deducted from
Your Account Value. The charges, which are a percentage of Your Account Value,
appear on Page 4A under Deductions From Account Value. Deductions will be made
on each Monthly Activity Date occurring during the first ten years of the Policy
and are equal to:
(a) the Federal and PremiumTax Rates divided by 12; multiplied by
(b) the Account Value on the Monthly Activity Date, prior to assessing the
Monthly Deduction Amount.
If you surrender this policy in full within nine years of the Policy Date, any
Premium Tax due and unpaid will be deducted from Your Cash Value at surrender.
ANNUAL MAINTENANCE FEE
An Annual Maintenance Fee shown on Page 4A will be taken on a Pro-Rata Basis
from the Sub-Accounts if applicable on each Policy Anniversary.
TRANSFERS
AMOUNT AND FREQUENCY OF TRANSFERS
Upon request and as long as this policy is in effect, You may transfer amounts
among the Sub-Accounts. However, We reserve the right to limit the number of
transfers to no more frequently than 12 per Policy Year with no two transfers
being made on consecutive valuations days. Subject to the following paragraph,
any such limitations will apply to all Owners.
VL-ALPINE SAMPLE Page 11 PRINTED IN U.S.A.
TRANSFERS (CONTINUED)
The right to reallocate Account Values between the Accounts is subject to
modification if the Company determines, in its sole opinion, that the exercise
of that right by one or more Owners is, or would be, to the disadvantage of
other Owners. Any modification could be applied to transfers to or from some or
all of the Sub-Accounts and could include, but not be limited to, the
requirement of a minimum time period between each transfer, not accepting
transfer requests of an agent acting under a power of attorney on behalf of more
than one Owner, or limiting the dollar amount that may be transferred between
the Sub-Accounts by a Owner at any one time. Such restrictions may be applied
in any manner reasonably designed to prevent any use of the transfer right which
is considered by the Company to be to the disadvantage of other Owners.
TRANSFERS TO OR FROM SUB-ACCOUNTS
In the event of a transfer from a Sub-Account, the number of Accumulation Units
credited to the Sub-Account from which the transfer is made will be reduced.
The reduction will be determined by dividing:
1. the amount transferred; by
2. the Accumulation Unit Value for that Sub-Account as of the next Valuation
Day after We receive Your request for transfer In Writing.
In the event of a transfer to a Sub-Account, We will increase the number of
Accumulation Units credited to that Sub-Account. The increase will equal:
1. the amount transferred; divided by
2. the Accumulation Unit Value for that Sub-Account as of the next Valuation
Day after We receive Your request for transfer In Writing.
TERMINATION AND MATURITY DATE
TERMINATION
The policy will terminate upon the earliest of the following events:
(a) Maturity Date of the policy; or
(b) full surrender of the policy; or
(c) the end of the Grace Period; or
(d) the death of the Insured.
MATURITY DATE
No insurance coverage will be effective on or after the Maturity Date. Any Cash
Surrender Value as of the Maturity Date will be paid to You.
VL-ALPINE SAMPLE Page 12 PRINTED IN U.S.A.
REINSTATEMENT
Prior to the death of the Insured, and unless this policy has been surrendered
for cash, this policy may be reinstated prior to the Maturity Date provided:
(a) You make Your request within five years;
(b) satisfactory evidence of insurability is submitted;
(c) any policy loan is repaid or reinstated; and
(d) sufficient premium must be paid to:
(i) cover all Monthly Deduction Amounts and Annual Maintenance Fee that
are due and unpaid during the Grace Period, and
(ii) keep the policy in force for three months after the date of
reinstatement.
The Face Amount of the reinstated policy cannot exceed the Face Amount at the
time of lapse. The Account Value on the reinstatement date will equal:
(a) the Cash Value at the time of termination; plus
(b) Net Premiums attributable to premiums paid at the time of reinstatement;
minus
(c) the Monthly Deduction Amounts that were due and unpaid during the Grace
Period; plus
(d) the Surrender Charge at the time of reinstatement.
The Surrender Charges will be based on the number of policy years from the
original Policy Date.
Upon reinstatement, any Indebtedness at the time of termination must be repaid
or carried over to the reinstated policy.
FULL SURRENDER
You may terminate this policy at any time before the Maturity Date by submitting
a request to Us In Writing. We will pay You the Cash Surrender Value at the
time of surrender, which includes any applicable tax charges not previously
deducted, and Our liability under this policy will cease.
The amount You will receive will be the Account Value less:
(a) any Indebtedness;
(b) any applicable due and unpaid tax charges as specified on Page 4A; and
(c) any applicable Surrender Charge as specified on Page 4A.
PARTIAL SURRENDERS, ANNUAL WITHDRAWAL AMOUNT,
AND SURRENDER CHARGES
PARTIAL SURRENDERS
You may request, In Writing, a partial surrender of Cash Surrender Values at any
time before the Maturity Date provided the Cash Surrender Value remaining after
the surrender is at least equal to Our minimum premium amount rules then in
effect. If the remaining Cash Surrender Value following such surrender is less
than Our minimum premium amount rules, We will terminate the policy and pay the
Cash Surrender Value. Unless specified otherwise, the partial surrender amount
will be deducted on a Pro-Rata Basis from the Sub-Accounts. The Face Amount of
the policy will be reduced proportional to the reduction in Account Value due to
the partial surrender. For Federal Tax purposes, any surrenders will be deemed
to be first from earnings, to the extent that they exist, and then from the
premium payments.
VL-ALPINE SAMPLE Page 13 PRINTED IN U.S.A.
PARTIAL SURRENDERS, ANNUAL WITHDRAWAL AMOUNT,
AND SURRENDER CHARGES (CONTINUED)
ANNUAL WITHDRAWAL AMOUNT
Surrender Charges applicable to this policy are described on Page 4A. However,
on a noncumulative basis, You may make partial surrenders during any Policy Year
up to the Annual Withdrawal Amount shown on Page 4B. Surrender Charges will not
be assessed against such amounts. Surrender of the Account Values in excess of
the above and additional surrenders made in any Policy Year will be subject to
the Surrender Charge, as described on Page 4A, if applicable.
SURRENDER CHARGES
Subject to the Annual Withdrawal Amount, surrenders of Account Values
attributable to premium payments may be subject to a Surrender Charge
("charge"), and the due and unpaid tax charges.
For Surrender Charge purposes, during the first ten policy years, all surrenders
will be first from premium payments and then from earnings. If an amount equal
to all premium payments has been surrendered, a charge will not be assessed
against the surrender of the remaining Account Value.
After the ninth Policy Year, all surrenders will be free of Surrender Charges
and due and unpaid tax charges. Only the Annual Maintenance Fee will be
charged.
No Surrender Charges will be assessed in the event the policy terminates due to
the death of the Insured, or upon the exercise of the Annual Withdrawal Amount.
POLICY LOANS
GENERAL
At any time while this policy is in force, You may borrow against this policy by
assigning it to Us as sole security.
LOAN AMOUNTS
Any new loan taken may not exceed 90% of the Cash Value less 100% of existing
loans, if any, on the date We grant a loan. Loan amounts will be subject to a
minimum of $25.00. Before advancing the loan amount, We may withhold an amount
sufficient to pay interest on total loans to the end of the Policy Year and any
Monthly Deduction Amounts due on or before the next Policy Anniversary. All
loan amounts will be transferred from the Sub-Accounts to the Loan Account.
Unless You specify otherwise, the amounts will be transferred on a Pro-Rata
Basis.
If total loans equals or exceeds the Cash Value, this policy will terminate 61
days after We have mailed notice to Your last known address and that of any
assignee of record. If sufficient loan repayment is not made by the end of this
Grace Period, the policy will end without value.
CREDITED INTEREST
Except for Preferred Loans described below, the Loan Account will be credited
with interest at a rate equal to the Policy Loan Rate applicable to that
Indebtedness, minus 2%.
VL-ALPINE SAMPLE Page 14 PRINTED IN U.S.A.
POLICY LOANS (CONTINUED)
PREFERRED LOAN
If the Cash Value exceeds the total of all premiums paid since issue, a
Preferred Loan is available. The amount available for a Preferred Loan is the
amount by which the Cash Value exceeds total premiums paid. The amount of the
Loan Account which equals a Preferred Loan will be credited with interest at a
rate equal to the Policy Loan Rate. The amount of loans that qualifies as a
Preferred Loan is determined on each Monthly Activity Date.
LOAN REPAYMENTS
All or part of a loan may be repaid at any time that:
(a) the policy is in force; and
(b) the Insured is alive.
However, each payment must be at least $50 or 100% of the outstanding loan
balance.
The amount of a loan repayment will be deducted from the Loan Account and will
be allocated among the Sub-Accounts in the same percentage as premiums are
allocated.
LOAN INTEREST
Loan interest will accrue daily by a rate not to exceed the Policy Loan Interest
Rate shown on Page 4. The difference between the value of the Loan Account and
the Indebtedness will be transferred on a Pro-Rata Basis from the Sub-Accounts
to the Loan Account on each Monthly Activity Date.
PAYMENTS BY US
GENERAL
We will pay Death Proceeds, Cash Surrender Values, partial surrenders, and loan
amounts attributable to the Sub-Accounts within seven days after We receive all
the information needed to process the payment unless:
(a) the New York Stock Exchange is closed on other than customary weekend and
holiday closings or trading on the New York Stock Exchange is restricted as
determined by the Securities and Exchange Commission (SEC); or
(b) an emergency exists, as determined by the SEC, as a result of which
disposal of securities is not reasonably practicable to determine the value
of the Sub-Accounts; or
(c) the SEC, by order, permits postponement for the protection of policy
Owners.
TAXATION
We do not expect to incur any federal, state, or local income tax on the
earnings or realized capital gains attributable to the Separate Account. Based
upon these expectations, no charge is currently being made to the Separate
Account for federal, state, or local income taxes. If We incur income taxes
attributable to the Separate Account or determine that such taxes will be
incurred, We may assess a charge for taxes against the policy in the future.
VL-ALPINE SAMPLE Page 15 PRINTED IN U.S.A.
THE CONTRACT
ENTIRE CONTRACT
The entire contract consists of this policy and the application, a copy of which
is attached. The contract is made in consideration of the application and the
payment of the Initial Premium. We will not use any statement to cancel this
policy or to defend a claim under it, unless that statement is contained in an
attached written application. All statements in the application will, in the
absence of fraud, be deemed representations and not warranties.
MODIFICATION
The only way this contract may be modified is by a written agreement signed by
Our President, or one of Our Vice Presidents, Secretaries, or Assistant
Secretaries.
NON-PARTICIPATION
This policy is non-participating. It does not share in Our surplus earnings, so
You will receive no dividends under it.
MISSTATEMENT OF AGE AND/OR SEX
On the date of death of the Insured, the Death Benefit will be reduced or
increased by the difference between the Death Benefit at the misstated age
and/or sex of the Insured and the Death Benefit that would have been provided by
the last Cost of Insurance Charge at the correct age and/or sex of the Insured,
if:
(a) the age of the Insured is misstated; or
(b) the sex of an Insured is misstated.
SUICIDE
If, within two years from the Date of Issue, the Insured dies by suicide, while
sane or insane, Our liability will be limited to the premiums paid less
Indebtedness and less any partial surrenders.
If, within two years from the effective date of any increase the Face Amount for
which evidence of insurability was obtained, the Insured dies by suicide, while
sane or insane, Our liability with respect to the increase in the Face Amount
will be limited to the additional premium paid which increased the Face Amount.
INCONTESTABILITY
We cannot contest this policy after it has been in force, during the Insured's
lifetime, for two years from its Date of Issue.
Any increase in the Face Amount for which evidence of insurability was obtained,
will be incontestable only after the increase has been in force, during the
Insured's lifetime, for two years from the effective date of the increase.
SEPARATE ACCOUNTS
We will have exclusive and absolute ownership and control of the assets of Our
Separate Accounts. The assets of a Fund will be available to cover the
liabilities of Our general Account only to the extent that those assets exceed
the liabilities of that Separate Account arising under the variable life
insurance contracts supported by that Separate Account. The assets of a Fund
will be valued at least as often as any contract benefits vary, but at least
monthly. Our determination of the value of an Accumulation Unit by the method
described in this policy will be conclusive. The investment policy of the
Separate Account will not be changed without the approval of the Insurance
Commissioner of the state where this policy is issued for delivery.
VL-ALPINE SAMPLE Page 16 PRINTED IN U.S.A.
THE CONTRACT (CONTINUED)
REPORTS TO THE OWNER
We will send You a report at least once each Policy Year showing:
(a) the current Account Value, Cash Value, and Face Amount;
(b) the premiums paid, Monthly Deduction Amounts, and loans since the last
report;
(c) the amount of any Indebtedness;
(d) notifications required by the provisions of this policy; and
(e) any other information required by the Insurance Department of the state
where this policy was delivered.
We will send You any shareholder reports of the Funds and any other notices,
reports, or documents required by law.
OWNERSHIP AND BENEFICIARY
CHANGE OF OWNER OR BENEFICIARY
The Owner and Beneficiary will be those named in the application until You
change them. To change the Owner or Beneficiary, notify Us In Writing while the
Insured is alive. After We receive written notice, the change will be effective
as of the date You signed such notice, whether or not the Insured is living when
We receive it. However, the change will be subject to any payment We made or
actions We may have taken before We received the request.
ASSIGNMENT
You may assign this policy. Until You notify Us In Writing, no assignment will
be effective against Us. We are not responsible for the validity of any
assignment.
VOTING RIGHTS
The Company shall notify the Owner of any Fund shareholders meeting at which the
shares held for the Owner's Account may be voted and shall also send proxy
materials and a form of instruction by means of which the Owner can instruct the
Company with respect to the voting of the shares held for the Owner's Account.
In connection with the voting of Fund shares held by it, the Company shall
arrange for the handling and tallying of proxies received from Owners. The
Company will vote the Fund shares held by it in accordance with the instructions
received from the Owners having the right to give voting instructions. If an
Owner desires to attend any meeting which shares held for the Owner's benefit
may be voted, the Owner may request the Company to furnish a proxy or otherwise
arrange for the exercise of voting rights with respect to the Fund shares held
for such Owner's Account.
In the event that the Owner gives no instructions or leaves the manner of voting
discretionary, the Company will vote such shares of the appropriate Fund in the
same proportion as shares of that Fund for which instructions have been
received. Also, the Company will vote the Fund shares in this proportionate
manner which are held by the Company for its own Account.
SUBSTITUTION
The Company reserves the right to substitute the shares of another registered
investment company for the shares of any Fund already purchased or to be
purchased in the future by the Separate Account provided that the substitution
has been approved by the Securities and Exchange Commission.
VL-ALPINE SAMPLE Page 17 PRINTED IN U.S.A.
OWNERSHIP AND BENEFICIARY (CONTINUED)
CHANGE IN THE OPERATION OF THE SEPARATE ACCOUNT
At the Company's election and subject to any necessary vote by persons having
the right to give instructions with respect to the voting of the Fund shares
held by the Sub-Accounts, the Variable Account may be operated as a management
company under the Investment Company Act of 1940 or it may be deregistered under
the Investment Company Act of 1940 in the event registration is no longer
required. Deregistration of the Variable Account requires an order by the
Securities and Exchange Commission.
OWNER'S RIGHTS
While the Insured is alive and no Beneficiary is irrevocably named, You may:
(a) exercise all the rights and options that this policy provides or that We
permit;
(b) assign this policy; and
(c) agree with Us to any change to this policy.
NO NAMED BENEFICIARY
If no named Beneficiary survives the Insured, then, unless this policy provides
otherwise:
(a) You will be the Beneficiary; or
(b) if You are the Insured, Your estate will be the Beneficiary.
EXCHANGE OPTION
If this policy is in effect, You may exchange it any time during the 24 months
following its Date of Issue for a permanent life insurance contract offered by
Us on the life of the Insured without evidence of insurability.
The new policy will be issued by Us:
1. with an amount at risk which equals or is less than the amount at risk in
effect on the Exchange Date;
2. with premiums based on the same risk classification as this policy.
This exchange is subject to adjustments in payments and Account Values to
reflect variances, if any, in the payments and Account Values under this policy
and the new policy.
INCOME SETTLEMENT OPTIONS
GENERAL
The Cash Surrender Value or the Death Proceeds may be paid in a lump sum or may
be applied to one of the following payment options. The minimum amount that may
be placed under a payment option is $5,000, unless We consent to a lesser
amount. Under Options 2, 3, and 4, no surrender or partial withdrawals are
permitted after payments commence. Full surrenders or partial withdrawals may
be made from Options 1 or 6. Only a full surrender is allowed from Option 5.
VL-ALPINE SAMPLE Page 18 PRINTED IN U.S.A.
INCOME SETTLEMENT OPTIONS (CONTINUED)
We will pay interest of at least 3 1/2% per year on the Death Proceeds from the
date of the Insured's death to the date payment is made or an Income Settlement
Option is elected. At such time the proceeds are not subject to the investment
experience of a Separate Account.
If any payee is a corporation, partnership, association, assignee, or fiduciary,
an option may be chosen only with Our consent.
The following options are available:
OPTION 1: INTEREST INCOME
This option offers payments of interest, at the rates We declare, on the amount
applied under this option. The interest rate will never be less than 3 1/2% per
year.
OPTION 2: LIFE ANNUITY
A life annuity is an annuity payable during the lifetime of the payee and
terminating with the last payment preceding the death of the payee. This option
offers the largest payment amount of any of the life annuity options since there
is no guarantee of a minimum number of payments nor a provision for a Death
Benefit payable to a Beneficiary.
It would be possible under this option for a payee to receive only one annuity
payment if he died prior to the due date of the second annuity payment, two if
he or she died before the date of the third annuity payment, etc.
OPTION 3: LIFE ANNUITY WITH 120, 180, OR 240 MONTHLY PAYMENTS CERTAIN
This annuity option is an annuity payable monthly during the lifetime of the
payee with the provision that payments will be made for a minimum of 120, 180,
or 240 months, as elected. If, at the death of the payee, payments have been
made for less than the minimum elected number of months, then the present value
as of the date of the payee's death, of any remaining guaranteed payments will
be paid in one sum to the Beneficiaries designated unless other provisions have
been made and approved by Us.
OPTION 4: JOINT AND LAST SURVIVOR ANNUITY
An annuity payable monthly during the joint lifetime of the payee and a
designated second person, and thereafter during the remaining lifetime of the
survivor, ceasing with the last payment prior to the death of the survivor.
Based on the options currently offered by Us, the payee may elect that the
payment to the survivor be less than the payment made during the joint lifetime
of the payee and a designated second person.
It would be possible under this option for a payee and designated second person
to receive only one payment in the event of the common or simultaneous death of
the parties prior to the due date for the second payment and so on.
OPTION 5: PAYMENTS FOR A DESIGNATED PERIOD
An amount payable monthly for the number of years selected which may be from 5
to 30 years. Under this option, You may, at any time, request a full surrender
and receive, within seven days, the Cash Surrender Value.
VL-ALPINE SAMPLE Page 19 PRINTED IN U.S.A.
INCOME SETTLEMENT OPTIONS (CONTINUED)
In the event of the payee's death prior to the end of the designated period, the
present value as of the date of the payee's death, of any remaining guaranteed
payments will be paid in one sum to the Beneficiary or Beneficiaries designated
unless other provisions have been made and approved by Us.
Option 5 is an option that does not involve life contingencies.
OPTION 6: DEATH PROCEEDS REMAINING WITH THE COMPANY
Proceeds from the Death Benefit may be left with the Company. These proceeds
will remain in the Sub-Accounts to which they were allocated at the time of
death unless the Beneficiary elects to reallocate them. Full or partial
withdrawals may be made at any time.
ALLOCATION OF ANNUITY
If an annuity option is effected, unless otherwise specified, the Cash Surrender
Value or Death Proceeds held in the Sub-Accounts will be applied to provide a
variable annuity based on the Pro-Rata amount in the various Sub-Accounts.
Fixed annuity options are also available.
VARIABLE ANNUITY AND FIXED DOLLAR ANNUITY
VARIABLE ANNUITY - A variable annuity is an annuity with payments increasing
or decreasing in amount in accordance with the net investment results of the
Sub-Accounts. After the first monthly payment for a variable annuity has
been determined by using the appropriate Variable Payment Annuity Tables, a
number of Sub-Account Annuity Units is determined by dividing that first
monthly payment by the appropriate Sub-Account Annuity Unit value on the
effective date of the annuity payments. The Annuity Unit value for each
Sub-Account will depend on the investment experience of the applicable Funds.
Once variable annuity payments have begun, the number of Annuity Units remains
fixed with respect to a particular Sub-Account. If the Owner elects that
continuing annuity payments be based on a different Sub-Account, the number will
change effective with that election but will remain fixed in number following
such election.
The dollar amount of the second and subsequent variable annuity payments is not
predetermined and may increase or decrease from month to month. The actual
amount of each variable annuity payment after the first is determined by
multiplying the number of Sub-Account Annuity Units by the Sub-Account Annuity
Unit value. The Sub-Account Annuity Unit value will be determined no earlier
than the fifth Valuation Day preceding the date the annuity payment is due.
FIXED DOLLAR ANNUITY - A fixed dollar annuity is an annuity with payments which
remain fixed as to dollar amount throughout the payment period. Fixed annuity
payments are determined by multiplying the amount applied to the annuity by a
rate to be determined by Us which is not less than the rate specified in the
Fixed Payment Annuity Tables. The annuity payment will remain level for the
duration of the annuity.
DESCRIPTION OF TABLES
The attached tables show the minimum dollar amount of the first monthly payments
for each $1,000 applied under the options. Under Option 2 and 3, the amount of
each payment will depend upon the age and sex of the payee at the time the first
payment is due. Under Option 4, the amount of each payment will depend upon the
sex of both payees and their ages at the time the first payment is due.
VL-ALPINE SAMPLE Page 20 PRINTED IN U.S.A.
INCOME SETTLEMENT OPTIONS (CONTINUED)
The variable payment annuity tables for Options 2, 3, and 4 are based on the
1983a Individual Annuity Mortality Table projected to the year 2000 using
Projection Scale G and an interest rate of 5% per year. The table for Option 5
is based on an interest rate of 5% per year.
The fixed annuity payment tables for Options 2, 3, and 4 are based on the 1983a
Individual Annuity Mortality Table projected to the year 2000 using Projection
Scale G and an interest rate of 3% per year. The table for Option 5 is based on
an interest rate of 3% per year.
The annuity tables for the Second through Fourth Options are age dependent. If
the first annuity payment is made before the year 2000, the amount of that
payment will be based on the Annuitant's then attained age (i.e., age as of last
birthday). For annuity payments beginning in the year 2000 or later, the amount
of the first payment will be based on an age a specified number of years younger
than the Annuitant's then attained age. The age setback is as follows:
DATE OF FIRST PAYMENT AGE SETBACK
2000 - 2009 1 year
2010 - 2019 3 years
2010 - 2029 4 years
2030 - 2039 5 years
2040 or later 6 years
VL-ALPINE SAMPLE Page 21 PRINTED IN U.S.A.
VARIABLE PAYMENT ANNUITY TABLES
AMOUNT OF FIRST MONTHLY PAYMENT
FOR EACH $1,000 APPLIED TO
VARIABLE PAYMENT ANNUITIES
Second and subsequent annuity payments, when based on the investment experience
of a Separate Account, are variable and are not guaranteed as to fixed dollar
amount.
SINGLE LIFE ANNUITIES
MALE PAYEE FEMALE PAYEE
MONTHLY PAYMENTS GUARANTEED MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240 NONE 120 180 240
35 $4.68 $4.67 $4.66 $4.64 $4.52 $4.52 $4.51 $4.50
40 4.86 4.85 4.82 4.79 4.65 4.65 4.64 4.62
45 5.10 5.07 5.03 4.97 4.83 4.82 4.80 4.77
50 5.41 5.35 5.28 5.20 5.06 5.04 5.01 4.97
51 5.48 5.41 5.34 5.24 5.12 5.09 5.06 5.01
52 5.55 5.48 5.40 5.30 5.17 5.14 5.11 5.05
53 5.63 5.55 5.46 5.35 5.23 5.20 5.16 5.10
54 5.71 5.63 5.53 5.40 5.30 5.26 5.22 5.15
55 5.80 5.70 5.60 5.45 5.37 5.33 5.28 5.20
56 5.89 5.79 5.67 5.51 5.44 5.40 5.34 5.26
57 5.99 5.88 5.74 5.57 5.52 5.47 5.40 5.31
58 6.10 5.97 5.82 5.62 5.60 5.54 5.47 5.37
59 6.21 6.07 5.90 5.68 5.69 5.62 5.54 5.43
60 6.33 6.17 5.98 5.74 5.79 5.71 5.62 5.49
61 6.46 6.28 6.07 5.80 5.89 5.80 5.70 5.55
62 6.60 6.40 6.16 5.86 6.00 5.90 5.78 5.61
63 6.75 6.52 6.25 5.91 6.11 6.00 5.86 5.67
64 6.91 6.64 6.34 5.97 6.23 6.11 5.95 5.74
65 7.09 6.78 6.43 6.02 6.37 6.22 6.04 5.80
66 7.27 6.91 6.52 6.08 6.51 6.34 6.14 5.87
67 7.47 7.06 6.62 6.12 6.66 6.47 6.24 5.93
68 7.68 7.21 6.71 6.17 6.82 6.60 6.34 5.99
69 7.91 7.36 6.81 6.22 7.00 6.74 6.44 6.05
70 8.15 7.52 6.90 6.26 7.19 6.89 6.54 6.11
75 9.65 8.35 7.30 6.41 8.41 7.74 7.06 6.34
80 11.78 9.16 7.59 6.48 10.24 8.70 7.46 6.46
85 14.73 9.80 7.74 6.51 13.00 9.55 7.69 6.50
90 18.62 10.21 7.80 6.51 17.00 10.10 7.79 6.51
JOINT AND LAST SURVIVOR ANNUITY
AGE OF AGE OF FEMALE PAYEE
MALE
PAYEE 35 40 45 50 55 60 65 70 75 80 85 90
35 $4.38 $4.42 $4.47 $4.52 $4.56 $4.59 $4.62 $4.64 $4.65 $4.66 $4.67 $4.68
40 4.41 4.47 4.54 4.60 4.66 4.71 4.75 4.79 4.81 4.83 4.85 4.85
45 4.43 4.51 4.60 4.68 4.77 4.85 4.91 4.97 5.01 5.05 5.07 5.08
50 4.45 4.55 4.65 4.76 4.88 5.00 5.10 5.19 5.26 5.31 5.35 5.37
55 4.47 4.57 4.70 4.84 4.99 5.15 5.30 5.44 5.56 5.65 5.71 5.75
60 4.49 4.60 4.73 4.90 5.09 5.30 5.52 5.73 5.92 6.07 6.17 6.24
65 4.50 4.61 4.76 4.95 5.17 5.43 5.73 6.04 6.34 6.59 6.79 6.91
70 4.50 4.63 4.78 4.98 5.23 5.54 5.92 6.34 6.79 7.21 7.55 7.80
75 4.51 4.64 4.80 5.01 5.28 5.63 6.07 6.60 7.22 7.87 8.46 8.91
80 4.51 4.64 4.81 5.03 5.31 5.69 6.18 6.81 7.60 8.52 9.45 10.24
85 4.52 4.65 4.82 5.04 5.34 5.73 6.25 6.96 7.89 9.07 10.40 11.67
90 4.52 4.65 4.82 5.05 5.35 5.75 6.30 7.05 8.09 9.49 11.21 13.03
PAYMENTS FOR A DESIGNATED PERIOD
AMOUNT OF AMOUNT OF AMOUNT OF AMOUNT OF AMOUNT OF AMOUNT OF
NO. OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
5 $18.74 10 $10.51 15 $7.82 20 $6.51 25 $5.76 30 $5.28
6 15.99 11 9.77 16 7.49 21 6.33 26 5.65
7 14.02 12 9.16 17 7.20 22 6.17 27 5.54
8 12.56 13 8.64 18 6.94 23 6.02 28 5.45
9 11.42 14 8.20 19 6.71 24 5.88 29 5.36
The monthly payment for any combination of ages not shown will be quoted upon
request.
VL-ALPINE SAMPLE Page 22 PRINTED IN U.S.A.
FIXED PAYMENT ANNUITY TABLES
AMOUNT OF MONTHLY PAYMENTS
FOR EACH $1,000 APPLIED TO
FIXED PAYMENT ANNUITIES
Payments are fixed and are guaranteed as to fixed dollar amount.
SINGLE LIFE ANNUITIES
MALE PAYEE FEMALE PAYEE
MONTHLY PAYMENTS GUARANTEED MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240 NONE 120 180 240
35 $3.41 $3.40 $3.39 $3.38 $3.23 $3.23 $3.22 $3.22
40 3.61 3.60 3.58 3.56 3.39 3.38 3.38 3.37
45 3.87 3.85 3.82 3.77 3.59 3.58 3.57 3.55
50 4.19 4.15 4.10 4.03 3.84 3.83 3.81 3.77
51 4.27 4.22 4.17 4.08 3.90 3.89 3.86 3.82
52 4.34 4.29 4.23 4.14 3.97 3.95 3.92 3.88
53 4.43 4.37 4.30 4.20 4.03 4.01 3.98 3.93
54 4.51 4.45 4.37 4.26 4.10 4.08 4.04 3.99
55 4.60 4.54 4.45 4.32 4.18 4.15 4.11 4.04
56 4.70 4.62 4.53 4.39 4.25 4.22 4.18 4.11
57 4.80 4.72 4.61 4.45 4.34 4.30 4.25 4.17
58 4.91 4.82 4.69 4.51 4.42 4.38 4.32 4.23
59 5.03 4.92 4.78 4.58 4.52 4.47 4.40 4.30
60 5.15 5.03 4.87 4.64 4.61 4.56 4.48 4.37
61 5.28 5.14 4.96 4.71 4.72 4.66 4.57 4.44
62 5.42 5.26 5.06 4.78 4.83 4.76 4.66 4.51
63 5.57 5.39 5.16 4.84 4.95 4.86 4.75 4.58
64 5.74 5.52 5.26 4.90 5.07 4.98 4.85 4.65
65 5.91 5.66 5.36 4.96 5.21 5.10 4.95 4.72
66 6.10 5.81 5.46 5.02 5.35 5.22 5.05 4.79
67 6.29 5.96 5.56 5.08 5.51 5.36 5.16 4.86
68 6.50 6.11 5.66 5.13 5.67 5.50 5.26 4.93
69 6.73 6.28 5.76 5.18 5.85 5.65 5.37 5.00
70 6.97 6.44 5.86 5.23 6.04 5.80 5.49 5.06
75 8.45 7.32 6.31 5.40 7.26 6.69 6.04 5.32
80 10.55 8.17 6.62 5.48 9.07 7.69 6.48 5.45
JOINT AND LAST SURVIVOR ANNUITY
AGE OF AGE OF FEMALE PAYEE
MALE
PAYEE 35 40 45 50 55 60 65 70 75 80
35 $3.07 $3.14 $3.20 $3.25 $3.30 $3.33 $3.35 $3.37 $3.39 $3.40
40 3.11 3.20 3.28 3.36 3.42 3.48 3.52 3.55 3.57 3.59
45 3.15 3.25 3.36 3.46 3.56 3.64 3.71 3.76 3.80 3.83
50 3.17 3.29 3.42 3.56 3.69 3.82 3.92 4.01 4.08 4.12
55 3.19 3.32 3.47 3.64 3.81 3.99 4.16 4.29 4.40 4.48
60 3.20 3.34 3.51 3.70 3.92 4.15 4.39 4.61 4.79 4.93
65 3.21 3.36 3.54 3.75 4.00 4.29 4.61 4.94 5.24 5.48
70 3.22 3.37 3.56 3.78 4.06 4.40 4.80 5.25 5.70 6.12
75 3.22 3.38 3.57 3.81 4.11 4.48 4.95 5.51 6.15 6.80
80 3.23 3.38 3.58 3.82 4.14 4.54 5.05 5.71 6.52 7.45
PAYMENTS FOR A DESIGNATED PERIOD
AMOUNT OF AMOUNT OF AMOUNT OF AMOUNT OF AMOUNT OF AMOUNT OF
NO. OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
5 $17.91 10 $9.61 15 $6.87 20 $5.51 25 $4.71 30 $4.18
6 15.14 11 8.86 16 6.53 21 5.32 26 4.59
7 13.16 12 8.24 17 6.23 22 5.15 27 4.47
8 11.68 13 7.71 18 5.96 23 4.99 28 4.37
9 10.53 14 7.26 19 5.73 24 4.84 29 4.27
The monthly payment for any combination of ages not shown will be quoted upon
request.
VL-ALPINE SAMPLE Page 23 PRINTED IN U.S.A.
ALPINE LIFE INSURANCE COMPANY
HARTFORD, CONNECTICUT 06104-2999
MODIFIED SINGLE PREMIUM VARIABLE
LIFE INSURANCE POLICY
VL-ALPINE SAMPLE PRINTED IN U.S.A.
