THE INSURED XXXXXXX XXX VARIABLE
POLICY OWNER XXXXXXX XXX LIFE INSURANCE
FACE AMOUNT $100,000 POLICY
POLICY NUMBER SPECIMEN
EQUITABLE
VARIABLE LIFE
INSURANCE COMPANY
[EVLICO LOGO]
EQUITABLE VARIABLE LIFE INSURANCE COMPANY
A Stock Life Insurance Company
Agrees
o To pay the insurance benefits of this policy to the Beneficiary upon
receiving proof of the Insured's death; and
o To provide you (the policy Owner) with the other rights and benefits of this
policy.
These agreements are subject to the provisions of this policy.
THE DEATH BENEFIT OF THIS POLICY DURING THE FIRST POLICY YEAR WILL EQUAL THE
FACE AMOUNT SHOWN ON PAGE 3. THEREAFTER, IT MAY INCREASE OR DECREASE EACH YEAR
AS DESCRIBED ON PAGE 5 DEPENDING UPON SEPARATE ACCOUNT INVESTMENT EXPERIENCE,
BUT SHALL NEVER BE LESS THAN THE FACE AMOUNT.
THE CASH VALUE OF THIS POLICY WILL VARY FROM DAY TO DAY. IT MAY INCREASE OR
DECREASE DEPENDING UPON SEPARATE ACCOUNT INVESTMENT EXPERIENCE.
Premiums are shown on page 3 and are fixed as to amount. They will not vary with
separate account investment experience.
RIGHT TO EXAMINE POLICY. You may examine this policy and if for any reason you
are not satisfied with it, you may cancel it by returning the policy with a
written request for cancellation to our Administrative Office by the later of:
(a) the 10th day after you receive it; or (b) the 45th day after Part 1 of the
application was signed. If you do this, we will refund the premium that was
paid.
SPECIMEN Secretary SPECIMEN President
Limited Payment Life Plan -- LEVEL FACE AMOUNT. Variable
insurance payable upon death. Guaranteed Minimum Death
Benefit. Fixed premiums payable for Premium Period shown on
page 3 or until earlier death. Non-Participating. Investment
experience reflected in benefits. Investment options described
on page 6.
No.81-01
[EVLICO LOGO]
0000 Xxxxxx xx xxx Xxxxxxxx, Xxx Xxxx, XX 00000
Contents
Insurance benefits 2
Policy owner and beneficiary 4
Premiums, grace, lapse, reinstatement 4
Death Benefit 5
Cash Value 5
Loans 5
The Separate Accounts 6
Investment Options,
allocations, transfers 6
Options on Lapse 7
Exchange of Policy 7
General Provisions 8
Payment Options 9
Basis of Values 11
(Net rates of return, variable adjustment amount, benefit base, calculation of
cash values)
Any additional benefit riders and a copy of the application are included in this
policy after page 12.
IN THIS POLICY:
"We," "our" and "us" mean Equitable Variable Life Insurance Company.
"You" and "your" mean the Owner of the policy at the time an Owner's right is
exercised.
ADMINISTRATIVE OFFICE
The address of our Administrative Office is shown on page 3. You should send
premiums and requests to that address unless instructed otherwise.
INSURANCE BENEFITS
The insurance benefits we pay at the Insured's death include:
o the Death Benefit described on page 5;
o plus any additional benefits due from riders to this policy;
o plus or minus any adjustment for the last premium;
o minus any loan (and loan interest) on the policy.
We will add interest to the resulting amount for the period from the date of
death to the date of payment. It will be computed at the interest rate we are
then paying under the Deposit Option on page 9.
We will pay these benefits only if premiums have been paid as called for by this
policy. However, even if premiums have been discontinued we may still pay
certain benefits. See Options on Lapse, page 7.
Payment of these benefits may also be affected by other provisions of this
policy. See the Suicide Exclusion, Incontestability and Age and Sex clauses on
page 8. Special exclusions or limitations (if any) are listed on page 3
No. 81-01
Page 2
THE INSURED XXXXXXX XXX REGISTER DATE JUN 1, 1981
POLICY OWNER XXXXXXX XXX DATE OF ISSUE JUN 1, 1981
FACE AMOUNT $100,000 ISSUE AGE, SEX 35, MALE
POLICY NUMBER SPECIMEN BENEFICIARY XXXXXXXX X. XXX
********************** BENEFITS AND PREMIUMS TABLE *****************************
BENEFITS ANNUAL PREMIUM PREMIUM PERIOD
LIFE INSURANCE - VARIABLE $1,659.00 40 YEARS
THE FIRST PREMIUM IS $1,659.00 AND IS DUE ON OR BEFORE DELIVERY OF THE POLICY.
SUBSEQUENT PREMIUMS ARE DUE ON JUN 01, 1982 AND EVERY 12 MONTHS THEREAFTER
DURING THE PREMIUM PERIOD IN ACCORDANCE WITH THE ABOVE PREMIUM TABLE.
********************** TABLE OF NET ANNUAL PREMIUMS ****************************
BEGINNING OF NET ANNUAL
POLICY YEAR PREMIUM
1 $ 752.00
2 - 4 1,455.00
5 - 40 1,526.00
********************INVESTMENT ALLOCATION OF NET ANNUAL PREMIUMS ***************
SEPARATE ACCOUNT I 50%
SEPARATE ACCOUNT II 50%
******ADMINISTRATIVE OFFICE: EQUITABLE VARIABLE LIFE INSURANCE COMPANY *********
SPECIMEN REGIONAL SERVICE CENTER
000 XXXXXXXX XX.
CITY, STATE 10001
V81-01-3
PAGE 3
THE INSURED XXXXXXX XXX REGISTER DATE JUN 1, 1981
FACE AMOUNT $100,000 DATE OF ISSUE JUN 1, 1981
POLICY NUMBER SPECIMEN ISSUE AGE, SEX 35, MALE
************************* TABULAR CASH VALUES **********************************
THE CASH VALUE OF THIS POLICY MAY BE GREATER OR LESS THAN AMOUNTS SHOWN
SEE PAGE 5 FOR CASH VALUE PROVISION
INTERIM TABULAR CASH VALUES IN FIRST POLICY YEAR
INTERIM INTERIM INTERIM
END OF TABULAR END OF TABULAR END OF TABULAR
POLICY CASH POLICY CASH POLICY CASH
MONTH VALUES MONTH VALUES MONTH VALUES
1 $ 0 5 $ 0 9 $278
2 0 6 16 10 366
3 0 7 104 11 452
4 0 8 192 12 540
TABULAR CASH VALUES AT ENDS OF POLICY YEARS*
END OF TABULAR END OF TABULAR END OF TABULAR
POLICY CASH POLICY CASH POLICY CASH
YEAR VALUES YEAR VALUES YEAR VALUES
1 $ 540 9 $12,069 17 $26,057
2 1,808 10 13,701 18 27,941
3 3,114 11 15,368 19 29,851
4 4,456 12 17,070 20 31,788
5 5,907 13 18,806 AGE 60 41,808
6 7,393 14 20,574 AGE 62 45,947
7 8,916 15 22,373 AGE 65 52,277
8 10,474 16 24,201 AGE 70 63,165
* VALUES NOT SHOWN WILL BE FURNISHED ON REQUEST.
V81-01-3A
PAGE 3A
TABLE OF NET SINGLE PREMIUMS
For $1.00 of Variable Adjustment Amount or Paid-Up Whole Life Insurance. Values
shown are applicable on policy anniversaries. The net single premium as of a
date during a policy year shall be determined by interpolation between the
values applicable on the immediately preceding and immediately following
anniversaries.
Age of Age of Age of Age of Age of
Insured Net Insured Net Insured Net Insured Net Insured Net
(Nearest Single (Nearest Single (Nearest Single (Nearest Single (Nearest Single
Birthday) Premium Birthday) Premium Birthday) Premium Birthday) Premium Birthday) Premium
--------- ------- --------- ------- --------- ------- --------- ------- --------- -------
MALE INSURED
------------
1 $.09647 21 $.17350 41 $.32865 61 $.57583 81 $.81560
2 .09871 22 .17890 42 .33918 62 .58929 82 .82496
3 .10126 23 .18450 43 .34995 63 .60272 83 .83394
4 .10397 24 .19031 44 .36096 64 .61610 84 .84259
5 .10685 25 .19635 45 .37222 65 .62940 85 .85096
6 .10990 26 .20263 46 .38370 66 .64260 86 .85909
7 .11312 27 .20915 47 .39541 67 .65565 87 .86704
8 .11650 28 .21591 48 .40733 68 .66851 88 .87488
9 .12005 29 .22293 49 .41945 69 .68114 89 .88268
10 .12377 30 .23021 50 .43176 70 .69350 90 .89050
11 .12764 31 .23775 51 .44424 71 .70559 91 .89841
12 .13166 32 .24556 52 .45688 72 .71744 92 .90648
13 .13581 33 .25366 53 .46968 73 .72908 93 .91479
14 .14008 34 .26205 54 .48261 74 .74057 94 .92350
15 .14447 35 .27073 55 .49568 75 .75194 95 .93291
16 .14897 36 .27970 56 .50886 76 .76319 96 .94339
17 .15360 37 .28896 57 .52214 77 .77427 97 .95520
18 .15835 38 .29850 58 .53550 78 .78512 98 .96810
19 .16323 39 .30830 59 .54892 79 .79566 99 .98063
20 .16828 40 .31835 60 .56237 80 .80583 100 1.00000
FEMALE INSURED
--------------
1 $.08586 21 $.15360 41 $.28896 61 $.52214 81 $.77427
2 .08774 22 .15835 42 .29850 62 .53550 82 .78512
3 .08993 23 .16323 43 .30830 63 .54892 83 .79566
4 .09228 24 .16828 44 .31835 64 .56237 84 .80583
5 .09478 25 .17350 45 .32865 65 .57583 85 .81560
6 .09743 26 .17890 46 .33918 66 .58929 86 .82496
7 .10023 27 .18450 47 .34995 67 .60272 87 .83394
8 .10318 28 .19031 48 .36096 68 .61610 88 .84259
9 .10629 29 .19635 49 .37222 69 .62940 89 .85096
10 .10953 30 .20263 50 .38370 70 .64260 90 .85909
11 .11290 31 .20915 51 .39541 71 .65565 91 .86704
12 .11641 32 .21591 52 .40733 72 .66851 92 .87488
13 .12004 33 .22293 53 .41945 73 .68114 93 .88268
14 .12379 34 .23021 54 .43176 74 .69350 94 .89050
15 .12764 35 .23775 55 .44424 75 .70559 95 .89841
16 .13166 36 .24556 56 .45688 76 .71744 96 .90648
17 .13581 37 .25366 57 .46968 77 .72908 97 .91479
18 .14008 38 .26205 58 .48261 78 .74057 98 .92350
19 .14447 39 .27073 59 .49568 79 .75194 99 .93291
20 .14897 40 .27970 60 .50886 80 .76319 100 .94339
101 .95520
102 .96810
103 .98063
104 1.00000
V81-01-3B
Page 3B
POLICY OWNER AND BENEFICIARY
OWNER. The Owner of this policy is the Insured unless otherwise stated in the
application, or later changed. As Owner, you can exercise all the rights in this
policy while the Insured is living. You do not need the consent of anyone who
has only a conditional or future ownership interest in this policy.
BENEFICIARY. The Beneficiary is as stated in the application, unless later
changed. If two or more persons are named, those surviving the Insured will
share equally unless otherwise stated.
We will pay any benefit for which there is no stated Beneficiary living at the
death of the Insured to the children of the insured who then survive, in equal
shares. If none survive, we will pay the estate of the Insured.
CHANGES. While the Insured is living, you may change the Owner or Beneficiary by
written notice in a form satisfactory to us. The change will take effect on the
date you sign the notice, except that it will not apply to any payment we make
or other action we take before we receive the notice at our Administrative
Office. If you change the Beneficiary, any previous arrangement you made under
the Payment Options provision on page 9 is cancelled.
ASSIGNMENT. You may assign this policy, but we will not be bound by an
assignment unless it is in writing and we have received it at our Administrative
Office. Your rights and those of any other person referred to in this policy
will be subject to the assignment. We assume no responsibility for the validity
of any assignment.
PREMIUMS
AMOUNTS AND DUE DATES. Page 3 shows the amounts and due dates of premiums and
the period for which they are to be paid. Each premium is payable on or before
its due date at our Administrative Office.
You may write and ask us to change the frequency of premium payment. If we
approve the change, the new premium will be determined on the rate scale for
this policy.
GRACE PERIOD. We allow a grace period of 31 days for payment of each premium,
after the first premium. The insurance will continue during the grace period. If
a premium is paid during the grace period, then all benefits under this policy
will be the same as if such premium had been paid on its due date.
LAPSE. If a premium is not paid by the end of its grace period, the policy will
lapse as of the premium due date. If this occurs, all insurance ends, except as
stated in Options on Lapse on page 7. Additional benefit riders do not continue
beyond the grace period of an unpaid premium.
REINSTATEMENT. You may reinstate this policy within five years after lapse if:
(1) the policy has not been given up for its net cash value; (2) you provide
evidence of insurability satisfactory to us; and (3) you pay the larger of: (a)
all overdue premiums with interest at 6% per year compounded annually; or (b)
110% of the difference between the following Items (i) and (ii). Item (i) is the
excess of the cash value immediately after reinstatement over the cash value
immediately before reinstatement. Item (ii) is any policy loan, and accrued loan
interest, in effect when any option on lapse became effective, with loan
interest to the date of reinstatement.
Upon reinstatement this policy will have the same Benefit Base and the same
Variable Adjustment Amount as to each separate account (as these are determined
in the Variable Adjustment Amount provision on page 11) as if default had not
occurred. Also, upon reinstatement this policy will have a loan equal to the sum
of the following Items (i) and (ii). Item (i) is any loan, and accrued loan
interest, in effect at the date any option on lapse became effective, with loan
interest to the date of reinstatement. Item (ii) is any loan arising after the
date any option on lapse became effective, with loan interest to the date of
reinstatement.
PREMIUM ADJUSTMENT. We will add to the insurance benefits any part of the last
premium paid that applies to a period beyond the policy month in which the
Insured dies. If the Insured dies during the grace period of an unpaid premium,
we will deduct from the benefits the part of the overdue premium for one policy
month.
V81-013-B
Page 4
DEATH BENEFIT
The Death Benefit equals:
o the face amount shown on page 3;
o plus the sum, if positive, of the Variable Adjustment Amounts, for each
separate account under this policy in which you have a cash value, for
the policy year in which the Insured dies.
A description of how the Variable Adjustment Amount for each separate account is
determined is on page 11.
CASH VALUE
You may give up this policy for its net cash value at any time while the Insured
is living. The net cash value is the cash value minus any loan and loan
interest.
We will determine the net cash value on the date we receive your signed request
for it at our Administrative Office. The policy will terminate on the date you
send the policy and the request to us.
CASH VALUE. The cash value of the policy will vary daily with the performance of
the separate accounts under this policy in which you have a cash value. See page
12 for a description of how cash values are determined.
LOANS
You may get a loan on this policy while it has a loan value and it is not being
continued as extended term insurance under the Options on Lapse on page 7. This
policy will be the sole security for the loan.
The amount of the loan may not be more than the loan value. Except when used to
pay premiums, a loan must be at least $100 more than any existing loan and loan
interest. Any existing loan and loan interest will be deducted from the new
loan. We may also deduct any unpaid premium then due.
A loan, whether you repay it or not, will have a permanent effect on the
Variable Adjustment Amounts, Death Benefit and cash value under this policy. It
will have no effect on the amount of the premiums payable under this policy.
We will allocate loans to the separate accounts based on your net cash value in
each separate account as of the dates the loans are made. We will allocate loan
repayments to the separate accounts based on the amount of your outstanding
loans as to each separate account as of the dates the repayments are made. See
page 12 for a description of how the cash value in each separate account is
determined.
LOAN VALUE. If this policy has not lapsed; the loan value is 75% of the policy's
cash value. If this policy has lapsed and is being continued as Reduced Paid-up
Insurance under the Options on Lapse on page 7, the loan value is the cash value
on the next policy anniversary, minus interest at the loan rate to that date.
LOAN INTEREST. Interest on a loan accrues daily, at an annual rate of 5%.
Interest is due on each policy anniversary. If the interest is not paid when
due, it will be added to the loan and bear interest at the loan rate.
When a loan plus loan interest first exceeds the cash value, we will mail to you
and any assignee of record at last known addresses a notice that the policy will
terminate if such excess amount is not repaid within 31 days after we mailed
such notice.
REPAYMENT. You may repay a loan and loan interest in whole or in part at any
time while the Insured is living and this policy is in effect. However, if this
policy has lapsed and you are continuing insurance under one of the Options on
Lapse on page 7, any loan that was deducted in determining the benefit on lapse
may not be repaid unless this policy is reinstated. We will deduct any existing
loan and loan interest from any benefits we pay at the Insured's death.
V81-01-5
Page 5
THE SEPARATE ACCOUNTS
We established and we maintain Separate Accounts I and II under the laws of New
York State. Realized and unrealized gains and losses from the assets of Separate
Accounts I and II are credited or charged against such accounts without regard
to our other income, gains, or losses. Assets are put in Separate Accounts I and
II to support this policy and other variable life insurance policies. Assets may
be put in Separate Accounts I and II for other purposes, but not to support
contracts or policies other than variable life insurance.
We expect the investments in Separate Account I will be, primarily, common
stocks and other equity-type investments. We expect the investments in Separate
Account II will be, primarily, short-term (not to exceed one year) money market
instruments, such as: United States (U.S.) government and U.S. government agency
securities; bank money instruments; time deposits; certificates of deposit; high
grade commercial paper, including master demand notes; and repurchase agreements
covering U.S. government obligations and certificates of deposit. But, we may
invest the assets of Separate Accounts I and II in any legal investments. We
will rely upon our own and outside counsel for advice in this regard.
Instead of making direct investments, we may also operate either Separate
Account I or II as a unit investment trust, or other form. We would invest all
or part of such account's assets in shares or units of a fund. We, an affiliate,
or The Equitable Life Assurance Society of the United States would be the
investment adviser and would invest the assets of the fund as above.
The assets of Separate Accounts I and II are our property. The portion of the
assets of Separate Accounts I and II equal to the reserves and other policy
liabilities with respect to such separate accounts will not be chargeable with
liabilities arising out of any other business we conduct. We may transfer assets
of such separate accounts in excess of such reserves and liabilities to our
general account.
We will value the assets of Separate Accounts I and II on each business day. A
business day is any day on which the New York Stock Exchange is open for
trading.
We have the right to create new separate accounts. We have the right to withdraw
assets of a class of policies to which this policy belongs from either separate
account and put them in another separate account. If we do this, we will
withdraw the same percentage of each investment in such separate account, but
will avoid odd lots and fractions. We also have the right to combine any two or
more separate accounts. The term "Separate Account I" or "Separate Account II"
in this policy shall then refer to any other separate account in which the
assets of a class of policies to which this policy belongs were placed.
We have the right to:
1. register or deregister either separate account under the Investment
Company Act of 1940;
2. run either separate account under the direction of a committee, and to
discharge such committee at any time; and
3. restrict or eliminate any voting rights of policyowners, or other persons
who have voting rights as to either separate account.
CHANCES OF INVESTMENT ADVISER OR INVESTMENT POLICY. Unless otherwise required by
law or regulation, the investment adviser or any investment policy may not be
changed without our consent. If required by law or regulation, the investment
policy of either separate account will not be changed unless approved by the
Superintendent of Insurance of New York State or deemed approved in accordance
with such law or regulation. If so required, the process for getting such
approval is filed with the insurance supervisory official of the jurisdiction in
which this policy is delivered.
INVESTMENT OPTIONS
ALLOCATION OF NET ANNUAL PREMIUMS. If premiums are duly paid, we will allocate
to each separate account at the beginning of each policy year a percentage of
the Net Annual Premium shown on page 3 for that year. Such allocations will be
based on the allocation percentages then in effect. The allocation percentages
for the first policy year are as designated in the application for this policy.
Unless you change them, such percentages shall also apply in later years.
V81-01-5
Page 6
INVESTMENT OPTIONS CONTINUED
You may change the allocation percentages for policy years after the first by
notifying us in writing of the new percentages. Each allocation percentage
greater than zero must be a whole number of not more than 100%. The sum of the
percentages must equal 100%. A change will take effect on the next policy
anniversary if we receive the notice at our Administrative Office at least 7
days before such anniversary.
TRANSFER OF CASH VALUES. You may ask us to transfer all or part of your cash
value in one of the separate accounts to the other. Only two such transfers may
be made in a policy year. We will make the transfer as of the date we receive
your written request for it at our Administrative Office.
OPTIONS ON LAPSE
You have a number of options if the policy lapses. You may apply for
reinstatement. If there is a net cash value, you may withdraw it and give up the
policy. Or, you may continue insurance under one of the following options:
REDUCED PAID-UP INSURANCE. This is fixed benefit insurance for the Insured's
lifetime and for the amount that the net cash value will buy.
EXTENDED TERM INSURANCE. This is fixed benefit term insurance for an amount
equal to the Death Benefit on the date of lapse, minus any unpaid loan and loan
interest. The insurance will continue from the date of lapse for as long a term
period as the net cash value will buy. In no event, however, will this period be
less than 90 days if premiums have been paid for at least three months before
lapse and there is no loan on this policy. This option is not available if so
stated on page 3.
An Option on Lapse will become effective on the date your written request for it
is received at our Administrative Office. If your request is not received within
three months after the date of lapse, extended term insurance will become
effective automatically at the end of such three month period. Reduced paid-up
insurance will apply instead if the extended term insurance option is not
available.
If the Insured dies after the grace period but within three months from the date
of lapse, the greater of the benefit under reduced paid-up or extended term
insurance will apply. In this case, any restriction on page 3 as to extended
term insurance will not apply.
We will determine the amounts of these options as of the date the option becomes
effective. We will use net cash values as of the date the option becomes
effective, adjusted for any loan transaction on or after that date. A term
period will begin as of the date of lapse (the due date of the unpaid premium).
We will use net single premiums for the Insured's age as of the date of lapse.
EXCHANGE OF POLICY
You may exchange this policy for a policy of permanent fixed benefit insurance
on the life of the Insured. You may make such an exchange within 18 months after
the Date of Issue shown on page 3. We will not require evidence of insurability.
We will require:
1. That this policy be in effect on the date of exchange with all premiums due
having been paid; and
2. Repayment of any loan and loan interest on this policy.
The date of exchange will be the later of: (a) the date you send us this policy
and the signed request on our form for such exchange; or (b) the date we receive
at our Administrative Office any sum due to be paid for such exchange.
THE NEW POLICY. The new policy will be the "Executive Plan" policy being offered
by The Equitable Life Assurance Society of the United States (Equitable) on the
Date of Issue of this policy. It is a policy of permanent fixed benefit life
insurance. The new policy will have the same face amount, Register Date, Date of
Issue, and Issue Age as this policy. Premiums for the new policy will be based
on Equitable's rates in effect on its Register Date for the same class of risk
as under this policy. Any additional benefit riders in this policy will be
included in the new policy only if Equitable was offering them with the new
policy as of its Date of Issue.
V81-01-7
Page 7
EXCHANGE OF POLICY CONTINUED
Upon request you will be told the amount of the first premium for the new
policy, and of any extra sum required or allowance to be made for a premium or
cash value adjustment that takes appropriate account of the premiums and cash
values under this policy and under the new policy. A detailed statement of the
method of computing such an adjustment has been filed with the insurance
supervisory official of the jurisdiction in which this policy is delivered.
GENERAL PROVISIONS
THE CONTRACT. This insurance is granted in consideration of payment of the
required premiums. This policy and the application (a copy of which is attached
at issue) constitute the entire contract. The rights conferred by this policy
are in addition to those provided by applicable Federal and State laws and
regulations.
The contract may not be modified, nor may any of our rights or requirements be
waived, except in writing signed by our President, one of our Vice Presidents,
or by our Secretary or Treasurer.
INCONTESTABILITY. All statements made in the application are representations and
not warranties. We have the right to contest the validity of this policy based
on material misstatements made in the application. However, this policy will
become incontestable after it has been in effect during the lifetime of the
Insured for two years from the Date of Issue shown on page 3.
See any additional benefit riders for modifications that apply to them.
AGE AND SEX. If the Insured's age or sex has been misstated, any benefits will
be those that the premium paid would have purchased at the correct age and sex.
SUICIDE EXCLUSION. If the Insured commits suicide, while sane or insane, within
two years after the Date of Issue shown on page 3, our liability will be limited
to the payment of a single sum equal to the premiums paid, minus any loan and
loan interest.
POLICY PERIODS AND ANNIVERSARIES. Policy years, policy months, policy
anniversaries and premium periods are measured from the Register Date. Each
policy month begins on the same day in each calendar month as in the Register
Date. If the end of a premium period or policy year is indicated by an age, it
ends on the policy anniversary nearest the birthday on which the Insured reaches
that age.
POLICY CHANGES. You may change this policy to another plan of insurance or add
additional benefit riders or make other changes, subject to our rules at the
time of change.
REPORTS. Each policy year after the first we will give you a report showing the
Death Benefit and the cash value as of the first day of such year. The amount of
any existing loan and the accrued loan interest for the previous policy year
will also be shown. No such reports will be given while this policy is lapsed.
We will also give you such other reports as may be required by law.
BASIS OF COMPUTATION. Cash values, reserves and net single premiums are based on
the Commissioners 1958 Standard Ordinary Mortality Table. For any extended term
insurance, they are based instead on the Commissioners 1958 Extended Term
Insurance Table. Continuous functions are used with interest compounded annually
at 4%.
The cash values and paid-up insurance benefits are equal to or more than those
required by law. A detailed statement of the method of computing values and
benefits has been filed with the insurance supervisory official of the
jurisdiction in which this policy is delivered. The tabular cash value at the
end of each policy year equals the reserve. Reserves referred to in this policy
are not less than reserves determined according to the Commissioners Reserve
Valuation Method. Our expense and mortality results will not adversely affect
the dollar amount of insurance benefits or cash values.
DETERMINATION AND PAYMENT OF VARIABLE BENEFITS. As long as this policy is not
being continued under one of the Options on Lapse, we will make payments under
this policy as follows:
o A cash value will be paid within 7 days after we receive your policy and
request at our Administrative Office;
o A loan will be paid within 7 days after we receive your request at our
Administrative Office; and
o The insurance benefits will be paid within 7 days after we receive at our
Administrative Office proof of the Insured's death and all other
requirements deemed necessary before such payment may be made.
V81-01-7 Page 8
GENERAL PROVISIONS CONTINUED
We may not be able to sell securities or determine the value of the assets of
the separate accounts if: (1) the New York Stock Exchange is closed; (2) the
Securities and Exchange Commission requires trading to be restricted or declares
an emergency; or (3) the Securities and Exchange Commission by order permits us
to defer payments for the protection of our policy Owners. During such times we
may defer:
1. Determination and payment of cash values;
2. Payment of loans;
3. Determination of a change in a Variable Adjustment Amount, and payment
of any portion of the Death Benefit equal to the Variable Adjustment
Amount;
4. Any requested transfer of cash value; and
5. Use of Insurance Benefits under the Payment Options.
DEFERMENT UNDER OPTIONS ON LAPSE. We may defer payment of a cash value and the
making of a loan for up to six months after we receive a request at our
Administrative Office if this policy is being continued under one of the Options
on Lapse. We will allow interest, at a rate of at least 3% a year, on any cash
value payment we defer for 30 days or more.
PAYMENT OPTIONS
Payments under these options will not be affected by the investment experience
of any separate account after proceeds are applied under such options.
Instead of having the insurance benefits or net cash value paid immediately in
one sum, you can choose another form of payment for all or part (if at least
$2,500). If you do not arrange for this before the Insured dies, the Beneficiary
will have this right when the Insured dies. Arrangements you make, however,
cannot be changed by the Beneficiary after the Insured's death. The options are:
1. DEPOSIT OPTION: Left on deposit for a period mutually agreed upon, with
interest paid at the end of each month, each 3 months, each 6 months or
each 12 months, as chosen.
2. INSTALMENT OPTIONS:
A. FIXED PERIOD: Paid in equal instalments for a specified number of
years (not more than 30). The instalments will not be less than those
shown in the Table of Guaranteed Payments on page 10.
B. FIXED AMOUNT: Paid in instalments as mutually agreed upon until the
amount applied, together with interest on the unpaid balance, is used
up.
3. LIFE INCOME OPTIONS:
Paid as a monthly income for life in an amount we determine but not
less than shown in the Table of Guaranteed Payments on page 10. We
guarantee payments for life and in any event for 10 years, 20 years,
or until the payments we make equal the amount applied (called "refund
certain"), according to the "certain" period chosen.
We guarantee interest under Option 1 at the rate of 3% a year and under Option
2 at 3-1/2% a year, or such higher rates as we may determine. We may allow
excess interest under Options 1 and 2.
We reserve the right to change how often we make payments, so that each payment
is for at least $25. The payee under an option may name and change a successor
payee for any amount we would otherwise pay the payee's estate.
Any arrangements involving more than one of the options, or a payee who is not a
natural person (such as a corporation) or who is a fiduciary, must have our
approval. Also, details of all arrangements will be subject to our rules at the
time the arrangement takes effect. These include withdrawal or commutation
rights, designation of payees and successor payees, and evidence of age and
survival.
Choices (or any later changes) under these options will be made and will take
effect in the same way as a change of Beneficiary. Amounts applied under these
options will not be subject to the claims of creditors or to legal process, to
the extent permitted by law.
V8l-01-9 Page 9
TABLE OF GUARANTEED PAYMENTS
(MINIMUM AMOUNT FOR EACH $1,000 APPLIED)
OPTION 2A
FIXED PERIOD INSTALMENTS
------------------------
Number Monthly Annual
of Years Instal- Instal-
Instalments ment ment
----------- ------- ---------
1 $84.70 $1000.00
2 43.08 508.60
3 29.21 344.86
4 22.28 263.04
5 18.12 213.99
6 15.36 181.32
7 13.38 158.01
8 11.91 140.56
9 10.76 127.00
10 9.84 116.18
11 9.09 107.34
12 8.47 99.98
13 7.94 93.78
14 7.49 88.47
15 7.11 83.89
16 6.77 79.89
17 6.47 76.37
18 6.20 73.25
19 5.97 70.47
20 5.76 67.98
21 5.57 65.74
22 5.40 63.70
23 5.24 61.85
24 5.10 60.17
25 4.97 58.62
26 4.84 57.20
27 4.73 55.90
28 4.63 54.69
29 4.54 53.57
30 4.45 52.53
If instalments are paid each 3 months, they will be 25.32% of the annual
instalments. If they are paid each 6 months, they will be 50.43% of the annual
instalments.
OPTION 3
MONTHLY LIFE INCOME
-------------------
10 Years Certain 10 Years Certain Refund Certain
---------------- ---------------- --------------
AGE Male Female Male Female Male Female
--- ---- ------ ---- ------ ---- ------
50 $4.50 $3.96 $4.27 $3.89 $4.28 $3.87
51 4.58 4.02 4.32 3.94 4.35 3.93
52 4.67 4.09 4.38 4.00 4.42 3.99
53 4.75 4.16 4.44 4.06 4.50 4.05
54 4.85 4.24 4.50 4.12 4.58 4.11
55 4.94 4.32 4.56 4.18 4.66 4.18
56 5.04 4.40 4.62 4.24 4.74 4.25
57 5.15 4.49 4.68 4.31 4.83 4.33
58 5.26 4.58 4.74 4.38 4.93 4.41
59 5.37 4.68 4.81 4.45 5.03 4.49
60 5.49 4.78 4.86 4.52 5.13 4.58
61 5.62 4.89 4.92 4.59 5.24 4.67
62 5.75 5.00 4.98 4.66 5.35 4.77
63 5.88 5.12 5.04 4.73 5.48 4.88
64 6.03 5.25 5.09 4.80 5.60 4.99
65 6.17 5.39 5.14 4.88 5.74 5.10
66 6.32 5.53 5.19 4.95 5.88 5.22
67 6.48 5.68 5.24 5.01 6.03 5.35
68 6.64 5.83 5.28 5.08 6.18 5.49
69 6.80 6.00 5.32 5.14 6.35 5.64
70 6.97 6.17 5.35 5.20 6.53 5.79
71 7.15 6.34 5.38 5.26 6.71 5.96
72 7.32 6.53 5.41 5.30 6.91 6.13
73 7.50 6.72 5.43 5.35 7.12 6.32
74 7.67 6.92 5.45 5.38 7.34 6.52
75 7.85 7.12 5.47 5.42 7.58 6.73
76 8.02 7.32 5.48 5.44 7.82 6.96
77 8.19 7.53 5.49 5.46 8.09 7.21
78 8.36 7.75 5.50 5.48 8.38 7.47
79 8.52 7.96 5.50 5.49 8.67 7.75
80 8.67 8.16 5.51 5.50 9.00 8.05
81 8.81 8.36 5.51 5.51 9.34 8.39
82 8.94 8.55 5.51 5.51 9.70 8.73
83 9.06 8.73 5.51 5.51 10.10 9.12
84 9.16 8.90 5.51 5.51 10.52 9.53
85 & over 9.26 9.05 5.51 5.51 10.96 9.97
Income amounts for Life Income Options are based on age nearest birthday when
income starts. Income amounts for ages not shown will be furnished on request.
V81-01-9
Page 10
BASIS OF VALUES
ACTUAL NET RATE OF RETURN (ACTUAL NRR). For each separate account, the Actual
Net Rate of Return for a policy year reflects the account's:
o investment income;
o plus realized and unrealized capital gains;
o minus realized and unrealized capital losses;
o minus any charges for taxes or amounts set aside as a reserve for taxes;
o minus a charge not exceeding .25% per year for investment management
expenses; and
o minus a charge not exceeding .50% per year for mortality, expenses and
other risks.
The Actual NRR for a period less than a year will be calculated in a consistent
manner.
BASE NET RATE OF RETURN (BASE NRR). The Base NRR is 4% per year. (It is a
pro-rata part of 4% for periods of less than a year.)
If the Actual NRR for all separate accounts always equals the Base NRR, then:
o the Death Benefit will always equal the Face Amount; and
o the Cash Value at the end of each policy year will equal the tabular
cash value shown on page 3A.
VARIABLE ADJUSTMENT AMOUNT (VAA). The VAA for a policy year is the amount of
insurance in effect for that policy year due to investment performance in past
years. On each policy anniversary we will determine a new VAA for the next
policy year. We will do this independently for each separate account, taking
into account the Actual NRR for the last policy year.
For the first policy year the VAA for each separate account is zero. For later
policy years, the VAA for each separate account will equal the VAA for that
account for the last policy year, plus the VAA Change Amount for that account. A
VAA does not change during a policy year.
VAA CHANGE AMOUNT. For each policy year after the first, the VAA Change Amount
for each separate account may be positive or negative. It will equal the product
of the following Items (a) and (b), divided by Item (c).
(a) The Actual NRR for the separate account minus the Base NRR for that
policy year.
(b) The Benefit Base for the separate account as of the last policy
anniversary.
(c) The Net Single Premium per $1.00 of VAA for the current policy
anniversary as shown on page 3B.
BENEFIT BASE. For each separate account, the Benefit Base on the Register Date
is the product of the following Items (1) and (2):
(1) The Allocation Percentage designated in the application for this
policy.
(2) The Net Annual Premium for the first policy year.
On policy anniversaries, the Benefit Base for a separate account is the sum of
the following Items (1) and (2):
(1) The allocation percentage for that anniversary, multiplied by the sum
of the following Items (a) and (b):
(a) The Tabular Cash Value on that anniversary.
(b) The Net Annual Premium for that anniversary.
(2) The Net Single Premium for the VAA for that separate account on that
anniversary.
The Net Annual Premiums, Tabular Cash Values and Net Single Premiums are shown
on pages 3, 3A and 3B, respectively.
For each separate account, the VAA Change Amount will also reflect the effect
of:
1. Any policy loans in effect on the last policy anniversary;
V81-01-11
Page 11
BASIS OF VALUES CONTINUED
2. All new policy loans and repayments during the previous policy year;
and
3. All transfers of cash value to or from that separate account during the
previous policy year.
In addition, if you have changed the allocation percentages, we will reallocate
the VAA's among the separate accounts.
CALCULATION OF CASH VALUES. The cash value of this policy on any date is the sum
of your cash values in each separate account on that date. If no premium is due
and unpaid, your cash value in each separate account on any date is the sum of
the following Items (1), (2) and (3):
(1) The tabular cash value on that date, multiplied by the allocation
percentage for that separate account in effect on the last policy
anniversary.
(2) The Net Single Premium on that date for the current VAA for that
separate account.
(3) If the date is not a policy anniversary, the product of the following
Items (a) and (b):
(a) The Actual NRR for the separate account minus the Base NRR for
the time elapsed since the last policy anniversary.
(b) The Benefit Base for the separate account on the last policy
anniversary.
If a premium is due and unpaid, then within three months after the due date your
cash value in each separate account is the sum of the following Items (1) and
(2):
(1) Your cash value in that separate account as of the due date of the
unpaid premium.
(2) The product of the following Items (a) and (b):
(a) The Actual NRR for the separate account minus the Net NRR for the
time elapsed since such due date.
(b) The cash value on such due date.
For each Separate account, the cash value will also reflect the effect of:
1. Any policy loans in effect on the last policy anniversary;
2. All new policy loans and repayments since the last policy anniversary;
and
3. All transfers of cash value to or from that separate account since the
last policy anniversary.
More than three months after the due date of an unpaid premium, if you continue
the policy under one of the options on lapse, your cash value will equal the
reserve for the policy. In such case, the cash value within 30 days after a
policy anniversary will never be less than the cash value on that anniversary.
If at any time you have a policy loan allocated to a separate account and your
net cash value in that separate account is zero, we will cancel the VAA and the
policy loan as to such separate account and reallocate them to the other
separate account. Also, the premium allocation percentage for such separate
account will be reduced to zero and the percentage for the other separate
account will be increased to 100%.
TABULAR CASH VALUE (TCV). The tables of TCV's on page 3A show interim TCV's at
the end of each month in the first policy year and at the end of later policy
years. We will determine the TCV on other dates in a consistent manner with
allowance for time elapsed and premiums paid. Any TCV's not shown will be
furnished on request.
V81-01-ll
Page 12
EQUITABLE VARIABLE LIFE INSURANCE COMPANY
[EVLICO LOGO]
VARIABLE
LIFE
INSURANCE Home Office: 0000 Xxxxxx xx xxx Xxxxxxxx, Xxx Xxxx, Xxx Xxxx 00000
POLICY
Limited Payment Life Plan -- LEVEL FACE AMOUNT. Variable
insurance payable upon death. Guaranteed Minimum Death
Benefit. Fixed premiums payable for Premium Period shown
on page 3 or until earlier death. Non-Participating.
Investment experience reflected in benefits. Investment
options described on page 6.
No. 81-01
SPECIMEN POLICY
NOTE -- Because of variations in state policy form requirements, the policy as
actually issued may differ somewhat from this specimen policy.
