Exhibit 26(d)(5)
LEVEL TERM INSURANCE AGREEMENT
This agreement is a part of the policy DOES THIS AGREEMENT PROVIDE CASH
to which it is attached. It is subject VALUES OR LOAN VALUES?
to all the terms and conditions of
the policy. This agreement is No. This agreement does not provide
effective as of the original policy any cash values or loan values.
date of this policy unless a different
effective date is shown on the policy CAN YOU RENEW OR CONVERT THE
data pages. ADDITIONAL TERM INSURANCE PROVIDED
BY THIS AGREEMENT?
WHAT DOES THIS AGREEMENT PROVIDE?
The additional term insurance
This agreement provides additional provided by this agreement will
one-year level term insurance payable automatically be renewed annually
at the death. until the date shown on your data
pages. The additional term insurance
WHAT IS THE AMOUNT OF THE provided by this agreement may not
INSURANCE? be converted.
The amount of term insurance is IS THIS AGREEMENT SUBJECT TO THE
shown on the policy data pages. INCONTESTABILITY AND SUICIDE
PROVISION OF THE POLICY?
WHAT IS THE CHARGE FOR THIS
AGREEMENT? Yes. Those provisions apply to this
agreement. The contestable and
The monthly charge for this suicide periods will be measured from
agreement is a cost of insurance rate the effective date of this agreement.
multiplied by the amount of insurance
provided by this agreement. The WHEN WILL THIS AGREEMENT TERMINATE?
monthly cost of insurance rates may
increase as the ages of the insureds This agreement will terminate on the
increase. If the rates used to earliest of:
determine the monthly charge are
adjusted, any such adjustment will be (1) the date this policy is
based on future estimated or surrendered or otherwise
emerging mortality experience as well terminates; or
as profit considerations. Those
experience factors that could cause a (2) the date we receive your
change in the rates are interest, written request to cancel this
mortality, persistency, taxes, and agreement; or
expenses. The maximum monthly
cost of insurance rates are shown on (3) the the date shown on your
the policy data pages. data pages.
WHEN AND TO WHOM WILL WE PAY THE CAN THIS AGREEMENT BE REINSTATED?
DEATH BENEFIT FOR THIS AGREEMENT?
Yes. If the policy to which this
If we receive proof satisfactory to agreement is attached is reinstated in
us of the death while this agreement accordance with its provisions, this
is in effect, we will pay to the agreement may also be reinstated
beneficiary as part of the death under the following conditions:
proceeds under the policy, the death
benefit for this agreement. (1) we receive written request
from you; and
CAN THE AMOUNT OF INSURANCE BE
CHANGED AFTER ISSUE? (2) your request to reinstate this
agreement is approved prior
Yes. You may request the amount of to the date shown on your
insurance to be decreased. However, data pages.
increases in the amount of insurance
are not allowed.
[Xxxx X. Xxxxxxxxxxx Xxxxxx Xxxxxxx
Secretary] President]
ICC14-20012 Term Insurance Agreement Minnesota Life Insurance Company
