Exhibit 1(5)
FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY
Insured: [XXXX XXX]
Owner: [XXXX XXX]
Payment Class: [STANDARD NON-SMOKER]
Policy Number: [SPECIMEN] Issue Age: [35]
Face Amount: [$250,000} Issue Date: [05/01/2000]
THIS IS A LEGAL CONTRACT - READ IT CAREFULLY
LINCOLN BENEFIT LIFE COMPANY promises to pay the death benefit to the
beneficiary on death of the insured upon receipt of due proof of death of the
insured.
PLEASE EXAMINE THE APPLICATION. We issued this contract based upon the answers
in the application (copy included) and receipt of your initial premium. If all
answers are not complete and true, the contract may be affected.
RIGHT TO CANCEL YOUR CONTRACT. You may cancel this contract by returning it
Lincoln Benefit Life Company, PO Box 80469, Lincoln, NE 68501-0469, or our
agent, before midnight of the 10th day after the day you receive the policy.
Return of the contract by mail is effective on being postmarked, properly
addressed and postage prepaid. We will refund any premiums allocated to the
separate account, adjusted to reflect investment gain or loss from the date of
allocation to the date of cancellation.
Executed for the company at its home office in Lincoln, Nebraska on its issue
date.
Xxxxx X. Xxxxxx B. Xxxxxx Xxxxxx
Secretary President
LINCOLN BENEFIT LIFE COMPANY
On Lincoln Benefit Life Drive
Lincoln, NE 68506
A Legal Reserve Stock Life Insurance Company
FLEXIBLE PREMIUM VARIABLE LIFE POLICY
Minimum Premium Required in the First Year
Death Benefit Payable on the Insured's Death
Flexible Premiums Payable for Life
The Death Benefit and other Values provided by this Contract
are based on the investment experience of the Separate Account
and other flexible factors.
These values may vary based on investment
and earnings experience and are not
guaranteed as to a fixed dollar
amount.
Nonparticipating
VUL 0040 Page 1
SUMMARY OF POLICY
This policy insures the life of the insured. If the insured dies while this
policy is in force, the death benefit will be paid to the beneficiary.
Payments for this policy are flexible. They may be made during the lifetime of
the insured.
During the lifetime of the insured, you may:
... change the planned payments and time between payments;
... obtain policy loans;
... change the beneficiary;
... change the death benefit option;
... surrender the policy for its net surrender value;
... exercise the other rights provided.
This is only a summary of the policy terms. The detailed provisions of the
policy will control. The provisions of your policy are set forth in the
following sections.
Policy Data.................................Page 3 Policy Value............................Page 11
Definitions.................................Page 5 Surrender Value.........................Page 12
Death Benefit...............................Page 7 Loans...................................Page 12
Beneficiary.................................Page 8 Other Terms of Your Policy..............Page 13
Ownership...................................Page 8 Exchange of Plan........................Page 15
Premium Payment.............................Page 9 Application.............................Insert
Account Provisions..........................Page 10 Benefit Riders (if any).................Insert
READ YOUR POLICY CAREFULLY
Page 2
POLICY DATA
Insured: [XXXX XXX]
Owner: [XXXX XXX]
Payment Class: [STANDARD NON-SMOKER]
Policy Number: [SPECIMEN] Issue Age: [35]
Face Amount: [$250,000} Issue Date: [05/01/2000]
Monthly Deduction Day [01]
Benefit Description
Year of Expiry
or Maturity
Flexible Premium Variable Life Life
Insurance - (Death Benefit Option 1)
Payment Information
Required Payment [$577.56]
Planned Payment [$577.56]
The payment of a monthly {SAFETY NET} premium of {$48.13} is guaranteed to keep
this policy in force for {5} years, assuming no loans or withdrawals are taken.
See {SAFETY NET} Premium Provision on Page 9 for details.
Page 3
Allocations
Separate Account: Lincoln Benefit Life Variable Life Account
Payment Deduction
Subaccount Allocation%
{Janus Worldwide Subaccount} {25}
{Fidelity VIPFII Asset Manager Subaccount} {75}
Minimum Withdrawal Amount {$500}
Minimum Transfer Amount {$100}
Loan Credited Rate {4.00%}
Maximum Loan Interest Rate Charged:
On preferred loans {4.00%}
On standard loans {6.00%}
Expense Deductions and Charges
Annual Mortality and Expense Risk Charge:
Contract Years 1-15 {0.60%}
Contract Years 16+ Current {0.40%}
Guaranteed 0.60%
Annual Distribution Expense Risk Charge:
Contract Years 1-20 {1.00%}
Contract Years 21+ {0.00%}
Monthly Policy Fee {$7.50}
Partial Withdrawal Service Fee {$10}
Page 3A
GUARANTEED MONTHLY COST OF INSURANCE
Policy Rate Policy Rate
Year Per $1000 Year Per $1000
---- --------- ---- ---------
1 0.14417 34 2.49333
2 0.15167 35 2.74833
3 0.16167 36 3.03667
4 0.17250 37 3.36583
5 0.18417 38 3.74583
6 0.19833 39 4.17583
7 0.21333 40 4.64833
8 0.22917 41 5.15333
9 0.24667 42 5.68667
10 0.26583 43 6.24417
11 0.28750 44 6.82917
12 0.31083 45 7.46000
13 0.33583 46 8.15667
14 0.36333 47 8.93750
15 0.39333 48 9.81833
16 0.42750 49 10.79500
17 0.46667 50 11.84833
18 0.51167 51 12.95417
19 0.56333 52 14.09833
20 0.62083 53 15.26333
21 0.68500 54 16.44417
22 0.75500 55 17.65750
23 0.82917 56 18.92083
24 0.91167 57 20.26333
25 1.00417 58 21.73500
26 1.10750 59 23.47917
27 1.22250 60 25.81917
28 1.35500 61 29.32167
29 1.50500 62 35.08250
30 1.67167 63 45.08333
31 1.85417 64 62.09583
32 2.05167 65 83.33333
33 2.26333
Page 4
VUL 0040
DEFINITIONS
When these words are used in this contract, they have the meaning stated:
"app"
The application which you completed requesting this policy.
"benefit rider"
An additional benefit we are providing.
"due proof of death"
(1) a certified original copy of the death certificate; or (2) a certified copy
of a decree of a court of competent jurisdiction as to the finding of death; or
(3) a written statement by a medical doctor who attended the deceased at the
time of death; or (4) any other proof satisfactory to the company.
"face amount"
The initial death benefit, shown on page 3, adjusted for any changes in
accordance with the terms of this policy.
"fund"
A series mutual fund.
"in force"
A term used to describe when the insured's life is covered under the terms of
this contract.
"insured"
The person upon whose life is covered by this policy as shown on Page 3.
"issue age"
The age of the insured at the time this policy was issued (issue date)
determined by the insured's last birthday.
"issue date"
The date the policy is issued, as shown on Page 3. It is used to determine
policy years and policy months in the policy.
"loan account"
An account established for amounts transferred from the subaccounts as security
for outstanding policy loans.
"monthly-automatic payment"
A method of making payments each month automatically; for example, by bank draft
or salary deduction.
"monthly deduction day"
The same day in each month, as shown on Page 3, as the issue date. The day of
the month on which deductions are made.
Page 5
"net"
Used in reference to the death benefit, policy value or surrender value. This
means that this item has been reduced by any policy debt.
"net death benefit"
The death benefit less any policy debt.
"net investment factor"
An index applied to measure the net investment performance of a subaccount from
one valuation date to the next. It is used to determine the policy value of a
subaccount in any valuation period.
"net surrender value"
The amount you would receive upon surrender of this contract, equal to the
surrender value less any policy debt. The net surrender value must be positive
in value for the policy to remain in force, unless the safety net premium factor
is in effect.
"payment class"
The class into which the insured is placed, determined by our rules for
providing insurance coverage.
"policy anniversary"
The same day and month as your issue date for each subsequent year your policy
remains in force.
"policy data"
The pages of this policy which identify specific information about the insured
and the benefits.
"policy debt"
The sum of all unpaid policy loans and accrued interest thereon.
"policy month"
A one month period beginning on the same day of the month as the issue date of
the policy.
"policy value"
The sum of the values of your interests in the subaccounts of the separate
account plus the value of the loan account. The amount from which monthly
deductions are made and the death benefit is determined.
"policy year"
A twelve month period beginning on an anniversary of the issue date.
"portfolio(s)"
The underlying mutual fund(s) (or investment series thereof) in which the
subaccounts invest.
"required payment"
The minimum premium which must be paid to keep the policy in force for the first
year.
"separate account"
A segregated investment account of the Company entitled Lincoln Benefit Life
Variable Life Account.
Page 6
"subaccount"
A subdivision of the separate account invested wholly in shares of one of the
portfolios.
"surrender value"
Is equal to the policy value.
"valuation date"
Each day the New York Stock Exchange ("NYSE") is open for business.
"valuation period"
The period commencing at the close of normal trading on the NYSE (currently 4:00
p.m. Eastern time) on each valuation date and ending at the close of the NYSE on
the next succeeding valuation date.
""we", "us", "our""
Our company, Lincoln Benefit Life Company.
"you"
The person(s) having the privilege of ownership defined in the policy.
DEATH BENEFIT
If the insured dies while this policy is in force, we will pay the death benefit
when we have received due proof of death. The death benefit will be based on:
1. The death benefit option in effect on the date of death;
2. Any increases or decreases to the face amount.
The death benefit will be reduced by any policy debt less any unpaid monthly
deduction amounts occurring during a grace period. If the proceeds are not paid
within 30 days after we receive due proof of the death of the insured, we will
pay interest on the proceeds. Interest will accrue at the legal rate of interest
and will accrue from the date of death until the claim is paid.
death benefit option
While the insured is alive you may choose between two death benefit options:
If you select Option 1, the death benefit will be the greater of:
a. The face amount on the date of death; or
b. The percentage of the policy value shown in the Compliance with Federal Laws
Provision.
If you select Option 2, the death benefit will be the greater of:
a. The face amount plus the policy value on the date of death; or
b. The percentage of the policy value shown in the Compliance with Federal Laws
Provision.
The initial death benefit option selected by you is stated in the app.
change of death benefit option
At any time after the first policy year, you may request us to change the death
benefit option by writing to us. If you ask to change from Option 2 to Option 1,
the face amount will be increased by the amount of the policy value. If you ask
to change from Option 1 to Option 2, the face amount will be decreased by the
amount of the policy value.
The change will take effect on the monthly deduction day on or following the
date we receive the written request. We will provide to you an endorsement
showing the actual start date of the death benefit option change and the new
face amount. We reserve the right to limit the frequency of the death benefit
option changes made under this policy.
Page 7
change of face amount
At any time after the first policy year, you may request either of the following
changes by writing us. The request will take effect on the monthly deduction day
on or following the date we approve the request:
1. Increasing the face amount. You must submit a new app for an increase
in face amount. We will require due proof that the insured is still
insurable. We reserve the right to limit the amount of any increases
made under this policy. The face amount may not be increased more than
once in any 12 month period.
2. Decreasing the face amount. A decrease in face amount will first be
applied against the most recent increase, then to the next most recent
increase successively, and finally to the initial face amount. The face
amount in effect after any decrease may not be less than $250,000.
We will provide you an endorsement showing the start date of any increase or
decrease and the new face amount. We reserve the right to limit the amount and
frequency of any increase or decrease in face amount.
BENEFICIARY
The beneficiary will receive the death benefit when the insured dies and we have
received due proof of death. The beneficiary is as stated in the app unless
changed.
The beneficiaries will receive the death benefit in the following order:
...Primary beneficiary, who will receive the death benefit if living when the
insured dies.
...Contingent beneficiary, who will receive the death benefit if the primary
beneficiary dies before the insured.
If a beneficiary dies at the same time as the insured or within fifteen days
thereafter, we will pay the death benefit as if that beneficiary were not living
when the insured died. If none of the named beneficiaries are living when the
insured dies, the death benefit will be paid to you.
We will pay the death benefit to the beneficiaries according to the most recent
written instruction we have received from you. If we do not have any written
instructions, we will pay the death benefit in equal shares to the beneficiaries
who are to share the funds. If there is more than one beneficiary in a class and
one of the beneficiaries predeceases you, the death benefit will be paid to the
surviving beneficiaries in that class.
You may name new beneficiaries. We will provide a form to be signed. You must
file it with us. Upon receipt, it is effective as of the date you signed the
form, subject to any action we have taken before we received it.
If you name one or more irrevocable beneficiaries, no change in the
beneficiaries and no changes which affect policy values may be made without
their consent. No beneficiary has any rights in this policy until the insured
dies.
OWNERSHIP
The insured is the owner if no other person is named in the app as owner. The
owner controls the policy during the lifetime of the insured. Unless you provide
otherwise, as owner, you may exercise all rights granted by the policy without
the consent of anyone else. If the named owner dies before the insured, then the
contingent owner named in the app is the new owner. If no owner named in this
policy is living, then the owner will be the estate of the last named owner.
You may name a new owner. We will provide a form to be signed. You must file it
with us. Upon receipt, it is effective as of the date you signed the form,
subject to any action we have taken before we received it.
You may assign this policy or an interest in it to another. You must do so in
writing and file the assignment with us. No assignment is binding on us until we
receive it. When we receive it your rights and those of the beneficiary will be
subject to the assignment.
We are not responsible for the validity of any assignment you make.
Page 8
PREMIUM PAYMENTS
payments
Premiums for this policy are referred to as payments. The planned payment,
required payment and the time between payments are shown on Page 3.
Payments are flexible. This means you may change the amount of planned payments
and the time between payments. During the first year, you must pay an amount at
least as great as the required payment.
We must have received the first payment on or before the issue date. This policy
will not be in effect before this amount is received.
We will send you a reminder notice if you pay annually, semi-annually or
quarterly. You may also make a monthly-automatic payment. We may establish
limits on both the amount of payment and the time between payments.
Payments must be sent to our home office. The amount you pay will affect the
policy value. If you pay too little, the policy will stop subject to the grace
period.
allocation of premium payments
We will invest the net premium payments in the subaccounts you select. You must
specify your allocations on the app, in whole percents from 0% to 100%. The
total allocation must equal 100%. You initially may allocate your policy value
to up to twenty-one options, counting each subaccount as one option. All net
premium payments not requiring underwriting will be allocated to the subaccounts
as of the date payments are received at our home office. Premium payments
requiring underwriting will not be credited with interest or earnings prior to
the issue date. We will allocate such net premium payments, plus earnings and
less monthly deductions, once underwriting approval is received, to the
subaccounts specified on the app or your most recent instructions. You may
change the allocation percentages at any time by writing us. Any change will be
effective when we receive it.
grace period
Except as provided in the safety net premium provision below, if on any monthly
deduction day the net surrender value is determined to be less than the monthly
deduction for the current policy month, you will be given a grace period of 61
days. This policy will be in force during the grace period. If you do not make
sufficient payment by the end of the grace period, the policy will stop. If the
insured dies during the grace period, we will deduct any monthly deductions from
the amounts we pay.
We will send a written notice to the most recent address we have for you and any
assignee at least 30 days prior to the day coverage stops.
safety net premium
If total payments, less partial withdrawals and policy debt are greater than or
equal to the sum of monthly safety net premium times the number of months
elapsed since the issue date, then the policy is guaranteed to stay in force for
a predetermined time period as shown on Page 3, even if the net surrender value
becomes insufficient to cover monthly deductions. The safety net premium is
equal to the required payment for the first policy year.
If, at any time the total payments, less partial withdrawals and policy debt,
are less than the monthly safety net premium times the number of months elapsed
the safety net premium provision will no longer be in effect. Once it is not in
effect, it cannot be reinstated and the policy will continue in force only as
long as it net surrender value is sufficient to pay the monthly deductions and
for any corresponding grace period.
Increases, decreases, partial withdrawals, death benefit option changes, and
additions or deletions of benefit riders, may affect the monthly safety net
premium.
Page 9
reinstatement
Prior to the death of the insured and if this contract has not been surrendered,
this policy may be reinstated provided you:
1. Make your request within five years of the date the policy entered the grace
period;
2. Give us the proof we require that the insured is still insurable in the same
payment class that the policy was issued; 3. Pay an amount large enough to cover
the unpaid monthly deductions for the grace period; 4. Make a payment sufficient
to keep the policy in force for 3 policy months; and 5. Repay or ask us to
reinstate any loan.
The policy value on the reinstatement date will reflect the policy value at the
time of termination and premiums applied at the time of reinstatement.
When this policy is reinstated, a new two-year contestable period will apply
with respect to statements made in the application for reinstatement. The
contestable period is explained in the incontestability provision on Page 13.
ACCOUNT PROVISIONS
assets of the separate account
The separate account, shown on page 3A, is a separate investment account to
which we allocate assets contributed under this and certain other life insurance
contracts. We will have exclusive and absolute ownership and control of the
assets of our separate accounts. The assets of the separate account will be
available to cover the liabilities of our general account only to the extent
those assets exceed the liabilities of that separate account arising under the
variable life policies supported by that separate account.
The assets of the separate account 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.
transfers and transfer fees
You may transfer amounts between subaccounts. We reserve the right to impose a
$10 transfer fee on the second and subsequent transfers within a calendar month,
and to impose a minimum size on transfer amounts as shown on page 3A.
separate account modifications
We reserve the right, subject to applicable law, to make additions to, deletions
from, or substitutions for the mutual fund shares underlying the subaccounts of
the separate account. We will not substitute any share attributable to your
interest in a subaccount without notice to you and prior approval of the
Securities and Exchange Commission, to the extent required by the Investment
Company Act of 1940, and the Nebraska Insurance Commissioner. The approval
process is on file with the insurance commissioner of the state where this
policy is delivered.
We reserve the right to establish additional subaccounts of the separate
account, each of which would invest in shares of another portfolio of the mutual
fund or another mutual fund. You may then instruct us to allocate premium
payments or transfers to such subaccounts, subject to any terms set by us or the
mutual fund.
In the event of any such substitution or change, we may by endorsement make such
changes as may be necessary or appropriate to reflect such substitution or
change.
If we deem it to be in the best interests of persons having voting rights under
the contracts, the separate account may be operated as a management company
under the Investment Company Act of 1940 or it may be deregistered under such
Act in the event such registration is no longer required.
Page 10
POLICY VALUE
On the issue date or, if later, the date the first premium is received, the
policy value is the net premium less the monthly deduction for the first policy
month.
On any other day, the policy value is the sum of the values in each subaccount.
On each valuation date, the value in a subaccount is:
1. The value of the subaccount of the preceding valuation date, multiplied by
the net investment factor for the subaccount for the current valuation period,
plus
2. Any net premium received and allocated to the subaccount during the current
valuation period, plus
3. Any policy value transferred to the subaccount during the current valuation
period, minus
4. Any policy value transferred from the subaccount during the current valuation
period, minus
5. Any partial withdrawals from the subaccount during the current valuation
period, minus
6. The portion of any monthly deduction allocated to the subaccount during the
current valuation period for the policy month following the monthly deduction
day.
All policy values equal or exceed those required by law. Detailed explanations
of methods of calculation are on file with appropriate regulatory authorities.
net investment factor
The net investment factor measures investment performance of a subaccount during
a valuation period. The net investment factor is (1) divided by (2) where:
1. is the net result of:
a. the net asset value per share of the portfolio held in the
subaccount at the end of the current valuation period, plus
b. the per share amount of any dividend or capital gain distribution
made by the portfolio during the current valuation period, plus
or minus
c. a per share credit or charge with respect to any taxes which we
paid or for which we reserved during the valuation period which
are determined by us to be attributable to the operation of the
subaccount (no federal income taxes are applicable under present
law.)
2. is the net asset value per share of the portfolio held in the subaccount at
the end of the last prior valuation period.
monthly deductions
The monthly deduction is the sum of:
1. A policy fee as shown on Page 3A;
2. The mortality and expense risk charge;
3. The distribution expense charge;
4. The cost of insurance for the policy; and
5. The cost of any benefit riders attached to the policy.
risk charge
The monthly mortality and expense risk charge is equal to the annual mortality
and expense risk rate shown on Page 3A for the appropriate policy year, divided
by 12, times the total value in the subaccount on the monthly deduction day.
Specifically, we bear the risk that the total amount of death benefit payable
will be greater than anticipated, and we also assume the risk that the actual
cost we incur to administer the policy will not be covered by administrative
charges assessed.
Page 11
distribution expense charge
The monthly distribution expense charge is equal to the annual distribution
expense charge rate shown on page 3A for the appropriate contract year, divided
by 12, times the total policy value on the monthly deduction day.
cost of insurance
The cost of insurance is determined as follows:
1. Subtract the policy value as of the prior monthly deduction day from the
death benefit as of the prior monthly deduction day, and divide the result by
1,000;
2. Multiply the results by the current cost of insurance rate. The cost of
insurance rate is based on the insured's sex, issue age, policy year, and
payment class. The rates will be determined by us, but they will never be more
than the guaranteed rates shown on Page 4.
SURRENDER VALUE
You may terminate your policy for its net surrender value, which may be paid in
cash or under an income plan.
The net surrender value of this policy is the amount we will pay you if you ask
us to stop this policy. It is equal to the policy value less any policy debt.
Termination will be effective on the date we receive your written request. We
may require that your policy accompany your written request before making any
payment.
continuation of coverage
If you stop making payments, this policy and any riders will remain in effect as
long as the net surrender value covers the monthly deductions or the policy is
still in force as defined in the monthly guarantee premiums provision. This
provision does not continue any riders beyond their normal termination dates.
partial withdrawal
You may request a partial withdrawal of your net surrender value by writing to
us. Your partial withdrawal will be effective on the next valuation date. You
may specify how much of your partial withdrawal you wish taken from each
subaccount. The partial withdrawal service fee, as shown on Page 3A, may be
deducted from the subaccounts in the same proportion as the partial withdrawal.
The policy value will be reduced by the amount of any partial withdrawal. Any
policy with Death Benefit Option 1 will also have a reduction in the face
amount. The minimum partial withdrawal amount is shown on Page 3A and the
maximum partial withdrawal amount may not reduce the net surrender value below
$500.
basis of values
Minimum surrender values are based on the 1980 CSO Mortality Table, age last
birthday, male or female, smoker or nonsmoker, as appropriate. The minimums are
not less than those required by the state in which the app is signed.
LOANS
You may have a loan if you assign this contract to us as sole security. The
total amount of any loan request must not be such that the total amount of loan,
loan interest, plus the requested loan exceeds 90% of the surrender value.
We will ordinarily disburse proceeds of policy loans within seven days from the
date of receipt of a request for a loan at our home office, although payments
may be postponed under certain circumstances as detailed in the "deferment of
payments" section on Page 15. As long as the policy remains in force, the loan
may be repaid in whole or in part without penalty at any time while the insured
is living.
loan interest
An amount equal to your policy value less all premiums paid may be taken as a
preferred loan. The annual loan interest rate charged for preferred loans is
shown on Page 3A. A standard loan is the amount that may be borrowed from the
sum of premiums paid. The annual loan interest rate for standard loans is shown
on Page 3A.
Page 12
Interest on policy loans accrues daily and is due at the end of each policy
year. Any interest not paid when due becomes part of the policy loan and will
bear interest at the rates described in this provision.
When a policy loan is made, a portion of the policy value sufficient to secure
the loan will be transferred to the loan account reducing the policy value in
the separate account. Any loan interest that is due and unpaid will also be so
transferred. All loan amounts will be transferred from the subaccounts to the
loan account in the same allocation percentages as specified for premium
payments. Xxxxxxx transferred to the loan account will no longer be affected by
the investment experience of the separate account and will instead accrue
interest at the annual loan credited rate as shown on Page 3A.
loan repayment
You may pay back your loan and loan interest at any time. If you do not, we will
deduct the loan and loan interest from the amounts we pay.
If your loan and loan interest exceed the surrender value, this contract will
stop except as provided in the grace period section. We must mail a notice to
you and all assignees at least 30 days before the contract stops.
OTHER TERMS OF YOUR POLICY
our contract with you
These pages and the signed app are your entire contract with us. We issued it
based upon your app and the payment made by you. A copy of the app is included.
Any supplemental app will also be attached to and made a part of the contract.
We will not use any statements, except those made in the app and any
supplemental app, to challenge any claim or to avoid any liability under this
policy. The statements made in the app will be treated as representations and
not as warranties.
Only our officers have authority to change this contract. No agent may do this.
Any change must be written.
when protection starts
The issue date is the date when this policy becomes effective if the insured is
then living and the first payment has been made.
termination
This policy will terminate upon the earliest of the following events:
1. Surrender of the policy; or
2. End of the grace period; or
3. Death of the insured.
misstatement of age or sex
If the insured's age or sex shown on the app has been misstated, any proceeds
will be adjusted to the amount which the initial safety net premium would have
purchased at the correct age and sex.
incontestability
Except as provided in the next provision or in any attached rider with an
incontestability provision, we may not contest this contract once it has been in
force while the insured is alive for 2 years from its issue date except for
failure to make payments that cause the net surrender value to be too small to
cover the monthly deductions required to keep this contract and its riders in
force.
We may not contest any increase in face amount once it has been in force while
the insured is alive for 2 years from the effective date of the increase.
We may not contest any reinstatement of this policy or any benefit riders after
they have been in force while the insured is alive for two years from the
reinstatement date.
Page 13
suicide or self-destruction
If the insured dies by suicide while sane or self destruction while insane
within 2 years from the issue date of the contract:
1. We will only pay an amount equal to the policy value less any policy debt;
and
2. The policy will stop.
If the insured dies by suicide while sane or self-destruction while insane
within two years of the effective date of any increase in face amount, our
liability with respect to the increase will be limited to the cost of insurance
for the increase.
annual report
Each year we will send you an annual report following the policy anniversary.
Each report will provide information on various transactions that took place
during the policy year just completed, as well as information on the current
status of the policy. This information will include items such as:
1. The policy value as of the end of the current and prior year.
2. Payments and withdrawals made during the year.
3. The monthly deductions and expense charges made during the year.
4. Earnings during the year.
5. The current death benefit.
6. The current surrender value.
7. The amount of policy debt.
8. Such additional information as required by applicable law and regulation.
If you ask us, we will send you an additional report, at any time during the
policy year. We may charge you for this extra report, but the charge will be no
more than $25. We will tell you what the current charge is before sending the
report.
conformity with state law
This policy is subject to the laws of the state where the app was signed. If any
part of the policy does not comply with the law, it will be treated by us as if
it did.
nonparticipating
This policy in nonparticipating. It does not share in our profits or surplus
earnings. We will pay no dividends on this policy.
compliance with federal laws
The two requirements below are intended to maintain the status of this policy as
life insurance under the current Internal Revenue Code:
First, the amount of payments that you may pay is limited by law. We will
conduct a test no less frequently than annually, and return any excess payments.
Second, the death benefit payable may not be less than the applicable percentage
of your policy value. This percentage is based on the attained age as shown in
the table below:
Attained Applicable
Age Percentage
--- ----------
0 to 40 250
41 243
42 236
43 229
44 222
45 215
46 209
47 203
48 197
49 191
50 185
51 178
52 171
53 164
54 157
55 150
56 146
57 142
58 138
59 134
60 130
61 128
62 126
63 124
64 122
65 120
66 119
67 118
68 117
69 116
70 115
71 113
72 111
73 109
74 107
75 to 90 105
91 104
92 103
93 102
94 and above 101
Page 14
We will conduct a test monthly and increase the death benefit, subject to our
then current underwriting limits, to be equal to the applicable percentage of
your policy value, if necessary. The death benefit will remain at that level
unless it has to be increased again. If we cannot increase the death benefit due
to underwriting limits, we will return the amount of policy value necessary so
that the death benefit will be equal to the applicable percentage of your policy
value after returning the amount.
We will perform any necessary action within 60 days of the end of the policy
year in which the requirement has not been met.
We reserve the right to amend the policy to comply with:
1. Future changes in the Internal Revenue Code;
2. Any regulations or rulings issued under the code; and
3. Any other requirements imposed by the Internal Revenue Service.
We will give you a copy of any such amendment.
payment of proceeds
The net death benefit, or the net surrender value in the event you withdraw it,
will be paid in one sum or applied to any settlement option we then provide.
When we pay the proceeds, we may ask that you give this policy back to us. No
surrenders or partial withdrawals are permitted after payments under a
settlement option have started.
Settlement options will include:
1. We will hold the proceeds at interest, and pay out the funds when the person
entitled to them requests.
2. We will pay a selected monthly income until the proceeds, with interest, are
exhausted.
3. We will pay a monthly income, based upon the amount of proceeds, interest
rate and the age and sex of the person or persons receiving the funds, for a
selected period or the lifetime of the person or persons to whom the funds are
being paid.
At the time the proceeds are payable, we will inform you concerning the rate of
interest to be paid on funds left with us. We guarantee that the rate of
interest will not be less than 3-1/2%. We may pay interest in excess of the
guaranteed rate. We will issue a supplementary contract setting forth the
benefits to be paid and the rights of the beneficiary. Each election must
include at least $5,000.00 of policy proceeds and must result in installment
payments of not less then $50.00.
deferment of payments
We will pay any amounts due under the separate account of this contract within
seven days, unless:
o The New York Stock Exchange is closed for other than usual weekends or
holiday, or trading on such exchange is restricted; o An emergency exists as
defined by the Securities and Exchange Commission; or o The Securities and
Exchange Commission permits delay for the protection of contract holders.
EXCHANGE OF PLAN
If this policy is in force, you may exchange it during the first two years after
the policy date or within two years of an increase in face amount, for a policy
in which values do not vary with the investment experience of the separate
account. This exchange will be implemented by transferring your policy value to
the fixed account and removing your future right to allocate funds to the
separate account. We may require you to return this contract to us to amend
before this exchange will be processed. This transfer will not be subject to the
excess transfer fee.
Page 15
FLEXIBLE PREMIUM VARIABLE LIFE POLICY
Minimum Premium Required in the First Year
Death Benefit Payable on the Insured's Death
Flexible Premiums Payable for Life
The Death Benefit and other Values provided by this Contract
are based on the investment experience of the Separate Account
and other flexible factors.
These values may vary based on investment
and earnings experience and are not
guaranteed as to a fixed dollar
amount.
Nonparticipating
XXXXXXX BENEFIT LIFE
C O M P A N Y
A MEMBER OF THE ALLSTATE LIFE GROUP
FLEXIBLE PREMIUM VARIABLE LIFE POLICY
Policy Amendment
This amendment has been added to your policy because the insured is an employee,
or an immediate family member of an employee, of the Allstate Corporation, its
subsidiaries, or an organization that distributes policies underwritten by the
Allstate Corporation or one of its subsidiaries, at the time of application.
The distribution expense charge on Page 3A is amended to be zero.
Except as amended, the policy remains unchanged.
LINCOLN BENEFIT LIFE COMPANY
/s/ X. Xxxxxx Xxxxxx
X. Xxxxxx Xxxxxx
President
UL 8306
Accidental Death Benefit Rider
For Flexible Premium Adjustable Life
benefit
We will pay the accidental death benefit shown in the Schedule in accordance
with the terms of the policy and this rider. The amount will be included in the
death benefit of the policy and will be paid upon receipt of proof of death of
the insured:
1. resulted directly and independently of all other causes, from an accidental
bodily injury; and
2. occurred within 90 days from the date of injury; and
3. occurred while the policy and this rider are in force.
beneficiary
The beneficiary for this rider is the same as for the policy, unless otherwise
provided.
risk not covered
This benefit will not be payable if the insured's death resulted from:
1. war or any act of war, whether or not the insured is in military service. The
term "war" includes declared or undeclared war or any conflict between the armed
forces of any country or countries.
2. suicide, or any attempt at suicide, while xxxx;
3. attempting a felony;
4. disease, infirmity of the body or mind, or treatment for any of these;
5. Voluntarily:
a. Taking a drug,
b. Inhaling a gas except while conducting the Insured person's duties
during the course of employment, Unless as ordered by a qualified
doctor, or
c. Taking a poison;
6. being in a falling from an air or spacecraft, if the insured:
a. is a pilot, officer, or member of the crew; or
b. is being flown for the purpose of descent from such aircraft while in
flight; or
c. is giving or receiving any kind of training or instructions; or
d. has any duties aboard such aircraft.
when the rider stops
This rider will stop:
1. on the policy anniversary following the insured's 70th birthday; or
2. on the next monthly activity day after you make a written request; or
3. when the policy stops.
other terms of this rider
1. This rider is made a part of the policy, and except as provided is subject to
all the terms of the policy.
2. We will have the right to examine the body of the insured and to have an
autopsy performed unless prohibited by law.
3. The cost for this rider is included in the monthly deductions. The amount of
deductions required are shown in the Schedule.
The start date of this rider is the issued date unless a later date is stated
here:
The insured for this rider is the insured under the policy unless the name of an
additional insured is stated here:
XXXXXXX BENEFIT LIFE COMPANY
President
UL 8311
Continuation of Payment
Disability Continuation Benefit Rider
benefit
We will credit the policy with payments equal to the monthly disability benefit
on each monthly activity day:
1. after the insured becomes totally disabled; and
2. while total disability continues.
monthly disability benefit
The monthly disability benefit is shown in the Schedule. After the first policy
year, you may ask for an increase or decrease in the monthly disability benefit
by writing to us. If you want an increase you must fill out an app that we will
send you. We will tell you in writing if we approve it. An increase will start
on the next monthly activity day after we approve it. A decrease will take
effect on the next monthly activity day after we receive your request. You may
not increase the monthly disability benefit more than once per year. You may not
decrease it to less than $10.
definition of total disability
Total disability means the insured has a disability which:
1. was caused by injury or disease;
2. first began while this rider is in force;
3. has lasted 6 straight months;
4. is not described in the section called causes of disability not covered; and
5. keeps the insured from doing any work for which the insured is reasonably
suited by education, training or experience.
causes of disability not covered
The insured will not qualify for benefits from this rider if disability is
caused by:
1. injury the insured caused on purpose; or
2. war or any act of war, whether declared or undeclared.
notice of proof of claim
Written notice of a claim and proof of total disability must be given to us at
our home office:
1. during the lifetime of the insured; and
2. within 1 year after the beginning of total disability.
Failure to give notice and proof within 1 year will not keep us from approving a
claim if it is shown that the notice and proof were given as soon as was
reasonably possible.
Prior to the approval of any claim for this benefit and while total disability
continues, we may require that the insured be examined by a physician we choose.
When we approve a claim for this benefit, we will also credit the policy with
payments of the monthly disability benefit for the months since the insured
became disabled; however, no benefit payments will be credited for months more
than 1 year prior to the time we receive proof of claim.
proof of continuance
After approval of a claim for this benefit, we may require proof of the
continuance of total disability. We will not require proof more often than once
a year after total disability has continued for 2 full years. If proof is not
furnished on request or if the insured fails to submit to a medical examination
that we request, we will stop crediting the policy with benefit payments.
notice of recovery
You must give immediate notice to us when the insured ceases being totally
disabled.
recurrence of prior disability
If, following recovery from a total disability which has lasted for at lest 6
straight months, the insured suffers another total disability which:
1. begins within 30 days of recovery; and
2. is due to the same or related causes as the prior total disability;
then, the total disability shall be considered to have continued during the
period between recovery and recurrence of total disability.
continuation of coverage
If the cash value becomes too small to continue the full benefits as provided in
the policy and any benefit riders, we will reduce the amount of coverage
provided by the policy and benefit riders to the amount which the cash value
including this benefit will provide. We will reduce the coverages on a pro-rata
basis after a 60 day grace period. All Increasing Insurance Riders will stop. We
will not reduce the monthly disability benefit at the time. We will give you
written notice before we reduce the amount of coverage. To increase the amount
of coverage on any insured under the policy or its benefit after it has been
reduced, you must give us due proof that the insured(s) is(are) still insurable.
when this rider stops
This rider will stop:
1. on the policy anniversary following the insured's 60th birthday; however,
such termination will not affect a claim for this benefit occurring before that
date; or
2. on the monthly activity day after you make a written request; or
3. when the policy stops.
other terms of this rider
1. This rider is made a part of the policy and except as provided is subject to
all the terms of the policy.
2. The cost for this rider is included in the monthly deductions. The amount of
deductions required are shown in this Schedule.
3. You may make payments while the insured is disabled. The benefit payments we
make will not be reduced because of any payments that your make.
The start of this rider is the issue date unless a later date is stated here:
XXXXXXX BENEFIT LIFE COMPANY
President
XX 0000
Children's Level Term Rider
For Flexible Premium Adjustable Life
benefit
The amount insured for each insured child is $5,000 for each unit of this rider.
We will pay the amount insured provided by this rider when we receive proof that
an insured child's death occurred:
1. while this rider is in force; and
2. after that insured child became 15 days old: and
3. before the earlier of that insured child's 25th birthday or the rider
termination date.
definitions
Insured child means:
1. any child, stepchild, or legally adopted child of the insured, if the child
is named in the application for the policy or this rider and is less than 18
years old on the issue date of this rider, and
2. any child who after the date of the applica- tion, is born of the marriage of
the insured and the insured's spouse or is legally adopt- ed by the insured
prior to the child's 18th birthday.
beneficiary
Any amount payable under this rider upon death of an insured child will be paid
to you unless otherwise provided. If you are deceased, payment will be made to
the estate of such in- sured child.
continuation of insurance
If the insured dies while this rider is in force, any remaining insurance
provided by this rider will continue in force as paid-up term insur- ance with
no further premium payable.
ownership
Unless otherwise provided in the policy, ownership of this rider will be as
follows:
1. you will be the owner while living;
2. after your death, insurance on the life of each insured child will be owned
by that child.
exchange right
The insurance on each insured child may be exchanged for a new policy upon the
child's 25th birthday or the policy anniversary following the insured's 65th
birthday, if earlier.
The exchange will be made on the following conditions:
1. This rider must be in force when you make the exchange.
2. The request for exchange must be written.
3. The new policy selected by you must be a whole life plan or flexible premium
adjustable life plan, then sold by us.
4. The amount insured of the new policy will not be greater than five times the
amount insured of this rider on the date of ex-change, but never less than
$5,000.
5. The issue date of the new policy will be the date of exchange.
6. The premium for the new policy will be based on the insured child's sex,
attained age and standard premium class. No new evidence of insurability will be
required.
7. Any benefit rider providing additional benefits in the event of disability or
death will be made a part of the new policy only with our consent.
when the rider stops
This rider will stop:
1. on the policy anniversary following the in-sured's 65th birthday; or
2. on the next monthly activity day after you make a written request; or
3. when the policy stops.
reinstatement
If the policy is reinstated, this rider may be reinstated at the same time
provided we receive evidence satisfactory to us of the good health and
insurability of all children to be insured under this rider.
Reinstatement will create no liability because of the death of any insured child
occurring prior to the date of reinstatement.
misstatement of age
If the age of any insured child has been misstated, the termination date of the
term insurance for that insured child will be based on the correct age.
suicide
If any insured child, while xxxx, dies by suicide within 1 year from the issue
date of this rider, this rider will immediately become void. Our liability under
this rider will be limited to an amount equal to the premium paid for this
rider.
cash value
This rider does not have cash value while on a premium-paying basis. If this
rider becomes fully paid-up, cash value is available upon surrender. The amount
of cash value is set forth in this table:
Cash Value for each $1,000 of Insurance
Attained age of Cash Attained age of Cash
Insured Child Value Insured Child Value
0 $19 15 $14
1 17 16 13
2 17 17 12
3 17 18 11
4 16 19 10
5 16 20 9
6 16 21 7
7 16 22 6
8 16 23 4
9 16 24 2
10 16 25 0
11 16
12 16
13 15
14 15
basis of values
The reserves for this rider are computed upon the Commissioners 1980 Standard
Ordinary Mortality Table, 4 1/2 % interest, the insured's age last birthday, and
the assumption that deaths occur at the end of policy years. The cash value of a
paid-up benefit surrendered within 30 days of a policy anniversary is not less
than the present value of future guaranteed benefits on the anniversary.
other terms of this rider
1. This rider is made a part of the policy, and except as provided is subject to
all the terms of the policy
2. The cost of this rider is included in the monthly deductions. The amount of
deductions required are shown in the Schedule.
The start date of this rider is the issue date unless a later date is stated
here:
XXXXXXX BENEFIT LIFE COMPANY
President
UL 9891
Additional Insured Term Insurance Benefit Rider
benefit
We will pay the amount insured provided by this rider when we receive proof that
the additional insured died while this rider was in force. The additional
insured and the death benefit for this rider are shown in the Policy Data.
beneficiary
Any amount payable under this rider upon the death of an additional insured will
be paid to you, unless otherwise provided. If you are deceased, payment will be
made to the estate of such additional insured.
exchange of this rider
Prior to the additional insured's 75th birthday, you may exchange this rider for
a policy insuring the life of the additional insured. The exchange will be made
on the following conditions.
1. This rider must be in force when you make the exchange.
2. The request for exchange must be written.
3. The new policy selected by you must be a whole life plan, or flexible premium
adjustable life plan, then sold by us.
4. The death benefit of the new policy will not be greater than the death
benefit of this rider on the date of exchange, but never less than $25,000.
5. The issue date of the new policy will be date of exchange.
6. The premium for the new policy will be based on the additional insured's sex,
attained age and the premium class applicable to this rider. No new evidence of
insurability will be required.
7. Any benefit riders providing additional benefits in the event of disability
or death will be made a part of the new policy only with our consent.
In addition, a special exchange provision will be allowed to any additional
insured if the policy stops due to the death of the insured. This special
exchange will be allowed regardless of
the age of the additional insured. All other conditions listed above will still
apply.
when this rider stops
This rider will stop:
1. on the policy anniversary following the additional insured's 99th birthday;
or
2. on the policy anniversary following the base insured's 99th birthday; or
3. when this rider is exchanged as provided; or
4. on the monthly activity day after you make a written request; or
5. when the policy stops.
basis of computations
The reserves for this rider are computed upon the Commissioners 1980 Standard
Ordinary Mortality Table, interest as prescribed in the Standard Valuation Law,
the insured's age last birthday, and the assumption that deaths occur at the end
of policy year.
other terms of this rider
1. This rider is made a part of the policy on the start date, and except as
provided is subject to all the terms of the policy.
2. The cost for this rider is included in the monthly deductions. The amount of
deductions required will never exceed the rates shown in the Policy Data.
The start date of this rider is the issue date unless a later date is stated
here:
XXXXXXX BENEFIT LIFE COMPANY
President
