Exhibit A(5)(a)
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The Northwestern Mutual Life Insurance Company agrees to pay
the benefits provided in this policy, subject to its terms and
conditions. Signed at Milwaukee, Wisconsin on the Date of
Issue.
/s/ Xxxxx X. Xxxxxxx /s/ Xxxx X. Xxxxxx
PRESIDENT AND C.E.O. SECRETARY
VARIABLE WHOLE LIFE POLICY WITH ADDITIONAL PROTECTION
Eligible For Annual Dividends
Insurance payable at death of Insured.
Premiums payable for period shown on page 3.
Benefits reflect investment results.
Variable benefits described in Sections 1, 3, 6, 7 and 8.
THE DEATH BENEFIT MAY INCREASE OR DECREASE DAILY DEPENDING ON INVESTMENT
RESULTS. HOWEVER, IF NO PREMIUM IS UNPAID AS OF ITS DUE DATE, THE DEATH BENEFIT
WILL NOT BE LESS THAN THE MINIMUM GUARANTEED DEATH BENEFIT SHOWN ON PAGE 3, LESS
ANY POLICY DEBT.
THE CASH VALUE UNDER THIS POLICY MAY INCREASE OR DECREASE DAILY DEPENDING ON
INVESTMENT RESULTS. THERE IS NO GUARANTEED MINIMUM CASH VALUE.
Right To Return Policy - Please read this policy carefully. The policy may be
returned by the Owner for any reason within (1) ten days after it was received
or (2) forty-five days after the application was signed, whichever is later. The
policy may be returned to your agent or to the Home Office of the Company at 000
Xxxx Xxxxxxxxx Xxxxxx, Xxxxxxxxx, XX 00000. If returned, the policy will be
considered void from the beginning. Any premium paid will then be refunded.
NORTHWESTERN
MUTUAL LIFE (R)
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Insured Xxxx X Xxx Age and Sex 35 Male
Policy Date June 1, 1995 Policy Number 12 345 678
Plan Variable Whole Life Initial Total
With Additional Protection Death Benefit $ 150,519
This policy is a legal contract between the Owner and The Northwestern Mutual
Life Insurance Company.
Read your policy carefully.
GUIDE TO POLICY PROVISIONS
BENEFITS AND PREMIUMS
SECTION 1. THE CONTRACT
Life Insurance Benefit payable on death of Insured.
Incontestablity. Suicide. Definition of dates.
SECTION 2. OWNERSHIP
Rights of the Owner. Assignment as collateral.
SECTION 3. ADDITIONAL PROTECTION
Description of Additional Protection. Reduction by Company.
Owners right to continue existing protection.
SECTION 4. PREMIUMS AND REINSTATEMENT
Payment of premiums. Grace period of 31 days to pay premium.
Amount of premium and premium adjustments.
Unscheduled additional premium payments.
Premium suspension. How to reinstate the policy.
SECTION 5. DIVIDENDS
Annual dividends. Use of dividends. Dividend at death.
SECTION 6. THE SEPARATE ACCOUNT
The Separate Account and the investment divisions.
Allocation of net premiums, dividends and deductions.
Transfer of assets.
SECTION 7. DETERMINATION OF VALUES
Policy Value. Cost of insurance charges. Excess amount.
Variable paid-up additional insurance.
SECTION 8. CASH VALUES AND PAID-UP INSURANCE
Cash value. Paid-up insurance if premium is not paid. Surrender.
SECTION 9. LOANS AND WITHDRAWALS
Policy loans. Interest on loans. Withdrawals.
SECTION 10. EXCHANGE OF POLICY
SECTION 11. BENEFICIARIES
Naming and change of beneficiaries.
Marital deduction provision for spouse of Insured.
Succession in interest of beneficiaries.
SECTION 12. PAYMENT OF POLICY BENEFITS
Payment of death or surrender proceeds.
Payment plans for policy proceeds.
Right to increase income under payment plans.
Guaranteed payment tables.
ADDITIONAL BENEFITS (if any)
APPLICATION
BENEFITS AND PREMIUMS
DATE OF ISSUE - JUNE 1, 1995
Initial Annual Payable
Plan and Additional Benefits Amount Premiums for
Variable Whole Life
With Additional Protection
Minimum Guaranteed Death Benefit $100,000 $1,347.00 Life
Additional Protection 50,000* 189.00 Life
Premiums To Increase Policy Value
Scheduled Additional Premium 1,000.00 Life
Excess Xxxxxx 000#
Initial Totals $150,519# $2,536.00
* This amount of Additional Protection is guaranteed to June 1, 2006 unless
the guaranteed period is terminated sooner under section 3.1. To continue
this amount of Additional Protection after June 1, 2006, an increased
premium may be required under section 3.2.
# This amount may increase or decrease daily depending on investment
results.
A premium is payable June 1, 1995 and every June 1 after that.
The first premium is $2,536.00.
The initial minimum premium is $1,536.00.
This policy is issued on a select basis.
Direct Beneficiary Xxxx X Xxx, spouse of the Insured
Owner Xxxx X Xxx, the Insured
Insured Xxxx X Xxx Age and Sex 35 Male
Policy Date June 1, 1995 Policy Number 12 345 678
Plan Variable Whole Life Initial Total
With Additional Protection Death Benefit $ 150,519
Page 3
POLICY NUMBER 12 345 678
-LIST OF CONTRACTUAL MINIMUMS-
The minimum increase in the scheduled additional premium is $100.00.
The minimum unscheduled additional premium is $100.00.
The minimum withdrawal amount is $250.00.
TABLE OF DEDUCTIONS FROM ANNUAL PREMIUMS (see section 4.5)
an amount not more than $114.00; plus
an amount not more than 8% of the remainder of the premium
TABLE OF DEDUCTIONS FROM ADDITIONAL PREMIUMS (see section 4.5)
an amount not more than 8%
TABLE OF CHARGES UNDER PREMIUM SUSPENSION (see section 7.1)
if premiums are suspended as described in section 4.6.
an amount of not more than $104.88 per year
TABLE OF SURRENDER CHARGES (see section 8.1)
Following Payment
Policy of Premium Due on Surrender
Year June 1, Charge
1 1995 $ 703.80
2 1996 716.10
3 1997 728.40
4 1998 740.70
5 1999 753.00
6 2000 711.00
7 2001 669.00
8 2002 627.00
9 2003 585.00
10 2004 543.00
11 2005 434.40
12 2006 325.80
13 2007 217.20
14 2008 108.60
15 and later 2009 0.00
Page 4
POLICY NUMBER 12 345 678
TABLE OF COST OF INSURANCE RATES
Beginning Beginning
of Policy of Policy
Year June 1, Rate Year June 1, Rate
1 1995 .00169 36 2030 .03463
2 1996 .00177 37 2031 .03891
3 1997 .00188 38 2032 .04256
4 1998 .00200 39 2033 .04744
5 1999 .00214 40 2034 .05292
6 2000 .00229 41 2035 .05880
7 2001 .00247 42 2036 .06506
8 2002 .00265 43 2037 .07164
9 2003 .00286 44 2038 .07847
10 2004 .00307 45 2039 .08572
11 2005 .00332 46 2040 .09367
12 2006 .00359 47 2041 .10252
13 2007 .00388 48 2042 .11252
14 2008 .00419 49 2043 .12379
15 2009 .00454 50 2044 .13611
16 2010 .00491 51 2045 .14920
17 2011 .00535 52 2046 .16280
18 2012 .00586 53 2047 .17679
19 2013 .00643 54 2048 .19089
20 2014 .00709 55 2049 .20529
21 2015 .00782 56 2050 .22019
22 2016 .00863 57 2051 .23584
23 2017 .00949 58 2052 .25275
24 2018 .01042 59 2053 .27163
25 2019 .01147 60 2054 .29565
26 2020 .01264 61 2054 .32996
27 2021 .01394 62 2055 .38455
28 2022 .01542 63 2056 .48020
29 2023 .01711 64 2057 .65798
30 2024 .01902 65 2058 1.00000
31 2025 .02113
32 2026 .02340
33 2027 .02586
34 2028 .02850
35 2029 .03138
Page 5
POLICY NUMBER 12 345 678
TABLE OF MAXIMUM ANNUAL PREMIUMS PER $1,000 OF TERM INSURANCE
Beginning Beginning
of Policy of Policy
Year June 1, Rate Year June 1, Rate
11 2005 $ 3.59 41 2035 $ 61.58
12 2006 3.88 42 2036 68.12
13 2007 4.18 43 2037 75.00
14 2008 4.50 44 2038 82.14
15 2009 4.87 45 2039 89.72
16 2010 5.26 46 2040 98.02
17 2011 5.72 47 2041 107.27
18 2012 6.25 48 2042 117.73
19 2013 6.85 49 2043 129.50
20 2014 7.54 50 2044 142.38
21 2015 8.30 51 2045 156.06
22 2016 9.14 52 2046 170.28
23 2017 10.04 53 2047 184.90
24 2018 11.02 54 2048 199.63
25 2019 12.11 55 2049 214.68
26 2020 13.34 56 2050 230.26
27 2021 14.69 57 2051 246.61
28 2022 16.24 58 2052 264.29
29 2023 18.01 59 2053 284.02
30 2024 20.00 60 2054 309.12
31 2025 22.21 61 2055 344.98
32 2026 24.58 62 2056 402.04
33 2027 27.15 63 2057 502.01
34 2028 29.21 64 2058 687.81
35 2029 32.92 65 2059 1,000.00
36 2030 36.32
37 2031 40.79
38 2032 44.61
39 2033 49.71
40 2034 55.43
The last term premium increase date is June 1, 2039.
Page 6
POLICY NUMBER 12 345 678
SEPARATE ACCOUNT (see section 6.1)
Account Divisions
Select Bond Division
International Equity Division
Money Market Division
Balanced Division
Index 500 Stock Division
Aggressive Growth Stock Division
High Yield Bond Division
Growth Stock Division
Growth & Income Stock Division
Index 400 Stock Division
Small Cap Growth Stock Division
Xxxxxxx Multi-Style Equity Division
Xxxxxxx Aggressive Equity Division
Xxxxxxx Non-US Division
Xxxxxxx Real Estate Securities Division
Xxxxxxx Core Bond Division
The maximum number of Divisions for allocation is ten.
The initial allocation date as used in section 6.2 is July 1, 1999.
The maximum transfer fee is $ 25.00.
The maximum withdrawal charge is $ 25.00. See section 9.8.
Page 7
POLICY NUMBER 12 345 678
TABLE OF TABULAR VALUES PER $1.00 OF INSURANCE
End End
of Policy Tabular of Policy Tabular
Year June 1, Value Year June 1, Value
1 1996 .01018 36 2031 .56194
2 1997 .02070 37 2032 .57992
3 1998 .03155 38 2033 .59785
4 1999 .04275 39 2034 .61536
5 2000 .05428 40 2035 .63237
6 2001 .06617 41 2036 .64887
7 2002 .07839 42 2037 .66487
8 2003 .09096 43 2038 .68042
9 2004 .10388 44 2039 .69559
10 2005 .11718 45 2040 .71045
11 2006 .13083 46 2041 .72495
12 2007 .14484 47 2042 .73904
13 2008 .15922 48 2043 .75262
14 2009 .17389 49 2044 .76555
15 2010 .18910 50 2045 .77777
16 2011 .20461 51 2046 .78929
17 2012 .22047 52 2047 .80018
18 2013 .23667 53 2048 .81054
19 2014 .25318 54 2049 .82055
20 2015 .26998 55 2050 .83041
21 2016 .28705 56 2051 .84031
22 2017 .30438 57 2052 .85052
23 2018 .32197 58 2053 .86134
24 2019 .33982 59 2054 .87320
25 2020 .35789 60 2055 .88639
26 2021 .37617 61 2056 .90105
27 2022 .39463 62 2057 .91703
28 2023 .41321 63 2058 .93375
29 2024 .43187 64 2059 .95015
30 2025 .45054 65 2060 1.00000
31 2026 .46920
32 2027 .48783
33 2028 .50643
34 2029 .52499
35 2030 .54352
The mortality basis is the Commissioners 1980 Standard Ordinary Mortality Table
for male nonsmokers. The annual effective interest rate used to calculate
quantities (a) and (b) of section 4.6 is 6%. All other net single premiums and
tabular values are based on an annual effective interest rate of 4%. All values
assume that claims are paid at the end of policy years.
The nonforfeiture factor is .01139284.
Page 8
SECTION 1. THE CONTRACT
1.1 LIFE INSURANCE BENEFIT
The Northwestern Mutual Life Insurance Company will pay a benefit on the
death of the Insured. Subject to the terms and conditions of the policy:
o payment of the death proceeds will be made after proof of the death
of the Insured is received at the Home Office; and
o payment will be made to the beneficiary or other payee under
Sections 11 and 12.
The amount of the death proceeds when all premiums due have been paid will be:
o the Insurance Amount; plus
o the amount of variable paid-up additional insurance under Section
7.4; less
o if premiums are not paid on an annual basis, an adjustment for any
premiums used to purchase variable paid-up additional insurance that
are due later in the policy year; plus
o the amount of any dividend at death (Section 5.3); less
o the amount of any policy debt (Section 9.3).
These amounts will be determined as of the date of death.
The Insurance Amount will be the greater of (a) and (b) where:
(a) is the sum of:
o the Minimum Guaranteed Death Benefit shown on page 3; plus
o the amount of Additional Protection then in force under
Section 3; plus
o the Excess Amount determined under Section 7.3; and
(b) is the amount of paid-up insurance which could be purchased by the
Policy Value applied as a net single premium using the basis of
values shown on page 8. If premiums are not paid on an annual basis,
this amount of paid-up insurance will be reduced by an adjustment
for any premiums due later in the policy year.
The amount of the death proceeds when the Insured dies during the grace
period following the due date of an a unpaid premium will be:
o the amount determined above assuming the overdue premium had been
paid; less
o the amount of the unpaid premium.
The amount of the death proceeds when the Insured dies while the policy is
in force as paid-up insurance will be determined under Section 8.
1.2 ENTIRE CONTRACT; CHANGES
This policy with the attached application is the entire contract.
Statements in the application are representations and not warranties. A change
in the policy is valid only if it is approved in writing by an officer of the
Company. The Company may require that the policy be sent to it for endorsement
to show a change. No agent has the authority to change the policy or to waive
any of its terms.
1.3 INCONTESTABILITY
The Company will not contest insurance under this policy after the
insurance has been in force during the lifetime of the Insured for two years
from the Date of Issue. In issuing the insurance, the Company has relied on the
application. While the insurance is contestable, the Company, on the basis of a
misstatement in the application, may rescind the insurance or deny a claim.
1.4 SUICIDE
If the Insured dies by suicide within one year from the Date of Issue, the
amount payable by the Company will be limited to the premiums paid, less the
amount of any policy debt and withdrawals and less the cash value of any
variable paid-up insurance surrendered.
1.5 POLICY DATE AND DATE OF ISSUE
Policy months, years and anniversaries are computed from the Policy Date.
The contestable and suicide periods begin with the Date of Issue. These dates
are shown on page 3. The Date of Issue for any increase in insurance issued
under Additional Premiums Scheduled After Issue (Section 4.2) or any Optional
Unscheduled Additional Premium (Section 4.3) will be shown on an amendment to
the Schedule of Benefits and Premiums.
1.6 MISSTATEMENT OF AGE OR SEX
If the age or sex of the Insured has been misstated, the amount payable
will be the amount which the premiums paid would have purchased at the correct
age and sex.
1.7 PAYMENTS BY THE COMPANY
All payments by the Company under this policy are payable at its Home
Office.
1.8 INSURABILITY REQUIREMENTS
To make some changes under this policy, the Insured must meet the
Company's insurability requirements. These requirements are as follows:
o evidence of insurability must be given that is satisfactory to the
Company; and
o under the Company's underwriting standards, the Insured is in an
underwriting classification that is the same as, or is better than,
the one for this policy.
9
SECTION 2. OWNERSHIP
2.1 THE OWNER
The Owner is named on page 3. The Owner, his successor or his transferee
may exercise policy rights without the consent of any beneficiary. After the
death of the Insured, policy rights may be exercised only as provided in
Sections 11 and 12.
2.2 TRANSFER OF OWNERSHIP
The Owner may transfer the ownership of this policy. Written proof of
transfer satisfactory to the Company must be received at its Home Office. The
transfer will then take effect as of the date that it was signed. The Company
may require that the policy be sent to it for endorsement to show the transfer.
2.3 COLLATERAL ASSIGNMENT
The Owner may assign this policy as collateral security. The Company is
not responsible for the validity or effect of the collateral assignment. The
Company will not be responsible to an assignee for any payment or other action
taken by the Company before receipt of the assignment in writing at its Home
Office.
The interest of any beneficiary will be subject to any collateral
assignment made either before or after the beneficiary is named.
The collateral assignee is not an Owner. A collateral assignment is not a
transfer of ownership. Ownership can be transferred only by complying with
Section 2.2.
SECTION 3. ADDITIONAL PROTECTION
3.1 ADDITIONAL PROTECTION
Additional Protection is insurance guaranteed for the period shown on page
3. The initial amount of and premium for Additional Protection are shown on page
3.
Additional Protection will terminate on any policy anniversary on which:
o the Owner has directed that dividends be used other than to increase
Policy Value; and
o the policy does not have Excess Amount.
3.2 REDUCTION BY COMPANY; OWNER'S RIGHT TO CONTINUE EXISTING PROTECTION
For any policy year after the end of the guaranteed period, the Company
may reduce the amount of Additional Protection if, at the attained age of the
Insured:
o the net annual policy premium; plus
o the excess, if any, of:
o the Policy Value 25 days before the policy anniversary plus
any dividend payable on the policy anniversary; over
o the tabular value of the Minimum Guaranteed Death Benefit on
the policy anniversary;
is less than:
o the Minimum Guaranteed Death Benefit times the nonforfeiture
factor (shown on page 8); plus
o that portion of the cost of insurance charge for the Insurance
Amount which the Company determines applies to Additional
Protection.
The amount of Additional Protection will be reduced to equal the amount of
term insurance which could be purchased by the premium for Additional Protection
plus any dividend payable on the policy anniversary. The premium rates for term
insurance will not be more than the rates shown on page 6. The Company will send
written notice of the reduction.
The Owner may prevent a reduction that would occur on or before the last
term insurance premium increase date shown on page 6. This may be done by the
payment of an increased minimum premium as determined under Section 4.2.
The increased premium will be payable for the remainder of the premium
paying period. The premium must be received at the Home Office within 31 days of
the date the reduction would take effect.
The right of the Owner to continue the amount of Additional Protection
will terminate as of the first policy anniversary on which the Owner fails to
pay an increased premium when due.
SECTION 4. PREMIUMS AND REINSTATEMENT
4.1 PREMIUM PAYMENT
Payment. All premiums after the first are payable at the Home Office or to an
authorized agent. A receipt signed by an officer of the Company will be
furnished on request. A premium must be paid on or before its due date. The date
when each premium is due and the number of years for which premiums are payable
are described on page 3.
No premiums may be paid while this policy is in force as paid-up insurance
under Section 8, except as provided in Reinstatement (Section 4.7).
Frequency. Premiums are payable annually. Premiums may be paid on any other
frequency, with the consent of the Company.
Grace Period. A grace period of 31 days will be allowed to pay a premium that is
not paid on its due date. The policy will be in full force during this period.
If a premium is paid during the grace period, policy values will be the same as
if the premium had been paid on the premium due date. If the Insured dies during
the grace period, any overdue premium will be paid from the proceeds of the
policy.
If a premium is not paid within the grace period, and the policy does not
qualify for Premium Suspension (Section 4.6), the policy will terminate as of
the due date unless it continues as paid-up insurance under Section 8.
10
4.2 AMOUNT OF PREMIUM; ADJUSTMENTS
Scheduled and Minimum Premiums. The premium due on this policy is the scheduled
premium plus any required unscheduled additional premium due under Section 4.4.
The scheduled premium is the sum of the minimum premium, any scheduled
additional premium used to purchase variable paid-up additional insurance or to
increase Policy Value, and any premium that is due for any additional benefit
that is a part of this policy. The minimum premium is the premium for the
Minimum Guaranteed Death Benefit and Additional Protection. The premium amounts
at issue are shown on page 3.
An increase in the minimum premium under Section 3.2 will be determined by
adding the premium for the Minimum Guaranteed Death Benefit to the term
insurance premium for the amount of Additional Protection at the attained age of
the Insured. The premium rates for term insurance will not be more than the
rates shown on page 6. The minimum premium will not be increased after the last
term insurance premium increase date shown on page 6.
Additional Premiums Scheduled At Issue. This policy may have been issued with
level additional premiums in excess of the minimum premium. The amount of these
additional premiums is shown on page 3.
Additional Premiums Scheduled After Issue. The Owner may pay additional premiums
by requesting that the level premium payable on the policy be increased. An
increase in the level amount may be made at any time before the policy
anniversary that is nearest to the 85th birthday of the Insured. The minimum
amount of increase is shown on page 4. Additional premiums may be scheduled only
if, at the time the increases are applied for:
o the insurance in force after applying the scheduled additional
premiums will be within the Company's issue limit; and
o the Company's insurability requirements are met.
Owner's Right To Decrease Scheduled Additional Premiums. The Owner may decrease
the amount of additional premium scheduled at issue or after issue. This may be
done at any time by written request sent to the Home Office. Later increases in
the level amount may be made only as provided in the preceding paragraph.
Effective Date. A premium change will take effect on the first premium due date
that follows the receipt at the Home Office of the Owner's written request for
change. When the Owner increases or decreases premiums, the Company will send an
amendment to the Schedule of Benefits and Premiums.
Additional Premiums Used To Purchase Paid-Up Additional Insurance Or Increase
Policy Value. As directed by the Owner each scheduled additional premium paid
will be used to purchase variable paid-up additional insurance or to increase
Policy Value as shown on page 3. The Owner may change this direction by written
notice sent to the Home Office, subject to evidence of insurability. The
purchase or increase will be made as of the policy anniversary.
4.3 OPTIONAL UNSCHEDULED ADDITIONAL PREMIUM
Unscheduled additional premiums may be paid to the Company at any time
before the policy anniversary that is nearest to the Insured's 85th birthday. An
unscheduled additional premium may be paid only if, at the time the premium is
paid:
o the insurance in force after applying the unscheduled additional
premium will be within the Company's issue limits; and
o the Company's insurability requirements are met.
Each unscheduled additional premium may not be less than the minimum
amount shown on page 4. As directed by the Owner, each net unscheduled
additional premium will be used, as of the date the premium is received by the
Company, to purchase variable paid-up additional insurance or to increase Policy
Value.
4.4 REQUIRED UNSCHEDULED ADDITIONAL PREMIUM
If a withdrawal has been made, the Company may require an unscheduled
additional premium to be paid. The due date of the required unscheduled
additional premium is the policy anniversary following written notice by the
Company. The net unscheduled additional premium will be used to increase Policy
Value.
The amount of required unscheduled additional premium due on a policy
anniversary will be the lesser of (a) and (b) where:
(a) is
o the tabular value for the Minimum Guaranteed Death Benefit;
minus
o the Policy Value, 25 days prior to the anniversary; and
(b) is
o the accumulation at 4% annual interest of all amounts
withdrawn; minus
o the accumulation at 4% annual interest of all additional
premiums used to increase Policy Value.
If either (a) or (b) is zero or less than zero, no unscheduled additional
premium will be required.
4.5 NET PREMIUMS
Net Annual Policy Premium. The net annual policy premium is:
o the annual premium for the Minimum Guaranteed Death Benefit;
plus
o the annual premium for Additional Protection; plus
o the annual scheduled additional premium used to increase
Policy Value; less
o deductions for expenses; less
o deductions for any classified mortality.
The deductions for expenses and classified mortality will not be more than the
amounts shown in the Table of Deductions from Annual Premiums shown on page 4.
11
Net Scheduled Additional Premium Used to Purchase Variable Paid-up Insurance. A
net scheduled additional premium used to purchase variable paid-up insurance is:
o the annual scheduled additional premium used to purchase additional
insurance; less
o deductions for expenses; less
o any classified mortality charge.
The deductions for expenses and the charge for classified mortality will not be
more than the amounts shown in the Table of Deductions from Additional Premiums
shown on page 4.
Net Unscheduled Additional Premium. A net unscheduled additional premium is:
o an optional or required unscheduled additional premium; less
o deductions for expenses; less
o any classified mortality charge.
The deductions for expenses and the charge for classified mortality will not be
more than the amounts shown in the Table of Deductions from Additional Premiums
shown on page 4.
4.6 PREMIUM SUSPENSION
A policy qualifies for premium suspension if at the end of the grace
period:
o the Excess Amount as of 25 days prior to the previous policy
anniversary is greater than or equal to one year's minimum premium
plus one year's premium for any additional benefits;
o the Company determines that the Policy Value 25 days prior to the
previous policy anniversary is greater than the sum of (a) plus (b)
where:
(a) is the net single premium on that anniversary for the
Insurance Amount. This net single premium will be calculated
using the basis of values for premium suspension shown on page
8; and
(b) is the present value of charges for premium suspension for all
future years. The present value will be calculated using:
o amounts which the Company is then charging for premium
suspension; and
o the basis of values for premium suspension shown on page
8; and
o no withdrawals have been made after a date 25 days prior to the
previous policy anniversary.
If a policy qualifies for premium suspension:
o the scheduled premium otherwise currently due does not need to be
paid; and
o the policy will not terminate because of the failure to pay the
premium.
The Owner may pay unscheduled additional premiums as provided under Section
4.3.
While premiums are being suspended, contract charges will be deducted from
the Policy Value on each policy anniversary, subject to the maximum charges
shown on page 4. If the premium frequency is other than annual, a deduction will
be made from Policy Value to pay a premium for the remainder of the policy year
and the premium frequency will be changed to annual.
The payment of premiums must resume as of a policy anniversary if either:
o the Excess Amount as of 25 days prior to a policy anniversary is
less than the sum of one year's minimum premium plus one year's
premium for any additional benefits; or
o the Owner elects to end premium suspension by written request sent
to the Home Office.
If a withdrawal of Policy Value is made, premiums will no longer be suspended
unless the policy requalifies for premium suspension as of the next policy
anniversary.
4.7 REINSTATEMENT
This policy may be reinstated within three years after the due date of the
overdue premium. All unpaid minimum premiums and premiums for any additional
benefits that are a part of this policy (and interest as required below) must be
received by the Company while the Insured is alive. The policy may not be
reinstated if the policy was surrendered. After reinstatement, the policy will
have the same Minimum Guaranteed Death Benefit, Additional Protection, Policy
Value and variable paid-up additional insurance as if:
o all minimum premiums had been paid when due;
o investment earnings for all Divisions, less charges against the
Separate Account, had been credited at an annual effective interest
rate of 4% from the due date of the overdue premium until the date
of reinstatement; and
o loan interest, less charges by the Company for expenses and taxes,
had been credited to Policy Value and to the cash value of variable
paid-up additional insurance at an annual effective interest rate of
4%, from the due date of the overdue premium until the date of
reinstatement.
In addition, for the policy to be reinstated more than 31 days after the
end of the grace period, the Company's insurability requirements must be met and
an amount must be paid equal to the greater of:
o all unpaid minimum premiums and premiums for additional benefits
with interest from the due date of each premium at an annual
effective rate of 5%; and
o 110% of the excess of the cash value of the policy upon
reinstatement over the cash value of the policy just before
reinstatement, plus all unpaid premiums for additional benefits with
interest from the due date of each premium at an annual effective
rate of 5%.
Any policy debt on the due date of the overdue premium, with interest at
an annual effective interest rate of 5% from that date, must be repaid or
reinstated.
12
SECTION 5. DIVIDENDS
5.1 ANNUAL DIVIDENDS
This policy will share in the divisible surplus of the Company. This
surplus is determined each year. This policy's share will be credited as a
dividend on the policy anniversary.
5.2 USE OF DIVIDENDS
Policy In Force As Variable Whole Life With Additional Protection. If Additional
Protection is in force and there is no Excess Amount, dividends will be used to
increase Policy Value. If Additional Protection is not in force, or if there is
Excess Amount, dividends may be paid in cash or used for one of the following:
o Policy Value. Dividends will be used to increase Policy Value.
o Paid-Up Additional Insurance. Dividends will purchase variable
benefit paid-up additional insurance.
o Premium Payment. Dividends will be used to reduce premiums. If the
dividend is greater than the premium, the balance will be used to
increase Policy Value.
Other uses of dividends may be made available by the Company.
If no direction is given for the use of dividends, they will be used to
increase Policy Value.
Policy In Force As Fixed Benefit Paid-Up Insurance. Dividends may be paid in
cash or used to purchase fixed benefit paid-up additional insurance. Other uses
of dividends may be made available by the Company.
If no direction is given for the use of dividends, they will be used to
purchase fixed benefit paid-up additional insurance.
Policy In Force As Variable Benefit Paid-Up Insurance. Dividends may be paid in
cash or used to purchase variable paid-up additional insurance. Other uses of
dividends may be made available by the Company.
If no direction is given for the use of dividends, they will be used to
purchase variable paid-up additional insurance.
5.3 DIVIDEND AT DEATH
If a dividend is payable for the period from the beginning of the policy
year to the date of the Insured's death, the dividend is payable as part of the
policy proceeds.
SECTION 6. THE SEPARATE ACCOUNT
6.1 DESCRIPTION
The Northwestern Mutual Variable Life Account (the Separate Account) has
been established by the Company pursuant to Wisconsin law and is registered as a
unit investment trust under the Investment Company Act of 1940.
The Separate Account has several Divisions, as shown on page 7. Assets of
the Separate Account are invested in shares of Northwestern Mutual Series Fund,
Inc. (the Fund). The Fund is registered under the Investment Company Act of 1940
as an open-end, diversified investment company. The Fund has one Portfolio for
each Division. Assets of each Division of the Separate Account are invested in
shares of the corresponding Portfolio of the Fund. Shares of the Fund are
purchased for the Separate Account at their net asset value. The Company may
make available additional Divisions and Portfolios.
Assets will be allocated to the Separate Account to support the operation
of this policy (except when in force as fixed benefit paid-up insurance) and
other variable life insurance policies. Assets may also be allocated for other
purposes, but not to support the operation of any contracts or policies other
than variable life insurance. Income and realized and unrealized gains and
losses from assets in the Separate Account are credited to or charged against it
without regard to other income, gains or losses of the Company.
The assets of the Separate Account will be valued on each valuation day.
They are the property of the Company. The portion of these assets equal to
policy reserves and liabilities will not be charged with liabilities arising out
of any other business the Company may conduct. The Company reserves the right to
transfer assets of the Separate Account in excess of these reserves and
liabilities to its General Account.
The Owner may exchange this policy for a fixed benefit life insurance
policy if the Fund changes its investment advisor or if a Portfolio has a
material change in its investment objectives or restrictions. The Company will
notify the Owner if there is any such change. The Owner may exchange this policy
within 60 days after the notice or the effective date of the change, whichever
is later.
If, in the judgment of the Company, a Portfolio no longer suits the
purposes of this policy due to a change in its investment objectives or
restrictions, the Company may substitute shares of another Portfolio of the Fund
or shares of another mutual fund. Any such substitution will be subject to any
required approval of the Securities and Exchange Commission (SEC), the Wisconsin
Commissioner of Insurance or other regulatory authority.
The Company also may, to the extent permitted by applicable laws and
regulations (including any order of the SEC), make changes as follows:
o the Separate Account or a Division may be operated as a management
company under the Investment Company Act of 1940, or in any other
form permitted by law, if deemed by the Company to be in the best
interest of the policyowners.
o the Separate Account may be deregistered under the Investment
Company Act of 1940 in the event registration is no longer required.
o the provisions of this and other policies may be modified to comply
with any other applicable federal or state laws.
13
In the event of a substitution or change, the Company may make appropriate
endorsement of this and other policies having an interest in the Separate
Account and take other actions as may be necessary to effect the substitution or
change.
6.2 ALLOCATION OF NET PREMIUMS, DIVIDENDS AND DEDUCTIONS
The first net annual policy premium and any net scheduled additional
premium used to purchase variable paid-up insurance will be allocated to the
Money Market Division on the Policy Date. Any net unscheduled additional
premium received prior to the Initial Allocation Date will be allocated to the
Money Market Division on the later of the Policy Date and the date the Company
receives the premium. The Initial Allocation Date is shown on page 7.
On the Initial Allocation Date, amounts in the Money Market Division will
be allocated in accordance with the application. This allocation will remain in
effect for later net premiums unless changed by the Owner by written request.
Any change in allocation will be in effect for net premiums credited to the
policy following the receipt of the written request at the Home Office.
Allocations must be in whole percentages. If a Division is to receive an
allocation, the allocation must be at least 10%. An allocation will not be
permitted that results in assets invested for this policy being apportioned
among more than the maximum number of Divisions for allocation shown on page 7.
Any deduction from Policy Value or from the value of variable paid-up
additional insurance, other than a decrease due to investment results, will be
allocated in proportion to the values in the Divisions.
6.3 TRANSFER OF ASSETS
On or after the Initial Allocation Date, the Owner may transfer the assets
(other than policy debt) invested for this policy to any of the Divisions, as
long as these assets, following the transfer, are allocated among not more than
the maximum number of Divisions for allocation shown on page 7. Transfers may be
made as often as twelve times in a policy year.
The transfer will take effect on the date a written request is received in
the Home Office. A fee may be required. The maximum fee is shown on page 7.
SECTION 7. DETERMINATION OF VALUES
7.1 POLICY VALUE
On the Policy Date, the Policy Value is equal to the net annual policy
premium plus any net unscheduled additional premium credited to Policy Value on
the Policy Date, less the cost of insurance charge. On any day after that, the
Policy Value is equal to what it was on the previous day plus these items:
o any increase due to investment results of all amounts invested in
all Divisions for the Policy Value;
o interest on the Policy Value's share of policy debt at an annual
rate equal to the loan interest rate less a charge by the Company
for expenses and taxes;
o on each policy anniversary, if the premium due is paid within the
grace period, the net annual policy premium;
o any net unscheduled additional premium used to increase Policy Value
credited that day;
o any policy dividend payable on that day directed to increase Policy
Value; and
o any amounts transferred to Policy Value from variable paid-up
additional insurance;
and minus any of these items applicable on that day:
o any decrease due to investment results of all amounts invested in
all Divisions for the Policy Value;
o a charge against the Separate Account at a rate of not more than
0.0016389% a day (0.60% a year) for mortality and expense risks that
the Company assumes;
o any amount charged against the Separate Account for taxes;
o if the annual premium is suspended under the Premium Suspension
provision (Section 4.6), any charges required under that provision;
o the cost of insurance charge for the Insurance Amount;
o any withdrawals; and
o any surrender charges, administrative charges or reduction in policy
debt that may result from a withdrawal, a decrease in face amount or
a change to variable benefit paid-up insurance
In addition, Policy Value will be adjusted for any increase or decrease,
other than on a policy anniversary, in the amount of scheduled additional
premiums used to increase Policy Value.
7.2 COST OF INSURANCE CHARGES FOR THE INSURANCE AMOUNT
A cost of insurance charge is deducted from the Policy Value on each
policy anniversary and is used in the determination of the Policy Value on the
Policy Date. The cost of insurance charge is the cost of insurance rate times
the net amount at risk. The cost of insurance rate is based on the attained age
of the Insured. The cost of insurance rates are shown on page 5. The net amount
at risk is (a) minus (b) where:
(a) is the projected Insurance Amount divided by 1.04. The projected
Insurance Amount is what the Insurance Amount would be at the end of
the policy year assuming a 4% annual effective interest rate on
invested funds; and
(b) is the Policy Value.
14
If an unscheduled additional premium paid on a date other than a policy
anniversary results in an increase in the net amount at risk, a cost of
insurance charge for the portion of the policy year remaining will be deducted
from Policy Value on the date the unscheduled additional premium is received by
the Company.
7.3 EXCESS AMOUNT
The Excess Amount is:
o the Policy Value; less
o the tabular value of the Minimum Guaranteed Death Benefit; less
o the tabular value of the amount of Additional Protection; less
o an adjustment, if premiums are not paid on an annual basis, for
premiums due later in the policy year.
If the amount determined above is less than zero, the Excess Amount will
be zero.
7.4 VARIABLE PAID-UP ADDITIONAL INSURANCE
Additional premiums and dividends used to purchase variable paid-up
additional insurance will immediately increase the death proceeds payable under
Section 1.1. These amount are not included in the Additional Protection.
The amount of variable paid-up additional insurance is equal to the cash
value of variable paid-up additional insurance divided by the net single premium
using the basis of values shown on page 8.
On the Policy Date, the cash value of variable paid-up additional insurance
is equal to any net additional premium used to purchase variable paid-up
additional insurance less the cost of insurance charge for the variable paid-up
additional insurance. On any day after that, the cash value of variable paid-up
additional insurance is equal to what it was on the previous day plus these
items:
o any increase due to investment results of all amounts invested in
all Divisions for the variable paid-up additional insurance;
o interest on the variable paid-up additional insurance's share of
policy debt at an annual rate equal to the loan interest rate less a
charge by the Company for expenses and taxes;
o on each policy anniversary, if the premium due is paid within the
grace period, the net scheduled additional premium used to purchase
variable paid-up additional insurance;
o any net unscheduled additional premium used to purchase variable
paid-up additional insurance credited that day; and
o any policy dividend payable on that day directed to purchase
variable paid-up additional insurance;
and minus any of these items applicable on that day:
o any decrease due to investment results of all amounts invested in
all Divisions for the variable paid-up additional insurance;
o a charge against the Separate Account at a rate of not more than
0.0016389% a day (0.60% a year) for mortality and expense risks that
the Company assumes;
o any amount charged against the Separate Account for taxes;
o the cost of insurance charge for the variable paid-up additional
insurance;
o any surrender of variable paid-up additional insurance; and
o any amount transferred to Policy Value.
In addition, variable paid-up additional insurance will be adjusted for
any increase or decrease, other than on a policy anniversary, in the amount of
scheduled additional premiums used to purchase variable paid-up additional
insurance.
Transfer Of Cash Value Of Variable Paid-Up Additional Insurance To Policy Value.
The Owner may transfer the cash value of any variable paid-up additional
insurance to Policy Value. The transfer will take effect on the date a written
request to transfer is received at the Home Office. Policy Value may not be
transferred to the cash value of variable paid-up additional insurance.
7.5 COST OF INSURANCE CHARGES FOR VARIABLE PAID UP ADDITIONAL INSURANCE
A cost of insurance charge is deducted from the cash value of variable
paid-up additional insurance on each policy anniversary and is used in the
determination of the cash value of variable paid-up additional insurance on the
Policy Date. The cost of insurance charge is the cost of insurance rate times
the net amount at risk. The cost of insurance rate is based on the attained age
of the Insured. The cost of insurance rates are shown on page 5. On a policy
anniversary, the net amount at risk is (a) minus (b) where:
(a) is the amount of variable paid-up additional insurance divided by
1.04; and
(b) is the cash value of variable paid-up additional insurance on the
policy anniversary.
If a net unscheduled additional premium is credited to the cash value of
variable paid-up additional insurance on a day other than the policy
anniversary, there will be a cost of insurance charge for the remainder of the
policy year based on the increase in the net amount at risk resulting from the
unscheduled additional premium.
7.6 VALUATION DAY AND VALUATION PERIOD
A valuation day is any day on which the assets of the Separate Account are
valued. A valuation period is a valuation day and any immediately preceding days
which are not valuation days.
Assets are valued as of the close of trading on the New York Stock
Exchange on each day the Exchange is open. Each Division's share of amounts
allocated, transferred or added to a Division or of amounts deducted, loaned,
transferred or withdrawn from a Division on any day will be determined as of the
end of the valuation period that contains that day.
15
SECTION 8. CASH VALUES AND PAID-UP INSURANCE
8.1 CASH VALUE
The cash value of this policy on any date when all premiums due have been
paid, during the grace period following the due date of an unpaid premium, or
when this policy is in force as variable benefit paid-up insurance is equal to:
o the Policy Value; plus
o the cash value of variable paid-up additional insurance; less
o any policy debt; less
o the surrender charge for the policy year shown on page 4. There is
no surrender charge if the policy is in force as variable benefit
paid-up insurance.
If premiums are not paid on an annual basis, the cash value will reflect a
reduction for any premiums due later in the policy year.
8.2 FIXED BENEFIT PAID-UP INSURANCE
If any premium is unpaid on the last day of the grace period and if the
cash value is at least $1,000 on the last day of the grace period, this policy
will be in force as fixed benefit paid-up insurance. If the cash value is less
than $1,000 as of the last day of the grace period, the policy will be treated
as surrendered under Section 8.4.
When the policy is in force as fixed benefit paid-up insurance, the
Minimum Guaranteed Death Benefit, Additional Protection and Policy Value will
not be in effect.
The amount of fixed benefit paid-up insurance will be determined by using
the cash value plus the policy debt, both as of the last day of the grace
period, as a net single premium at the attained age of the Insured. However, if
a portion of the cash value is attributable to variable paid-up additional
insurance, that portion will be applied to purchase fixed benefit paid-up
additions. The variable paid-up additional insurance will no longer be in force.
The cash value of fixed benefit paid-up insurance or fixed benefit paid-up
additions will be the net single premium for that insurance at the attained age
of the Insured less any policy debt. If fixed benefit paid-up insurance is
surrendered within 31 days after a policy anniversary, the cash value will not
be less than the cash value on that anniversary reduced by any later surrender
of paid-up additions and adjusted for any later change in policy debt.
The amount of the death proceeds when this policy is in force as fixed
benefit paid-up insurance will be:
o the amount of fixed benefit paid-up insurance determined above; plus
o the amount of any fixed benefit paid-up additions then in force;
plus
o the amount of any dividend at death; less
o the amount of any policy debt.
These amounts will be determined as of the date of death.
Any policy debt will continue on fixed benefit paid-up insurance. Fixed
benefit paid-up insurance will share in divisible surplus.
8.3 VARIABLE BENEFIT PAID-UP INSURANCE
Variable benefit paid-up insurance may be selected in place of fixed
benefit paid-up insurance provided the cash value of the policy is at least
$5,000 on the last day of the grace period. A written request must be received
at the Home Office no later than the last day of the grace period.
When the policy is in force as variable benefit paid-up insurance, the
Minimum Guaranteed Death Benefit and Additional Protection will not be in
effect. On the due date of the unpaid premium, the Policy Value is set equal to
the cash value plus the policy debt. The cash value of variable paid-up
additional insurance is set at zero.
The amount of the death proceeds when this policy is in force as variable
benefit paid-up insurance will be:
o the Policy Value of variable benefit paid-up insurance divided by
the net single premium using the basis of values on page 8; plus
o the amount of any in force variable paid-up additional insurance
purchased by dividends; plus
o the amount of any dividend at death; less
o the amount of any policy debt.
These amounts will be determined as of the date of death.
Any policy debt will continue on variable benefit paid-up insurance.
Variable benefit paid-up insurance will share in divisible surplus.
8.4 SURRENDER
The Owner may surrender this policy for its cash value. A written
surrender of all claims, satisfactory to the Company, will be required. The date
of surrender will be the date of receipt at the Home Office of the written
surrender. The policy will terminate, and the cash value will be determined, as
of the end of the valuation period which includes the date of surrender, or, in
the case of fixed benefit paid-up insurance, as of the date of surrender. The
Company may require that the policy be sent to it.
16
8.5 DEFERRAL OF PAYMENTS
Variable Insurance. During any period when:
o the sale of securities or the determination of investment results is
not reasonably practicable because
(i) the New York Stock Exchange is closed; or
(ii) conditions are such that, under rules and regulations adopted
by the SEC, trading is deemed to be restricted or an emergency
is deemed to exist; or
o the SEC, by order, permits deferral for the protection of the
Company's policy owners;
the Company reserves the right:
o to defer determination of cash value and payment of the cash value;
o to defer payment of a loan or withdrawal;
o to defer determination of a change in the amount of variable
insurance or other variable amounts payable on death, and, if such
determination has been deferred, to defer payment of any portion of
the death benefit based on a variable amount; and
o if payment of all or part of the death benefit is deferred, to defer
application of the death proceeds to a payment plan under Section
12.
Fixed Benefit Insurance. The Company may defer paying the cash value of the
fixed benefit paid-up insurance for up to six months from the date of surrender.
If payment is deferred for 30 days or more, interest will be paid on the cash
value at an annual effective rate of 4% from the date of surrender to the date
of payment.
The Company may defer making a loan for up to six months.
8.6 TABULAR VALUES
The tabular value of the Minimum Guaranteed Death Benefit is equal to the
Minimum Guaranteed Death Benefit times the tabular value per $1 of insurance.
The tabular value of Additional Protection is equal to the amount of Additional
Protection times the tabular value per $1 of insurance. Tabular values per $1 of
insurance are shown on page 8 for each policy anniversary. Tabular values during
a policy year will reflect the time elapsed in that year.
Tabular values are the net level premium reserves for a whole life policy
calculated using the basis of values shown on page 8. Calculations assume annual
premiums are paid at the beginning of the policy year and claims are paid at the
end of the policy year.
Tabular values are used to determine:
o whether the amount of Additional Protection may be reduced under
Section 3.2;
o to determine the amount of any required unscheduled additional
premium under Section 4.4;
o whether the policy qualifies for premium suspension under Section
4.6; and
o the Excess Amount under Section 7.3.
SECTION 9. LOANS AND WITHDRAWALS
9.1 POLICY LOANS
The Owner may obtain a loan from the Company in an amount that, when added
to existing policy debt, is not more than the loan value.
A loan may be obtained on written request or to pay an overdue premium if
the premium loan provision is in effect on this policy and premiums are not
suspended under Section 4.6. If the loan value is not large enough to pay the
overdue premium, a premium will be paid for any other frequency permitted by the
Company for which the loan value is large enough. The Owner may elect or revoke
the premium loan provision by written request received at the Home Office.
9.2 LOAN VALUE
The loan value is 90% of the sum of the cash value and any existing policy
debt on the date of the loan.
9.3 POLICY DEBT
Policy debt consists of all outstanding loans and accrued interest. It may
be paid to the Company at any time. Any policy debt will be deducted from the
policy proceeds.
If the cash value decreases to zero, this policy will terminate unless a
sufficient portion of the policy debt is repaid. Termination occurs 31 days
after a notice has been mailed to the Owner and to any assignee on record at the
Home Office. The notice will state the amount that must be repaid to keep the
policy in force.
9.4 ALLOCATION OF LOANS
Except when this policy is in force as fixed benefit paid-up insurance, a
loan will be allocated between Policy Value and variable paid-up additional
insurance in proportion to the amount of cash value attributable to Policy Value
and the cash value of variable paid-up additional insurance. On the date a loan
is made, or on the date unpaid interest is added to the loan, the amounts
invested for this policy in each Division will be reduced in proportion to the
amounts in each Division. On the date a loan repayment is made, the amounts
invested for this policy in each Division will be increased in proportion to the
amounts in each Division.
17
9.5 LOAN INTEREST
Interest accrues and is payable on a daily basis from the date of the loan
on loans requested by the Owner and from the premium due date on loans to pay
premiums. Unpaid interest is added to the loan.
The Specified Rate loan interest option or the Variable Rate loan interest
option is elected on the application. The Owner may change this election at any
time, but the change will not take effect until the January 1st following
receipt of a written request at the Company's Home Office.
9.6 SPECIFIED RATE LOAN INTEREST OPTION
Interest is payable at an annual effective rate of 5%.
9.7 VARIABLE RATE LOAN INTEREST OPTION
Interest is payable at an annual effective rate that is set by the Company
annually and applied to new or outstanding policy debt during the year beginning
each January 1. The highest loan interest rate that may be set by the Company is
the greater of:
o a rate 1% higher than the rate shown on page 8 used to calculate
tabular values; and
o a rate based on the Corporate Bond Yield Averages -- Monthly Average
Corporates for the immediately preceding October. This Average is
published by Xxxxx'x Investors Service, Inc. If it is no longer
published, the highest loan interest rate will be based on some
other similar average established by the insurance supervisory
official of the state in which this policy is delivered.
The loan interest rate set by the Company will not exceed the maximum rate
permitted by the laws of the state in which this policy is delivered. The loan
interest rate will not be changed unless the change in the annual effective rate
is at least 1/2%.
The Company will give notice:
o of the initial loan interest rate in effect at the time a policy
loan is made.
o of an increase in loan interest rate on outstanding policy debt no
later than 30 days before the January 1st on which the increase
takes effect.
This policy will not terminate during a policy year as the sole result of
an increase in the loan interest rate during that policy year.
9.8 WITHDRAWALS
The Owner may make a withdrawal of Policy Value. A fee may be charged
subject to the maximum shown on page 7. However, the Owner may not:
o withdraw more than the Excess Amount less the surrender charge shown
on page 4;
o withdraw an amount which would reduce the loan value to less than
the policy debt;
o withdraw less than the minimum withdrawal amount shown on page 4; or
o make more than four withdrawals in a policy year.
Any withdrawal from Policy Value will be allocated between the Divisions
in proportion to the amount attributable to each Division.
SECTION 10. EXCHANGE OF POLICY
Within 24 months after the Date of Issue shown on page 3, provided
premiums are duly paid, the Owner may exchange this policy without evidence of
insurability for a fixed benefit life insurance policy on the life of the
Insured. The new policy will be on a form determined by the Company to be
similar to this policy.
To effect the change the Owner must send this policy, a completed
application for change, and any required payment to the Home Office of the
Company. The change will be effective on the later of the date of the
application or the date the required items are received at the Home Office.
The new policy will have the same initial guaranteed death benefit, policy
date and issue age as this one, and the premiums and cash values will be the
same as those for whole life policies issued on the Date of Issue of this
policy.
Any additional benefit included in this policy will be included with the
new policy only to the extent that such provisions were being offered with the
new policy on the Date of Issue of this policy.
18
SECTION 11. BENEFICIARIES
11.1 DEFINITION OF BENEFICIARIES
The term "beneficiaries" as used in this policy includes direct
beneficiaries, contingent beneficiaries and further payees.
11.2 NAMING AND CHANGE OF BENEFICIARIES
By Owner. The Owner may name and change the beneficiaries of death proceeds:
o while the Insured is living.
o during the first 60 days after the date of death of the Insured, if
the Insured was not the Owner immediately prior to the Insured's
death. A change made during this 60 days may not be revoked.
By Direct Beneficiary. A direct beneficiary may name and change the contingent
beneficiaries and further payees of the direct beneficiary's share of the
proceeds:
o if the direct beneficiary is the Owner;
o if, at any time after the death of the Insured, no contingent
beneficiary or further payee of that share is living; or
o if, after the death of the Insured, the direct beneficiary elects a
payment plan. The interest of any other beneficiary in the share of
that direct beneficiary will end.
These direct beneficiary rights are subject to the Owner's rights during
the 60 days after the date of death of the Insured.
By Spouse (Marital Deduction Provision).
o Power To Appoint. The spouse of the Insured will have the power
alone and in all events to appoint all amounts payable to the spouse
under the policy if:
a. immediately before the Insured's death, the Insured was the
Owner; and
b. the spouse is a direct beneficiary; and
c. the spouse survives the Insured.
o To Whom Spouse Can Appoint. Under this power, the spouse can
appoint:
a. to the estate of the spouse; or
b. to any other persons as contingent beneficiaries and further
payees.
o Effect Of Exercise. As to the amounts appointed, the exercise of
this power will:
a. revoke any other designation of beneficiaries;
b. revoke any election of payment plan as it applies to them; and
c. cause any provision to the contrary in Section 11 or 12 of
this policy to be of no effect.
Effective Date. A naming or change of a beneficiary will be made on receipt at
the Home Office of a written request that is acceptable to the Company. The
request will then take effect as of the date that it was signed. The Company is
not responsible for any payment or other action that is taken by it before the
receipt of the request. The Company may require that the policy be sent to it to
be endorsed to show the naming or change.
11.3 SUCCESSION IN INTEREST OF BENEFICIARIES
Direct Beneficiaries. The proceeds of this policy will be payable in equal
shares to the direct beneficiaries who survive and receive payment. If a direct
beneficiary dies before receiving all or part of the direct beneficiary's full
share, the unpaid portion will be payable in equal shares to the other direct
beneficiaries who survive and receive payment.
Contingent Beneficiaries. At the death of all of the direct beneficiaries, the
proceeds, or the present value of any unpaid payments under a payment plan, will
be payable in equal shares to the contingent beneficiaries who survive and
receive payment. If a contingent beneficiary dies before receiving all or part
of the contingent beneficiary's full share, the unpaid portion will be payable
in equal shares to the other contingent beneficiaries who survive and receive
payment.
Further Payees. At the death of all of the direct and contingent beneficiaries,
the proceeds, or the present value of any unpaid payments under a payment plan,
will be paid in one sum:
o in equal shares to the further payees who survive and receive
payment; or
o if no further payees survive and receive payment, to the estate of
the last to die of all of the direct and contingent beneficiaries
who survive the Insured.
Owner Or The Owner's Estate. If no beneficiaries are alive when the Insured
dies, the proceeds will be paid to the Owner or to the Owner's estate.
11.4 GENERAL
Transfer Of Ownership. A transfer of ownership of itself will not change the
interest of a beneficiary.
Claims Of Creditors. So far as allowed by law, no amount payable under this
policy will be subject to the claims of creditors of a beneficiary.
Succession Under Payment Plans. A direct or contingent beneficiary who succeeds
to an interest in a payment plan will continue under the terms of the plan.
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SECTION 12. PAYMENT OF POLICY BENEFITS
12.1 PAYMENT OF PROCEEDS
Death proceeds will be paid under the payment plan that takes effect on
the date of death of the Insured. The Interest Income Plan (Option A) will be in
effect if no patient plan has been elected. Interest will accumulate from the
date of death until a payment plan is elected or the proceeds are withdrawn in
cash.
Surrender proceeds will be paid in cash or under a payment plan that is
elected.
12.2 PAYMENT PLANS
Interest Income Plan (Option A). The proceeds will earn interest which may be
received each month or accumulated. The first payment is due one month after the
date on which the plan takes effect. Interest that has accumulated may be
withdrawn at any time. Part or all of the proceeds may be withdrawn at any time.
Installment Income Plans. Payments will be made each month on the terms of the
plan that is elected. The first payment is due on the date that the plan takes
effect.
o Specified Period (Option B). The proceeds with interest will be paid
over a period of from one to 30 years. The present value of any
unpaid installments may be withdrawn at any time.
o Specified Amount (Option D). Payments of not less than $10 per
$1,000 of proceeds will be made until all of the proceeds with
interest have been paid. The balance may be withdrawn at any time.
Life Income Plans. Payments will be made each month on the terms of the plan
that is elected. The first payment is due on the date that the plan takes
effect. Proof of the date of birth, acceptable to the Company, must be furnished
for each person on whose life the payments are based.
o Single Life Income (Option C). Payments will be made for a chosen
period and, after that, for the life of the person on whose life the
payments are based. The choices for the period are:
a. zero years;
b. 10 years;
c. 20 years; or
d. a refund period which continues until the sum of the payments
that have been made is equal to the proceeds that were placed
under the plan.
o Joint And Survivor Life Income (Option E). Payments are based on the
lives of two persons. Level payments will be made for a period of 10
years and, after that, for as long as one or both of the persons are
living.
o Other Selections. The Company may offer other selections under the
Life Income Plans.
o Withdrawal. The present value of any unpaid payments that are to be
made for the chosen period (Option C) or the 10 year period (Option
E) may be withdrawn only after the death of all of the persons on
whose lives the payments are based.
o Limitations. A direct or contingent beneficiary who is a natural
person may be paid under a Life Income Plan only if the payments
depend on that beneficiary's life. A corporation may be paid under a
Life Income Plan only if the payments depend on the life of the
Insured or, after the death of the Insured, on the life of the
Insured's spouse or dependent.
Payment Frequency. On request, payments will be made once every 3, 6 or 12
months instead of each month.
Transfer Between Payment Plans. A beneficiary who is receiving payment under a
plan which includes the right to withdraw may transfer the amount withdrawable
to any other plan that is available.
Minimum Payment. The Company may limit the election of a payment plan to one
that results in payments of at least $50.
If payments under a payment plan are or become less than $50, the Company
may change the frequency of payments. If the payments are being made once every
12 months and are less than $50, the Company may pay the present value or the
balance of the payment plan.
12.3 PAYMENT PLAN RATES
Interest Income And Installment Income Plans. Proceeds will earn interest at
rates declared each year by the Company. None of these rates will be less than
an annual effective rate of 2%. Interest of more than 2% will increase the
amount of the payments or, for the Specified Amount Plan (Option D), increase
the number of payments. The present value of any unpaid installments will be
based on the 2% rate of interest.
The Company may offer guaranteed rates of interest higher than 2% with
conditions on withdrawal.
Life Income Plans. Payments will be based on rates declared by the Company.
These rates will provide at least as much income as would the Company's rates,
on the date that the payment plan takes effect, for a single premium immediate
annuity contract. Payments under these rates will not be less than the amounts
that are described in Minimum Payment Rates.
20
Minimum Payment Rates. The minimum payment rates for the Installment Income
Plans (Options B and D) and the Life Income Plans (Options C and E) are shown in
the Minimum Payment Rate Tables.
The Life Income Plan payment rates in those tables depend on the sex and
on the adjusted age of each person on whose life the payments are based. The
adjusted age is:
o the age on the birthday that is nearest to the date on which the
payment plan takes effect; plus
o the age adjustment shown below for the number of policy years that
have elapsed from the Policy Date to the date that the payment plan
takes effect. A part of a policy year is counted as a full year.
--------------------------------------------------------------------------------
POLICY POLICY
YEARS AGE YEARS AGE
ELAPSED ADJUSTMENT ELAPSED ADJUSTMENT
--------------------------------------------------------------------------------
1 to 8 0 33 to 40 -4
9 to 16 -1 41 to 48 -5
17 to 24 -2 49 or more -6
25 to 32 -3
--------------------------------------------------------------------------------
12.4 EFFECTIVE DATE FOR PAYMENT PLAN
A payment plan that is elected will take effect on the date of death of
the Insured if:
o the plan is elected by the Owner; and
o the election is received at the Home Office while the Insured is
living.
In all other cases, a payment plan that is elected will take effect:
o on the date the election is received at the Home Office; or
o on a later date, if requested.
12.5 PAYMENT PLAN ELECTIONS
For Death Proceeds By Owner. The Owner may elect payment plans for death
proceeds:
o while the Insured is living.
o during the first 60 days after the date of death of the Insured, if
the Insured was not the Owner immediately prior to the Insured's
death. An election made during this 60 days may not be changed.
For Death Proceeds By Direct Or Contingent Beneficiary. A direct or contingent
beneficiary may elect payment plans for death proceeds payable to that
beneficiary, if no payment plan that has been elected is in effect. This right
is subject to the Owner's rights during the 60 days after the date of death of
the Insured.
For Surrender Proceeds. The Owner may elect payment plans for surrender
proceeds. The Owner will be the direct beneficiary.
12.6 INCREASE OF MONTHLY INCOME
A direct beneficiary who is to receive proceeds under a payment plan may
increase the amount of the monthly payment. This is done by the payment of an
annuity premium to the Company at the time the payment plan elected under
Section 12.5 takes effect. The amount that will be applied under the payment
plan will be the net premium. The net premium is the annuity premium less a
charge of not more than 2% and less any premium tax. The net premium will be
applied under the same payment plan and at the same rates as the proceeds. The
Company may limit this net premium to an amount that is equal to the direct
beneficiary's share of the proceeds payable under this policy.
MINIMUM PAYMENT RATE TABLES
Minimum Monthly Income Payments Per $1,000 Proceeds
INSTALLMENT INCOME PLANS (OPTIONS B AND D)
--------------------------------------------------------------------------------
PERIOD MONTHLY PERIOD MONTHLY PERIOD MONTHLY
(YEARS) PAYMENT (YEARS) PAYMENT (YEARS) PAYMENT
--------------------------------------------------------------------------------
1 $ 84.65 11 $ 9.09 21 $ 5.56
2 43.05 12 8.46 22 5.39
3 29.19 13 7.94 23 5.24
4 22.27 14 7.49 24 5.09
5 18.12 15 7.10 25 4.96
6 15.35 16 6.76 26 4.84
7 13.38 17 6.47 27 4.73
8 11.90 18 6.20 28 4.63
9 10.75 19 5.97 29 4.53
10 9.83 20 5.75 30 4.45
--------------------------------------------------------------------------------
21
PAYMENT RATE TABLES
Monthly Income Payments Per $1,000 Benefits
Guaranteed Fixed Payment or First Payment Under Variable Payment Plan
LIFE INCOME PLAN (OPTION C)
-------------------------------------------------------------------------------------------
SINGLE LIFE MONTHLY PAYMENTS
-------------------------------------------------------------------------------------------
MALE CHOSEN PERIOD (YEARS) FEMALE CHOSEN PERIOD (YEARS)
ADJUSTED --------------------------- ADJUSTED -------------------------
AGE* XXXX 00 00 AGE* ZERO 10 20
-------------------------------------------------------------------------------------------
55 $ 4.48 $ 4.43 $ 4.28 55 $ 4.09 $ 4.07 $ 4.00
56 4.56 4.50 4.34 56 4.15 4.13 4.05
57 4.65 4.59 4.40 57 4.22 4.20 4.11
58 4.75 4.68 4.46 58 4.30 4.27 4.17
59 4.85 4.77 4.52 59 4.38 4.34 4.23
60 4.96 4.87 4.59 60 4.46 4.42 4.29
61 5.07 4.97 4.66 61 4.55 4.50 4.36
62 5.20 5.08 4.72 62 4.65 4.59 4.43
63 5.33 5.19 4.79 63 4.75 4.69 4.50
64 5.48 5.32 4.86 64 4.86 4.79 4.57
65 5.63 5.44 4.92 65 4.97 4.89 4.64
66 5.80 5.58 4.99 66 5.10 5.01 4.71
67 5.97 5.72 5.05 67 5.23 5.12 4.79
68 6.16 5.86 5.12 68 5.38 5.25 4.86
69 6.36 6.01 5.18 69 5.53 5.39 4.93
70 6.58 6.17 5.23 70 5.70 5.53 5.01
71 6.81 6.33 5.29 71 5.88 5.68 5.08
72 7.05 6.49 5.34 72 6.08 5.83 5.15
73 7.31 6.66 5.38 73 6.29 6.00 5.21
74 7.59 6.83 5.43 74 6.52 6.17 5.27
75 7.89 7.01 5.46 75 6.77 6.35 5.33
76 8.21 7.19 5.50 76 7.04 6.54 5.38
77 8.56 7.37 5.53 77 7.33 6.73 5.43
78 8.93 7.55 5.56 78 7.65 6.93 5.47
79 9.32 7.72 5.58 79 7.99 7.13 5.51
80 9.75 7.90 5.60 80 8.36 7.34 5.54
81 10.20 8.07 5.62 81 8.76 7.54 5.57
82 10.69 8.23 5.63 82 9.20 7.74 5.59
83 11.21 8.39 5.64 83 9.67 7.93 5.61
84 11.76 8.54 5.65 84 10.18 8.12 5.63
85 and over 12.35 8.68 5.66 85 and over 10.74 8.30 5.64
-------------------------------------------------------------------------------------------
LIFE INCOME PLAN (OPTION E)
--------------------------------------------------------------------------------------
JOINT AND SURVIVOR MONTHLY PAYMENTS
--------------------------------------------------------------------------------------
MALE FEMALE ADJUSTED AGE*
ADJUSTED --------------------------------------------------------------------
AGE* 55 60 65 70 75 80 85 and over
--------------------------------------------------------------------------------------
55 $ 3.79 $ 3.93 $ 4.07 $ 4.19 $ 4.29 $ 4.35 $ 4.39
60 3.87 4.07 4.27 4.46 4.61 4.73 4.80
65 3.94 4.18 4.45 4.73 4.98 5.19 5.32
70 3.99 4.27 4.61 4.99 5.37 5.70 5.94
75 4.02 4.34 4.73 5.20 5.72 6.21 6.60
80 4.05 4.38 4.81 5.35 6.00 6.67 7.24
85 and over 4.06 4.40 4.86 5.45 6.18 7.00 7.75
--------------------------------------------------------------------------------------
* See Section 12.3.
22
AMENDMENT TO SECTION 6 THE SEPARATE ACCOUNT
FOR VARIABLE WHOLE LIFE
AS OF THE DATE OF ISSUE, THE SECOND PARAGRAPH OF SECTION 6.1 IS AMENDED TO
READ AS FOLLOWS:
The Separate Account has several Divisions, as shown on page 7. Assets of
the Separate Account are invested in shares of corresponding mutual funds or
portfolios of mutual funds, both of which are referred to in this policy as
Portfolios. Shares of the Portfolios are purchased for the Separate Account at
their net asset value. The Company may make available additional Divisions and
Portfolios.
AS OF THE DATE OF ISSUE, THE FIFTH AND SIXTH PARAGRAPHS OF SECTION 6.1 ARE
AMENDED TO READ AS FOLLOWS:
The Owner may exchange this policy for a fixed benefit life insurance
policy being offered at that time by the Company if the Portfolio changes its
investment advisor or has a material change in its investment objectives or
restrictions. The Company will notify the Owner if there is any such change.
The Owner may exchange this policy within 60 days after the notice or the
effective date of the change, whichever is later.
If, in the judgment of the Company, a Portfolio no longer suits the
purposes of this policy due to a change in its investment objectives or
restrictions, the Company may substitute shares of another Portfolio. Any such
substitution will be subject to any required approval of the Securities and
Exchange Commission (SEC), the Wisconsin Commissioner of Insurance or other
regulatory authority.
Secretary
NORTHWESTERN MUTUAL LIFE
INSURANCE COMPANY
VCL.FUNDS.(0799)
POLICY APPLICATION SUPPLEMENT FOR
VARIABLE WHOLE LIFE WITH ADDITIONAL PROTECTION
THE NORTHWESTERN MUTUAL LIFE INSURANCE COMPANY
000 Xxxx Xxxxxxxxx Xxxxxx
Xxxxxxxxx, Xxxxxxxxx 00000
INSURED:
--------------------
POLICY: Variable Whole Life (Minimum Guaranteed Death Benefit) $
------
with Additional Protection $
-------
Initial Death Benefit $
-------
Other
Annual Initial
Premium Premium
------- -------
Variable Whole Life Premium $
-------
Additional Protection Premium $
-------
Premiums to Increase Policy Value:
Scheduled Additional Premium $
-------
Unscheduled Additional Premium $
-------
Premiums to Purchase Variable Paid-Up Insurance:
Scheduled Additional Premium $
-------
Unscheduled Additional Premium $
-------
Waiver of Premium Benefit $
-------
Additional Purchase Benefit $
-------
Amount Each Purchase Date $
-------
ALLOCATION OF NET PREMIUMS
USE WHOLE PERCENTAGES ONLY. Up to ten choices can be selected. There must be a
minimum of 10% in each Division selected. If dollar cost averaging is used, the
Money Market Division is utilized and considered one choice (with nine
additional selections available). If dollar cost averaging is desired, allocate
100% to the Money Market Division and complete the monthly dollar cost averaging
section.
Select Bond Division % Growth & Income Stock Division %
----- -----
International Equity Division % Index 400 Stock Division %
----- -----
Money Market Division % Small Cap Growth Stock Division %
----- -----
Balanced Division % Xxxxxxx Multi-Style Equity Division %
----- -----
Index 500 Stock Division % Xxxxxxx Aggressive Equity Division %
----- -----
Aggressive Growth Stock Division % Xxxxxxx Non-US Division %
----- -----
High Yield Bond Division % Xxxxxxx Real Estate Securities Division %
----- -----
Growth Stock Division % Xxxxxxx Core Bond Division %
----- -----
Total 100%
----
----
Illustration No.
-----------
90-1 VCL.Supp.(0799) Page 1 of 4
MONTHLY DOLLAR COST AVERAGING
To elect monthly dollar cost averaging, choose one of the following options and
indicate the desired allocation of transfers below:
Option One: Transfer funds from the Money Market Division in monthly
-- installments such that by the end of the policy year the balance in the
Money Market division will be zero.
-- Option Two: Transfer the following amount from the Money Market Division
each month until the balance is zero: $_____________.
Use whole percentages only. There must be a minimum of 10% in each Division
selected.
Select Bond Division % Growth & Income Stock Division %
----- -----
International Equity Division % Index 400 Stock Division %
----- -----
Balanced Division % Small Cap Growth Stock Division %
----- -----
Index 500 Stock Division % Xxxxxxx Multi-Style Equity Division %
----- -----
Aggressive Growth Stock Division % Xxxxxxx Aggressive Equity Division %
----- -----
High Yield Bond Division % Xxxxxxx Non-US Division %
----- -----
Growth Stock Division % Xxxxxxx Real Estate Securities Division %
----- -----
Xxxxxxx Core Bond Division %
-----
Total 100%
----
----
ANNUAL DIVIDENDS
If Additional Protection is present and there is no Excess Amount, dividends
will be used to increase Policy Value. In other situations, until otherwise
directed, dividends will:
Increase Policy Value
-----
Reduce current premium with excess used to increase Policy Value
-----
Purchase Variable Paid-Up Additional Insurance
-----
Be paid in cash
-----
POLICY LOAN INTEREST RATE OPTION
5%
-----
Variable Rate
-----
OWNER'S ADDRESS
Insured's address or:
-----
----- ------------------------------------
Xxxxxx & Xx. xx X.X.X.
------------------------------------
Xxxx Xxxxx Zip
Insured:
---------------------
Illustration No.
-------------
90-1 VCL.Supp.(0799) Page 2 of 4
The Company is required to make the following inquiries for purposes of
determining the suitability of this sale. All responses will be kept
confidential.
1. In addition to providing a benefit upon death, what is the purpose for the
purchase?
To fund a trust
-----
To supplement retirement income
-----
To supplement education funding
-----
Other (specify)
----- --------------------------------------------------
2. By whom will the purchase be funded?
---------------------------------------
Annual income (all sources) of person/trust funding the purchase: $
--------
Net worth of person/trust funding the purchase: $
--------------------------
3. Applicant's experience with the following:
Up to Five or
Five More
None Years Years
Mutual Funds
----- ----- -----
Individual Common Stocks
----- ----- -----
Variable Annuities
----- ----- -----
Variable Life Insurance
----- ----- -----
Insured:
---------------------
Illustration No.
-------------
90-1 VCL.Supp.(0799) Page 3 of 4
I believe that a Variable Whole Life with Additional Protection policy is
consistent with my investment objectives.
I understand that an illustration of benefits, including death benefits and cash
values, is available upon request assuming a hypothetical annual investment
return of 0% and another rate of my choice not greater than 12%.
I UNDERSTAND THAT THE DEATH BENEFIT FOR THE VARIABLE WHOLE LIFE WITH ADDITIONAL
PROTECTION POLICY APPLIED FOR MAY INCREASE OR DECREASE TO REFLECT THE INVESTMENT
EXPERIENCE OF THE NORTHWESTERN MUTUAL VARIABLE LIFE ACCOUNT. PROVIDED ALL
REQUIRED PREMIUMS ARE PAID AS OF THE DUE DATE AND PROVIDED THERE IS NO POLICY
DEBT, THE DEATH BENEFIT WILL NOT BE LESS THAN THE SUM OF THE VARIABLE WHOLE LIFE
AND ADDITIONAL PROTECTION AMOUNTS IN THE FIRST XX YEARS AND NOT LESS THAN THE
VARIABLE WHOLE LIFE AMOUNT THEREAFTER.
I UNDERSTAND THAT THE CASH VALUE FOR THE VARIABLE WHOLE LIFE WITH ADDITIONAL
PROTECTION POLICY APPLIED FOR MAY INCREASE OR DECREASE TO REFLECT THE INVESTMENT
EXPERIENCE OF THE NORTHWESTERN MUTUAL VARIABLE LIFE ACCOUNT. THERE ARE NO
GUARANTEED MINIMUM CASH VALUES.
I understand that if investment experience and/or dividends are less than
illustrated a greater number of premiums may have to be paid in cash than what
was shown on any sales document, including illustrations that assume a zero cash
outlay in some years.
If this policy is issued other than in the [Select] underwriting classification,
I will be notified by a letter from Northwestern Mutual Life. Before accepting
the policy, I should request and review revised copies of any sales document I
relied upon in the decision to purchase.
I acknowledge receipt of the prospectus for Variable Whole Life with Additional
Protection.
dated: ____ /____ /____
MO. DAY YEAR
[I direct that this policy be changed to a paid up Variable Whole Life Policy at
the first policy anniversary.
____ ____ ]
YES NO
DATE: ____ /____ /_____
MO. DAY YEAR SIGNATURE OF APPLICANT:
----------------------
Based on the information furnished by the Applicant in this application, I
certify that I have reasonable grounds for believing the purchase of the policy
applied for is suitable for the Applicant. I further certify that a current
prospectus was delivered and that no written sales materials other than those
furnished by the Home Office were used.
Signature of Licensed Agent:
----------------------------------------------------
(Registered Representative)
Based on the information furnished by the Applicant in this application, I
certify that I have reasonable grounds for believing the purchase of the policy
applied for is suitable for the Applicant.
Signature of General Agent:
-----------------------------------------------------
For Office Use Only
VCL, Illustration No.
-------------- -------------------
Dividend Scale Year 1998 QQ
Und. Amt. $
------------------------
Policy Number
----------------------
Page 4 of 4
90-1 VCL.Supp.(0799)
HOL03 116607
THE NORTHWESTERN MUTUAL LIFE
INSURANCE COMPANY No..........
MILWAUKEE, WISCONSIN
LIFE INSURANCE APPLICATION |_| Life & Disability Application
=============================================================================================================================
1. INSURED
--------------------------------------------------------------------------------
|x| Mr. |_| Mrs. |_| Xx. Xxxx X Xxx |X| Male
|_| Dr. |_| Other ______ -------------------------------------------------------------------------------- |_| Female
First Middle Initial Last
|_| Companion policies |_| 0000 Xxxxxxxx
XXXXX XX XXXXX
0X. INSURED'S DATE OF BIRTH 6 / 1 / 60 B. (or FOREIGN COUNTRY): WI
-------------- --------
Month Day Year
3. APPLICANT, if other than Insured
|_| Mr. |_| Mrs. |_| Ms. ________________________________________________________ Relationship
|_| Dr. |_| Other______ First Middle Initial Last to Insured ________________________
If business organization: |_| Corporation |_| Partnership |_| Other type of business __________________________________
4. RESIDENCE OF INSURED 0000 Xxxx Xxxxxx
----------------------------------------------------------------------------------------------------
Street & No. or RFD
This address will be used for
all of the Insured's policies. Milwaukee Xxxxxxxxx XX 00000
---------------------------------------------------------------------------------------
City County State Zip Code
5A. PREMIUM PAYER Send premium and other notices regarding this policy 5B. PAYER'S DAYTIME TELEPHONE NUMBER:
Insurance Service to: |X| Insured |_| Owner |_| Applicant (000) 000-0000
to: |_| Account (ISA) |_| Other___________________________ --------------------
Payer Full Name Area Code
or
at: |_| Insured's address in 4 or 5C. PAYER'S TAXPAYER IDENTIFICATION NUMBER
________________________________ (000) 000-0000
Street & No. or RFD --------------------
See TIN Instructions
________________________________
City
________________________________
State Zip Code
6. Has an application or informal inquiry ever been made to Northwestern Mutual Life for annuity, life or disability
insurance on the life of the Insured? |_| Yes |X| No If yes, the last policy number is ______________________________
============================================================================================================================
7. Complete this question only if exercising an ADDITIONAL PURCHASE BENEFIT OPTION. (Smoking questionnaire may be required.)
A. List policy number(s) under which an option is being exercised. 1. _____________ 2. _____________ 3. _____________
B. This application is: |_| Regular Purchase |_| Advance Purchase (Complete item C. below)
C. If this is an Advance Purchase, the event is: |_| Marriage |_| Birth of a child |_| Adoption of a child
Name of: |_| Spouse ____________________________ Date and place of marriage, birth, or final decree of adoption:
|_| Child _____/___/____ ____________________________________________
Month Day Year City State
D. Is the amount applied for more than the additional purchase option amount available? |_| Yes |_| No
If yes, what is the excess amount to be underwritten? $____________________________
=============================================================================================================================
8. SPECIAL DATE
|_| Short term - Policy Date will coincide with ISA Payment Date. (For Monthly ISA only)
Prepaid: |_| Short term to _______/_____/______ |_| Date to save age |_| Backdate to _______/_____/______
Month Day Year Month Day Year
Non-prepaid: |_| Specified future date _____/___/____ |_| Date to save age |_| Backdate to _______/_____/______
Month Day Year Month Day Year
=============================================================================================================================
POLICY APPLIED FOR (For CompLife plans do not complete A & B. Go to C.)
9A. PLAN and AMOUNT 9B. ADDITIONAL BENEFITS
(1) Variable Whole Life with Additional Protection (1)|_| (2)|_| Waiver of Premium
--------------------------------------------------
Plan (1)|_| (2)|_| Accidental Death (1) $________ (2) $________
$ see attached supplement
-------------------------------------------------- (1)|_| (2)|_| Additional Purchase (1) $________ (2) $________
Amount Benefit Amt. per Amt. per
(2) (1)|_| (2)|_| Payor Benefit option option
--------------------------------------------------
Plan (1)|_| (2)|_| Index Protection
$
-------------------------------------------------- (1)|_| (2)|_| Other________________
Amount
=============================================================================================================================
90-1 L.I. (1194) (page 1)
====================================================================================================================================
9C. FLEXIBLE LIFE PLANS (CompLife)
|_| Whole Life $______________ with Additional Protection $______________ (Custom CompLife)
Amount Amount
(1) |_| Additional initial premium $__________ Use to: |_| Reduce term insurance _____%
(2) |_| Inflation Protection Option |_| Increase coverage _____%
|_| Whole Life $__________ with a premium for Increasing Insurance $____________________ (Increasing CompLife)
Amount Level annual premium
|_| Additional initial premium $_______________
|_| Executive Whole Life $__________ with Additional Protection $__________ (Executive CompLife)
Amount Amount
Premium for Increasing Insurance $__________ Use to: |_| Convert term insurance _____%
|_| Increase coverage _____%
|_| Additional initial premium $__________ Use to: |_| Convert term insurance _____%
|_| Increase coverage _____%
|_| Whole Life $__________ with Adjustable Term Protection $__________ (Adjustable CompLife)
Amount Amount
(1) a. |_| Scheduled annual additional $______________________ |_| Reduce term insurance ____%
Level annual premium Use to: |_| Increase coverage ____%
b. |_| Annual increase in additional premium ____________ $_______________
(Not more than 20 years, or to age 69, if less) No. of years Annual increase
(2) |_| Additional initial premium $_______________ Use to: |_| Reduce term insurance ____%
|_| Increase coverage ____%
(3) Only one may be selected: |_| Inflation Protection Option
|_| Scheduled annual increase in term amount ____________ $____________________
(Not more than 20 years. or to age 69. if less) No. of years Annual increase amt.
|_| Corporate Whole Life (See attached Supplement)
9D. ADDITIONAL BENEFITS FOR FLEXIBLE LIFE PLANS
|_| Waiver of Premium |_| Additional Purchase Benefit $___________________________________
Amount per option
|_| Accidental Death $_________________ |_| Other___________________________________________________________
Amount
====================================================================================================================================
10. If an additional benefit cannot be approved, should the Company issue the policy without the benefit? |_|Yes |_| No
11. Shall the PREMIUM LOAN provision, if available, become operative according to its terms? |X| Yes |_| No
12. ANNUAL DIVIDENDS until otherwise directed will: see attached supplement
First policy Second policy
|_| |_| Reduce current premium. If flexible plan Additional Protection or Adjustable Term,
additions purchased by eligible dividend will be used to:
|_| |_| Purchase paid-up additions. |_| Reduce term insurance ___%
|_| |_| Accumulate at interest. |_| Increase coverage ___%
|_| |_| Be paid in cash.
|_| |_| Be used for combination of options above
(Complete form 18-1364).
13. POLICY LOAN INTEREST RATE OPTION |_| 8% |_| Variable Rate see attached supplement
14. PREMIUM PAYABLE |X| Annually |_| Semiannually |_| Quarterly |_| Single |_| Monthly (Variable Life Only
====================================================================================================================================
90-1 L.I. (1194) (page 2)
================================================================================
------------------------------------------------------------------
INSURED Xxxx X Xxx
------------------------------------------------------------------
First Middle Initial Last
15A. DIRECT BENEFICIARY
Xxxx X Xxx spouse
---------------------------------------------------------------
First Middle Initial Last Relationship to Insured
---------------------------------------------------------------
First Middle Initial Last Relationship to Insured
---------------------------------------------------------------
First Middle Initial Last Relationship to Insured
B. CONTINGENT BENEFICIARY
---------------------------------------------------------------
First Middle Initial Last Relationship to Insured
---------------------------------------------------------------
First Middle Initial Last Relationship to Insured
---------------------------------------------------------------
First Middle Initial Last Relationship to Insured
Box (1) or (2) may be selected to include all of the children or brothers
and sisters without naming them, or to add to the contingent beneficiaries
named. Box (3) may be selected to provide for the children of a deceased
contingent beneficiary; use only if contingent beneficiaries are named
and/or box (1) or (2) is checked, NOTE: The word "children" includes child
and any legally adopted child.
|_| (1) and all (other) children of the Insured.
|_| (2) and all (other) brothers and sisters of the Insured born of the
marriage of or legally adopted by ____________ and ____________
before the Insured's death.
|_| (3) any amount that would have been paid to a deceased contingent
beneficiary, if living, will be paid in one sum and in equal shares
to the children of that contingent beneficiary who survive and
receive payment.
C. FURTHER PAYEES
---------------------------------------------------------------
First Middle Initial Last Relationship to Insured
---------------------------------------------------------------
First Middle Initial Last Relationship to Insured
|_| D. SEE ATTACHED SUPPLEMENT FORM
(To be used in place of designations above)
================================================================================
16. The OWNER will be: (Caution: A minor owner cannot exercise policy rights.
If the Insured is under age 15, consider selecting item D, E or F.)
Select only one.
|X| A. Insured
|_| B. Applicant
|_| C. Other _____________________________________
First Middle Initial Last
_____________________________________
Relationship to Insured
|_| D. Applicant. If the Applicant dies before the Insured, the Insured
will be the Owner.
|_| E. Applicant. If the Applicant dies before the Insured, the Owner will
be:
_____________________________________________
First Middle Initial Last
_____________________________________________
Relationship to Insured
If both die before the Insured, the Insured will be the Owner.
|_| F. Applicant until the Insured attains the age of ______ years. If the
Applicant dies before the Insured, the Owner will be:
_____________________________________________
First Middle Initial Last
____________________________until the Insured
Relationship to Insured
attains such age. Upon the Insured attaining such age, or if both
die before the Insured, the Insured will be the Owner.
|_| G. SEE ATTACHED SUPPLEMENT FORM.
(To be used in place of designations above)
================================================================================
RESIDENCE OF OWNER
|X| Insured's address in 4
|_| Premium payer's address in 5A or
___________________________________________________________________________
Street & No. or RFD
___________________________________________________________________________
City State Zip Code
OWNERS TAXPAYER IDENTIFICATION NUMBER
(See Instructions) ________________________________________________________
================================================================================
17. Has the premium for the policy applied for been paid to the agent in
exchange for the Conditional Life Insurance Agreement with the same number
as this application? |X| Yes |_| No
18A. Will the insurance applied for replace any Northwestern Mutual Life
insurance (or annuities) on the Insured's life? If yes, agent should
explain and send required papers. |_| Yes |X| No
B. Will the insurance applied for replace life insurance (or annuities) on the
insured's life from a source other than the Northwestern Mutual Life? If
yes, agent should explain and send required papers. |_| Yes |X| No
================================================================================
90-1 L.I. (1194) (page 3)
PERSONAL HISTORY QUESTIONS TO BE ANSWERED BY INSURED
|_| Payor Benefit for Applicant (Payor)_________________________________________
First Middle Initial Last
Payor's Date of Birth _____/___/____ Policy Number _________ Relationship
Month Day Year to Insured _______
20. Have you ever had life, disability or health insurance declined, rated,
modified, issued with an exclusion rider, cancellel, or not renewed? (If
yes, explain in REMARKS) ..................................... |_|Yes |X| No
21. When was your last examination or application for life, disability, or
accidental death insurance?
Month ______________ Year _________ Company ___________________ |X| None
22. Indicate below whether any other life i surance on your life is Individual
(Ind) or Group (Grp) and identify In Force (I), Pending (P) or Contemplated
(C) or |X| NONE
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Insurer Ind or Grp Life Insurance Amount Accidental Death Amount I, P, or C
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23. Marital Status: |_| Single, Widowed or Divorced |X| Married
24. a Citizen of: |X| USA |_| Other
If other: Visa Type: ____________________ Visa Number:_____________________
25. Do you regularly travel outside the U.S.A. or do you have plans to leave the
U.S.A. for travel or residence? ............................. |_| Yes |X| No
If yes, complete the chart below.
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Destination Number of Trips Duration of Departure Date Purpose of Trip
(List all Cities and Countries) Per Year Each Trip
This Yr. Last Yr. (No. of Days) (Month/Year)
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26. a. What is your occupation(s)? Lawyer
What are your duties? __________________________________________________
b. Employer(s) Name: ABC Corporation
Address: 0000 Xxxx Xxxxxx
Xxxx, Xxxxx, ZipCode: Xxxxxxxxx, XX 00000
c. How long employed? 5 years (If less than 2 years, explain in REMARKS)
27. (Not required if under age 17) Are you a member of, or do you plan on
joining any branch of the Armed Forces or reserve military unit? If yes,
complete Military Section 90-5 .............................. |_| Yes |X| No
28. (Not required if under age 16) Except as a passenger on a regularly
scheduled flight, have you flown within the past 2 ears, or do you have
plans to fly in the future? If yes, complete Aviation
Section 90-5 ................................................ |_| Yes |X| No
29. (Not required if under age 10) In the past 2 years have you participated in
or do you have plans to participate in: racing (automobile, snowmobile,
motorcycle, boat or go-cart), underwater or sky diving, hang gliding, bungee
jumping, mountain or rock climbing, or rodeos? If yes, complete Avocation
Section 90-6 ................................................ |_| Yes |X| No
30. (Not required if under age 16)
a. What is your automobile driver's license number? ABC 123 45678 State WI
or, |_| I do not have a driver's license.
x.Xx the past 5 years, have you been in a motor vehicle accident, been
charged with a moving violation of any motor vehicle law, or had your
license restricted, suspended or revoked? If yes, explain in the chart
below ...................................................... |_| Yes |X| No
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Type of Details
(Speeding. Reckless Driving While Action Accident
Date Intoxicated, Etc.) (Citation, Fine, Etc.) (Yes or No)
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ADDITIONAL REMARKS
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90-1 L.I. (1194) (page 4)
The Insured consents to this application and declares that the answers and
statements made on this application are correctly recorded, complete and true to
the best of the Insured's knowledge and belief. Answers and statements brought
to the attention of the agent, medical examiner, or paramedical examiner are not
considered information brought to the attention of the Company unless stated in
the application. Statements in this application are representations and not
warranties.
It is agreed that:
(1) If the premium is not paid when the application is signed, no insurance
will be in effect. The insurance will take effect at the time the policy
is delivered and the premium is paid, if: the Insured is living at the
time; and the answers and statements in the application are then true to
the best of the Insured's knowledge and belief.
(2) If the premium is paid when the application is taken, no life insurance
will be in effect if Section I. of the Conditional Life Insurance
Agreement applies.
(3) If the policy is issued in an extra premium class, acceptance of the
policy will amend it so that extended term insurance can be in force only
if: the Company gives its consent; or the loan value is not large enough
to grant a premium loan. If a premium is not paid within the grace period
and extended term insurance cannot be in force, paid-up insurance will be
selected.
(4) No agent is authorized to make or alter contracts or to waive any of the
Company's rights or requirements.
The owner of the policy applied for herein certifies, under penalties of
perjury, (1) that the number shown in Question 16 of this application is his
correct Taxpayer Identification Number (or he is waiting for a number to be
issued) and (2) he is not subject to backup withholding either because he has
not been notified by the Internal Revenue Service (IRS) that he is subject to
backup withholding as a result of a failure to report all interest or dividends,
or the IRS has notified him that he is no longer subject to backup withholding.
(See instructions).
INSURED'S AUTHORIZATION TO OBTAIN AND DISCLOSE INFORMATION
I authorize Northwestern Mutual Life, its agents, employees, reinsurers,
insurance support organizations and their representatives to obtain information
about me to evaluate this application and to verify information in this
application. This information will include: (a) age; (b) medical history,
condition and care; (c) physical and mental health; (d) occupation; (e) income
and financial history; (f) foreign travel; (g) avocations; (h) driving record;
(i) other personal characteristics; and (j) other insurance. This authorization
extends to information on the use of alcohol, drugs and tobacco; the diagnosis
or treatment of HIV (AIDS virus) infection and sexually transmitted diseases;
and the diagnosis and treatment of mental illness. During the time this
authorization is valid it extends to information required to determine
eligibility for benefits under any policy issued as a result of this
application.
I authorize any person, including any physician, health care professional,
hospital, clinic, medical facility, government agency including the Veterans and
Social Security Administrations, the MIB, Inc., employer, consumer reporting
agency, accountant, tax preparer, or other insurance company, to release
information about me to Northwestern Mutual Life or its representatives on
receipt of this Authorization. Northwestern Mutual Life or its representatives
may release this information about me to its reinsurer, to the MIB, Inc., or to
another insurance company to whom I have applied or to whom a claim has been
made. No other release may be made except as allowed by law or as I further
authorize.
I have received a copy of the Medical Information Bureau and Fair Credit
Reporting Act notices. I authorize Northwestern Mutual Life to obtain an
investigative consumer report on me.
|_| I request to be interviewed if an investigative consumer report is done.
This authorization is valid for 30 months from the date it is signed. A copy of
this authorization is as valid as the original and will be provided on request.
The signatures below apply to the authorization and to the application.
(signed) Xxxx X Xxx (signed) Xxxx X Xxx
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Signature of INSURED (if other than Signature of APPLICANT
Applicant and 15 years of age or over)
Print name of Insured if under age 15.
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Signature of PARENT OR GUARDIAN (if other Signature of OWNER (if other than
than Applicant and Insured is a minor) Applicant or Insured)
Signed at Milwaukee Milwaukee WI (signed) Norm M Western
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City, County & State Signature of LICENSED AGENT
Date June 1, 1995
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90-1 L.I. (1194) (page 5)
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It is recommended that you ...
read your policy.
notify your Northwestern Mutual agent or the Company at 000 Xxxx Xxxxxxxxx
Xxxxxx, Xxxxxxxxx, XX 00000, of an address change.
call your Northwestern Mutual agent for information--particularly on a
suggestion to terminate or exchange this policy for another policy or plan.
Election of Trustees
The members of The Northwestern Mutual Life Insurance Company are its
policyholders of insurance policies and deferred annuity contracts. The members
exercise control through a Board of Trustees. Elections to the Board are held
each year at the annual meeting of members. Members are entitled to vote in
person or by proxy.
VARIABLE WHOLE LIFE POLICY WITH ADDITIONAL PROTECTION
Eligible For Annual Dividends
Insurance payable at death of Insured.
Fixed premiums payable for period shown on page 3.
Benefits reflect investment results.
Variable benefits described in Section 1, 3, 6, 7 and 8.
THE DEATH BENEFIT MAY INCREASE OR DECREASE DAILY DEPENDING ON INVESTMENT
RESULTS. HOWEVER, IF NO PREMIUM IS UNPAID AS OF ITS DUE DATE, THE DEATH BENEFIT
WILL NOT BE LESS THAN THE MINIMUM GUARANTEED DEATH BENEFIT SHOWN ON PAGE 3, LESS
ANY POLICY DEBT.
THE CASH VALUE UNDER THIS POLICY MAY INCREASE OR DECREASE DAILY DEPENDING ON
INVESTMENT RESULTS. THERE IS NO GUARANTEED MINIMUM CASH VALUE.
NORTHWESTERN
MUTUAL LIFE (R)
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