LIBERTY LIFE ASSURANCE COMPANY OF BOSTON
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LAST SURVIVOR This is a Joint and Last Survivor Benefit Certificate Agreement
DEATH BENEFIT which summarizes changes in coverage under the Group Contact. The
AGREEMENT provisions summarized herein modify those in Your Certificate of
coverage. If this Agreement is attached to Your Certificate,
coverage is extended to two Insureds. The Insured individuals are
those shown on the Certificate Information page. The Death
Benefit under a Certificate is payable if the surviving Insured
dies while coverage under the Group Contract is in force and
before the Maturity Date. The surviving Insured is the Insured
who is living upon the death of the other Insured under this
Certificate. No Death Benefit is payable upon the death of the
first Insured to die.
DEFINITIONS
The Attained Age is an Insured's age on his or her last birthday.
THE BENEFIT
In determining the Death Benefit, the applicable percentage of
the Account Value is based upon the Attained Age of the younger
Insured.
MATURITY BENEFIT
The Maturity Date provision will be based upon the Attained Age
of the younger Insured.
REINSTATEMENT
You may reinstate the coverage under the Group Contract subject
to the Reinstatement provision provided that: both Insureds are
alive; or one Insured is alive and the termination of coverage
without value occurred after the death of the first Insured.
MISSTATEMENT OF AGE OR SEX, ASSIGNMENT
The Misstatement of Age or Sex and Assignment provisions apply to
either Insured.
OWNER
During the lifetime of both Insureds, the rights and privileges
stated in the Certificate may be exercised only by You, the
owner.
BENEFICIARY
The Beneficiary is as named in the application on the Certificate
Date, and may be changed from time to time. The interest of any
Beneficiary who dies before the surviving Insured will terminate
at the death of that Beneficiary.
If no Beneficiary designation is in effect at the surviving
Insured's death, or if there is no designated Beneficiary then
living, the You will be the Beneficiary. However, if the
surviving Insured was the Owner, the executors or administrators
of the Insured's estate will be the Beneficiary.
CHANGE OF OWNERSHIP OR BENEFICIARY
You may change the Owner or any Beneficiary by Written Request
during the lifetime of either Insured. The change will take
effect as of the date the request is signed after We acknowledge
receipt in writing, whether or not the Owner or an Insured are
living at the time of acknowledgment. The change will be subject
to any assignment, and to any payment made or action taken by Us
before acknowledgment.
INCONTESTABILITY AFTER TWO YEARS
The Incontestability After Two Years provision applies to both
Insureds.
Before the end of the second year from the Certificate Date, We
will send a notice to You requesting notification of the death of
any Insured. Failure to notify Us of the death of either Insured
will not avoid a contest of the Group Contract.
SUICIDE WITHIN TWO YEARS
The Suicide Within Two Years provision applies to either Insured.
COST OF INSURANCE RATE
The Cost of Insurance Rate is based on the Attained Age, sex and
rating classification of both Insureds. Pages 18 and page 19 of
this Certificate, which contain the Guaranteed Monthly Maximum
Cost of Insurance Rates, are hereby deleted and replaced with the
following:
The Guaranteed Monthly Maximum Cost of Insurance Rates are based
on the exact age and rating classification of each Insured using
the Xxxxxxx Method and the 1980 Commissioners Standard Ordinary
Mortality Table, age last birthday, on a smoker/non-smoker basis.
A Table of the Guaranteed Monthly Maximum Cost of Insurance Rates
applicable to the Insureds named in Your application has been
printed on the Certificate Information page.
ACCELERATED DEATH BENEFIT
After the death of the first Insured, the Death Benefit may be
accelerated, subject to the conditions of the Accelerated Death
Benefit provision.
PAYMENT OF PROCEEDS
The Proceeds of this Certificate will be subject first to the
interest of an assignee, to whom payment will be made in one sum.
We will pay any remaining Proceeds to You before the surviving
Insured's death, and to the Beneficiary after the surviving
Insured's death.
Payment to the Beneficiary will be made only if We receive proof,
satisfactory to Us, of the death of both Insureds. Unless
otherwise provided, payment will be made in equal shares to those
Beneficiaries entitled to receive the Proceeds.
TERMINATION OF AN INSURED'S COVERAGE
Coverage under the Group Contract will terminate when one of the
following events occur:
o the surviving Insured dies;
o an Insured's coverage matures;
o the date an Insured's coverage ends without value;
o the date an Insured's coverage is surrendered for its
Surrender Value; or
o the date the Group Contract terminates or is discontinued,
except as provided in the Continuation of Insureds' Coverage
After Discontinuance provision.
THIS AGREEMENT AND THE CERTIFICATE
This Agreement is made a part of your Certificate if We have
listed it on the Certificate Information page.
EFFECTIVE DATE
This Agreement takes effect on the Certificate Date shown on the
Certificate Information page.
/s/ Xxxxxx X. Xxxxx
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PRESIDENT
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