----------------------------====================================================
RIDER FOR FLEXIBLE TERM INSURANCE BENEFIT
ON LIFE OF INSURED
This rider is a part of this contract only if it is
listed on a contract data page.
RIDER DEATH BENEFIT We will pay an amount under this benefit if we
receive due proof that the Insured died; (1) in the
term period for this benefit; and (2) while this
contract is in force and not in default past the
last day of the grace period. The term period starts
on the effective date for this rider shown under
Other Benefit(s) on the Insured in the contract data
pages. The term period ends on the contract
anniversary on or after the Insured's one hundredth
birthday. Our payment is subject to all the
provisions of the benefit and of the rest of the
contract.
To determine the rider death benefit on any date, we
first take the effective Target Coverage Amount
shown in the Life Insurance on the Insured section
of the contract data pages and subtract from it the
death benefit as calculated in the Death Benefit
provision. If this contract has a Type A death
benefit (see Type of Death Benefit in the contract
data pages), the resultant amount is the rider death
benefit. If this contract has a Type B death
benefit, the rider death benefit is the resultant
amount plus the contract fund before deduction of
any monthly charges due on that date. If this
contract has a Type C death benefit, the rider death
benefit is the resultant amount plus the total
premiums paid minus total withdrawals to this
contract both accumulated with interest at the
rate(s) displayed in the contract data pages. The
total premiums paid will not include any charge to
reinstate this contract as described under
Reinstatement.
If the rider death benefit is less than zero, we
consider it to be zero.
RIDER CHARGES On each monthly date, we will deduct a charge for
this rider from the contract fund. To determine the
maximum charge for this rider, we use the following
method:
We determine the maximum cost of insurance rate for
each currently effective rider coverage segment
amount shown in the Segment Table in the contract
data pages using the maximum monthly rate shown
under the Table of Maximum Monthly Insurance Rates
for the appropriate rating class. If there is only
one rider coverage segment amount currently in
effect, we multiply the rate by the rider death
benefit amount divided by $1000 and add an
administrative charge of up to $0.05 multiplied by
the rider coverage amount divided by $1000 to
determine the maximum charge for this rider.
If there are two or more rider coverage segment
amounts currently in effect, we first allocate the
rider death benefit amount to each rider coverage
segment based on the proportion of its rider
coverage amount to the total of all rider coverage
amounts currently in effect. We multiply the rate by
the apportioned rider death benefit amount for each
rider segment component amount divided by $1000 and
add the results. To this amount, we add an
administrative charge of up to $0.05 multiplied by
the rider coverage amount for each rider segment
currently in effect divided by $1000 to determine
the total maximum charge for this rider.
REQUESTED CHANGES IN You may change the Rider Coverage Amount, while this
RIDER COVERAGE rider is in force, subject to our approval and the
AMOUNT following conditions:
1. You must ask for the change in a form that
meets our needs.
2. The change must be one permitted by our current
underwriting rules.
3. The amount of an increase or decrease must be
at least equal to the minimum increase or
decrease in the Rider Coverage Amount shown
under Contract Limitations in the contract data
pages.
4. The Rider Coverage Amount after a decrease must
be at least equal to the minimum Rider Coverage
Amount shown under Contract Limitations in the
contract data pages.
-----------------
| PLIY 128-1999 |
-----------------
5. The sum of the basic insurance amount and the
Rider For Flexible Term Insurance Benefit on
Life of Insured coverage amount must equal or
exceed the amount shown under Contract
Limitations.
6. If we ask you to do so, you must send us the
contract to be endorsed.
7. You must prove to us that the Insured is
insurable for any increase.
8. The contract must not be in default.
9. We may deny an increase if it would cause the
number of segments shown in the Segment Table
in the contract data pages to exceed
ninety-nine.
A change will take effect only if we approve your
request for it at our Home Office. Unless you ask us
otherwise, the change will take effect on the
monthly date immediately following the date we
approve the change. You may request an earlier date,
but it may not be more than 90 days prior to the
date of request. If we approve the change, we will
also recompute the contracts charges, values and
limitations. We will send you new contract data
pages showing the amount and effective date of the
change and the recomputed charges, values and
limitations. If the Insured is not living on the
effective date, the change will not take effect. We
may deduct the administrative charge (shown under
Adjustments to the Contract Fund) for the change.
SUICIDE The Suicide Exclusion provision of the contract
applies to this rider as issued.
If the Insured, whether sane or insane, dies by
suicide after two years from the issue date but
within two years of the effective date of an
increase in the Rider Coverage Amount, we will pay,
as to the increase in the Rider Coverage Amount, no
more than the sum of the premiums paid on and after
the effective date of the increase.
TERMINATION This rider will end on the earliest of:
1. the end of its term period;
2. the end of the grace period if the contract is
in default and the premium required to bring it
out of default has not been paid;
3. the date the contract is surrendered for its
net cash value if it has one; and
4. the date the contract ends for any other
reason.
We will allow you to cancel this rider only if the
Basic Insurance Amount equals or exceeds the minimum
amount shown under Contract Limitations for the sum
of both the basic insurance amount and the rider
coverage amount. We will then cancel the rider as of
the monthly date on or after the date we receive
your request. If we do so, monthly charges due then
and later will be reduced accordingly.
THIS SUPPLEMENTARY BENEFIT RIDER ATTACHED TO THIS
CONTRACT ON THE CONTRACT DATE
Pruco Life Insurance Company of New Jersey,
SPECIMEN [stamp]
BY /s/XXXXX X. XXXXXX
---------------------
Xxxxx X. Xxxxxx
Secretary
-----------------
| PLIY 128-1999
-----------------
PROCESSING DATE: JUL 10, 1999
CONTRACT DATA
INSURED
XXXX XXX Male, Issue Age 35
================================================================================
RATING CLASS
(See Segment Table on Page 4)
================================================================================
BASIC CONTRACT INFORMATION
Policy Number xx xxx xxx
Contract Date July 1,1999
Premium Period Life
Beneficiary See Beneficiary Provision attached
Loan Interest Rate 5.00%
Preferred Loan Interest Rate 4.25%
================================================================================
TYPE OF DEATH BENEFIT (SEE DEATH BENEFIT PROVISIONS)
Type B
================================================================================
LIFE INSURANCE ON THE INSURED
Rider for Flexible
Term Insurance
on Life of Insured Target
Basic Insurance (Target Term Rider) Coverage
Effective Date Amount_______ Coverage Amount Amount
--------------------------------------------------------------------------------
Contract Date $5,000.00 $95,000.00 $100,000.00
================================================================================
CONTRACT DATA CONTINUED ON NEXT PAGE
Page 3 (99)
PROCESSING DATE. JUL 10, 1999
POLICY NO. XX XXX XXX
CONTRACT DATA CONTINUED
OTHER BENEFIT(S) ON THE INSURED (see appropriate form for details)
Rider PLIY 128 - Rider for Flexible Term Insurance Benefit on Life of Insured
- Variable Benefit (Target Term rider).
The Term Period starts on the Contract Date.
================================================================================
Minimum Initial Premium
The minimum initial premium due on the Contract Date is $17.54.
================================================================================
CONTRACT LIMITATIONS
The minimum premium we will accept is $25.00.
The minimum basic insurance amount is $5,000.00.
The minimum increase in basic insurance amount is $5,000.00.
The minimum decrease in basic insurance amount is $5,000.00.
The sum of the basic insurance amount and the Rider for Flexible Term
Insurance Benefit on Life of Insured Rider Coverage Amount must equal or
exceed $100,000.00.
The minimum decrease in the Rider for Flexible Term Insurance Benefit on Life
of Insured Rider Coverage Amount is $5,000.00.
The minimum increase in the Rider for Flexible Term Insurance Benefit on Life
of Insured Rider Coverage Amount is $5,000.00.
The minimum the Rider for Flexible Term Insurance Benefit on Life of Insured
Rider Coverage Amount is $5,000.00.
The minimum amount you may withdraw is $500.00.
The minimum amount you may borrow is $200.00.
================================================================================
ADJUSTMENTS TO PREMIUM PAYMENTS
From each premium paid we will:
Subtract a charge of up to 7.5% for any taxes attributable to premiums. For
purposes of this charge, the term "taxes attributable to premiums" shall
include: (a) any federal, state or local income tax. (b) any premium,
excise, or business tax, and (c) any other type of tax (or component
thereof) measured by or based upon the amount of premium received by us.
CONTRACT DATA CONTINUED ON NEXT PAGE
Page 3A (99) (NJ)
PROCESSING DATE: JUL 10, 1999
POLICY NO. XX XXX XXX
CONTRACT DATA CONTINUED
Subtract a charge for sales expenses from premiums paid as described in
the Charge For Sales Expenses provision.
The remainder of the premium is the invested premium amount.
================================================================================
ADJUSTMENTS TO THE CONTRACT FUND
On the Contract Date the contract fund is equal to the invested premium
amount credited on that date, minus
a charge for administrative expenses of up to $0.05 per $1,000 of the
basic insurance amount effective on the Contract Date plus $10.00.
a charge for the cost of insurance (see Cost of Insurance).
a charge for the Rider for Flexible Term Insurance Benefit on Life of
Insured using the method described in the rider under Rider Charges.
On each day after the contract date, we will adjust the contract fund by:
adding any invested premium amounts.
adding any increase due to investment results of the variable investment
options.
adding guaranteed interest at an effective annual rate of 4% (0.01074598%
a day) on that portion of the contract fund that is attributable to any
loan amount (see Loans).
subtracting any decrease due to investment results of the variable
investment options.
subtracting a charge against the variable investment options at an
effective annual rate of not more than 0.50% (.00136646% a day) for
mortality and expense risks that we assume.
subtracting any withdrawals.
subtracting an administrative charge of up to $25.00 for any withdrawals.
subtracting an administrative charge of up to $25.00 for any change in
basic insurance amount.
subtracting an administrative charge of up to $25.00 for any change in the
coverage amount for the Rider for Flexible Term Insurance Benefit on Life
of Insured.
CONTRACT DATA CONTINUED ON NEXT PAGE
Page 3B (99) (NJ)
PROCESSING DATE. JUL 10, 1999
POLICY NO. XX XXX XXX
CONTRACT DATA CONTINUED
subtracting an administrative charge of up to $25.00 for each transfer
between variable investment options exceeding twelve in any contract year.
And on each monthly date, we will adjust the contract fund by:
subtracting a charge for administrative expenses of up to $0.05 per $1,000
of the basic insurance amount of each Basic Insurance Segment, totaled,
plus $10.00.
subtracting a deduction for the cost of any other benefits.
subtracting a charge for the cost of insurance (see Cost of Insurance).
subtracting a charge for the Rider for Flexible Term Insurance Benefit on
Life of Insured using the method described in the rider under Rider
Charges.
================================================================================
CONTRACT DATA CONTINUED ON NEXT PAGE
Page 3C (99) (NJ)
PROCESSING DATE: JUL 10, 1999
POLICY NO. XX XXX XXX
CONTRACT DATA CONTINUED
VARIABLE INVESTMENT OPTIONS
THE PRUCO LIFE OF NEW JERSEY VARIABLE APPRECIABLE ACCOUNT
Each variable Investment option of this account invests in a specific
portfolio of The Prudential Series Fund, Inc. and such other funds as we
may specify from time to time We show the available variable investment
options of the account below. Unless we say otherwise, the variable
investment options invest in funds or fund portfolios with the same names.
This account is registered with the SEC under the Investment Company Act
of 1940.
THE PRUDENTIAL SERIES FUND, INC.
Money Market Portfolio
Diversified Bond Portfolio
Conservative Balanced Portfolio
Flexible Managed Portfolio
High Yield Bond Portfolio
Stock Index Portfolio
Equity Income Portfolio
Equity Portfolio
Prudential Xxxxxxxx Portfolio
Global Portfolio
AIM VARIABLE INSURANCE FUNDS, INC.
AIM V.I. Value Fund
JANUS ASPEN SERIES
Janus Aspen Growth Portfolio
MFS VARIABLE INSURANCE TRUST
MFS Emerging Growth Series
X. XXXX PRICE INTERNATIONAL SERIES, INC.
X. Xxxx Price International Stock Portfolio
CONTRACT DATA CONTINUED ON NEXT PAGE
Page 3D (99) (NJ)
PROCESSING DATE: JUL 10, 1999
POLICY NO. XX XXX XXX
CONTRACT DATA CONTINUED
AMERICAN CENTURY VARIABLE PORTFOLIO, INC.
American Century VP Value Fund
================================================================================
INITIAL ALLOCATION OF INVESTED PREMIUM AMOUNTS
High Yield Bond Portfolio 40%
Money Market Portfolio 60%
================================================================================
END OF CONTRACT DATA
Page 3E (99)
PROCESSING DATE: JUL 10, 1999
POLICY NO. XX XXX XXX
TABLE(S)
SEGMENT TABLE
This table is used to compute the charge for sales expenses and the cost of
insurance. See the Charge for Sales Expenses and Cost of Insurance provisions
for details. The information shown below for each segment starts on the
effective date of that segment.
SEGMENT,
ISSUE AGE, &
EFFECTIVE DATE RATING CLASS (RC) SEGMENT ALLOCATION AMOUNT
--------------------------------------------------------------------------------
Contract Date $5,000.00 Basic Insurance $194.85
Amount changing on JUL 1, 2009
Issue Age 35 to $0.00.
RC = Preferred (non-smoker)
Contract Date $95,000.00 Rider Coverage Not applicable.
Amount (see the Rider for
Flexible Term Insurance
Benefit on Life of Insured)
Issue Age 35
RC = Preferred (non-smoker)
================================================================================
TABLE(S) CONTINUED ON NEXT PAGE
Page 4 (99) (NJ)
PROCESSING DATE: JUL 10, 1999
POLICY NO. XX XXX XXX
TABLE(S) CONTINUED
TABLE OF MAXIMUM MONTHLY INSURANCE RATES PER $1,000
RATING CLASS: PREFERRED
INSURED'S MAXIMUM INSURED'S MAXIMUM
ATTAINED AGE* MONTHLY RATE ATTAINED AGE* MONTHLY RATE
--------------------------------------------------------------------------------
35 0.14417 65 1.85417
36 0.15167 66 2.05167
37 0.16167 67 2.26333
38 0.17250 68 2.49333
39 0.18417 69 2.74833
40 0.19833 70 3.03667
41 0.21333 71 3.36583
42 0.22917 72 3.74583
43 0.24667 73 4.17583
44 0.26583 74 4.64833
45 0.28750 75 5.15333
46 0.31083 76 5.68667
47 0.33583 77 6.24417
48 0.36333 78 6.82917
49 0.39333 79 7.46000
50 0.42750 80 8.15667
51 0.46667 81 8.93750
52 0.51167 82 9.81833
53 0.56333 83 10.79500
54 0.62083 84 11.84833
55 0.68500 85 12.95416
56 0.75500 86 14.09833
57 0.82917 87 15.26333
58 0.91167 88 16.44416
59 1.00417 89 17.65750
60 1.10750 90 18.92083
61 1.22250 91 20.26333
62 1.35500 92 21.73500
63 1.50500 93 23.47917
64 1.67167 94 25.81917
TABLE(S) CONTINUED ON NEXT PAGE
Page 4A (99)
PROCESSING DATE. JUL 10, 1999
POLICY NO. XX XXX XXX
TABLE(S) CONTINUED
INSURED'S MAXIMUM INSURED'S MAXIMUM
ATTAINED AGE* MONTHLY RATE ATTAINED AGE* MONTHLY RATE
--------------------------------------------------------------------------------
95 29.32167 98 62.09583
96 35.08250 99 and above 83.33333
97 45.08333
--------------------------------------------------------------------------------
* For the segment amount(s) effective on the contract date (see Segment Table),
the Insured's attained age is the issue age found on page 3 plus the length of
time since the contract date.
For any segment amount(s) effective after the contract date, the Insured's
attained age is the issue age of that segment plus the length of time since
its effective date.
We may charge less than the maximum monthly rates. From time to time, we will
consider the need to change the rates we charge. We describe the factors we use
to determine such changes under General Provisions.
See the Basis of Computation for a description of the basis we use to compute
these rates.
--------------------------------------------------------------------------------
TABLE(S) CONTINUED ON NEXT PAGE
Page 4B (99)
PROCESSING DATE: JUL 10, 1999
POLICY NO. XX XXX XXX
TABLE(S) CONTINUED
TABLE OF ATTAINED AGE FACTORS
These factors are used to determine your death benefit as described under Death
Benefit Provisions.
These factors apply during each contract year starting on the contract
anniversary.
CONTRACT CONTRACT
YEAR FACTORS YEAR FACTORS
-------------------------------------------------------------------------------
1 2.50 31 1.20
2 2.50 32 1.19
3 2.50 33 1.18
4 2.50 34 1.17
5 2.50 35 1.16
6 2.50 36 1.15
7 2.43 37 1.13
8 2.36 38 1.11
9 2.29 39 1.09
10 2.22 40 1.07
11 2.15 41 1.05
12 2.09 42 1.05
13 2.03 43 1.05
14 1.97 44 1.05
15 1.91 45 1.05
16 1.85 46 1.05
17 1.78 47 1.05
18 1.71 48 1.05
19 1.64 49 1.05
20 1.57 50 1.05
21 1.50 51 1.05
22 1.46 52 1.05
23 1.42 53 1.05
24 1.38 54 1.05
25 1.34 55 1.05
26 1.30 56 1.05
27 1.28 57 1.04
28 1.26 58 1.03
29 1.24 59 1.02
30 1.22 60 1.01
TABLE(S) CONTINUED ON NEXT PAGE
Page 4C (99)
PROCESSING DATE: JUL 10, 1999
POLICY NO. XX XXX XXX
TABLE(S) CONTINUED
CONTRACT CONTRACT
YEAR FACTORS YEAR FACTORS
----------------------------------------------------
61 1.00 64 1.00
62 1.00 65 1.00
63 1.00 66 and above 1.00
----------------------------------------------------
===============================================================================
END OF TABLE(S)
Page 4D (99)
