Exhibit 1.A(5)(a)(v)
SECURITY LIFE OF DENVER
INSURANCE COMPANY
INSURED: XXXX XXX
POLICY DATE: May 1, 1998
POLICY NUMBER: 65000001
INITIAL STATED DEATH BENEFIT: $100,000.00
[WE AGREE TO PAY the death benefit to the beneficiary upon the death of the
insured while this policy is in force.
WE ALSO AGREE to provide the other rights and benefits of the policy. These
agreements are subject to the provisions of the policy.]
[RIGHT TO EXAMINE PERIOD. You have the right to examine and return this policy
within [10] days after receipt. The policy may be returned by delivering or
mailing it to us at our Customer Service Center. Immediately upon return it will
be deemed void as of the policy date. Upon return of the policy to us, we will
refund all premiums paid.]
In this policy "you" and "your" refer to the owner of the policy. "We", "us" and
"our" refer to Security Life of Denver Insurance Company.
/s/ Xxxx X. Xxxxxxxx /s/ Xxxxxxx X. Xxxxxxxxxxx
Secretary President
[THIS POLICY IS A FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY.]
[DEATH BENEFITS AND OTHER VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE. THESE VALUES MAY
INCREASE OR DECREASE BASED ON INVESTMENT EXPERIENCE AND ARE NOT GUARANTEED AS TO
FIXED DOLLAR AMOUNT. DEATH BENEFITS ARE PAYABLE BY US UPON THE DEATH OF THE
INSURED. THERE IS NO MATURITY DATE. FLEXIBLE PREMIUMS ARE PAYABLE BY YOU DURING
THE LIFETIME OF THE INSURED UNTIL THE POLICY ANNIVERSARY NEAREST THE INSURED'S
100TH BIRTHDAY.]
[ ]
SECURITY LIFE OF DENVER INSURANCE COMPANY
A Stock Company
Customer Service Center
P.O. Box 173888; Denver, Colorado 80217
Toll Free Number: 0(000) 000-0000
Form 2503 (VUL)-6/98
TABLE OF CONTENTS
SCHEDULE.......................................................................5
DEFINITION OF TERMS............................................................6
INSURANCE COVERAGE PROVISIONS..................................................7
EFFECTIVE DATE OF COVERAGE.................................................7
BASE DEATH BENEFIT.........................................................7
CHANGE IN REQUESTED INSURANCE COVERAGE.....................................7
Requested Increases in Coverage..........................................8
Requested Decreases in Coverage..........................................8
Death Benefit Option Changes.............................................8
CONTINUATION OF COVERAGE AFTER AGE 100 ..................................8
PAYOUT OF PROCEEDS.........................................................9
PREMIUM PROVISIONS.............................................................9
INITIAL PREMIUM ALLOCATION.................................................9
SUBSEQUENT PREMIUM ALLOCATIONS............................................10
CHANGES TO PREMIUM ALLOCATIONS............................................10
SCHEDULED PREMIUMS........................................................10
UNSCHEDULED PREMIUMS......................................................10
NET PREMIUM...............................................................10
PREMIUM LIMITATION........................................................10
VARIABLE ACCOUNT PROVISION....................................................11
THE VARIABLE ACCOUNT......................................................11
VARIABLE ACCOUNT DIVISIONS................................................11
CHANGES WITHIN THE VARIABLE ACCOUNT.......................................11
GENERAL ACCOUNT PROVISIONS....................................................12
THE GENERAL ACCOUNT.......................................................12
GUARANTEED INTEREST DIVISION..............................................12
LOAN DIVISION.............................................................12
Form 2503 (VUL) - 6/98
Page 2
TRANSFER PROVISIONS...........................................................12
ACCOUNT VALUE PROVISIONS......................................................12
ACCOUNT VALUES ON THE INVESTMENT DATE.....................................13
ACCUMULATION UNIT VALUE...................................................13
ACCUMULATION EXPERIENCE FACTOR............................................13
ACCOUNT VALUE OF THE DIVISIONS OF THE VARIABLE ACCOUNT....................13
ACCOUNT VALUE OF THE GUARANTEED INTEREST DIVISION.........................14
ACCOUNT VALUE OF THE LOAN DIVISION........................................14
MONTHLY DEDUCTION AND REFUND..................................................15
MONTHLY DEDUCTION.........................................................15
COST OF INSURANCE.........................................................15
PERSISTENCY REFUND........................................................15
LOAN PROVISIONS...............................................................16
POLICY LOANS..............................................................16
LOAN INTEREST.............................................................16
LOAN DIVISION.............................................................16
PARTIAL WITHDRAWAL PROVISIONS.................................................16
SURRENDER PROVISIONS..........................................................17
SURRENDER VALUE...........................................................17
BASIS OF COMPUTATIONS.....................................................17
FULL SURRENDERS...........................................................17
GRACE PERIOD, TERMINATION AND REINSTATEMENT PROVISIONS........................18
GRACE PERIOD..............................................................18
THREE YEAR CONTINUATION PERIOD............................................18
GUARANTEE PERIOD......................................................... 19
TERMINATION...............................................................19
REINSTATEMENT.............................................................19
DEFERRAL OF PAYMENT.......................................................20
Form 2503 (VUL) - 6/98
Page 3
GENERAL POLICY PROVISIONS.....................................................20
THE POLICY................................................................20
AGE.......................................................................20
PROCEDURES................................................................21
OWNERSHIP.................................................................21
BENEFICIARIES.............................................................21
EXCHANGE RIGHT............................................................21
COLLATERAL ASSIGNMENT.....................................................21
INCONTESTABILITY..........................................................21
MISSTATEMENT OF AGE OR SEX................................................22
SUICIDE EXCLUSION.........................................................22
PERIODIC REPORTS..........................................................22
ILLUSTRATION OF BENEFITS AND VALUES.......................................22
NONPARTICIPATING..........................................................22
CUSTOMER SERVICE CENTER...................................................22
PAYOUTS OTHER THAN AS ONE SUM.................................................23
ELECTION..................................................................23
PAYOUT OPTIONS............................................................23
CHANGE AND XXXXXXXXXX.....................................................23
EXCESS INTEREST...........................................................24
MINIMUM AMOUNTS...........................................................24
SUPPLEMENTARY POLICY......................................................24
INCOME PROTECTION.........................................................24
DEATH OF PRIMARY PAYEE....................................................24
PAYMENTS OTHER THAN MONTHLY...............................................24
SETTLEMENT OPTION TABLES......................................................25
Additional benefits or riders, if any, will be listed in the Schedule. The
additional provisions will be inserted in the policy.
Form 2503 (VUL) - 6/98
Page 4
SCHEDULE
(Schedule Date: PolicyDate)
POLICY INFORMATION
Policy Number 65000001 Initial Stated Death Benefit $100,000.00
Insured XXXX XXX
Death Benefit Option OPTION 1
Age And Sex 35, Male Minimum Annual Premium $365.76
Premium Class Non-Smoker Guarantee Period Annual Premium
Policy Date May 1, 1998 Initial Scheduled Premium $1,600.00 Annually
Definition of Life Insurance Test Guideline Premium/Cash Value Corridor Test
CUSTOMER SERVICE CENTER: P.O. Box 173888, Denver, Colorado 80217-3888
[Coverage will expire prior to the policy anniversary nearest the insured's
100th birthday if premiums are insufficient to continue coverage. Coverage will
also be affected by Partial Withdrawals, Policy Loans, changes in the current
cost of insurance rates, the actual credited interest rate for the Guaranteed
Interest Division and the investment experience of the Variable Account.]
[ ]
Form 2503 (VUL) - 6/98
Page 5
SCHEDULE (CONTINUED)
BENEFIT PROFILE
Segment Guideline Segment
Benefit Issue Effective Annual Target
Description Amount Age Date Premium Premium
--------------------------------- ------------- --------- --------------- -------------- -------------
Stated Death Benefit (Segment #1) $100,000.00 35 May 1, 1998 $1,445.24 $3,981.00
[ ]
Form 2503 (VUL) - 6/98
Page 5A
SCHEDULE (CONTINUED)
EXPENSE CHARGES
A. PREMIUM EXPENSE CHARGES (As a Percent of all premiums) - Premium expense
charges will equal the sum of the following:
1. Sales Load:
Premiums Paid Premiums Paid in
Up to Segment Target Premium Excess of Segment Target Premium
Years 1-10 12% 3%
Years 11+ 3% 3%
2. State and Local Taxes: 2.5%
3. Federal Deferred Acquisition Cost Tax: [1.5%]
[We reserve the right to increase or decrease the premium expense
charges for taxes due to any change in tax law. We further reserve the
right to increase or decrease the premium expense charges for federal
deferred acquisition cost taxes due to any change in the cost to us.]
B. MONTHLY EXPENSE CHARGES - Monthly expense charges will equal the sum of the
following:
Initial Policy Charge: $13 per month for the first 36 months
$3 per month thereafter
Monthly Administrative Charge: $0.025 per thousand of Stated Death
Benefit (or Target Death Benefit,
if greater), for all years.
ANNUAL MORTALITY AND EXPENSE RISK CHARGE (Based on the percentage of assets
in each Variable Account Division)
[Mortality And Expense Risk Charge: 0.75%]
Form 2503 (VUL) - 6/98
Page 5B
SCHEDULE (CONTINUED)
[POLICYHOLDER TRANSACTION CHARGES]
[Requests for Sales Illustrations:]First illustration each year is free of
charge; thereafter $25 for each
illustration requested.
Partial Withdrawal Service Fee: See below
[Other Policy Transaction Charges: The charges for transfers divisions of
the Variable Account or between the
Guaranteed Interest Division and the
Variable Account Divisions; charges
for premium allocation changes; and
charges for other Variable Account
management functions are governed by
the Prospectus in effect at the time of
the transaction.]
POLICY LOANS
Policy Loan Interest Rate: 4.75% per year
Guaranteed Interest Rate Credited to Loan Division: 4.00% per year
Minimum Loan Amount: $100
Maximum Loan Amount: Refer to the Loan
Provisions section
PARTIAL WITHDRAWALS
Minimum Partial Withdrawal Amount: $100
Maximum Partial Withdrawal Amount: Amount which will leave
$500 as the Net Account
Value
Partial Withdrawal Service Fee: $25
Limit on Partial Withdrawals: One per policy year
GUARANTEED INTEREST DIVISION
[Guaranteed Interest Rate For
Guaranteed Interest Division: 4.00% per year]
Form 2503 (VUL) - 6/98
Page 5C
SCHEDULE (CONTINUED)
To comply with the Definition of Life Insurance Test you have elected, the
policy's Base Death Benefit at any time will be at least equal to the Account
Value times the appropriate factor from this table.
DEFINITION OF LIFE INSURANCE DEATH BENEFIT FACTORS BASED ON
GUIDELINE PREMIUM / CASH VALUE CORRIDOR TEST
ATTAINED FACTOR ATTAINED FACTOR ATTAINED FACTOR ATTAINED
FACTOR
AGE AGE AGE AGE
-------- -------- -------- -------- -------- -------- -------- ---------
0 2.50 25 2.50 50 1.85 75 1.05
1 2.50 26 2.50 51 1.78 76 1.05
2 2.50 27 2.50 52 1.71 77 1.05
3 2.50 28 2.50 53 1.64 78 1.05
4 2.50 29 2.50 54 1.57 79 1.05
5 2.50 30 2.50 55 1.50 80 1.05
6 2.50 31 2.50 56 1.46 81 1.05
7 2.50 32 2.50 57 1.42 82 1.05
8 2.50 33 2.50 58 1.38 83 1.05
9 2.50 34 2.50 59 1.34 84 1.05
10 2.50 35 2.50 60 1.30 85 1.05
11 2.50 36 2.50 61 1.28 86 1.05
12 2.50 37 2.50 62 1.26 87 1.05
13 2.50 38 2.50 63 1.24 88 1.05
14 2.50 39 2.50 64 1.22 89 1.05
15 2.50 40 2.50 65 1.20 90 1.05
16 2.50 41 2.43 66 1.19 91 1.04
17 2.50 42 2.36 67 1.18 92 1.03
18 2.50 43 2.29 68 1.17 93 1.02
19 2.50 44 2.22 69 1.16 94 1.01
20 2.50 45 2.15 70 1.15 95 1.00
21 2.50 46 2.09 71 1.13 96 1.00
22 2.50 47 2.03 72 1.11 97 1.00
23 2.50 48 1.97 73 1.09 98 1.00
24 2.50 49 1.91 74 1.07 99 1.00
100 and 1.00
older
Form 2503 (VUL) - 6/98
Page 5D
SCHEDULE (CONTINUED)
[TABLE OF GUARANTEED RATES]
Guaranteed Maximum Cost of Insurance Rates Per $1000
(Basic)
[Attained Monthly Cost of [Attained Monthly Cost of [Attained Monthly Cost of [Attained Monthly Cost of
Age] Insurance Rate Age] Insurance Rate Age] Insurance Rate Age] Insurance Rate
-------- --------------- -------- --------------- -------- --------------- -------- ----------------
0 0.34845 26 0.14419 51 0.60870 76 5.91225
1 0.08917 27 0.14252 52 0.66377 77 6.46824
2 0.08251 28 0.14169 53 0.72636 78 7.04089
3 0.08167 29 0.14252 54 0.79730 79 7.64551
4 0.07917 30 0.14419 55 0.87326 80 8.30507
5 0.07501 31 0.14836 56 0.95591 81 9.03761
6 0.07167 32 0.15252 57 1.04192 82 9.86724
7 0.06667 33 0.15919 58 1.13378 83 10.80381
8 0.06334 34 0.16669 59 1.23235 84 11.82571
9 0.06167 35 0.17586 60 1.34180 85 12.91039
10 0.06084 36 0.18670 61 1.46381 86 14.03509
11 0.06417 37 0.20004 62 1.60173 87 15.18978
12 0.07084 38 0.21505 63 1.75809 88 16.36948
13 0.08251 39 0.23255 64 1.93206 89 17.57781
14 0.09584 40 0.25173 65 2.12283 90 18.82881
15 0.11085 41 0.27424 66 2.32623 91 20.14619
16 0.12585 42 0.29675 67 2.54312 92 21.57655
17 0.13919 43 0.32260 68 2.77350 93 23.20196
18 0.14836 44 0.34929 69 3.02328 94 25.28174
19 0.15502 45 0.37931 70 3.30338 95 28.27411
20 0.15836 46 0.41017 71 3.62140 96 33.10676
21 0.15919 47 0.44353 72 3.98666 97 41.68475
22 0.15752 48 0.47856 73 4.40599 98 58.01259
23 0.15502 49 0.51777 74 4.87280 99 83.33333
24 0.15169 50 0.55948 75 5.37793
25 0.14752
The rates shown are for a standard rate class. If the policy is based on a
special rate class (other than standard), the maximum cost of insurance rates
will be adjusted using the rating factor shown in the Benefit Profile of the
Schedule for the special class. If the special rate class is a stated percentage
increase, the maximum cost of insurance rates will be determined by multiplying
the rates for a standard rate class shown above by the rating factor shown in
the Benefit Profile of the Schedule. If the special rate class is a flat amount
per $1,000, the maximum cost of insurance rates will be determined by adding the
flat amount per $1,000 shown in the Benefit Profile of the Schedule to the rate
per $1,000 for the standard rate class shown above. The rates shown above are
based on the 1980 Commissioners' Standard Ordinary Male Smoker Composite
Mortality Table (Male), age nearest birthday.
Form 2503 (VUL) - 6/98
Page 5E
DEFINITION OF TERMS
ACCOUNT VALUE - The sum of the amounts allocated to the Divisions of the
Variable Account and to the Guaranteed Interest Division, as well as any amount
set aside in the Loan Division to secure a Policy Loan.
ACCUMULATION UNIT - A unit of measurement used to calculate the Account Value in
each Division of the Variable Account.
ACCUMULATION UNIT VALUE - The value of an Accumulation Unit of each
Division of the Variable Account. The Accumulation Unit Value is
determined as of each Valuation Date.
BASE DEATH BENEFIT - The Base Death Benefit is defined in the Base Death Benefit
provision of the policy.
CASH SURRENDER VALUE - The amount of your Account Value plus any refund of sales
load due.
CUSTOMER SERVICE CENTER - Our administrative office whose address is P.O. Box
173888, Denver, CO 80217.
DIVISION(S) OF THE VARIABLE ACCOUNT - The investment options available, each of
which invests in shares of one of the investment portfolios.
GENERAL ACCOUNT - The account which contains all of our assets other than those
held in the variable account or our other separate accounts.
GUARANTEED INTEREST DIVISION - Part of our General Account to which a portion of
the Account Value may be allocated and which provides guarantees of principal
and interest.
GUIDELINE ANNUAL PREMIUM - The premium used to calculate how Net Premium is
allocated to each segment of Stated Death Benefit and to determine any
persistency refund.
INITIAL PERIOD - The Initial Period ends on the earlier of: a) the date this
policy was delivered to you plus the Right to Examine Period, so long as we
receive notice of the delivery date at our Customer Service Center before the
date defined in (b), or (b) the date this policy is mailed from our Customer
Service Center plus five days and the Right to Examine Period.
INVESTMENT DATE -The date we allocate funds to your policy. We will allocate the
initial Net Premium to your policy on the Valuation Date immediately following
the latest of the date: (1) we receive the amount of premium required for
coverage to begin; (2) we have approved the policy for issue; and (3) all issue
requirements have been met and received in our Customer Service Center.
LOAN DIVISION - Part of our General Account in which funds are set aside to
secure any outstanding Policy Loan and accrued loan interest when due.
MONTHLY PROCESSING DATE - The date each month on which the monthly deductions
from the Account Value are due. The first Monthly Processing Date will be the
policy date or the Investment Date, if later. Subsequent Monthly Processing
Dates will be the same date as the policy date each month thereafter unless this
is not a Valuation Date, in which case the Monthly Processing Date occurs on the
next Valuation Date.
NET ACCOUNT VALUE - The amount of the Account Value minus any Policy Loan and
accrued loan interest.
NET CASH SURRENDER VALUE - The amount of the Cash Surrender Value minus any
Policy Loan and accrued loan interest.
NET PREMIUM - The Net Premium equals the premium paid minus the premium expense
charges shown in the Schedule. These charges are deducted from the premiums
before the premium is applied to your Account Value.
[PARTIAL WITHDRAWAL - The withdrawal of a portion of your Net Account Value from
the policy. The Partial Withdrawal may reduce the amount of Base Death Benefit
in force.]
POLICY LOAN - The sum of amounts you have borrowed from your policy, increased
by any Policy Loan interest capitalized when due, and reduced by any Policy Loan
repayments.
Form 2503 (VUL)-6/98
Page 6
[RIGHT TO EXAMINE PERIOD - The period of time within which the owner may examine
the policy and return it for a refund.]
[SCHEDULED PREMIUM - The premium amount which you specify on the application as
the amount you intend to pay at fixed intervals over a specified period of time.
Premiums may be paid on a quarterly, semiannual, or annual basis, as you
determine. You need not pay the Scheduled Premium, and you may change it at any
time. Also, within limits, you may pay less or more than the Scheduled Premium.]
SEGMENT - The Stated Death Benefit shown on the Benefit Profile of the Schedule
is the initial Segment, or Segment 1. Each increase in the Stated Death Benefit
(other than an option change) is a new Segment. Each new Segment will be shown
separately on the Benefit Profile of the Schedule. The first year for a Segment
begins on the effective date of the Segment and ends one year later. Each
subsequent year begins at the end of the prior Segment year. Each new Segment
may be subject to new expense charges, cost of insurance charges and
incontestability and suicide exclusion periods.
STATED DEATH BENEFIT - The sum of the Segments under the policy. The Stated
Death Benefit changes when there is an increase or a decrease or when a
transaction on the policy causes it to change (for example, a partial withdrawal
under an Option 1 Base Death Benefit may cause the Stated Death Benefit to
change).
TARGET DEATH BENEFIT - The Target Death Benefit for your policy is defined in
the Adjustable Term Insurance Rider, if any, attached to the policy.
VALUATION DATE - Each date as of which the net asset value of the shares of the
investment portfolios and unit values of the Divisions are determined,
Except for days that a Division's corresponding portfolio does not value its
shares, a Valuation Date is any day:
(a) The New York Stock Exchange ("NYSE") is open for trading and on which
Security Life's Customer Service Center is open for business; or
(b) as may be required by law.
VALUATION PERIOD - The period which begins at 4:00 p.m. Eastern Time on
Valuation Date and ends at 4:00 p.m. Eastern Time on the next succeeding
Valuation Date.
Form 2503 (VUL)-6/98
Page 6a
INSURANCE COVERAGE PROVISIONS
EFFECTIVE DATE OF COVERAGE
[The policy date shown in the Schedule is the effective date for all coverage
provided in the original application. The effective date is subject to the
payment of the amount of premium required for coverage to begin and the
acceptance of the policy by you during the continued insurability of all persons
insured by this policy and any riders attached. The policy date is the date from
which we measure policy years and determine the Monthly Processing Date. Monthly
Processing Dates are the same calendar day of each month as the policy date
unless this is not a Valuation Date in which case the Monthly Processing Date
occurs on the next Valuation Date. A policy anniversary occurs each year on the
same month and day as the policy date unless this is not a Valuation Date in
which case the policy anniversary occurs on the next Valuation Date. The
effective date for new Segments and additional benefits is shown in the
Schedule.]
BASE DEATH BENEFIT
The Base Death Benefit will be, at any time, determined as follows:
Option 1: Under Option 1, the Base Death Benefit is the greater of:
(a) the Stated Death Benefit; or
(b) your Account Value multiplied by the appropriate factor from
the Definition of Life Insurance Factors shown in the schedule.
Option 2: Under Option 2, the Base Death Benefit is the greater of:
(a) the Stated Death Benefit plus the Account Value, or
(b) your Account Value multiplied by the appropriate factor from
the Definition of Life Insurance Factors shown in the schedule.
The Stated Death Benefit and the death benefit option are shown in the Schedule.
[This policy is designed to qualify as a life insurance contract under the
Internal Revenue Code. All terms and provisions of the policy shall be construed
in a manner consistent with that design. The Base Death Benefit in force at any
time shall not be less than the amount of insurance necessary to achieve such
qualification under the applicable provisions of the Internal Revenue Code in
existence at the time the policy is issued. We reserve the right to amend the
policy or adjust the amount of insurance when required. We will send you a copy
of any policy amendment.]
CHANGE IN REQUESTED INSURANCE COVERAGE
You may request that the insurance coverage be increased or decreased. Decreases
are not allowed before the first policy anniversary. The change in coverage may
not be for an amount less than $1,000. The effective date of the change will be
the monthly anniversary immediately following the date your written application
is approved by us. After any change to the Stated Death Benefit, you will
receive an amended Schedule reflecting the change, the benefit under any riders,
if applicable, the guaranteed cost of insurance rates, the Guideline Annual
Premium, and the new target premium.
REQUESTED INCREASES IN COVERAGE
[Subject to our limits, you may request an increase in the Stated Death Benefit.
An increase will become effective as of the monthly anniversary after we have
approved your application for increase. You must provide evidence satisfactory
to us that the insured is insurable according to our normal rules of
underwriting for this type of policy. This evidence will include an application
and may include required medical information. An
Form 2503 (VUL)-6/98
Page 7
increase will consist of a new Segment of Stated Death Benefit. Each new Segment
will result in a new sales load which will be deducted from the premium
allocated to the new Segment. The new Segment may also be subject to new monthly
expense charges, cost of insurance charges and incontestability and suicide
exclusion periods.]
REQUESTED DECREASES IN COVERAGE
[After the first policy anniversary, you may request a decrease in the Stated
Death Benefit. A decrease will be effective as of the monthly anniversary
immediately following the date your written application is approved by us. A
decrease will first reduce Adjustable Term Insurance Rider coverage, if any is
attached to your policy, and will then reduce each of the Stated Death Benefit
Segments in the same proportion as the Stated Death Benefit is reduced.]
[The Stated Death Benefit after any change must equal at least the lesser of the
Initial Stated Death Benefit or $50,000.]
DEATH BENEFIT OPTION CHANGES
[Beginning with the first policy anniversary and ending with the policy
anniversary nearest the Insured's 100th birthday, you may request a change to
the death benefit option. Changes must be requested at least 30 days prior to
the policy anniversary. The change will be effective as of the policy
anniversary. A death benefit option change applies to the entire Stated Death
Benefit. For us to approve a change to the death benefit option from Option 1 to
Option 2, you must submit evidence to us that the insured is insurable according
to our normal rules of underwriting for this type of policy. This evidence will
include an application and may include required medical information. We may not
allow any change if it would reduce the Stated Death Benefit below the minimum
we require to issue this policy at the time of reduction. After the effective
date of the change, the Stated Death Benefit will be changed according to the
following table:]
OPTION CHANGE
FROM TO STATED DEATH BENEFIT FOLLOWING CHANGE EQUALS:
Option 1 Option 2 Stated Death Benefit prior to such change minus
your Account Value as of the effective date of
the change.
Option 2 Option 1 Stated Death Benefit prior to such change plus
your Account Value as of the effective date of
the change.
For purposes of death benefit option changes, your Account Value will be
allocated to each Segment in the same proportion that the Segment bears to the
Stated Death Benefit as of the effective date of the change.
CONTINUATION OF COVERAGE AFTER AGE 100
If the policy is in force on the policy anniversary nearest the Insured's 100th
birthday, the policy will continue pursuant to the terms of the policy, except:
on this date: (1) if an Adjustable Term Insurance Rider (ATR) is attached to the
policy, the Target Death Benefit defined in the ATR will become the Stated Death
Benefit for the policy and the ATR will terminate; (2) All other riders attached
to the policy will also terminate; (3) the portion of your Account Value
invested in the divisions of the Variable Account will be transferred into the
Guaranteed Interest Division and no further investment in the divisions of the
Variable Account will be allowed;. and (4) If the death benefit option in force
on the policy is Option 2, the policy will be converted to death benefit Option
1 in accordance with the procedures outlined in the Death Benefit Option Changes
provision of the policy and no further changes will be allowed tn the death
benefit option.
Form 2503 (VUL)-6/98
Page 8
[After the policy anniversary nearest the Insured's 100th birthday, no further
premiums will be accepted and no monthly deductions will be made. However, a one
time administrative fee of $200 will be charged against the policy's Account. We
will continue to credit interest to the Account Value. Policy loans and
withdrawals continue to be available. Any existing policy loan will continue.
Policy loan interest will continue to accrue. Payments on policy loans and
policy loan interest will be accepted. The policy will enter the 61-day grace
period if the surrender value is zero or less.]
PAYOUT OF PROCEEDS
The proceeds is the amount we will pay:
a) upon surrender of the policy, or
b) upon the death of the insured.
The proceeds upon surrender of this policy will be the Net Cash Surrender Value.
The insured's age is the age listed in the Schedule increased by the number of
completed policy years since the policy date. The amount of proceeds payable
upon the death of the insured will be the Base Death Benefit in effect on the
date of the insured's death; plus any amounts payable from any additional
benefits provided by rider; minus any outstanding Policy Loan including accrued
but unpaid interest; minus any unpaid monthly deductions incurred prior to the
date of the insured's death, plus any premiums received after the date of the
insured's death. The calculation of the death benefit will be computed as of the
date of the insured's death.
[We will determine the amount of proceeds payable upon the death of the insured
when we have received due proof of death satisfactory to us and any other
information which is necessary to process the claim. Any proceeds we pay are
subject to adjustments as provided in the Misstatement of Age or Sex, Suicide
Exclusion and Incontestability provisions.]
[We will pay proceeds in one sum unless you request an alternate form of
payment. There are many possible methods of payment. The available payout
options are described in the Payouts Other Than As One Sum provision. Contact us
or your registered representative for additional information. Interest will be
paid on the one sum death proceeds from the date of the insured's death to the
date of payment, or until a payout option is selected. Interest will be at the
rate we declare, or at any higher rate required by law.] [ ]
PREMIUM PROVISIONS
INITIAL PREMIUM ALLOCATION
If the Initial Period has not ended on the Investment Date, Net Premium amounts
designated for allocation to divisions of the Variable Account will be allocated
to the money market division and any Net Premium amount designated for
allocation to the Guaranteed Interest Division will be allocated to that
division. On the Valuation Date immediately following the end of the Initial
Period, the balance of the money market division will be transferred to the
other divisions of the Variable Account according to the allocations shown in
your latest instructions received at our Customer Service Center.
The amounts allocated to the Guaranteed Interest Division will remain in that
division.
If the Initial Period has ended on the Investment Date, Net Premium amounts will
be allocated to divisions of the Variable Account and/or Guaranteed Interest
Division in accordance with the allocation shown in your latest instructions
received at our Customer Service Center.
Form 2503(VUL)-6/98
Page 9
SUBSEQUENT PREMIUM ALLOCATIONS
After the initial premium allocation, all future scheduled and unscheduled
premiums will be allocated to the Investment Divisions in accordance with the
allocation shown in the latest instructions received at our Customer Service
Center (unless you otherwise specify in writing) on the Valuation date
immediately following our receipt of the premium at our Customer Service Center.
CHANGES TO PREMIUM ALLOCATIONS
[You may change your premium allocation in accordance with the instructions
included in your annual policy prospectus. If the change causes a premium
allocation charge to be incurred according to the Schedule, we will deduct a
charge from the Divisions of the Variable Account and the Guaranteed Interest
Division in the same proportion that your Account Value of each Division bears
to your Net Account Value. The amount of this charge is shown in the Schedule.]
SCHEDULED PREMIUMS
[The Scheduled Premium as shown in the Schedule may be paid while this policy is
in force prior to the policy anniversary nearest the Insured's 100th birthday.
You may increase or decrease the amount of the Scheduled Premium, subject to
limits we may set and provisions in the Premium Limitation provision. Under
conditions provided in the Grace Period provision and the Guarantee Period
provision, you may be required to make premium payments to keep the policy in
force. You may pay premiums on a monthly basis through an automated payment
facility. All payment modes are subject to our minimum requirements for the
payment mode selected.]
UNSCHEDULED PREMIUMS
[You may make unscheduled premium payments at any time the policy is in force
prior to the policy anniversary nearest the Insured's 100th birthday, subject to
the Premium Limitation provision. Unless you tell us otherwise, these premium
payments will first be applied to reduce or pay off any existing Policy Loan
and, as such, premium expense charges will not be deducted. We may limit the
amount of such unscheduled premium payments if the payment would result in an
increase in the Base Death Benefit. If the net amount at risk is increased as a
result of an unscheduled premium, we may require evidence of insurability
satisfactory to us that the insured is insurable according to our normal rules
of underwriting for this type of policy. This evidence will include an
application and may include required medical information. The net amount at risk
is the difference between the Base Death Benefit and your Account Value.]
NET PREMIUM
The Net Premium equals the premium paid minus the premium expense charges shown
in the Schedule. Premiums allocated to a new Segment will be subject to a new
sales load. Premiums are allocated in the same proportion that the Guideline
Annual Premium of each Segment bears to the sum of the Guideline Annual Premiums
of all Segments. The Guideline Annual Premium for each Segment is shown in the
Schedule. The target premium for each Segment is also shown in the Schedule.
PREMIUM LIMITATION
If the Definition of Life Insurance test used for your policy is the Guideline
Premium/Cash Value Corridor Test, we will not accept any premium that causes
your policy not to qualify as a life insurance policy under the Internal Revenue
Code. No premium may be paid after the Insured's death.
[ ]
Form 2503(VUL)-6/98
Page 10
VARIABLE ACCOUNT PROVISION
THE VARIABLE ACCOUNT
[The Variable Account is an account established by us, pursuant to the laws of
the State of Colorado, to separate the assets funding the benefits for the class
of policies to which this policy belongs from the other assets of Security Life
of Denver Insurance Company.]
[The Variable Account is registered as a unit investment trust under the
Investment Company Act of 1940. All income, gains and losses, whether or not
realized, from assets allocated to the Variable Account are credited to or
charged against the Variable Account without regard to income, gains or losses
of our General Account. The assets of the Variable Account are our property but
are separate from our General Account and our other Variable Accounts. That
portion of the assets of the Variable Account which is equal to the reserves and
other policy liabilities with respect to the Variable Account is not subject to
creditor claims against us.]
VARIABLE ACCOUNT DIVISIONS
[The Variable Account is divided into divisions, each of which invests in a
series fund portfolio designed to meet the objectives of the division. The
current eligible divisions are shown in your annual policy prospectus. We may,
from time to time, add additional divisions. If we do, you may be permitted to
select from these other divisions subject to the terms and conditions we may
impose on those allocations.]
We reserve the right to limit the number of divisions in which you may invest
over the life of the policy. This limit, if any, will be listed in the updated
policy prospectus provided to you each year.
CHANGES WITHIN THE VARIABLE ACCOUNT
[When permitted by law, and subject to any required notice to you and approval
of the Securities and Exchange Commission ("SEC"), state regulatory authorities
or policy owners, we may from time to time make the following changes to the
Variable Account:
o Make additional divisions available. These divisions will invest in
investment portfolios we find suitable for the policy.
o Eliminate divisions from the Variable Account, combine 2 or more
divisions, or substitute a new portfolio for the portfolio in which a
division invests. A substitution may become necessary if, in our
judgment, a portfolio no longer suits the purposes of the policy. This
may happen due to a change in laws or regulations, or a change in a
portfolio's investment objectives or restrictions. This may also happen
if the portfolio is no longer available for investment, or for some
other reason, such as a declining asset base.
o Transfer assets of the Variable Account , which we determine to be
associated with the class of policies to which your policy belongs, to
another Variable Account.
o Withdraw the Variable Account from registration under the Investment
Company Act of 1940.]
o Operate the Variable Account as a management investment company under
the Investment Company Act of 1940.
o Cause one or more divisions to invest in a mutual fund other than or in
addition to the portfolios.
[o Discontinue the sale of policies.]
Form 2503(VUL)-6/98
Page 11
[o Terminate any employer or plan trustee agreement with us pursuant to its
terms.]
[o Restrict or eliminate any voting rights as to the Variable Account.]
[o Make any changes required by the Investment Company Act of 1940 or the
rules or regulations thereunder.]
GENERAL ACCOUNT PROVISIONS
THE GENERAL ACCOUNT
The General Account holds all of our assets other than those held in the
Variable Account or our other separate accounts. The Guaranteed Interest
Division is a part of our General Account.
GUARANTEED INTEREST DIVISION
[The Guaranteed Interest Division is another division to which you may allocate
premium or make transfers. The Account Value of the Guaranteed Interest Division
is equal to the Net Premium allocated to this division plus any earned interest
minus deductions taken from this division. Interest is credited at the
guaranteed rate shown in the schedule or may be credited at a higher rate. Any
higher rate is guaranteed to be in effect for at least 12 months.]
LOAN DIVISION
The Loan Division is the account which is set aside to secure the Policy Loan,
if any. See the Loan Provisions section for information.
TRANSFER PROVISIONS
[After the Initial Period and until the policy anniversary nearest the Insured's
100th birthday, your Account Value in each division may be transferred to any
other division of the Variable Account or to the Guaranteed Interest Division
upon your request. On the policy anniversary nearest the Insured's 100th
birthday your account value in each division of the Variable Account will be
transferred into the Guaranteed Interest Division and no further transfers will
be allowed. One transfer from the Guaranteed Interest Division into the Variable
Divisions may be made during the first 30 days of each policy year. Additional
limitations, requirements and charges for transfers will be listed in and
governed by your annual policy prospectus in effect at the time of the transfer.
We reserve the right to modify these limitations, requirements, and charges from
time to time.]
ACCOUNT VALUE PROVISIONS
The Account Value is the sum of the current amounts allocated to the divisions
of the Variable Account and to the Guaranteed Interest Division plus your
balance in the Loan Division.
Form 2503(VUL)-6/98
Page 12
The Account Value is based on the amount and number of premiums paid, policy and
rider charges assessed, loans and withdrawals taken, monthly deductions, premium
expense charges, transaction charges, and the investment experience or credited
interest of the division to which your Account Value is allocated.
Your Net Account Value is equal to your Account Value minus any Policy Loan and
accrued but unpaid loan interest.
ACCOUNT VALUES ON THE INVESTMENT DATE
The Account Value of each division of the Variable Account and the Guaranteed
Interest Division as of the Investment Date is equal to:
a) The allocation to that division of the first Net Premium paid; minus
b) The portion of any monthly deductions due on the Investment Date
allocated to that division.
ACCUMULATION UNIT VALUE
The investment experience of a division of the Variable Account is determined as
of each Valuation Date. We use an Accumulation Unit Value to measure the
experience of each of the Variable Account Divisions during a Valuation Period.
We set the Accumulation Unit Value at $10 on the Valuation Date when the first
investments in each division of the Variable Account are made. The Accumulation
Unit Value for a Valuation Period equals the Accumulation Unit Value for the
preceding Valuation Period multiplied by the Accumulation Experience Factor
defined below for the Valuation Period.
The number of units for a given transaction related to a division of the
Variable Account as of a Valuation Date is determined by dividing the dollar
value of that transaction by that division's Accumulation Unit Value for that
date.
ACCUMULATION EXPERIENCE FACTOR
For each division of the Variable Account, the Accumulation Experience Factor
reflects the investment experience of the portfolio in which that division
invests and the charges assessed against that division for a Valuation Period.
The Accumulation Experience Factor is calculated as follows:
a) The net asset value of the portfolio in which that division invests as
of the end of the current Valuation Period; plus
b) The amount of any dividend or capital gains distribution declared and
reinvested in the portfolio in which that division invests during the
current Valuation Period; minus
c) A charge for taxes, if any.
[d) The result of (a), (b) and (c) divided by the net asset value of the
portfolio in which that division invests as of the end of the preceding
Valuation Period; minus]
e) The daily equivalent of the annual mortality and expense risk charge
shown in the Schedule for each day in the current Valuation Period.
ACCOUNT VALUE OF THE DIVISIONS OF THE VARIABLE ACCOUNT
On subsequent Valuation Dates after the Investment Date, your Account Value of
each division of the Variable Account is calculated as follows:
a) The number of Accumulation Units in that division as of the beginning of
the current Valuation Period multiplied by that division's Accumulation
Unit Value for the current Valuation Period; plus
b) Any additional Net Premiums allocated to that division during the
current Valuation Period; plus
Form 2503(VUL)-6/98
Page 13
c) Any Account Value transferred to or minus any Account Value transferred
from the Variable Division during the current Valuation Period
(including the applicable portion of any transfer fee); minus
d) Any Partial Withdrawals allocated to that division and any applicable
withdrawal service fees which are allocated to the Variable division
during the current Valuation Period; plus
e) Any amounts released from the Loan Division as a result of a loan or
loan interest payment, or minus amounts transferred to the Loan Division
as a result of any loans which are allocated to the Variable Division
during the current Valuation Period; minus
f) The portion of the monthly deduction allocated to the Variable Division,
if a Monthly Processing Date occurs during the current Valuation Period.
ACCOUNT VALUE OF THE GUARANTEED INTEREST DIVISION
On Valuation Dates after the Investment Date, your Account Value of the
Guaranteed Interest Division is calculated as follows:
a) The Account Value of the Guaranteed Interest Division at the end of the
preceding Valuation Period plus interest at the declared rate credited
during the current Valuation Period; plus
b) Any additional Net Premiums allocated to the Guaranteed Interest
Division plus interest credited to these premiums during the current
Valuation Period; plus
c) Any account Value transferred to or minus any Account Value transferred
from the Guaranteed Interest Division during the current Valuation
Period (including the applicable portion of any transfer fee); minus
d) Any Partial Withdrawals taken and any applicable withdrawal service fees
which are allocated to the Guaranteed Interest Division during the
current Valuation Period; plus
e) Any amounts released from the Loan Division as a result of a loan or
loan interest payment, or minus amounts transferred to the Loan division
as a result of any loans which are allocated to the Guaranteed Interest
Division during the current Valuation Period; minus
f) The portion of the monthly deduction allocated to the division, if a
Monthly Processing Date occurs during the current Valuation Period.
ACCOUNT VALUE OF THE LOAN DIVISION
On Valuation Dates after the Investment Date, your Account Value of the Loan
Division is equal to:
a) The Account Value of the Loan Division on the prior Valuation Date; plus
b) Any interest credited to the Loan Division during the Valuation Period;
plus
c) An amount equal to any additional loans since the prior Valuation Date;
minus
d) Any loan repayments, including payment of loan interest in cash; plus
e) The amount of accrued loan interest if the Valuation Date is a policy
anniversary; minus
f) The amount of interest credited to the Loan Division during the year if
the Valuation Date is a policy anniversary.
On policy anniversaries, any amount of interest credited to the Loan Division
during the year is transferred from the Loan Division to the Variable Account
and Guaranteed Interest Divisions according to your premium allocation then in
effect.
Form 2503(VUL)-6/98
Page 14
MONTHLY DEDUCTION AND REFUND
MONTHLY DEDUCTION The monthly deduction is equal to:
a) the cost of insurance charges for this policy; plus
b) the monthly charges for any other additional benefits provided by rider;
plus
c) the monthly expense charges shown in the Schedule.
The monthly deductions are allocated to the divisions of the Variable Account
and Guaranteed Interest Division in the same proportion that your Account Value
in the division bears to your Net Account Value as of the Monthly Processing
Date. This deduction is taken from your Account Value as of the Monthly
Processing Date. After the policy anniversary nearest the Insured's 100th
birthday, no further monthly deductions will be made.
COST OF INSURANCE
[The cost of insurance is determined on a monthly basis for each Segment. Such
cost is the monthly cost of insurance rate for the insured's premium class for
each Segment multiplied by the net amount at risk. The net amount at risk is (a)
minus (b) where:]
a) is the Base Death Benefit for all Segments as of the Monthly Processing
Date after the monthly deductions (other than cost of insurance charges
for the Base Death Benefit, any Adjustable Term Insurance Rider and any
Waiver of Monthly Deductions Rider), divided by 1 plus the monthly
equivalent of the guaranteed interest rate for the Guaranteed Interest
Division as shown in the Schedule; and
b) is your Account Value as of the Monthly Processing Date after the
monthly deductions (other than the cost of insurance for the Base Death
Benefit, any Adjustable Term Insurance Rider and any Waiver of Monthly
Deduction Rider).
[The cost of insurance rates will be determined by us from time to time. They
will be based on the sex and age as of the effective date of coverage, the
duration since the coverage began and the premium class. Any change in rates
will apply to all individuals of the same premium class and whose policies have
been in effect for the same length of time. The rates will never exceed those
rates shown in the Table of Guaranteed Rates in the Schedule as adjusted for any
special premium class.]
Each time there is a new Segment, the net amount at risk will be allocated to
each Segment in the same proportion that Segment bears to the Stated Death
Benefit. Different rates will apply to each Segment depending upon the premium
class, the age as of the effective date of the increase and the duration since
the effective date of the increase.
PERSISTENCY REFUND
[Each month, we will credit your Net Account Value with a persistency refund for
each Segment of the Stated Death Benefit which remains in force after its 10th
Segment year. (Such a Segment is referred to as a qualifying segment.) The
monthly refund is equal to .0005 times the Account Value allocated to the
Divisions of the Variable Account and the Loan Division times the sum of the
persistency factors for the qualifying segments. The persistency factor for a
qualifying segment equals: the qualifying segment's Guideline Annual Premium
multiplied by the number of years the qualifying segment has been in force,
divided by the sum of the Guideline Annual Premium for each qualifying and
non-qualifying segment multiplied by the number of years such segment has been
in force.]
Form 2503(VUL)-6/98
Page 15
The persistency refund will be added to the Divisions of the Variable Account
and the Guaranteed Interest Division in the same proportion that your Account
Value in each division bears to your Net Account Value as of the Monthly
Processing Date.
LOAN PROVISIONS
POLICY LOANS
[You may obtain a policy loan after the first policy anniversary. The maximum
amount you may borrow at any time equals the Net Account Value on the date of
the loan request less all monthly deductions to the next policy anniversary. The
policy loan is a first lien on your policy. The minimum amount you may borrow is
shown in the Schedule. The outstanding policy loan amount is equal to the loan
amount as of the beginning of the policy year plus new loans and minus loan
repayments, plus accrued interest.]
LOAN INTEREST
[The annual policy loan interest rate is 4.75% as shown in the Schedule. If a
loan is made, interest is due and payable at the end of the policy year.
Thereafter, interest on the loan amount is due annually at the end of each
policy year until the loan is repaid. If interest is not paid when due, it is
added to the Policy Loan.]
If the Policy Loan amount plus any accrued interest equals or exceeds the
Account Value, a premium sufficient to keep this policy in force must be paid as
provided in the Grace Period provision.
LOAN DIVISION
When a Policy Loan is taken or when interest is not paid in cash when due, an
amount equal to the loan (or unpaid loan interest, respectively) is transferred
from the divisions of the Variable Account and the Guaranteed Interest Division
to the Loan Division to secure the loan. This amount will be deducted from the
divisions of the Variable Account and the Guaranteed Interest Division in the
same proportion that your Account Value in each division bears to your Net
Account Value as of the date the transfer is effective unless otherwise
specified in your instructions to us. Your Account Value in the Loan Division
will be credited with interest at the interest rate for the Loan Division shown
in the Schedule.
When a loan repayment is made an amount equal to the repayment is transferred
from the Loan Division to the Guaranteed Interest Division and the divisions of
the Variable Account in the same proportion as your current premium allocation
unless you request a different allocation.
PARTIAL WITHDRAWAL PROVISIONS
You may apply for a partial withdrawal of your Account Value on any Monthly
Processing Date after the first policy anniversary by writing to us at our
Customer Service Center. The minimum and maximum partial withdrawal amounts are
shown in the Schedule. When a partial withdrawal is made, the amount of the
withdrawal plus a service fee is deducted from your Account Value. The amount of
the service fee is shown in the Schedule. We limit the number of partial
withdrawals in a policy year and this number is shown in the Schedule.
The Stated Death Benefit is not reduced by a partial withdrawal taken when the
Base Death Benefit has been increased to qualify your policy as life insurance
under the Internal Revenue Code and the amount withdrawn is no greater than that
which reduces your Account Value to the level which no longer requires the Base
Death Benefit to be increased for Internal Revenue Code purposes.
[For a policy under an Option 1 death benefit, the Stated Death Benefit is not
reduced by a partial withdrawal in the circumstances described above. In
addition, if no more than 15 years have elapsed since the policy date and the
insured is not yet age 81, a partial withdrawal of an amount up to
Form 2503(VUL)-6/98
Page 16
10% of your Account Value or, if greater, 5% of the Stated Death Benefit,
calculated immediately before the partial withdrawal is taken will not reduce
the Stated Death Benefit. Any additional amount withdrawn reduces your Stated
Death Benefit by that additional amount.]
For a policy under an Option 2 death benefit, a partial withdrawal does not
reduce your Stated Death Benefit.
Any reduction in death benefit or Account Value will occur as of the date the
partial withdrawal occurs. No partial withdrawal will be allowed if the Stated
Death Benefit remaining in force after any such partial withdrawal would be
reduced below the lesser of the Initial Stated Death Benefit or $50,000.
For a policy under an Option 2 death benefit, a partial withdrawal generally
reduces the Base Death Benefit by the amount of the withdrawal. Under any death
benefit option, if the Base Death Benefit has been increased in order to qualify
your policy as a life insurance contract under the Internal Revenue Code, the
partial withdrawal reduces the Base Death Benefit by an amount greater than the
withdrawal.
You may specify how much of the withdrawal you wish taken from each division of
the Variable Account or from the Guaranteed Interest Division. You may not
withdraw from the Guaranteed Interest Division more than the total withdrawal
times the ratio of your Account Value in the Guaranteed Interest Division to
your Net Account Value immediately prior to the withdrawal. Unless you indicate
otherwise, we will make the withdrawal from the amounts in the Guaranteed
Interest Division and the divisions of the Variable Account in the same
proportion that your Account Value in each division bears to your Net Account
Value immediately prior to the withdrawal. The withdrawal service fee is
deducted from each Variable Division and the Guaranteed Interest Division in the
same proportion that your Account Value of each division bears to your Net
Account Value immediately after the withdrawal.
We may send you a new Schedule to reflect the effect of the withdrawal if there
is any change to the Stated Death Benefit. We may ask you to return your policy
to our Customer Service Center to make this change. The withdrawal and the
reductions in death benefits will be effective as of the Valuation Date after we
received your request.
SURRENDER PROVISIONS
The Net Cash Surrender Value on any date will be your Account Value plus any
refund of sales load due and minus any Policy Loan including accrued but unpaid
loan interest.
BASIS OF COMPUTATIONS
[The Cash Surrender Value under the policy is not less than the minimum required
as of the policy date by the state in which your policy was delivered. A
detailed statement of the method of computation of policy values under the
policy has been filed with the insurance department of the state in which the
policy was delivered, if required.]
FULL SURRENDERS
[You may surrender your policy after the Right to Examine Period or at any time
during the lifetime of the insured and receive the net Cash Surrender Value. We
will compute the Net Cash Surrender Value as of the next Valuation Date after we
receive both your request and the policy at our Customer Service Center. This
policy will be canceled as of the date we receive your request, and there will
be no further benefits under this policy.]
Form 2503(VUL)-6/98
Page 17
If you surrender your policy within the first two policy years but after the
Right to Examine Policy Period has ended, the Net Cash Surrender Value will
include a refund of a portion of the sales load which was previously deducted
from your premiums paid. In the first policy year, the refund is equal to 5% of
the premium paid. In the second year, the refund is equal to 2.5% of the premium
paid in the first policy year.
GRACE PERIOD, TERMINATION AND REINSTATEMENT PROVISIONS
GRACE PERIOD
If the following three conditions occur on a Monthly Processing Date, the policy
will enter into the 61 day grace period:
a) The Net Account Value is zero or less, and
b) The three year continuation period described below has expired or the
required premium for the three year continuation period has not been
paid, and
[c) the guarantee period defined below has expired or been terminated.]
[We will give you a 61 day grace period from this Monthly Processing Date to
make the required premium payment. The required premium payment then due must be
paid to keep the policy in force. If this amount is not received in full by the
end of the grace period, the policy will lapse without value. The required
premium payment will be equal to past due charges plus an amount we expect to be
sufficient to keep the policy and any riders in force for 2 months following the
receipt of the required premium payment. If we receive at least the required
premium payment during the grace period we will make deductions from the Net
Premium payment for the past due amounts and apply any remaining amount as
premium to the policy.]
[Notice of the amount of the required premium payment will be mailed to you or
any assignee at the last known address at least 30 days before the end of the
grace period. If the insured dies during the grace period, we will deduct any
overdue monthly deductions from the death proceeds of the policy.]
THREE YEAR CONTINUATION PERIOD
[During the first 3 policy years, your policy will remain in force regardless of
the Net Account Value, if, on a Monthly Processing Date, the sum of your
premiums paid minus the sum of your partial withdrawals, policy loans and
accrued but unpaid policy loan interest is not less than the sum of the
applicable minimum monthly premiums for each policy month starting with the
first policy month to and including the policy month which begins on the current
Monthly Processing Date. Each minimum monthly premium equals 1/12 of the minimum
annual premium. The minimum annual premium is shown in the Schedule. We use this
premium for each policy month until the effective date of a change in the Stated
Death Benefit. If there is a change, the new Schedule will show the applicable
minimum annual premium for subsequent policy years during the 3 year period.]
Form 2503(VUL)-6/98
Page 18
[GUARANTEE PERIOD]
[The policy will not terminate during the guarantee period even if the Net
Account Value is zero except as provided below.]
[Each monthly guarantee period premium equals 1/12 of the guarantee period
annual premium. The guarantee period annual premium is shown in the Schedule. We
use this premium for each policy year until the effective date of a change in
the Stated Death Benefit. If there is a change, a new Schedule will show the
applicable minimum guarantee period annual premium for subsequent policy years.]
[The guarantee period will expire on the later of the 10th policy anniversary or
the policy anniversary nearest the Insured's 65th birthday. The guarantee period
will terminate prior to the guarantee period expiration date if, on any Monthly
Processing Date:
a) the actual premiums paid, minus the amount of any partial withdrawals and
any policy loan including accrued but unpaid interest are less than
b) the sum of the guarantee monthly premiums for each policy month starting
with the first policy month to and including the policy month that begins
on the current Monthly Processing Date.]
[The guarantee period will also terminate if your Account Value, on any Monthly
Processing Date, is not diversified according to the following rules:
a) No more than 35% of your Net Account Value may be invested in any one
division; and
b) Your Net Account Value must be invested in at least 5 divisions.]
[You will satisfy these diversification requirements if: (i) you are
participating in the automatic rebalancing feature defined in and governed by
the policy prospectus in effect on the policy effective date and your automatic
rebalancing allocations comply with the diversifications specified above; or
(ii) you elect dollar cost averaging and direct the resulting transfers into at
least four other divisions with no more than 35% of any transfer being to any
one division.]
TERMINATION
All coverage provided by this policy will end as of the earliest of:
a) The date the policy is surrendered;
b) The date of death of the insured; or
c) The date the grace period ends without payment of the required premium.
REINSTATEMENT
[The policy may be reinstated within five years after the beginning of the grace
period. The reinstatement will be effective as of the Monthly Processing Date on
or next following the date we approve your written application.]
We will reinstate the policy and any riders if the following conditions are met:
a) You have not surrendered the policy for its Net Cash Surrender Value;
b) You submit evidence satisfactory to us that the insured and those
insured under any riders are still insurable according to our normal
rules of underwriting for this type of policy; and
Form 2503(VUL)-6/98
Page 19
[c) We receive payment of the amount of premium sufficient to keep the
policy and any riders in force from the beginning of the grace period to
the end of the expired grace period and for 2 months after the date of
reinstatement. We will let you know, at the time you request
reinstatement, the amount of premium needed for this purpose.]
We will reinstate any policy loan, with accrued loan interest to the end of the
grace period, which existed when coverage ended.
Upon reinstatement, the Net Premium received minus past due amounts will be
allocated to the Divisions of the Variable Account and the Guaranteed Interest
Division according to the premium allocation percentages in effect at the start
of the grace period or as directed by you in writing at the time of
reinstatement.
DEFERRAL OF PAYMENT
[Requests for transfers, withdrawals, payment of proceeds for a full surrender
will be mailed within 7 days of receipt of the request in a form acceptable to
us. However, we may postpone the processing of any such Variable Account
transactions for any of the following reasons:
a) The NYSE is closed, other than customary weekend and holiday closings.
b) Trading on the NYSE is restricted by the SEC.
c) The SEC declares that an emergency exists as a result of which disposal
of securities in the Variable Account is not reasonably practicable to
determine your Account Value in the divisions.
d) A governmental body having jurisdiction over the Variable Account by
order permits such suspension.]
Rules and regulations of the SEC, if any, are applicable and will govern as to
whether conditions described in (b), (c), or (d) exist.
[Death proceeds will be paid within 7 days of determination of the proceeds and
are not subject to deferment. We may defer for up to 6 months payment of any
surrender proceeds, withdrawal or loan amounts from the Guaranteed Interest
Division.]
GENERAL POLICY PROVISIONS
THE POLICY
[The policy, including the original application and applications for an
increase, riders, endorsements, any Schedule pages, and any reinstatement
applications make up the entire contract between you and us. A copy of the
original application will be attached to the policy at issue. A copy of any
application as well as a new Schedule will be attached or furnished to you for
attachment to the policy at the time of any change in coverage. In the absence
of fraud, all statements made in any application will be considered
representations and not warranties. No statement will be used to deny a claim
unless it is in an application.]
AGE
The policy is issued at the age shown in the Schedule. This is the insured's age
nearest birthday on the policy date. The insured's age at any time is the age
shown in the Schedule increased by the number of completed policy years.
Form 2503(VUL)-6/98
Page 20
PROCEDURES
We must receive any election, designation, assignment or any other change
request you make in writing, except those specified on the application. It must
be in a form acceptable to us. We may require a return of the policy for any
change or for a full surrender. We are not liable for any action we take before
we receive and record the written request at our Customer Service Center.
[In the event of the death of the insured, please let us or our agent know as
soon as possible. Claim procedure instructions will be sent to the beneficiary
immediately. We may require proof of age and a certified copy of the death
certificate. We may require the beneficiary and next of kin to sign
authorizations as part of due proof. These authorization forms allow us to
obtain information about the insured, including, but not limited to, medical
records of physicians and hospitals used by the insured.]
OWNERSHIP
The original owner is the person named as the owner in the application. You, as
the owner, can exercise all rights and receive the benefits during the insured's
life. This includes the right to change the owner, beneficiaries, and methods
for the payment of proceeds. All rights of the owner are subject to the rights
of any assignee and any irrevocable beneficiary.
You may name a new owner by sending written notice to us. The effective date of
the change to the new owner will be the date you sign the notice. The change
will not affect any payment made or action taken by us before recording the
change at our Customer Service Center.
BENEFICIARIES
The primary beneficiary surviving the insured will receive any death proceeds
which become payable. Surviving contingent beneficiaries are paid death proceeds
only if no primary beneficiary has survived the insured. If more than one
beneficiary in a class survives the insured, they will share the death proceeds
equally, unless your designation provides otherwise. If there is no designated
beneficiary surviving, you or your estate will be paid the death proceeds. The
beneficiary designation will be on file with us or at a location designated by
us. While you are living, you may name a new beneficiary. The effective date of
the change will be the date the request was signed. We will pay proceeds to the
most recent beneficiary designation on file. We will not be subject to multiple
payments.
EXCHANGE RIGHT
[If, for any reason within the first 2 policy years, you want to exchange this
policy for a policy in which values do not vary with the investment experience
of the Variable Account, we will exchange this policy. This transfer will not be
subject to the excess transfer charge. The exchange will be implemented by
transferring your Account Value in all the Divisions of the Variable Account to
the Guaranteed Interest Division and removing your future right to choose to
allocate funds to the divisions of the Variable Account. We will require a
return of this policy before this change will be processed.]
COLLATERAL ASSIGNMENT
[You may assign this policy as collateral security by written notice to us. Once
it is recorded with us, the rights of the owner and beneficiary are subject to
the assignment. It is your responsibility to make sure the assignment is valid.]
INCONTESTABILITY
[After this policy has been in force during the insured's life for 2 years from
the policy date, we will not contest the statements in the application attached
at issue.]
Form 2503(VUL)-6/98
Page 21
After this policy has been in force during the insured's life for 2 years from
the effective date of any new Segment or of an increase in any other benefit
with respect to the insured, we will not contest the statements in the
application for the new Segment or other increase.
After this policy has been in force during the insured's life for 2 years from
the effective date of any reinstatement, we will not contest the statements in
the application for such reinstatement.
MISSTATEMENT OF AGE OR SEX
[If the age or sex of the insured has been misstated, the death benefit will be
adjusted. The death benefit will be that which the cost of insurance which was
deducted from your Account Value on the last Monthly Processing Date prior to
the death of the insured would have purchased for the insured's correct age and
sex.]
SUICIDE EXCLUSION
[If the insured commits suicide, while sane or insane, within [2] years of the
policy date, we will make a limited payment to the beneficiary. We will pay in
one sum the amount of all premiums paid to us during that time, minus any
outstanding policy loan (including accrued but unpaid interest) and partial
withdrawals. If the insured commits suicide, while sane or insane, within 2
years of the effective date of a new Segment or of an increase in any other
benefit, we will make a limited payment to the beneficiary for the new Segment
or other increase. This payment will equal the cost of insurance and any
applicable monthly expense charges deducted for such increase.]
PERIODIC REPORTS
[We will send you at least once each year a report which shows the current
Account Value, Cash Surrender Value and premium paid since the last report. The
report will also show the allocation of your Account Value as of the date of the
report and the amounts added to or deducted from your Account Value of each
division since the last report. The report will include any other information
that may be currently required by the Insurance supervisory official of the
jurisdiction in which this policy is delivered.]
[ ]
ILLUSTRATION OF BENEFITS AND VALUES
We will send you, upon written request, a hypothetical illustration of future
death benefits and Account Values. This illustration will include the
information as required by the laws or regulations where this policy is
delivered. If you request more than one illustration during a policy year, we
will charge a reasonable fee for each additional illustration. The maximum
amount of this fee is shown in the Schedule.
NONPARTICIPATING
The policy does not participate in our surplus earnings.
CUSTOMER SERVICE CENTER
Our Customer Service Center is at the address shown in the Schedule. Unless you
are otherwise notified:
a) All requests and payments should be sent to us at our Customer Service
Center; and
b) All transactions are effective as of the Valuation Date the required
information is received at our Customer Service Center.
Form 2503(VUL)-6/98
Page 22
PAYOUTS OTHER THAN AS ONE SUM
ELECTION
During the insured's lifetime, you may elect that the beneficiary receive the
proceeds upon death of the insured other than in one sum. If you have not made
an election, the beneficiary may do so within 60 days after We receive due proof
satisfactory to us of the insured's death. You may also elect to take the Net
Cash Surrender Value of the policy upon its surrender other than in one sum.
Satisfactory written request must be received at our Customer Service Center
before payment can be made. A payee that is not a natural person may not be
named without our consent. The various methods of settlement are shown below.
PAYOUT OPTIONS
[OPTION I. Payouts for a Designated Period. Payouts will be made in 1, 2, 4, or
12 installments per year as elected for a designated period, which may be 5 to
30 years. The installment dollar amounts will be equal except for any excess
interest as described below. The amount of the first monthly payout for each
$1,000 of Account Value applied is shown in Settlement Option Table I.]
[OPTION II. LIFE INCOME WITH PAYOUTS FOR DESIGNATED PERIOD. Payouts will be made
in 1, 2, 4, or 12 installments per year throughout the payee's lifetime, or if
longer, for a period of 5, 10, 15 or 20 years as elected. The installment dollar
amounts will be equal except for any excess interest, as described below. The
amount of the first monthly payout for each $1,000 of Account Value applied is
shown in Settlement Option Table II. This option is not available for ages not
shown in the Table.]
OPTION III. HOLD AT INTEREST. Amounts may be left on deposit with us to be paid
upon the death of the payee or at any earlier date elected. Interest on any
unpaid balance will be at the rate declared by us or at any higher rate required
by law. Interest may be accumulated or paid in 1, 2, 4, or 12 installments per
year, as elected. Money may not be left on deposit for more than 30 years.
OPTION IV. PAYOUTS OF A DESIGNATED AMOUNT. Payouts will be made until proceeds,
together with interest, which will be at the rate declared by us or at any
higher rate required by law, are exhausted. Payouts will be made in 1, 2, 4, or
12 equal installments per year, as elected.
OPTION V. OTHER. Settlement may be made in any other manner as agreed upon in
writing between you (or the beneficiary) and us.
CHANGE AND WITHDRAWAL
You may change an election at any time before the death of the insured. If you
have given the beneficiary the right to make changes or withdrawals, or if the
beneficiary has elected the option, the beneficiary (as primary payee) may take
the actions below.
a) Changes may be made from Payout Options I, III, and IV to another
option.
b) Full withdrawals may be made under Payout Option III or IV. Partial
Withdrawals of not less than $300 may be made under Payout Option III.
c) Remaining installments under Payout Option I may be commuted at 3 1/2%
interest and received in one sum.
d) Changes in any contingent payee designation may be made.
A written request must be sent to our Customer Service Center in writing to make
a change or withdrawal. We also may require that you send in the Supplemental
Policy. We may defer payment of commuted and withdrawable amounts for a period
up to 6 months.
Form 2503(VUL)-6/98
Page 23
EXCESS INTEREST
[If we declare that payout options are to be credited with an interest rate
above that guaranteed, it will apply to Payout Options I, II, III, and IV. The
crediting of excess interest for one period does not guarantee the higher rate
for other periods. Any declared interest rate will be in effect for at least 12
months.]
MINIMUM AMOUNTS
The minimum amount which may be applied under any option is $2,000. If the
payments to the payee are ever less than $20, we may change the frequency of
payments so as to result in payments of at least that amount.
SUPPLEMENTARY POLICY
When an option becomes effective, the policy will be surrendered in exchange for
a Supplementary Policy. It will provide for the manner of settlement and rights
of the payees. The Supplementary Policy's effective date will be the date of the
insured's death or the date of other settlement. The first payment under Options
I, II, and IV will be payable as of the effective date. The first interest
payment under Option III will be made as of the end of the interest payment
period elected. Subsequent payments will be made in accordance with the
frequency of payment elected. The Supplementary Policy may not be assigned or
payments made to another without our consent.
INCOME PROTECTION
Unless otherwise provided in the election, a payee does not have the right to
commute, transfer or encumber amounts held or installments to become payable. To
the extent provided by law, the proceeds, amount retained, and installments are
not subject to any payee's debts, policies, or engagements.
DEATH OF PRIMARY PAYEE
Upon the primary payee's death, any payments certain under Option I or II,
interest payments under Option III, or payments under Option IV will be
continued to the contingent payee. Or, amounts may be released in one sum if
permitted by the policy. The final payee will be the estate of the last to die
of the primary payee and any contingent payee.
PAYMENTS OTHER THAN MONTHLY
The tables which follow show monthly installments for Options I and II. To
arrive at annual, semiannual, or quarterly payments, multiply the appropriate
figures by 11.813, 5.957 or 2.991 respectively. Factors for other periods
certain or for other options which may be provided by mutual agreement will be
provided upon reasonable request.
Form 2503(VUL)-6/98
Page 24
SETTLEMENT OPTION TABLES
SETTLEMENT OPTION TABLE I
(Per $1,000 of Net Proceeds)
NO. OF Monthly No. of Monthly
YEARS PAYABLE Installments Years Payable Installments
------------- ------------ ------------- ------------
1 $84.65 16 6.76
2 43.05 17 6.47
3 29.19 18 6.20
4 22.27 19 5.97
5 18.12 20 5.75
6 15.35 21 5.56
7 13.38 22 5.39
8 11.90 23 5.24
9 10.75 24 5.09
10 9.83 25 4.96
11 9.09 26 4.84
12 8.46 27 4.73
13 7.94 28 4.63
14 7.49 29 4.53
15 7.10 30 4.45
Form 2503(VUL)-6/98
Page 25
SETTLEMENT OPTION TABLE II
MALE
( Per $1,000 of Net Proceeds)
Age of Payee Monthly Age of Payee Monthly
Nearest Installment Nearest Installments
Birthday When First Birthday When First
Installment is Installment is
Payable Payable
------------------- ------------------------------------- ------------------- -------------------------------------
5 Years 10 Years 15 Years 20 Years 5 Years 10 Years 15 Years 20 Years
Male Certain Certain Certain Certain Male Certain Certain Certain Certain
------------------- ------- -------- -------- -------- ------------------- ------- -------- -------- ---------
15 3.28 3.28 3.27 3.27 41 4.01 4.00 3.97 3.94
16 3.29 3.29 3.29 3.28 42 4.06 4.04 4.01 3.98
17 3.31 3.31 3.30 3.30 43 4.11 4.09 4.06 4.02
18 3.32 3.32 3.32 3.32 44 4.16 4.14 4.11 4.06
19 3.34 3.34 3.34 3.33 45 4.22 4.20 4.16 4.11
20 3.36 3.36 3.35 3.35 46 4.28 4.25 4.21 4.16
21 3.38 3.38 3.37 3.37 47 4.34 4.31 4.27 4.21
22 3.40 3.40 3.39 3.39 48 4.41 4.38 4.33 4.26
23 3.42 3.42 3.41 3.41 49 4.48 4.44 4.39 4.31
24 3.44 3.44 3.43 3.43 50 4.55 4.51 4.45 4.36
25 3.46 3.46 3.45 3.45 51 4.62 4.58 4.52 4.42
26 3.49 3.48 3.48 3.47 52 4.70 4.66 4.58 4.48
27 3.51 3.51 3.50 3.49 53 4.79 4.74 4.65 4.54
28 3.54 3.53 3.53 3.52 54 4.88 4.82 4.73 4.60
29 3.56 3.56 3.55 3.54 55 4.97 4.91 4.80 4.66
30 3.59 3.59 3.58 3.57 56 5.07 5.00 4.88 4.72
31 3.62 3.62 3.61 3.60 57 5.17 5.10 4.97 4.78
32 3.65 3.65 3.64 3.62 58 5.29 5.20 5.05 4.85
33 3.68 3.68 3.67 3.65 59 5.41 5.31 5.14 4.91
34 3.72 3.71 3.70 3.68 60 5.53 5.42 5.23 4.97
35 3.75 3.75 3.73 3.72 61 5.67 5.54 5.33 5.04
36 3.79 3.78 3.77 3.75 62 5.81 5.67 5.42 5.10
37 3.83 3.82 3.81 3.78 63 5.97 5.80 5.52 5.16
38 3.87 3.86 3.85 3.82 64 6.13 5.94 5.62 5.22
39 3.92 3.90 3.89 3.86 65 6.31 6.08 5.72 5.28
40 3.96 3.95 3.93 3.90
Form 2503(VUL)-6/98
Page 26
SETTLEMENT OPTION TABLE II/MALE
(Continued)
(Per $1,000 of Net Proceeds)
Age of Payee Age of Payee
Nearest Birthday Nearest Birthday
When First Monthly Installment When First Monthly Installment
Installment is Installment is
Payable Payable
--------------------- ------------------------------------ ------------------- --------------------------------------
5 Years 10 Years 15 Years 20 Years 5 Years 10 Years 15 Years 20 Years
Male Certain Certain Certain Certain Male Certain Certain Certain Certain
------------------- ------- -------- -------- -------- ------------------- ------- -------- -------- ---------
66 6.49 6.23 5.82 5.33 91 14.64 9.64 7.09 5.75
67 6.69 6.38 5.92 5.38 92 15.00 9.68 7.10 5.75
68 6.90 6.54 6.02 5.43 93 15.34 9.72 7.10 5.75
69 7.12 6.71 6.12 5.48 94 15.68 9.75 7.10 5.75
70 7.35 6.87 6.21 5.52 95 16.00 9.78 7.10 5.75
71 7.60 7.05 6.30 5.55 96 16.30 9.80 7.10
72 7.86 7.22 6.39 5.59 97 16.59 9.81 7.10
73 8.13 7.40 6.47 5.62 98 16.86 9.82 7.10
74 8.42 7.57 6.55 5.64 99 17.11 9.83 7.10
75 8.72 7.75 6.62 5.66 100 17.33 9.83 7.10
76 9.04 7.92 6.69 5.68 101 17.53 9.83
77 9.37 8.09 6.75 5.70 102 17.69 9.83
78 9.72 8.26 6.81 5.71 103 17.82 9.83
79 10.08 8.42 6.86 5.72 104 17.92 9.83
80 10.44 8.57 6.90 5.73 105 18.00 9.83
81 10.82 8.71 6.94 5.74 106 18.05
82 11.21 8.85 6.97 5.74 107 18.08
83 11.59 8.97 7.00 5.75 108 18.10
84 11.99 9.09 7.02 5.75 109 18.11
85 12.38 9.20 7.04 5.75 110 18.11
86 12.76 9.29 7.05 5.75
87 13.15 9.38 7.07 5.75
88 13.53 9.46 7.08 5.75
89 13.91 9.53 7.08 5.75
90 14.28 9.59 7.09 5.75
[ ]
Form 2503(VUL)-6/98
Page 27
SETTLEMENT OPTION TABLE II
FEMALE
( Per $1,000 of Net Proceeds)
Age of Payee Monthly Age of Payee Monthly
Nearest Installment Nearest Installments
Birthday When First Birthday When First
Installment is Installment is
Payable Payable
------------------- ------------------------------------- ------------------- --------------------------------------
5 Years 10 Years 15 Years 20 Years 5 Years 10 Years 15 Years 20 Years
Female Certain Certain Certain Certain Female Certain Certain Certain Certain
------------------- ------- -------- -------- -------- ------------------- ------- -------- -------- ---------
15 3.19 3.19 3.19 3.19 41 3.76 3.76 3.75 3.73
16 3.20 3.20 3.20 3.20 42 3.80 3.80 3.78 3.77
17 3.22 3.22 3.21 3.21 43 3.84 3.84 3.82 3.81
18 3.23 3.23 3.23 3.23 44 3.88 3.88 3.86 3.84
19 3.24 3.24 3.24 3.24 45 3.93 3.92 3.91 3.88
20 3.26 3.26 3.26 3.25 46 3.98 3.97 3.95 3.92
21 3.27 3.27 3.27 3.27 47 4.03 4.02 4.00 3.97
22 3.29 3.29 3.29 3.28 48 4.08 4.07 4.05 4.01
23 3.31 3.30 3.30 3.30 49 4.13 4.12 4.10 4.06
24 3.32 3.32 3.32 3.32 50 4.19 4.18 4.15 4.11
25 3.34 3.34 3.34 3.33 51 4.25 4.24 4.21 4.16
26 3.36 3.36 3.35 3.35 52 4.32 4.30 4.26 4.21
27 3.38 3.38 3.37 3.37 53 4.38 4.36 4.33 4.27
28 3.40 3.40 3.39 3.39 54 4.46 4.43 4.39 4.32
29 3.42 3.42 3.41 3.41 55 4.53 4.51 4.46 4.38
30 3.44 3.44 3.43 3.43 56 4.61 4.58 4.53 4.44
31 3.46 3.46 3.46 3.45 57 4.70 4.66 4.60 4.51
32 3.49 3.48 3.48 3.48 58 4.79 4.75 4.68 4.57
33 3.51 3.51 3.51 3.50 59 4.88 4.84 4.76 4.64
34 3.54 3.54 3.53 3.52 60 4.99 4.93 4.84 4.70
35 3.57 3.56 3.56 3.55 61 5.09 5.03 4.93 4.77
36 3.60 3.59 3.59 3.58 62 5.21 5.14 5.02 4.84
37 3.63 3.62 3.62 3.61 63 5.33 5.25 5.12 4.91
38 3.66 3.65 3.65 3.64 64 5.46 5.37 5.21 4.98
39 3.69 3.69 3.68 3.67 65 5.60 5.50 5.31 5.05
40 3.73 3.72 3.71 3.70 66 5.75 5.63 5.42 5.12
Form 2503(VUL)-6/98
Page 28
SETTLEMENT OPTION TABLE II/FEMALE
(Continued)
(Per $1,000 of Net Proceeds)
Age of Payee Age of Payee
Nearest Birthday Nearest Birthday
When First Monthly Installment When First Monthly Installment
Installment is Installment is
Payable Payable
--------------------- ------------------------------------ ---------------- --------------------------------------
5 Years 10 Years 15 Years 20 Years 5 Years 10 Years 15 Years 20 Years
Female Certain Certain Certain Certain Female Certain Certain Certain Certain
------------------- ------- -------- -------- -------- ---------------- ------- -------- -------- ---------
67 5.91 5.77 5.53 5.19 92 14.45 9.61 7.09 5.75
68 6.08 5.91 5.63 5.25 93 14.81 9.66 7.10 5.75
69 6.26 6.07 5.74 5.32 94 15.16 9.70 7.10 5.75
70 6.46 6.23 5.86 5.37 95 15.49 9.73 7.10 5.75
71 6.67 6.40 5.97 5.43 96 15.80 9.76 7.10
72 6.89 6.58 6.08 5.48 97 16.11 9.79 7.10
73 7.13 6.76 6.18 5.52 98 16.40 9.80 7.10
74 7.39 6.95 6.29 5.57 99 16.68 9.82 7.10
75 7.67 7.14 6.39 5.60 100 16.95 9.82 7.10
76 7.96 7.34 6.48 5.63 101 17.20 9.83
77 8.28 7.54 6.57 5.66 102 17.43 9.83
78 8.61 7.74 6.65 5.68 103 17.62 9.83
79 8.97 7.94 6.72 5.70 104 17.78 9.83
80 9.34 8.13 6.79 5.71 105 17.91 9.83
81 9.73 8.32 6.84 5.72 106 18.00
82 10.14 8.50 6.89 5.73 107 18.06
83 10.57 8.67 6.94 5.74 108 18.09
84 11.01 8.83 6.97 5.74 109 18.11
85 11.46 8.97 7.00 5.75 110 18.11
86 11.91 9.10 7.02 5.75
87 12.36 9.22 7.04 5.75
88 12.81 9.32 7.06 5.75
89 13.25 9.41 7.07 5.75
90 13.67 9.48 7.08 5.75
91 14.07 9.55 7.09 5.75
Form 2503(VUL)-6/98
Page 29
[THIS POLICY IS A FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY]
DEATH BENEFITS AND OTHER VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE. THESE VALUES MAY
INCREASE OR DECREASE BASED ON INVESTMENT EXPERIENCE AND ARE NOT GUARANTEED AS TO
FIXED DOLLAR AMOUNT. DEATH BENEFITS ARE PAYABLE BY US UPON THE DEATH OF THE
INSURED. THERE IS NO MATURITY DATE. FLEXIBLE PREMIUMS ARE PAYABLE BY YOU DURING
THE LIFETIME OF THE INSURED UNTIL THE POLICY ANNIVERSARY NEAREST THE INSURED'S
100TH BIRTHDAY.
SECURITY LIFE OF DENVER INSURANCE COMPANY
A Stock Company
[ ]
CUSTOMER SERVICE CENTER
P.O. Box 173888 Denver, Colorado 80217-3888
Toll Free Number: 0(000) 000-0000
Form 2503 (VUL)-6/98
