INSURED PERSON XXXXXXX XXX
[EVLICO LOGO]
POLICY OWNER XXXXXXX XXX
FACE AMOUNT
OF INSURANCE $50,000 VARIABLE
LIFE
DEATH BENEFIT OPTION A (SEE PAGE 6) INSURANCE
POLICY NUMBER XX XXX XXX POLICY
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We agree to pay the Insurance Benefit of this policy and to provide its other
benefits and rights in accordance with its provisions.
FLEXIBLE PREMIUM VARIABLE LIFE POLICY
This is a flexible premium variable life insurance policy. You can, within
limits:
o increase or decrease the Face Amount of Insurance;
o make premium payments at any time and in any amount;
o change the death benefit option;
o change the allocation of net premiums and deductions among your
investment options; and
o transfer amounts among your investment options.
THIS POLICY IS GUARANTEED NOT TO LAPSE DURING THE POLICY YEARS SHOWN ON PAGE
3, SUBJECT TO PREMIUMS HAVING BEEN PAID IN ACCORDANCE WITH THE NO LAPSE
GUARANTEE PROVISION AS DESCRIBED IN THIS POLICY.
All of these rights and benefits are subject to the terms and conditions of
this policy. All requests for policy changes are subject to our approval and
may require evidence of insurability.
We will put your net premiums into your Policy Account. You may then
allocate them to one or more investment funds of our Separate Account(s)
(SA) and to our Guaranteed Interest Account (GIA).
THE PORTION OF YOUR POLICY ACCOUNT THAT IS IN AN INVESTMENT FUND OF OUR SA
WILL VARY UP OR DOWN DEPENDING ON THE UNIT VALUE OF SUCH INVESTMENT FUND,
WHICH IN TURN DEPENDS ON THE INVESTMENT PERFORMANCE OF THE SECURITIES HELD
BY THAT SA FUND. THERE ARE NO MINIMUM GUARANTEES AS TO SUCH PORTION OF YOUR
POLICY ACCOUNT.
The portion of your Policy Account that is in our GIA will accumulate, after
deductions, at rates of interest we determine. Such rates will not be less
than 4% a year.
THE AMOUNT AND DURATION OF THE DEATH BENEFIT MAY BE VARIABLE OR FIXED AS
DESCRIBED IN THIS POLICY.
This is a non-participating policy.
RIGHT TO EXAMINE POLICY. You may examine this policy and if for any reason
you are not satisfied with it, you may cancel it by returning this policy
with a written request for cancellation to our Administrative Office by the
10th day after you receive it. If you do this, we will refund the premiums
that were paid on this policy.
/s/ Xxxxxxx Xxxxxxx /s/ Xxxxxx X. Xxxxxx
------------------- --------------------
Xxxxxxx Xxxxxxx, Vice President & Secretary Xxxxxx X. Xxxxxx, Chairman &
Chief Executive Officer
No. 96-400
Contents
--------
Policy Information 3
Table of Maximum Monthly Charges
for Benefits 4
Those Who Benefit from this Policy 5
The Insurance Benefit We Pay 5
Changing the Face Amount of Insur-
ance or the Death Benefit Option 7
The Premiums You Pay 7
Your Policy Account and How it
Works 9
Your Investment Options 10
The Value of Your Policy Account 11
The Cash Surrender Value of this
Policy 12
How a Loan Can Be Made 13
Our Separate Account(s) (SA) 14
Our Annual Report to You 15
How Benefits are Paid 15
Other Important Information 16
IN THIS POLICY:
---------------
"We, "our," and "us" mean
Equitable Variable Life Insurance
Company.
"You" and "your" mean the
owner of this policy at the time
an owner's right is exercised.
Unless otherwise stated, all
references to interest in this
policy are effective annual rates
of interest.
Attained age means on the
birthday nearest to the beginning
of the current policy year.
ADMINISTRATIVE OFFICE:
----------------------
The address of our Administra-
tive Office is shown on Page 3.
You should send premiums and
correspondence to that address
unless instructed otherwise.
Copies of the application for this
policy and any additional benefit
riders are attached to the policy.
INTRODUCTION
The premiums you pay, after deductions are made in accordance with the Table of
Expense Charges in the Policy Information section, are put into your Policy
Account. Amounts in your Policy Account are allocated at your direction to one
or more investment funds of our SA and to our GIA.
The investment funds of our SA invest in securities and other investments whose
value is subject to market fluctuations and investment risk. There is no
guarantee of principal or investment experience.
Our GIA earns interest at rates we declare in advance of each policy year. The
rates are guaranteed for each policy year. The principal, after deductions, is
also guaranteed.
If death benefit Option A is in effect, the death benefit is the Face Amount of
Insurance, and the amount of the death benefit is fixed except when it is a
percentage of your Policy Account. If death benefit Option B is in effect, the
death benefit is the Face Amount of Insurance plus the amount in your Policy
Account. The amount of the death benefit is variable. Under either option, the
death benefit will never be less than a percentage of your Policy Account as
stated on Page 6.
This policy is guaranteed not to lapse during the policy years shown on Page 3,
subject to premiums having been paid in accordance with the No Lapse Guarantee
provision as described in this policy.
We make monthly deductions from your Policy Account to cover the cost of the
benefits provided by this policy and the cost of any benefits provided by riders
to this policy. If you give up this policy for its Net Cash Surrender Value,
reduce the Face Amount of Insurance, or if this policy ends without value at the
end of the grace period, we may deduct a surrender charge from your Policy
Account.
This is only a summary of what this policy provides. You should read all of it
carefully. Its terms govern your rights and our obligations.
No. 96-400 Page 2
POLICY INFORMATION
INSURED PERSON XXXXXXX XXX
POLICY OWNER XXXXXXX XXX
FACE AMOUNT
OF INSURANCE $50,000
DEATH BENEFIT OPTION A (SEE PAGE 6)
POLICY NUMBER XX XXX XXX SEPARATE ACCOUNT [FP]
BENEFICIARY XXXXXXXX X. XXX
REGISTER DATE AUGUST 3, 1996 ISSUE AGE 35
DATE OF ISSUE AUGUST 3, 1996 SEX MALE
INSURED PERSON'S PREFERRED
STATE OF RESIDENCE SPECIMEN NON-TOBACCO USER
A MINIMUM INITIAL PREMIUM PAYMENT OF $95.53 IS DUE ON OR BEFORE DELIVERY OF THE
POLICY.
THE PLANNED PERIODIC PREMIUM OF [$150.00] IS PAYABLE [QUARTERLY].
NO LAPSE GUARANTEE PERIOD - 20 YEARS - SEE NO LAPSE GUARANTEE PROVISION.
SEE PAGE 3 - CONTINUED FOR TABLE OF NO LAPSE GUARANTEE PREMIUMS.
PREMIUM PAYMENTS ARE FOR THE INSURANCE BENEFIT AND ANY ADDITIONAL BENEFIT RIDERS
LISTED BELOW.
COST OF LIVING RIDER
THE PLANNED PERIODIC PREMIUMS SHOWN ABOVE MAY NOT BE SUFFICIENT TO CONTINUE THE
POLICY AND LIFE INSURANCE COVERAGE IN FORCE TO THE FINAL POLICY DATE, WHICH IS
THE POLICY ANNIVERSARY NEAREST THE INSURED PERSON'S 100TH BIRTHDAY. THE PERIOD
FOR WHICH THE POLICY AND COVERAGE WILL CONTINUE IN FORCE WILL DEPEND ON: (1) THE
AMOUNT, TIMING AND FREQUENCY OF PREMIUM PAYMENTS; (2) CHANGES IN THE FACE AMOUNT
OF INSURANCE AND THE DEATH BENEFIT OPTIONS; (3) CHANGES IN THE INTEREST RATES
CREDITED TO OUR GIA AND IN THE INVESTMENT PERFORMANCE OF THE INVESTMENT FUNDS OF
OUR SA; (4) CHANGES IN THE MONTHLY DEDUCTIONS FROM THE POLICY ACCOUNT FOR THIS
POLICY AND ANY BENEFITS PROVIDED BY RIDERS TO THIS POLICY; AND (5) LOAN AND
PARTIAL NET CASH SURRENDER VALUE WITHDRAWAL ACTIVITY.
96-400-3 PAGE 3
(CONTINUED ON NEXT PAGE)
POLICY INFORMATION CONTINUED - POLICY NUMBER XX XXX XXX
-------- TABLE OF NO LAPSE GUARANTEE PREMIUMS ---------
BENEFITS MONTHLY PREMIUM
PREMIUM PERIOD
BASIC LIFE INSURANCE $31.42 20 YEARS
COST OF LIVING RIDER $ 0.51 20 YEARS
96-400-3 PAGE 3 - CONTINUED
POLICY INFORMATION CONTINUED - POLICY NUMBER XX XXX XXX
-------- TABLE OF AUTOMATIC EXPENSE CHARGES --------
DEDUCTIONS FROM PREMIUM PAYMENTS:
CHARGE FOR APPLICABLE TAXES (OTHER THAN TAXES DISCUSSED ON PAGE 12):
[2,000%] OF EACH PREMIUM PAYMENT. THIS AMOUNT IS SUBTRACTED FROM EACH
PREMIUM PAYMENT. WE RESERVE THE RIGHT TO CHANGE THIS PERCENTAGE TO
CONFORM TO CHANGES IN THE LAW OR IF THE INSURED PERSON CHANGES
RESIDENCE.
PREMIUM CHARGE:
6% OF EACH PREMIUM PAYMENT.
DEDUCTIONS FROM YOUR POLICY ACCOUNT:
INITIAL ADMINISTRATIVE CHARGE:
$25.00 IS DEDUCTED AT THE BEGINNING OF EACH POLICY MONTH DURING THE
FIRST POLICY YEAR.
SUBSEQUENT YEARS ADMINISTRATIVE CHARGE:
[$6.00} IS DEDUCTED AT THE BEGINNING OF EACH POLICY MONTH DURING EACH
POLICY YEAR AFTER THE FIRST POLICY YEAR. WE RESERVE THE RIGHT TO CHANGE
THIS CHARGE BUT IT WILL NEVER BE MORE THAN $10.00 A MONTH. CHANGES WILL
BE AS DESCRIBED IN "CHANGES IN POLICY COST FACTORS" ON PAGE 16.
96-400-3 PAGE 3 - CONTINUED
POLICY INFORMATION CONTINUED - POLICY NUMBER XX XXX XXX
-------- TABLE OF MAXIMUM SURRENDER CHARGES --------
FOR THE INITIAL FACE AMOUNT
BEGINNING OF BEGINNING OF
POLICY POLICY
YEAR CHARGE YEAR CHARGE
---- ------ ---- ------
1 $300.30 9 $300.30
2 300.30 10 296.13
3 300.30 11 246.08
4 300.30 12 196.03
5 300.30 13 145.98
6 300.30 14 95.93
7 300.30 15 45.88
8 300.30 16 AND LATER 0.00
A SURRENDER CHARGE WILL BE SUBTRACTED FROM YOUR POLICY ACCOUNT IF THIS POLICY IS
GIVEN UP FOR ITS NET CASH SURRENDER VALUE OR IF THIS POLICY TERMINATES WITHIN
THE FIRST FIFTEEN POLICY YEARS. THE MAXIMUM CHARGE IN THE FIRST POLICY MONTH OF
EACH POLICY YEAR IS SHOWN IN THE TABLE ABOVE (SUBJECT TO ANY APPLICABLE
LIMITATIONS IMPOSED BY THE INVESTMENT COMPANY ACT OF 1940). AFTER THE NINTH
POLICY YEAR, THE MAXIMUM CHARGE IN ANY OTHER POLICY MONTH WILL BE BASED ON THE
NUMBER OF POLICY MONTHS SINCE THE BEGINNING OF THE POLICY YEAR.
THIS TABLE ASSUMES NO FACE AMOUNT INCREASES. SEE PAGE 12 FOR A DESCRIPTION OF
CHANGES TO MAXIMUM SURRENDER CHARGES FOR FACE AMOUNT INCREASES.
IF THE FACE AMOUNT OF INSURANCE IS REDUCED WITHIN THE FIRST FIFTEEN POLICY
YEARS, A PRO RATA SHARE OF THE APPLICABLE SURRENDER CHARGE AT THAT TIME WILL BE
DEDUCTED FROM YOUR POLICY ACCOUNT. SEE PAGE 12 FOR A DESCRIPTION OF THE PRO RATA
SURRENDER CHARGE.
*****ADMINISTRATIVE OFFICE: EQUITABLE VARIABLE LIFE INSURANCE COMPANY*****
SPECIMEN SERVICE CENTER
000 XXXXXXXX XXXXXX
XXXX, XXXXX 00000-0000
96-400-3 PAGE 3 - CONTINUED
POLICY INFORMATION CONTINUED - POLICY NUMBER XX XXX XXX
-------- TABLE OF MAXIMUM MONTHLY CHARGES FOR BENEFITS --------
MONTHLY DEDUCTION
BENEFITS FROM POLICY ACCOUNT PERIOD
BASIC COST OF INSURANCE MAXIMUM MONTHLY COST OF
INSURANCE RATE (SEE PAGE
4 - CONTINUED) TIMES
THOUSANDS OF NET AMOUNT
AT RISK (SEE PAGE 9) 65 YEARS
COST OF LIVING RIDER $0.00917 TIMES THOUSANDS
OF FACE AMOUNT OF
INSURANCE 24 YEARS
96-400-4 PAGE 4
(CONTINUED ON NEXT PAGE)
POLICY INFORMATION CONTINUED - POLICY NUMBER XX XXX XXX
---- TABLE OF GUARANTEED MAXIMUM MONTHLY COST OF INSURANCE RATES ----
PER $1,000 OF NET AMOUNT AT RISK (SEE PAGE 9) FOR BASIC LIFE INSURANCE
INSURED INSURED INSURED
PERSON'S PERSON'S PERSON'S
ATTAINED ATTAINED ATTAINED
AGE RATE AGE RATE AGE RATE
35 0.14083 55 0.65333 75 5.03667
36 0.14750 56 0.72167 76 5.59000
37 0.15667 57 0.79417 77 6.17500
38 0.16667 58 0.87250 78 6.78667
39 0.17833 59 0.96083 79 7.44000
40 0.19083 60 1.05917 80 8.16167
41 0.20583 61 1.16833 81 8.97250
42 0.22083 62 1.29417 82 9.89750
43 0.23833 63 1.43667 83 10.95167
44 0.25583 64 1.59833 84 12.11833
45 0.27667 65 1.77750 85 13.37417
46 0.29917 66 1.97083 86 14.69833
47 0.32333 67 2.18083 87 16.08083
48 0.34917 68 2.40583 88 17.49667
49 0.37833 69 2.65333 89 18.96583
50 0.41000 70 2.93250 90 20.51167
51 0.44667 71 3.30167 91 22.16500
52 0.48917 72 3.61750 92 23.98667
53 0.53667 73 4.04167 93 26.06583
54 0.59250 74 4.52000 94 28.78417
95 32.81750
96 39.64250
97 53.06583
98 83.33250
99 83.33250
96-400-4 PAGE 4 - CONTINUED
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THOSE WHO BENEFIT FROM THIS POLICY
OWNER. The owner of this policy is the insured person unless otherwise stated in
the application, or later changed.
As the owner, you are entitled to exercise all the rights of this policy while
the insured person is living. To exercise a right, you do not need the consent
of anyone who has only a conditional or future ownership interest in this
policy.
BENEFICIARY. The beneficiary is as stated in the application, unless later
changed. The beneficiary is entitled to the Insurance Benefit of this policy.
One or more beneficiaries for the Insurance Benefit can be named in the
application. If more than one beneficiary is named, they can be classed as
primary or contingent. If two or more persons are named in a class, their shares
in the benefit can be stated. The stated shares in the Insurance Benefit will be
paid to any primary beneficiaries who survive the insured person. If no primary
beneficiaries survive, payment will be made to any surviving contingent
beneficiaries. Beneficiaries who survive in the same class will share the
Insurance Benefit equally, unless you have made another arrangement with us.
If there is no designated beneficiary living at the death of the insured person,
we will pay the Insurance Benefit to the insured person's surviving children in
equal shares. If none survive, we will pay the insured person's estate.
CHANGING THE OWNER OR BENEFICIARY. While the insured person is living, you may
change the owner or beneficiary by written notice in a form satisfactory to us.
You can get such a form from our agent or by writing to us at our Administrative
Office. The change will take effect on the date you sign the notice. But, it
will not apply to any payment we make or other action we take before we receive
the notice. If you change the beneficiary, any previous arrangement you made as
to a payment option for benefits is cancelled. You may choose a payment option
for the new beneficiary in accordance with "How Benefits Are Paid" on Page 15.
ASSIGNMENT. You may assign this policy, if we agree. In any event, we will not
be bound by an assignment unless we have received it in writing at our
Administrative Office. Your rights and those of any other person referred to in
this policy will be subject to the assignment. We assume no responsibility for
the validity of an assignment. An absolute assignment will be considered as a
change of ownership to the assignee.
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THE INSURANCE BENEFIT WE PAY
We will pay the Insurance Benefit of this policy to the beneficiary when we
receive at our Administrative Office (1) proof satisfactory to us that the
insured person died before the Final Policy Date; and (2) all other requirements
we deem necessary before such payment may be made. The Insurance Benefit
includes the following amounts, which we will determine as of the date of the
insured person's death:
o the death benefit described on Page 6;
o PLUS any other benefits then due from riders to this policy;
o MINUS any policy loan and accrued interest;
o MINUS any overdue deductions from your Policy Account if the insured
person dies during a grace period.
We will add interest to the resulting amount in accordance with applicable law.
We will compute the interest at a rate we determine, but not less than the
greater of (a) the rate we are paying on the date of payment under the Deposit
Option on Page 15, or (b) the rate required by any applicable law. Payment of
the Insurance Benefit may also be affected by other provisions of this policy.
See Pages 16 and 17, where we specify our right to contest the policy, the
suicide exclusion, and what happens if age or sex has been misstated. Special
exclusions or limitations (if any) are listed in the Policy Information section.
96-400-5 Page 5
DEATH BENEFIT. The death benefit at any time will be determined under either
Option A or Option B below, whichever you have chosen and is in effect at such
time.
Under Option A, the death benefit is the greater of (a) the Face Amount of
Insurance; or (b) a percentage (see Table below) of the amount in your Policy
Account. Under this option, the amount of the death benefit is fixed, except
when it is determined by such percentage.
Under Option B, the death benefit is the greater of (a) the Face Amount of
Insurance plus the amount in your Policy Account; or (b) a percentage (see Table
below) of the amount in your Policy Account. Under this option the amount of the
death benefit is variable.
The percentages referred to above are the percentages from the following table
for the insured person's age (nearest birthday) at the beginning of the policy
year of determination.
TABLE OF PERCENTAGES
For ages not shown, the percentages shall
decrease by a ratable portion for each full year
INSURED INSURED
PERSON'S AGE PERCENTAGE PERSON'S AGE PERCENTAGE
------------ ---------- ------------ ----------
40 and under 250% 65 120%
45 215 70 115
50 185 75 thru 95 105
55 150 100 100
60 130
Section 7702 of the Internal Revenue Code of 1986, as amended (i.e., the
"Code"), gives a definition of life insurance which limits the amounts that may
be paid into a life insurance policy relative to the benefits it provides. Even
if this policy states otherwise, at no time will the "future benefits" under
this policy be less than an amount such that the "premiums paid" do not exceed
the Code's "guideline premium limitations". We may adjust the amount of premium
paid to meet these limitations. Also, at no time will the "death benefit" under
the policy be less than the "applicable percentage" of the "cash surrender
value" of the policy. The above terms are as defined in the Code. In addition,
we may take certain actions, described here and elsewhere in the policy, to meet
the definitions and limitations in the Code, based on our interpretation of the
Code. Please see "Policy Changes - Applicable Tax Law" for more information.
MATURITY BENEFIT. If the Insured person is living on the Final Policy Date
defined in the Policy Information section, we will pay you the amount in your
Policy Account on that date minus any policy loan and accrued interest. This
policy will then end.
96-400-5 Page 6
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CHANGING THE FACE AMOUNT OF INSURANCE OR THE DEATH
BENEFIT OPTION
You may change the death benefit option or the Face Amount of Insurance by
written request to us at our Administrative Office, subject to our approval and
the following:
1. At any time after the first policy year while this policy is in force, you
may ask us to increase the Face Amount of Insurance if you provide evidence
satisfactory to us of the insurability of the insured person. If you request
an increase and the rating class of the insured person on the date of the
increase is higher, a separate policy will be issued for the amount of the
increase. Any increase you ask for must be at least $10,000. There is a
charge for such increase of $1.50 for each $1,000 of insurance, but not more
than $240.00 per increase. We will deduct the charge from your Policy
Account as of the date the increase takes effect. Such deduction will be
made in accordance with the "Allocations" provision on Page 10. If you
increase the face amount, an additional fifteen year surrender charge may
apply to that increase if any or all of that increase is surrendered before
the end of the fifteenth year from the effective date of increase.
2. At any time after the second policy year while this policy is in force, you
may ask us to reduce the Face Amount of Insurance but not to less than the
minimum amount for which we would then issue this policy under our rules.
Any such reduction in the Face Amount of Insurance may not be less than
$10,000. If you do this before the end of the fifteenth policy year or
before the end of the fifteenth year following an increase in the face
amount, we will deduct from your Policy Account a pro rata share of the
applicable surrender charge (see Page 12). Reductions will first be applied
against the most recent increase in the Face Amount of Insurance. They will
then be applied to prior increases in the Face Amount of Insurance in the
reverse order in which such increases took place, and then to the original
Face Amount of Insurance.
3. At any time after the second policy year while this policy is in force, you
can change your death benefit option. If you ask us to change from Option A
to Option B, we will decrease the Face Amount of Insurance by the amount in
your Policy Account on the date the change takes effect. However, we reserve
the right to decline to make such change if it would reduce the Face Amount
of Insurance below the minimum amount for which we would then issue this
policy under our rules. We also reserve the right to request evidence of
insurability for a change to Option B. If you ask us to change from Option B
to Option A, we will increase the Face Amount of Insurance by the amount in
your Policy Account on the date the change takes effect. Such decreases and
increases in the Face Amount of Insurance are made so that the death benefit
remains the same immediately before and after the change.
4. The change will take effect at the beginning of the policy month that
coincides with or next follows the date we approve your request.
5. We reserve the right to decline to make any change that we determine would
cause this policy to fail to qualify as life insurance under applicable tax
law as interpreted by us (see Page 16).
6. You may ask for a change by completing an application for change, which you
can get from our agent or by writing to us at our Administrative Office. A
copy of your application for change will be attached to the new Policy
Information section that we will issue when the change is made. The new
section and the application for change will become a part of this policy. We
may require you to return this policy to our Administrative Office to make a
policy change.
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THE PREMIUMS YOU PAY
The minimum initial premium payment shown in the Policy Information section is
due on or before delivery of this policy. No insurance will take effect before a
premium at least equal to the minimum initial premium payment is paid. Other
premiums may be paid at any time while this policy is in force and before the
Final Policy Date at our Administrative Office.
We will send premium notices to you for the planned periodic premium shown in
the Policy Information section. You may skip planned periodic premium payments.
However, this may adversely affect the duration of the death benefit and your
policy's values. We will assume that any payment you make to us is a premium
payment, unless you tell us in writing that it is a loan repayment.
96-400-7 Page 7
LIMITS. Each premium payment after the initial one must be at least $100. We may
increase this minimum limit 90 days after we send you written notice of such
increase. We reserve the right to limit the amount of any premium payments you
may make which are in excess of the greater of the Planned Periodic Premium or
the No Lapse Guarantee Premium shown on Page 3 - Continued.
We also reserve the right not to accept premium payments or to return excess
amounts (in a policy year) that we determine would cause this policy to fail to
qualify as life insurance under applicable tax law as interpreted by us (see
Page 16).
NO LAPSE GUARANTEE. This policy is guaranteed not to lapse during the policy
years shown on Page 3 if the sum of premium payments accumulated at 4%, less any
partial withdrawals accumulated at 4%, is at least equal to the No Lapse
Guarantee Premium(s) (shown on Page 3 - Continued for base policy and additional
benefit riders, if any) accumulated at 4%, and any outstanding loan and accrued
loan interest does not exceed the cash surrender value. Certain policy changes
after issue will change the No Lapse Guarantee Premium(s). This no lapse
guarantee terminates at the end of the policy year shown on Page 3.
GRACE PERIOD. At the beginning of each policy month, the Net Cash Surrender
Value will be compared to the total monthly deductions described on Page 9. If
the Net Cash Surrender Value is sufficient to cover the total monthly
deductions, the policy is not in default.
If the Net Cash Surrender Value at the beginning of any policy month during the
no lapse guarantee period is less than such deductions for that month we will
perform the following calculations to determine whether the policy is in
default:
1. Determine the No Lapse Guarantee Premium fund. The No Lapse Guarantee
Premium fund for any policy month is the accumulation of all the No Lapse
Guarantee premiums shown on Page 3 - Continued up to that month at 4%
interest.
2. Determine the actual premium fund. The actual premium fund for any policy
month is the accumulation of all the premiums received at 4% interest
minus all withdrawals accumulated at 4% interest.
3. If the result in Step 2 is greater than or equal to the result in Step 1,
and any loan and accrued loan interest does not exceed the Cash Surrender
Value, the policy is not in default. The no lapse guarantee will be in
effect and monthly deductions in excess of the Policy Account will be
waived.
4. If the result of Step 2 is less than the result in Step 1, or if the
result of Step 2 is greater than or equal to the result in Step 1 and any
loan and accrued loan interest exceeds the Cash Surrender Value, the
policy is in default as of the first day of this policy month. This is
the date of default.
If the no lapse guarantee has terminated (see No Lapse Guarantee provision) the
calculations in Steps 1. - 4. above will not be performed. In that case, if the
Net Cash Surrender Value at the beginning of any policy month is less than the
monthly deductions for that month, the policy is in default as of the first day
of such policy month.
If the policy is in default, we will send you and any assignee on our records at
last known addresses written notice stating that a grace period of 61 days has
begun as of the date of default. The notice will also state the amount of
payment that is due.
The payment required will not be more than an amount sufficient to increase the
Net Cash Surrender Value to cover all monthly deductions for 3 months calculated
assuming no interest or investment performance were credited to or charged
against the Policy Account and no policy changes were made.
If we do not receive such amount at our Administrative Office before the end of
the grace period, your policy will lapse as of the date of default and we will
then (1) withdraw and retain the entire amount in your Policy Account; and (2)
send a written notice to you and any assignee on our records at last known
addresses stating that this policy has ended without value.
If we receive the requested amount before the end of the grace period, but the
Net Cash Surrender Value is still insufficient to cover total monthly
deductions, we will send a written notice that a new 61-day grace period has
begun and request an additional payment.
If the insured person dies during a grace period, we will pay the Insurance
Benefit as described on Page 5.
96-400-7 Page 8
RESTORING YOUR POLICY BENEFITS. If this policy has ended without value, you may
restore policy benefits while the insured person is alive if you: Ask for
restoration of policy benefits within 6 months from the end of the grace period;
and
1. Provide evidence of insurability satisfactory to us; and
2. Make a required payment. The required payment will not be more than an
amount sufficient to cover (i) the monthly administrative charges from
the date of default to the effective date of restoration; (ii) total
monthly deductions for 3 months, calculated from the effective date of
restoration; (iii) any excess of the applicable surrender charge on the
date of restoration over the surrender charge that was deducted on the
date of default; and (iv) the charge for applicable taxes, the premium
charge, and any increase in surrender charges associated with this
payment. We will determine the amount of this required payment as if no
interest or investment performance were credited to or charged against
your Policy Account.
From the required payment we will deduct the charge for applicable taxes and the
premium charge. The policy account on the date of restoration will be equal to
the balance of the required payment plus a surrender charge credit. The
surrender charge credit will be the surrender charge that was deducted on the
date of default, but not greater than the applicable surrender charge as of the
effective date of restoration.
The effective date of the restoration of policy benefits will be the beginning
of the policy month which coincides with or next follows the date we approve
your request.
We will start to make monthly charges again as of the effective date of
restoration. The monthly administrative charges from the date of default to the
effective date of restoration will be deducted from the Policy Account as of the
effective date of restoration.
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YOUR POLICY ACCOUNT AND HOW IT WORKS
PREMIUM PAYMENTS. When we receive your premium payments, we subtract the expense
charges shown in the table in the Policy Information section and any overdue
monthly deductions (unless waived under the No Lapse Guarantee provision.) We
put the balance (the net premium) into your Policy Account as of the date we
receive the premium payment at our Administrative Office, and before any
deductions from your Policy Account due on that date are made. However, we will
put the initial net premium payment into your Policy Account as of the Register
Date if it is later than the date of receipt. No premiums will be applied to
your Policy Account until the minimum initial premium payment, as shown in the
Policy Information Section, is received at our Administrative Office.
MONTHLY DEDUCTIONS. At the beginning of each policy month we make a deduction
from your Policy Account to cover monthly administrative charges and to provide
insurance coverage. Such deduction for any policy month is the sum of the
following amounts determined as of the beginning of that month:
o the monthly administrative charges;
o the monthly cost of insurance for the insured person; and
o the monthly cost of any benefits provided by riders to this policy.
The monthly cost of insurance is the sum of a) our current monthly cost of
insurance rate times the net amount at risk at the beginning of the policy month
divided by $1,000; plus b) any flat extra charge shown in the Policy Information
section. The net amount at risk at any time is the death benefit minus the
amount in your Policy Account at that time.
We will determine cost of insurance rates from time to time. Any change in the
cost of insurance rates we use will be as described in "Changes in Policy Cost
Factors" on Page 16. They will never be more than those shown in the Table of
Guaranteed Maximum Cost of Insurance Rates on Page 4 - Continued.
96-400-9 Page 9
OTHER DEDUCTIONS. We also make the following other deductions from your Policy
Account as they occur:
o We deduct a withdrawal charge if you make a partial withdrawal of the Net
Cash Surrender Value (see Page 13).
o We deduct a surrender charge if, before the end of the fifteenth policy year,
you give up this policy for its Net Cash Surrender Value, you reduce the Face
Amount of Insurance, or if this policy terminates without value at the end of
a grace period (see Page 12). A surrender charge will also apply to such
transactions for up to fifteen years following a face amount increase.
o We deduct a charge if you increase the Face Amount of Insurance (see Page 7).
o We deduct a charge for certain transfers (see below).
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YOUR INVESTMENT OPTIONS
ALLOCATIONS. This policy provides investment options for the amount in your
Policy Account. Amounts put into your Policy Account and deductions from it are
allocated to the investment funds of our SA and to the unloaned portion of our
GIA at your direction. You specified your initial premium allocation and
deduction allocation percentages in your application for this policy, a copy of
which is attached to this policy. Unless you change them, such percentages shall
also apply to subsequent premium and deduction allocations. However, any amounts
which are put into your Policy Account prior to the Allocation Date and which
are to be allocated to the investment funds of our SA will initially be
allocated to (and monthly deductions taken from) the Money Market Fund of our SA
except for any amount allocated to the GIA. The Allocation Date is the first
business day (see Page 12) twenty calendar days after the date of issue of this
policy. On the Allocation Date, any such amounts then in the Money Market Fund
will be allocated in accordance with the directions contained in your policy
application.
Allocation percentages must be zero or a whole number not greater than 100. The
sum of the premium allocation percentages and of the deduction allocation
percentages must each equal 100.
You may change such allocation percentages by written notice to our
Administrative Office. A change will take effect on the date we receive it at
our Administrative Office except for changes received on or prior to the
Allocation Date which will take effect on the first business day following the
Allocation Date.
If we cannot make a monthly deduction on the basis of the deduction allocation
percentages then in effect, we will make that deduction based on the proportion
that your unloaned value in our GIA and your values in the investment funds of
our SA bear to the total unloaned value in your Policy Account.
TRANSFERS. At your written request to our Administrative Office, we will
transfer amounts from your value in any investment fund of our SA to one or more
other funds of our SA or to our GIA. Any such transfer will take effect on the
date we receive your written request at our Administrative Office. However, no
transfers will be made prior to the Allocation Date.
Once during each policy year you may ask us by written request to our
Administrative Office to transfer an amount you specify from your unloaned value
in our GIA to one or more investment funds of our SA. However, we will make such
a transfer only if (1) we receive your written request at our Administrative
Office within 30 days before or after a policy anniversary; and (2) the amount
you specify is not more than the greater of 25% of your unloaned value in our
GIA as of the date the transfer takes effect or $500.00. In no event will we
transfer more than your unloaned value in our GIA. The transfer will take effect
on the date we receive your written request for it at our Administrative Office
but not before the policy anniversary.
The minimum amount that we will transfer from your value in an investment fund
of our SA on any date is the lesser of $500.00 or your value in that investment
fund on that date, except as stated in the next paragraph. The minimum amount
that we will transfer from your value in our GIA is the lesser of $500.00 or
your unloaned value in our GIA as of the date the transfer takes effect, except
as stated in the next paragraph.
We will waive the minimum amount limitations set forth in the immediately
preceding paragraph if the total amount being transferred on that date is at
least $500.00.
96-400-9 Page 10
We reserve the right to make a transfer charge up to $25.00 for each transfer of
amounts among your investment options. The transfer charge, if any, is deducted
from the amounts transferred from the investment funds of our SA and the GIA
based on the proportion that the amount transferred from each investment fund
and the GIA bears to the total amount being transferred. A transfer from the
Money Market Fund on the Allocation Date (if applicable) will not incur a
transfer charge. If you ask us to transfer the entire amount of your value in
the investment funds of our SA to our GIA, we will not make a charge for that
transfer.
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THE VALUE OF YOUR POLICY ACCOUNT
The amount in your Policy Account at any time is equal to the sum of the amounts
you then have in our GIA and the investment funds of our SA under this policy.
YOUR VALUE IN OUR GIA. The amount you have in our GIA at any time is equal to
the amounts allocated and transferred to it, plus the interest credited to it,
minus amounts deducted, transferred and withdrawn from it.
We will credit the amount in our GIA with interest rates we determine. We will
determine such interest rates annually in advance for unloaned and loaned
amounts in our GIA. The rates may be different for unloaned and loaned amounts.
The interest rates we determine each year will apply to the policy year that
follows the date of determination. Any change in the interest rates we determine
will be as described in "Changes in Policy Cost Factors" on Page 16. Such
interest rates will not be less than 4%. Interest accrues and is credited on
unloaned amounts in the GIA daily. However, we will credit interest on the
initial net premium from the Register Date if it is later than the date of
receipt provided the initial premium is at least equal to the minimum initial
premium shown on Page 3 of the policy.
We credit interest on the loaned portion of our GIA daily. The interest rate we
credit to the loaned portion of our GIA will be at an annual rate up to 2% less
than the loan interest rate we charge. However, we reserve the right to credit a
lower rate than this if in the future tax laws change such that our taxes on
policy loans or policy loan interest is increased. In no event will we credit
less than 4% a year. On each policy anniversary and at any time you repay all of
a policy loan, we allocate the interest that has been credited to the loaned
portion of our GIA to the investment funds of our SA and the unloaned portion of
our GIA in accordance with your premium allocation percentages.
YOUR VALUE IN THE INVESTMENT FUNDS OF OUR SA. The amount you have in an
investment fund of our SA under this policy at any time is equal to the number
of units this policy then has in that fund multiplied by the fund's unit value
at that time.
Amounts allocated, transferred or added to an investment fund of our SA are used
to purchase units of that fund; units are redeemed when amounts are deducted,
loaned, transferred or withdrawn. These transactions are called policy
transactions.
The number of units a policy has in an investment fund at any time is equal to
the number of units purchased minus the number of units redeemed in that fund to
that time. The number of units purchased or redeemed in a policy transaction is
equal to the dollar amount of the policy transaction divided by the fund's unit
value on the date of the policy transaction. Policy transactions may be made on
any day. The unit value that applies to a transaction made on a business day
will be the unit value for that day. The unit value that applies to a
transaction made on a non-business day will be the unit value for the next
business day.
We determine unit values for the investment funds of our SA at the end of each
business day. Generally, a business day is any day we are open and the New York
Stock Exchange is open for trading. A business day immediately preceded by one
or more non-business days will include those non-business days as part of that
business day. For example, a business day which falls on a Monday will consist
of that Monday and the immediately preceding Saturday and Sunday.
00-000-00 Page 11
The unit value of an investment fund of our SA on any business day is equal to
the unit value for that fund on the immediately preceding business day
multiplied by the net investment factor for that fund on that business day.
The net investment factor for an investment fund of our SA on any business day
is (a) divided by (b), minus (c), where:
(a) is the net asset value of the shares in designated investment companies that
belong to the investment fund at the close of business on such business day
before any policy transactions are made on that day, plus the amount of any
dividend or capital gain distribution paid by the investment companies on that
day;
(b) is the value of the assets in that investment fund at the close of business
on the immediately preceding business day after all policy transactions were
made for that day; and
(c) is a charge for each calendar day in that business day, as defined above,
corresponding to a charge not exceeding .80% yearly for mortality and expense
risks, plus any charge for that day for taxes or amounts set aside as a reserve
for taxes.
The net asset value of an investment company's shares held in each investment
fund shall be the value reported to us by that investment company.
THE CASH SURRENDER VALUE OF THIS POLICY
CASH SURRENDER VALUE. The Cash Surrender Value on any date is equal to the
amount in your Policy Account on that date minus any surrender charge.
NET CASH SURRENDER VALUE. The Net Cash Surrender Value is equal to the Cash
Surrender Value minus any policy loan and accrued loan interest. You may give up
this policy for its Net Cash Surrender Value at any time while the insured
person is living. You may do this by sending us a written request for it and
this policy to our Administrative Office. Your written request for cancellation
or surrender must include the following:
1. An unequivocal request for cancellation or surrender;
2. The policy number of the policy to be canceled or surrendered;
3. The name of the insured and owner (if other than the insured) and address
where proceeds should be mailed;
4. The signature of the owner of the policy and, if required by the policy or
by a legally binding document of which we have an actual notice, the
signature of a collateral assignment, irrevocable beneficiary, or other
person having an interest in the policy through the legally binding
document.
If this policy has a cash surrender value and is being given up for its net cash
surrender value, a completed withholding authorization (I.R.S. Form W-9) must
also be included with your written request. If this form is not provided to us
with your written request for cancellation or surrender, we will withhold income
tax on the taxable portion of your distribution at the mandated federal and
state tax rates. We will compute the Net Cash Surrender Value as of the date we
receive your request for it and this policy at our Administrative Office. If the
policy has been lost, stolen or destroyed, you must include a statement in the
written request that the policy was lost, stolen or destroyed with an
approximate date of when the policy was lost, stolen or destroyed. All insurance
coverage under this policy ends on the date we receive your written request.
SURRENDER CHARGES. If you give up this policy for its Net Cash Surrender Value
or if it ends without value at the end of a grace period before the end of the
fifteenth policy year, we will subtract a surrender charge from your Policy
Account. A table of maximum surrender charges for the initial face amount is in
the Policy Information section.
We will also establish surrender charges for any increase in the Face Amount of
Insurance that represents an increase over the previous highest Face Amount.
These will apply before the end of the fifteenth year from the effective date of
the increase. Changes in Face Amount resulting from a change in death benefit
option will not be considered in computing the previous highest Face Amount.
If the Face Amount of Insurance is reduced before the end of the fifteenth
policy year or within fifteen years following a face amount increase, we will
also deduct a proportionate amount of any applicable surrender charge from your
Policy Account. Such deduction will be made in accordance with the "Allocations"
provision on Page 10. Reductions will first be applied against the most recent
increase in the Face Amount of Insurance. They will then be applied to prior
increases in the Face Amount of Insurance in the reverse order in which such
increases took place, and then to the original Face Amount of Insurance.
We have filed a detailed statement of the method of computing surrender charges
with the insurance supervisory official of the jurisdiction in which this policy
is delivered.
00-000-00 Page 12
PARTIAL NET CASH SURRENDER VALUE WITHDRAWAL. After the first policy year and
while the insured person is living, you may ask for a partial Net Cash Surrender
Value withdrawal by written request to our Administrative Office. Your request
will be subject to our approval based on our rules in effect when we receive
your request, and to the minimum withdrawal amount of $500.00. The amount
withdrawn from the Policy Account is equal to the amount requested plus an
expense charge equal to the lesser of $25.00 and 2% of the amount withdrawn. We
have the right to decline a request for a partial Net Cash Surrender Value
withdrawal. A partial withdrawal will result in a reduction in the Cash
Surrender Value and in your Policy Account equal to the amount withdrawn plus
the expense charge as well as a reduction in your death benefit. If the death
benefit is Option A, the withdrawal may also result in a decrease in the face
amount.
You may tell us how much of each partial withdrawal is to come from your
unloaned value in our GIA and from your values in each of the investment funds
of our SA. If you do not tell us, we will make the withdrawal on the basis of
your monthly deduction allocation percentages then in effect. The expense charge
is deducted from your value remaining in the investment options from which the
withdrawal was made, based on the proportion that the amount withdrawn from each
investment fund and the GIA bears to the total amount being withdrawn. If we
cannot make the withdrawal or deduct the expense charge as indicated above, we
will make the withdrawal and deduction based on the proportion that your
unloaned value in our GIA and your values in the investment funds of our SA bear
to the total unloaned value in your Policy Account.
Such withdrawal and resulting reduction in the death benefit, in the Cash
Surrender Value and in your Policy Account will take effect on the date we
receive your written request at our Administrative Office. We will send you a
new Policy Information section if a withdrawal results in a reduction in the
Face Amount of Insurance. It will become a part of this policy. We may require
you to return this policy to our Administrative Office to make a change.
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HOW A LOAN CAN BE MADE
POLICY LOANS. You can take a loan on this policy while it has a loan value. This
policy will be the only security for the loan. The initial loan and each
additional loan must be for at least $500.00. Any amount on loan is part of your
Policy Account (see Page 11). We refer to this as the loaned portion of your
Policy Account.
LOAN VALUE. The loan value on any date is 90% of the Cash Surrender Value on
that date. The amount of the loan may not be more than the loan value. If you
request an increase to an existing loan, the additional amount requested will be
added to the amount of the existing loan and accrued loan interest.
Your request for a policy loan must be in writing to our Administrative Office.
You may tell us how much of the requested loan is to be allocated to your
unloaned value in our GIA and your value in each investment fund of our SA. Such
values will be determined as of the date we receive your request. If you do not
tell us, we will allocate the loan on the basis of your monthly deduction
allocation percentages then in effect. If we cannot allocate the loan on the
basis of your direction or those percentages, we will allocate it based on the
proportion that your unloaned value in our GIA and your values in the investment
funds of our SA bear to the total unloaned value in your Policy Account.
The loaned portion of your Policy Account will be maintained as a part of our
GIA. Thus, when a loaned amount is allocated to an investment fund of our SA, we
will redeem units of that investment fund sufficient in value to cover the
amount of the loan so allocated and transfer that amount to our GIA.
LOAN INTEREST. Interest on a loan accrues daily at an adjustable loan interest
rate. We will determine the rate at the beginning of each policy year, subject
to the following paragraphs. It will apply to any new or outstanding loan under
the policy during the policy year next following the date of determination.
The maximum loan interest rate for a policy year shall be the greater of: (1)
the "Published Monthly Average," as defined below, for the calendar month that
ends two months before the date of determination; or (2) 5%. "Published Monthly
Average" means the Monthly Average Corporates yield shown in Moody's Corporate
Bond Yield Averages published by Xxxxx'x Investors Service, Inc., or any
successor thereto. If such averages are no longer published, we will use such
other averages as may be established by regulation by the insurance supervisory
official of the jurisdiction in which this
00-000-00 Page 13
policy is delivered. In no event will the loan interest rate for a policy year
be greater than the maximum rate permitted by applicable law. We reserve the
right to establish a rate lower than the maximum.
No change in the rate shall be less than 1/2 of 1% a year. We may increase the
rate whenever the maximum rate as determined by clause (1) of the preceding
paragraph exceeds the rate being charged by 1/2 of 1% or more. We will reduce
the rate to or below the maximum rate as determined by clause (1) of the
preceding paragraph if such maximum is lower than the rate being charged by 1/2
of 1% or more.
We will notify you of the initial loan interest rate when you make a loan. We
will also give you advance written notice of any increase in the interest rate
of any outstanding loan.
Loan interest is due on each policy anniversary. If the interest is not paid
when due, it will be added to your outstanding loan and allocated on the basis
of the deduction allocation percentages then in effect. If we cannot make the
allocation on the basis of these percentages, we will make it based on the
proportion that your unloaned value in our GIA and your values in the investment
funds of our SA bear to the total unloaned value in your Policy Account. The
unpaid interest will then be treated as part of the loaned amount and will bear
interest at the loan rate.
When unpaid loan interest is allocated to an investment fund of our SA, we will
redeem units of that investment fund sufficient in value to cover the amount of
the interest so allocated and transfer that amount to our GIA.
LOAN REPAYMENT. You may repay all or part of a policy loan at any time while the
insured person is alive and this policy is in force.
Repayments will first be allocated to our GIA until you have repaid any loaned
amounts that were allocated to our GIA. You may tell us how to allocate payments
above that amount among our GIA and the investment funds of our SA. If you do
not tell us, we will make the allocation on the basis of the premium allocation
percentages then in effect.
Failure to repay a policy loan or to pay loan interest will not terminate this
policy unless at the beginning of a policy month the Net Cash Surrender Value is
less than the total monthly deduction then due. In that case, the Grace Period
provision will apply (see Page 8).
A policy loan will have a permanent effect on your benefits under this policy
even if it is repaid.
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OUR SEPARATE ACCOUNT(S) (SA)
We established and we maintain our SA under the laws of New York State. Realized
and unrealized gains and losses from the assets of our SA are credited or
charged against it without regard to our other income, gains, or losses. Assets
are put in our SA to support this policy and other variable life insurance
policies. Assets may be put in our SA for other purposes, but not to support
contracts or policies other than variable contracts.
The assets of our SA are our property. The portion of its assets equal to the
reserves and other policy liabilities with respect to our SA will not be
chargeable with liabilities arising out of any other business we conduct. We may
transfer assets of an investment fund in excess of the reserves and other
liabilities with respect to that fund to another investment fund or to our
General Account.
INVESTMENT FUNDS. Our SA consists of investment funds. Each fund may invest its
assets in a separate class of shares of a designated investment company or
companies or make direct investments in securities. The investment funds of our
SA that you chose for your initial allocations are shown on the application for
this policy, a copy of which is attached to this policy. We may from time to
time make other investment funds available to you or we may create a new SA. We
will provide you with written notice of all material details including
investment objectives and all charges.
We have the right to change or add designated investment companies. We have the
right to add or remove investment funds. We have the right to withdraw assets of
a class of policies to which this policy belongs from an investment fund and put
them in another investment fund. We also have the right to combine any two or
more investment funds. The term investment fund in this policy shall then refer
to any other investment fund in which the assets of a class of policies to which
this policy belongs were placed.
00-000-00 Page 14
We have the right to:
1. register or deregister any SA available under this policy under the
Investment Company Act of 1940;
2. run any SA available under this policy under the direction of a committee,
and discharge such committee at any time;
3. restrict or eliminate any voting rights of policy owners, or other persons
who have voting rights as to any SA available under this policy; and
4. operate any SA available under this policy or one or more of its investment
funds by making direct investments or in any other form. If we do so, we may
invest the assets of such SA or one or more of the investment funds in any
legal investments. We will rely upon our own or outside counsel for advice in
this regard. Also, unless otherwise required by law or regulation, an
investment adviser or any investment policy may not be changed without our
consent. If required by law or regulation, the investment policy of an
investment fund of any SA available under this policy will not be changed by
us unless approved by the Superintendent of Insurance of New York State or
deemed approved in accordance with such law or regulation.
If any of these changes result in a material change in the underlying
investments of an investment fund of our SA, we will notify you of such change,
as required by law. If you have value in that investment fund, if you wish, we
will transfer it at your written direction from that fund (without charge) to
another fund of our SA or to our GIA, and you may then change your premium and
deduction allocation percentages.
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OUR ANNUAL REPORT TO YOU
For each policy year we will send you a report for this policy that shows the
current death benefit, the value you have in our GIA and the value you have in
each investment fund of any SA available under this policy, the Cash Surrender
Value and any policy loan with the current loan interest rate. It will also show
the premiums paid and any other information as may be required by the insurance
supervisory official of the jurisdiction in which this policy is delivered.
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HOW BENEFITS ARE PAID
You can have the Insurance Benefit, your Net Cash Surrender Value withdrawals or
your Policy Account payable on the Final Policy Date paid immediately in one
sum. Or, you can choose another form of payment for all or part of them. If you
do not arrange for a specific choice before the insured person dies, the
beneficiary will have this right when the insured person dies. If you do make an
arrangement, however, the beneficiary cannot change it after the insured person
dies.
Payments under the following options will not be affected by the investment
experience of any investment fund of our SA after proceeds are applied under
such options.
The options are:
1. DEPOSIT: The sum will be left on deposit for a period mutually agreed upon.
We will pay interest at the end of every month, every 3 months, every 6
months or every 12 months, as chosen.
2. INSTALLMENT PAYMENTS: There are two ways that we pay installments:
A. FIXED PERIOD: We will pay the sum in equal installments for a specified
number of years (not more than 30). The installments will be at least
those shown in the Table of Guaranteed Payments on Page 18.
B. FIXED AMOUNT: We will pay the sum in installments as mutually agreed
upon until the original sum, together with interest on the unpaid
balance, is used up.
3. MONTHLY LIFE INCOME: We will pay the sum as a monthly income for life. The
amount of the monthly payment will be at least that shown in the Table of
Guaranteed Payments on Page 18. You may choose any one of three ways to
receive monthly life income. We will guarantee payments for at least 10
years (called "10 Years Certain"); at least 20 years (called "20 Years
Certain"); or until the payments we make equal the original sum (called
"Refund Certain").
4. OTHER: We will apply the sum under any other option requested that we make
available at the time of payment.
00-000-00 Page 15
The payee may name and change a successor payee for any amount we would
otherwise pay to the payee's estate.
Any arrangements involving more than one of the options, or a payee who is not a
natural person (for example, a corporation) or who is a fiduciary, must have our
approval. Also, details of all arrangements will be subject to our rules at the
time the arrangement takes effect. These include rules on: the minimum amount we
will apply under an option and minimum amounts for installment payments;
withdrawal or commutation rights; naming payees and successor payees; and
proving age and survival.
Payment choices (or any later changes) will be made and will take effect in the
same way as a change of beneficiary. Amounts applied under these options will
not be subject to the claims of creditors or to legal process, to the extent
permitted by law.
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OTHER IMPORTANT INFORMATION
YOUR CONTRACT WITH US. This policy is issued in consideration of payment of the
initial premium payment shown in the Policy Information section.
This policy, and the attached copy of the initial application and all subsequent
applications to change this policy, and all additional Policy Information
sections added to this policy, make up the entire contract. The rights conferred
by this policy are in addition to those provided by applicable Federal and State
laws and regulations.
Only our Chairman of the Board, our President or one of our Vice Presidents can
modify this contract or waive any of our rights or requirements under it. The
person making these changes must put them in writing and sign them.
POLICY CHANGES - APPLICABLE TAX LAW. For you and the beneficiary to receive the
tax treatment accorded to life insurance under Federal law, this policy must
qualify initially and continue to qualify as life insurance under the Code or
successor law. Therefore, we have reserved earlier in this policy the right to
decline to accept premium payments, to decline to change death benefit options,
to decline to change the Face Amount of Insurance, or to decline to make partial
withdrawals that, in our opinion, would cause this policy to fail to qualify as
life insurance under applicable tax law. Further, we reserve the right to make
changes in this policy or its riders (for example, in the percentages on Page 6)
or to require additional premium payments or to make distributions from this
policy or to change the Face Amount of Insurance to the extent we deem it
necessary to continue to qualify this policy as life insurance. Any such changes
will apply uniformly to all policies that are affected. You will be given
advance written notice of such changes.
CHANGES IN POLICY COST FACTORS. Changes in policy cost factors (interest rates
we credit, cost of insurance deductions and expense charges) will be by class
and based upon changes in future expectations for such elements as: investment
earnings, mortality, persistency, expenses and taxes. Any change in policy cost
factors will be determined in accordance with procedures and standards on file,
if required, with the insurance supervisory official of the jurisdiction in
which this policy is delivered.
WHEN THE POLICY IS INCONTESTABLE. We have the right to contest the validity of
this policy based on material misstatements made in the initial application for
this policy. We also have the right to contest the validity of any policy change
or restoration based on material misstatements made in any application for that
change or restoration. However, we will not contest the validity of this policy
after it has been in effect during the lifetime of the insured person for two
years from the date of issue shown in the Policy Information section. We will
not contest any policy change that requires evidence of insurability, or any
restoration of this policy, after the change or restoration has been in effect
for two years during the insured person's lifetime.
No statement shall be used to contest a claim unless contained in an
application.
All statements made in an application are representations and not warranties.
See any additional benefit riders for modifications of this provision that apply
to them.
WHAT IF AGE OR SEX HAS BEEN MISSTATED? If the insured person's age or sex has
been misstated on any application, the death benefit and any benefits provided
by riders to this policy shall be those which would be purchased by the most
recent deduction for the cost of insurance, and the cost of any benefits
provided by riders, at the correct age and sex.
00-000-00 Page 16
HOW THE SUICIDE EXCLUSION AFFECTS BENEFITS. If the insured person commits
suicide (while sane or insane) within two years after the Date of Issue shown in
the Policy Information section, our liability will be limited to the payment of
a single sum. This sum will be equal to the premiums paid, minus any loan and
accrued loan interest and minus any partial withdrawal of the Net Cash Surrender
Value. If the insured person commits suicide (while sane or insane) within two
years after the effective date of a change that you asked for that increases the
death benefit, then our liability as to the increase in amount will be limited
to the payment of a single sum equal to the monthly cost of insurance deductions
made for such increase plus the expense charge deducted for the increase (see
Page 7).
HOW WE MEASURE POLICY PERIODS AND ANNIVERSARIES. We measure policy years, policy
months, and policy anniversaries from the Register Date shown in the Policy
Information section. Each policy month begins on the same day in each calendar
month as the day of the month in the Register Date.
HOW, WHEN AND WHAT WE MAY DEFER. We may not be able to obtain the value of the
assets of the investment funds of our SA if: (1) the New York Stock Exchange is
closed; or (2) the Securities and Exchange Commission requires trading to be
restricted or declares an emergency. During such times, as to amounts allocated
to the investment funds of our SA, we may defer:
1. Determination and payment of Net Cash Surrender Value withdrawals;
2. Determination and payment of any death benefit in excess of the Face Amount
of Insurance;
3. Payment of loans;
4. Determination of the unit values of the investment funds of our SA; and
5. Any requested transfer or the transfer on the Allocation Date.
As to amounts allocated to our GIA, we may defer payment of any Net Cash
Surrender Value withdrawal or loan amount for up to six months after we receive
a request for it. We will allow interest, at a rate of at least 3% a year, on
any Net Cash Surrender Value payment derived from our GIA that we defer for 30
days or more.
THE BASIS WE USE FOR COMPUTATION. We provide Cash Surrender Values that are at
least equal to those required by law. If required to do so, we have filed with
the insurance supervisory official of the jurisdiction in which this policy is
delivered a detailed statement of our method of computing such values. We
compute reserves under this policy by the Commissioners Reserve Valuation
Method.
We base minimum cash surrender values and reserves on the Commissioners 1980
Standard Ordinary Male and Female Mortality Tables at attained ages 0-19 or the
Commissioners 1980 Standard Ordinary, Male and Female, Smoker and Non-Smoker,
Mortality Tables at attained ages 20 and over. We also use these tables as the
basis for determining maximum insurance costs, taking account of sex, attained
age, class of risk and Tobacco User status of the insured person. We use an
effective annual interest rate of 4%.
POLICY ILLUSTRATIONS. Upon request we will give you an illustration of the
future benefits under this policy based upon both guaranteed and current cost
factor assumptions. However, if you ask us to do this more than once in any
policy year, we reserve the right to charge you a fee for this service.
POLICY CHANGES. You may add additional benefit riders or make other changes,
subject to our rules at the time of change.
00-000-00 Page 17
TABLE OF GUARANTEED PAYMENTS
(MINIMUM AMOUNT FOR EACH $1,000 APPLIED)
OPTION 2A OPTION 3
FIXED PERIOD INSTALLMENTS MONTHLY LIFE INCOME
------------------------- -------------------
Number Monthly Annual
of Years' Install- Install- 10 Years Certain 20 Years Certain Refund Certain
Installments ment ment ---------------- ---------------- --------------
------------ ---- ---- Age Male Female Male Female Male Female
--- ---- ------ ---- ------ ---- ------
1 $84.28 $1000.00 50 $3.48 $3.19 $3.42 $3.17 $3.37 $3.14
2 42.66 506.17 51 3.54 3.23 3.47 3.21 3.42 3.17
3 28.79 341.60 52 3.59 3.28 3.51 3.25 3.46 3.21
4 21.86 259.33 53 3.65 3.32 3.56 3.29 3.51 3.25
5 17.70 210.00 54 3.70 3.37 3.61 3.33 3.56 3.29
6 14.93 177.12 55 3.77 3.42 3.66 3.37 3.61 3.34
7 12.95 153.65 56 3.83 3.47 3.72 3.42 3.67 3.38
8 11.47 136.07 57 3.90 3.52 3.77 3.47 3.72 3.43
9 10.32 122.40 58 3.97 3.58 3.83 3.52 3.78 3.48
10 9.39 111.47 59 4.04 3.64 3.88 3.57 3.84 3.53
11 8.64 102.54 60 4.12 3.70 3.94 3.62 3.90 3.58
12 8.02 95.11 61 4.20 3.76 4.00 3.68 3.97 3.64
13 7.49 88.83 62 4.29 3.83 4.06 3.74 4.04 3.69
14 7.03 83.45 63 4.38 3.90 4.12 3.79 4.11 3.75
15 6.64 78.80 64 4.48 3.98 4.18 3.85 4.19 3.82
16 6.30 74.73 65 4.58 4.06 4.25 3.92 4.26 3.88
17 6.00 71.15 66 4.68 4.14 4.31 3.98 4.35 3.95
18 5.73 67.97 67 4.79 4.23 4.37 4.04 4.43 4.02
19 5.49 65.13 68 4.90 4.32 4.43 4.11 4.52 4.10
20 5.27 62.58 69 5.02 4.42 4.50 4.18 4.62 4.18
21 5.08 60.28 70 5.14 4.52 4.56 4.25 4.71 4.26
22 4.90 58.19 71 5.26 4.63 4.62 4.31 4.82 4.35
23 4.74 56.29 72 5.39 4.75 4.67 4.38 4.92 4.44
24 4.60 54.55 73 5.52 4.87 4.73 4.45 5.03 4.53
25 4.46 52.95 74 5.66 4.99 4.78 4.51 5.14 4.63
26 4.34 51.48 75 5.80 5.12 4.83 4.58 5.27 4.74
27 4.22 50.12 76 5.95 5.26 4.88 4.64 5.39 4.84
28 4.12 48.87 77 6.10 5.40 4.93 4.70 5.53 4.96
29 4.02 47.70 78 6.25 5.55 4.97 4.75 5.66 5.08
30 3.93 46.61 79 6.40 5.70 5.01 4.80 5.80 5.20
80 6.56 5.85 5.04 4.86 5.96 5.33
81 6.72 6.01 5.08 4.90 6.11 5.45
82 6.88 6.18 5.11 4.95 6.27 5.60
83 7.04 6.34 5.13 4.99 6.43 5.73
84 7.20 6.51 5.16 5.03 6.62 5.89
85 & over 7.36 6.67 5.18 5.07 6.81 6.04
If installments are paid every 3 months, they will be 25.23% of the annual
installments. If they are paid every 6 months, they will be 50.31% of the annual
installments.
Amounts for Monthly Life Income are based on age nearest birthday when income
starts. Amounts for ages not shown will be furnished on request.
00-000-00 Page 18
EQUITABLE
VARIABLE LIFE INSURANCE COMPANY
A Stock Life Insurance Company
Home Office: 000 Xxxxxxx Xxxxxx, Xxx Xxxx, Xxx Xxxx 00000-0000
Flexible Premium Variable Life Insurance Policy. Insurance payable
upon death before Final Policy Date. Policy Account less outstanding
loans and accrued interest payable on Final Policy Date. Adjustable
Death Benefit. Premiums may be paid while insured person is living and
before the Final Policy Date. Premiums must be sufficient to keep the
policy in force. Values provided by this policy are based on declared
interest rates, and on the investment experience of the investment
funds of a separate account which in turn depends on the investment
performance of the securities held by such investment fund. They are
not guaranteed as to dollar amount. Investment options are described
on Page 10. This is a non-participating policy.
No. 96-400
