EXHIBIT 99.(d)(3)
COUNTRY INVESTORS LIFE ASSURANCE COMPANY TERM INSURANCE
AGREEMENT
0000 X. Xxxxxxx Xxxxxx FOR INSURED SPOUSE
X.X. Xxx 0000, Xxxxxxxxxxx, Xxxxxxxx 00000-0000
Supplemental Agreement attached to and made a part of this policy in
consideration of the application and payment of its cost of insurance. The cost
of insurance is the monthly deduction as defined below. This Agreement will
remain in force only as long as the monthly deductions for this policy continue
to include the cost of insurance for this benefit.
1. COST OF INSURANCE: The cost of insurance for this benefit is a monthly
deduction which is equal to the product of A times B where:
A. is the cost of insurance rate for the Insured Spouse's Amount of
Benefit which is based on the Insured Spouse's:
1. sex;
2. attained age on the preceding anniversary of the effective date
of this Agreement, and
3. rate class shown on Page 1 (Policy Schedule) of this policy for
the Insured Spouse.
- Attained age on the preceding anniversary of the effective date-
of this Agreement means the Insured Spouse's age on the last
birthday prior to the anniversary of the effective date of this
Agreement. The guaranteed maximum cost of insurance rates are
shown in the schedule of Insured Spouse rates included in this
policy. These rates apply to a standard rate class. They may be
increased if the Insured Spouse's Amount of Benefit is in a
different rate class. We can use cost of insurance rates that are
lower than the guaranteed maximum rates.
B. is the Amount of Benefit for the Insured Spouse as shown on Page 1
(Policy Schedule) of this policy.
2. INSURED SPOUSE: Insured Spouse means the spouse named in the application or
supplemental application for this policy as the spouse of the Insured under this
policy.
3. DEATH BENEFIT: The death benefit is the Amount of Benefit for the Insured
Spouse as shown on Page 1 (Policy Schedule) of this policy. We agree to pay the
death benefit upon receipt of due proof of death of the Insured Spouse. Death
must occur while this Agreement is in force. Payment is subject to the
provisions of this policy and this Agreement.
4. MISSTATEMENT OF AGE OR SEX: Two questions in the application concern the
Insured Spouse's age and sex. If either or both of these are not correct, the
amount payable as a Death Benefit will be determined by first calculating the
Monthly Deduction on the basis of the Insured Spouse's age and sex as stated in
the application; then, using that Monthly Deduction, the amount payable as a
Death Benefit will be calculated as the amount of Death Benefit which requires
the same Monthly Deduction at the Insured Spouse's true age and sex.
5. SUICIDE: If the Insured Spouse commits suicide, while sane or insane, within
2 years from the effective date of this Agreement, the total liability shall be
the Cost of Insurance for this benefit.
6. BENEFICIARY: Any amount payable under this Agreement, upon the death of the
Insured Spouse will be paid:
CI-95-01-88
1
a) To the Beneficiary then designated for this benefit on our
records as named in the application or subsequently changed as
provided in the policy, if living;
b) Otherwise, to the Insured under this policy, if living;
c) But if neither of the above are living, to the estate of the
Insured Spouse.
7. CONVERSION: Insurance on the Insured Spouse under this Agreement may be
converted on or before the anniversary of this Agreement following the 65th
birthday of the Insured Spouse. The amount of insurance converted may be for
any amount up to but not more than the Insured Spouse's Amount of Benefit.
Conversion may be to any plan of insurance except term insurance, issued by
use at the time of conversion. Evidence of insurability shall not be required
upon conversion. All plans of insurance available on conversion are subject
to plan requirements. Supplemental Agreements providing benefits in event of
total disability or accidental death will be included in the new policy only
with our consent. The new policy will be issued on the basis of the rates in
effect at the time of the conversion.
8. VALUES: This Agreement has no cash or loan values.
9. REPRESENTATIONS AND CONTESTABILITY: All statements made in the application
for this Agreement by or on behalf of the Insured Spouse will, in the absence of
fraud, be deemed representations and not warranties. The validity of this
Agreement with respect to the Insured Spouse shall not be contestable after it
has been in force for 2 years during the lifetime of the Insured Spouse.
Any increase in coverage after the effective date of this Agreement shall be
incontestable only after such increase has been in force during the lifetime of
the Insured Spouse for two years from its effective date.
10. TERMINATION OF AGREEMENT: This Agreement terminates:
a) On the Monthly Deduction Day on or next following the date we
receive written request of the Owner and presentation of the
policy at the Home Office of the Company for endorsement;
b) Upon the termination date shown in the Policy Schedule (Page 1);
c) Upon termination of this policy; or
d) When this policy matures.
When coverage is scheduled to terminate on a given date, it will terminate at
12:00 midnight on that date.
This Agreement is effective on the Policy Date of Issue of this policy unless
another effective date is stated below.
Effective Date: _______________ COUNTRY INVESTORS LIFE ASSURANCE COMPANY
(if other than Policy Date of Issue) BLOOMINGTON, ILLINOIS
2
TABLE OF GUARANTEED
MAXIMUM INSURANCE RATES
MALE NON-TOBACCO RATE CLASSIFICATION
INSURED SPOUSE
MONTHLY COST OF INSURANCE
ATTAINED RATE PER
AGE $1000
------------------- -----------------
26 0.122500
27 0.120833
28 0.120000
29 0.120000
30 0.120833
31 0.123333
32 0.126667
33 0.131667
34 0.137500
35 0.144167
36 0.151667
37 0.161667
38 0.172500
39 0.184167
40 0.198333
41 0.213333
42 0.229167
43 0.246667
44 0.265833
45 0.287500
46 0.310833
47 0.335833
48 0.363333
49 0.393333
50 0.427500
51 0.466667
52 0.511667
53 0.563333
54 0.620833
55 0.685000
56 0.755000
57 0.829167
58 0.911667
59 1.004167
60 1.107500
61 1.222500
62 1.355000
63 1.505000
64 1.671667
65 1.854167
66 2.051667
67 2.263333
68 2.493333
69 2.748333
70 3.036667
71 3.365833
72 3.745833
73 4.175833
74 4.648333
75 5.153333
76 5.686667
77 6.244167
78 6.829167
79 7.460000
80 8.156667
81 8.937500
82 9.818333
83 10.795000
84 11.848333
85 12.954167
86 14.098333
87 15.263333
88 16.444167
89 17.657500
90 18.920833
91 20.263333
92 21.735000
93 23.479167
94 25.819167
CI-VUL-04
2B
