Exhibit 4
AB SURVIVOR FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE INSURANCE
POLICY
PLEASE READ YOUR POLICY CAREFULLY
This policy is a legal contract between the Owner (you, your) and Nationwide
Life Insurance Company (we, our, us, the Company).
INSURING AGREEMENT:
We issue this policy in consideration of your application and the payment of the
Initial Premium. We agree to pay the Death Proceeds to the Beneficiary upon
receiving proof that both Insureds have died while this policy is in force prior
to the Maturity Date. We agree to pay the Maturity Proceeds to you if either
Insured is living on the Maturity Date.
You and we are bound by the conditions and provisions of this policy.
The Cash Surrender Value of this policy will vary from day to day. It may
increase or decrease depending on the investment experience of the policy. Refer
to the Nonforfeiture Provisions on page 11 for details. There is no guaranteed
Cash Surrender Value.
The amount or duration of the death benefit will be variable and depend on the
investment experience of the policy. The death benefit will never be less than
the Specified Amount as long as your policy is in force. Refer to the Death
Benefit Provisions on page 9 for details.
RIGHT TO EXAMINE POLICY
You may return this policy to us within (1) 10 days after you get it, or (2) 45
days after you sign the application, or (3) 10 days after we mail or deliver the
Notice of Withdrawal Right, whichever is latest. The policy, with a written
request for cancellation, must be mailed or delivered to our Home Office or to
the agent who sold it to you. The returned policy will be treated as if we never
issued it, and we will pay you the amount specified by the laws of the state in
which the policy was issued.
If you have any questions about your policy or need additional insurance
service, contact your agent or write to our Home Office.
Signed at our Home Office on the Policy Date.
ABCDABCD
Secretary President
Adjustable Death Benefit
Flexible premiums payable during either Insured's lifetime until the Maturity
Date Death Proceeds payable at death
of both Insureds
Maturity Proceeds payable on the Maturity Date
Non-Participating
Not eligible for dividends
Investment experience reflected in benefits
NATIONWIDE LIFE INSURANCE COMPANY
Home Office: Xxx Xxxxxxxxxx Xxxxx X Xxxxxxxx, Xxxx 00000-2220
CONTENTS
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PROVISION PAGE
Annual Report.......................................................7
Assignment..........................................................8
Beneficiary.........................................................8
Cash Surrender Value................................................4
Cash Value.........................................................11
Death Benefit.......................................................9
Definitions.........................................................4
Error in Age or Sex.................................................6
Fixed Account......................................................16
Grace Period........................................................8
Incontestability....................................................6
Insureds............................................................4
Insuring Agreement..................................................1
Loan...............................................................14
Maturity Extension.................................................10
Monthly Cost of Insurance..........................................12
Nonforfeiture......................................................11
Optional Modes of Settlement.......................................17
Ownership...........................................................7
Policy Data Page....................................................3
Premium.............................................................8
Reinstatement.......................................................9
Suicide.............................................................6
Surrender..........................................................13
Termination.........................................................7
Transfers..........................................................17
Valuation of Assets................................................15
Variable Account...................................................16
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DEFINITIONS
ATTAINED AGE: For each Insured, Attained Age is the Issue Age plus the number of
full years since the Policy Date.
BENEFICIARY: The Beneficiary is the person to whom the Death Proceeds are paid.
The Beneficiary is named in the application, unless changed.
CASH SURRENDER VALUE: The Cash Surrender Value of your policy on any date is
equal to:
1. the Cash Value; minus
2. any Indebtedness; minus
3. any Surrender Charge.
CASH VALUE: Your policy's Cash Value is the sum of the associated values in any
Variable Account, the Fixed Account, and the Policy Loan Account. Refer to the
Nonforfeiture Provisions for details.
COMPANY: The Company is the Nationwide Life Insurance Company. "We," "our", and
"us" refer to the Company.
CONTINGENT BENEFICIARY: The Contingent Beneficiary will become the Beneficiary
if the named Beneficiary dies or is no longer in existence prior to the date
Death Proceeds become payable. The Contingent Beneficiary is named in the
application, unless changed.
CONTINGENT OWNER: The Contingent Owner will become the Owner if the named Owner
dies or ceases to be in existence prior to the date Death Proceeds become
payable. The Contingent Owner is named in the application, unless changed.
DEATH PROCEEDS: The Death Proceeds are the amount of money payable to the
Beneficiary if both Insureds die while your policy is in force prior to the
Maturity Date. Refer to the Death Benefit Provisions for details.
FIXED ACCOUNT: A Fixed Account is an investment option which is funded by the
General Account of the Company.
FUND: A Fund is the underlying mutual fund in which Subaccount assets are
invested. There is a Fund that corresponds to each Subaccount in a Variable
Account. The Funds are listed on the policy data page with the corresponding
Subaccounts.
GENERAL ACCOUNT: The General Account is made up of all of our assets other than
those held in any separate investment account.
HOME OFFICE: The Home Office of the Company is at Xxx Xxxxxxxxxx Xxxxx,
Xxxxxxxx, Xxxx.
INDEBTEDNESS: Indebtedness is any amount you owe us as a result of a policy
loan. Indebtedness consists of principal amount plus accrued interest.
INITIAL INVESTMENT DATE : The Initial Investment Date is the later of the Policy
Date or the date we receive the Initial Premium at our Home Office.
INITIAL PREMIUM : The Initial Premium is the premium required for coverage to
become effective on the Policy Date. It is shown on the policy data page.
INSUREDS: The Insureds are the persons whose lives are covered by this insurance
policy and are named in the application.
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ISSUE AGE: For each Insured, Issue Age is the Insured's age on the last birthday
on or before the Policy Date. It is shown on the policy data page.
MATURITY DATE : The Maturity Date is the Policy Anniversary on or next following
the younger Insured's 100th birthday, unless the Maturity Date is extended.
Refer to the Maturity Date Extension Provision for details.
MATURITY PROCEEDS: The Maturity Proceeds are the amount of money payable to you
on the Maturity Date if your policy is still in force. The Maturity Proceeds
will be equal to the amount of the Cash Value, less any Indebtedness.
MONTHLY ANNIVERSARY DAY: The Monthly Anniversary Day is the same day as the
Policy Date for each succeeding month.
NET AMOUNT AT RISK: The Net Amount at Risk on a Monthly Anniversary Day is the
death benefit minus the Cash Value, calculated prior to deduction of the base
policy cost of insurance charge. On any other day, the Net Amount at Risk is the
death benefit minus the Cash Value.
NET PREMIUM: The Net Premium is equal to the actual premium minus the percent of
premium charge. The percent of premium charge is shown on the policy data page.
The Company may at its sole discretion apply a lower percent of premium charge.
OWNER: The Owner has all rights under this policy and is named in the
application unless later changed and endorsed on this policy. "You" or "your"
refer to the Owner of this policy.
POLICY ANNIVERSARY: The Policy Anniversary is the same day and month as the
Policy Date for each succeeding year.
POLICY DATE: The Policy Date is the date the provisions of this policy take
effect. It is shown on the policy data page. Policy years and policy months are
measured from the Policy Date.
POLICY LOAN ACCOUNT: The Policy Loan Account is that portion of the Cash Value
which results from policy loans.
PROCEEDS: The Proceeds are the amount payable on the Maturity Date, on the
surrender of this policy prior to the Maturity Date, or on the death of both
Insureds while this policy is in force.
SEC: SEC is the United States Securities and Exchange Commission.
SPECIFIED AMOUNT: The Specified Amount is a dollar amount used to determine the
death benefit of your policy. It is shown on the policy data page.
SUBACCOUNT: A Subaccount is a part of a Variable Account. The assets in each
Subaccount are invested exclusively in a specified Fund. The Subaccounts are
listed on the policy data page.
SURRENDER CHARGE: If you lapse or surrender this policy, we deduct a Surrender
Charge from the Cash Value. The Surrender Charge varies by policy year as shown
in the Table of Surrender Charges on the policy data page.
VALUATION DAY: A Valuation Day is each day that the New York Stock Exchange is
open for trading.
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VALUATION PERIOD: A Valuation Period is the interval of time between a Valuation
Day and the next Valuation Day.
VARIABLE ACCOUNT: One or more Variable Accounts are named on the policy data
page. Each is a separate investment account of the Company.
GENERAL POLICY PROVISIONS
ENTIRE CONTRACT: The entire contract consists of this policy, any attached
riders or endorsements, and the attached copy of any written application,
including any written supplemental applications. No agent, registered
representative, or other person may change this policy or waive any of its
provisions. Any agreement to alter this policy must be in writing, signed by our
President or Secretary and attached to or endorsed on your policy. We will not
be bound by any promise or representations made by any agent or other persons.
APPLICATION: All statements made in an application are considered
representations and not warranties. In issuing this policy, we have relied on
the statements made in any application to be true and complete. No such
statement will be used to void the policy or to deny a claim unless that
statement is a material misrepresentation.
INCONTESTABILITY: We will not contest payment of the Death Proceeds based on the
initial Specified Amount after this policy has been in force during the lifetime
of both Insureds for 2 years from the Policy Date. For any increase in Specified
Amount requiring evidence of insurability, we will not contest payment of the
Death Proceeds based on such an increase after it has been in force during the
lifetime of both Insureds for 2 years from its effective date.
SUICIDE: If either Insured commits suicide, while sane or insane, within 2 years
from the Policy Date, we will not pay the Death Proceeds. Instead, we will pay
the Beneficiary an amount equal to all premiums paid, less any Indebtedness, and
less any partial surrenders.
For any increase in Specified Amount requiring evidence of insurability, if
either Insured commits suicide, while sane or insane, within 2 years from the
effective date of any such increase, we will not pay the Death Proceeds
associated with such an increase. Instead, our liability with respect to such an
increase will be limited to its cost of insurance charges.
ERROR IN AGE OR SEX: If the age or sex of either Insured has been misstated, the
death benefit and Cash Value will be adjusted. The adjusted death benefit will
be:
1. the Net Amount at Risk at the time of the second Insured's death;
multiplied by
2. the ratio of the monthly cost of insurance applied in the policy
month of the second Insured's death and the monthly cost of
insurance that should have been applied at the true ages and
sexes in the policy month of the second Insured's death; plus
3. the Cash Value at the time of the second Insured's death.
The Cash Value will be adjusted to reflect the cost of insurance charges based
on the correct age and sex from the Policy Date.
PAYMENT OF PROCEEDS: Unless an optional mode of settlement is elected, the Death
Proceeds will be paid in one sum to the Beneficiary. Unless an optional mode of
settlement is elected, any Proceeds payable on the Maturity Date or upon
surrender of this policy will be paid in one sum to you.
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POSTPONEMENT OF PAYMENTS: We will normally pay any amount payable on maturity,
surrender, partial surrenders or policy loan within seven days after we receive
your written request. We will normally pay any Death Proceeds within seven days
after we receive proofs of death for both Insureds and any other information we
may reasonably require to pay a claim.
However, such payments may be postponed if:
1. the New York Stock Exchange is closed; or
2. the SEC requires trading be restricted or declares an emergency; or
3. the SEC lets us defer payments for the protection of our policyowners;
or
4. policy values are being withdrawn from the Fixed Account.
EFFECTIVE DATE OF COVERAGE: The effective date of coverage of any person insured
under your policy is as follows:
1. the Policy Date is the effective date for all coverage provided in the
original application;
2. for any increase or addition to coverage, the effective date will be
the Monthly Anniversary Day on or next following the date we approve
the supplemental application; and
3. for any insurance that has been reinstated, the effective date is the
Monthly Anniversary Day on or next following the date we approve the
application for reinstatement.
TERMINATION: All coverage under your policy will terminate when any one of the
following events occurs:
1. we receive at our Home Office your written request that the coverage
terminate;
2. both Insureds die;
3. the policy matures;
4. the grace period ends; or
5. you surrender the policy for its Cash Surrender Value.
ANNUAL REPORT: We will send you a report at least once a year which shows the
current Cash Value, Cash Surrender Value, amount of insurance, premiums paid,
all charges since the last report and outstanding policy Indebtedness. The
report will also include any other information required by laws and regulations,
both federal and state. We will mail this report to you at your last known
address.
ILLUSTRATION OF BENEFITS AND VALUES: We will provide a projection of
illustrative future benefits and values under this policy at any time. Your
written request and payment of a service fee set by us at the time of the
request will be required.
NONPARTICIPATION: This is a nonparticipating policy on which no dividends are
payable. Your policy will not share in our profits or surplus earnings.
CURRENCY: Any money we pay, or that is paid to us, must be in United States
currency.
SIGNATURE GUARANTEE: For your protection, all written requests must be signed.
The Company may require the signature to be guaranteed by a member firm of the
New York, American, Boston, Midwest, Philadelphia, or Pacific Stock Exchange, or
by a commercial bank or a savings and loan, which is a member of the Federal
Deposit Insurance Corporation. In some cases, the Company may require additional
documentation of a customary nature.
OWNER, BENEFICIARY AND ASSIGNMENT PROVISIONS
OWNERSHIP: While either Insured is living, all rights in your policy belong to
you. Your rights in your policy belong to your estate if you die before both
Insureds die and there is no Contingent Owner.
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You may name a Contingent Owner or a new Owner at any time while either Insured
is living. If a new Owner is named, any earlier designation is automatically
revoked. Any change must be in a written form satisfactory to us and recorded at
our Home Office. Once recorded, the change will take effect as of the date you
signed it. It will not affect any payment made or any action taken by us before
it was recorded. We may require that you send us your policy for endorsement
before making a change.
BENEFICIARY: The Beneficiary and Contingent Beneficiary on the Policy Date are
named in the application. More than one Beneficiary or Contingent Beneficiary
may be named. If more than one Beneficiary is designated when the Death Benefit
becomes payable, payment to the survivors will made in equal shares, or in full
to the last survivor, unless some other distribution of proceeds is provided.
If any Beneficiary dies or ceases to exist before the Death Benefit becomes
payable, that Beneficiary's interest will be paid to any surviving Beneficiaries
or Contingent Beneficiaries according to their respective interests, unless you
have specified otherwise. If no Beneficiary is living or in existence when the
Death Benefit becomes payable, we will consider you or your estate to be the
Beneficiary.
While either Insured is living, you may change any Beneficiary or Contingent
Beneficiary. Any change must be in a written form satisfactory to us and
recorded at our Home Office. Once recorded, whether or not the Insured is then
alive, the change will take effect as of the date you signed it. It will not
affect any payment made or action taken by us before it was recorded. We may
require that you send us your policy for endorsement before making a change.
ASSIGNMENT: While either Insured is living, you may assign any or all rights
under your policy. We will not be bound by any assignment unless it is in a
written form acceptable to us and is recorded at our Home Office. An assignment
will not affect any payments made or actions taken by us before we record it. We
will not be responsible for the sufficiency or validity of any assignment.
The assignment will be subject to any Indebtedness owed to us before it was
recorded. The interest of any Beneficiary will be subject to the rights of any
assignee of record at our Home Office.
PREMIUM PROVISIONS
PREMIUM PAYMENTS: The Initial Premium is due on the Policy Date. It will be
credited on the Initial Investment Date. Any due and unpaid monthly deductions
will be subtracted from the Cash Value at this time. Insurance will not be
effective until the Initial Premium is paid. The Initial Premium is shown on the
policy data page.
Premiums, other than the Initial Premium, may be paid at any time while your
policy is in force subject to the limits described below. We will send planned
premium payment reminder notices to you. We will send them according to the
premium mode shown on the policy data page. You may pay the Initial Premium to
us at our Home Office or to an authorized agent. All premiums after the first
are payable at our Home Office. Premium receipts will be furnished upon request.
LIMITS: Each premium payment must be at least $50. Additional premium payments
may be made at any time while your policy is in force. However, we reserve the
right to require satisfactory evidence of insurability before accepting any
additional premium payment which results in any increase in the Net Amount at
Risk. Also, we will refund any portion of any premium payment which is
determined to be in excess of the premium limit established by law to qualify
your policy as a contract for life insurance.
GRACE PERIOD PROVISIONS
GRACE PERIOD: If the Cash Surrender Value on a Monthly Anniversary Day is not
sufficient to cover the current monthly deduction, and the premium payments
required under the Guaranteed Policy Continuation Provision have not been met, a
grace period will be allowed for the payment of a premium of the lesser of 3
times the current monthly deduction or the premium necessary to satisfy the
Guaranteed Policy Continuation Provision. We will send you a notice of your
lapse pending status when you enter the grace period, at your address in the
application or another address you specify, stating the amount of premium
required. The grace period will end 61 days after the
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day we mail you the notice. We will send an additional reminder notice at least
31 days prior to the end of the grace period. If you do not pay the required
amount by the end of the grace period, this policy will terminate without value.
If Death Proceeds become payable during the grace period, we will pay the Death
Proceeds.
GUARANTEED POLICY CONTINUATION PROVISION: During the Death Benefit Guarantee
Period, we will not lapse this policy if on each Monthly Anniversary Day (1) is
greater than or equal to (2) where:
1. is the sum of all premiums paid to date, including the Initial Premium,
minus any Indebtedness, and minus any partial surrender amounts; and
2. is the sum of the monthly death benefit guarantee premiums due since
the Policy Date including such premium for the current Monthly
Anniversary Day.
If (1) is not greater than or equal to (2) then the Guaranteed Policy
Continuation Provision is not in effect, and the Grace Period Provision will
apply. The monthly death benefit guarantee premiums and the Death Benefit
Guarantee Period are shown on the policy data page. The monthly death benefit
guarantee premiums may vary by policy duration and may be affected by changes to
the policy.
This policy has two levels of Guaranteed Policy Continuation guarantees, the
Initial Death Benefit Guarantee and the Limited Death Benefit Guarantee. Each
level of guarantee has its own minimum premium requirement. Each level of
premium and the period in which it applies is shown on the policy data page. The
Limited Death Benefit Guarantee will be permanently lost when premium payments
fall below those required to maintain this benefit unless sufficient premiums
are paid within a 61-day grace period.
REINSTATEMENT: If the grace period has ended and you have not paid the required
premium and have not surrendered your policy for its Cash Surrender Value, you
may reinstate your policy if you:
1. submit a written request at any time within 3 years after the end of
the grace period and prior to the Maturity Date;
2. provide evidence of insurability of both Insureds satisfactory to us;
3. pay sufficient premium to cover all monthly deductions that were due
and unpaid during the grace period;
4. pay sufficient premium to keep the policy in force for 3 months from
the date of reinstatement; and
5. repay or reinstate any Indebtedness against the policy which existed at
the end of the grace period.
The effective date of a reinstated policy will be the Monthly Anniversary Day on
or next following the date the application for reinstatement is approved by us.
If your policy is reinstated, the Cash Value on the date of reinstatement, but
prior to applying any premiums or loan repayments received, will be set equal to
the lesser of:
1. the Cash Value at the end of the grace period; or
2. the Surrender Charge for the policy year in which this policy is
reinstated.
Unless you have provided otherwise, all amounts will be allocated based on the
Fund allocation factors in effect at the start of the grace period.
DEATH BENEFIT PROVISIONS
DEATH BENEFIT: If both Insureds die while the policy is in force, your policy
will provide a death benefit. The death benefit will be determined in accordance
with one of the following options, whichever is in effect when Death Proceeds
become payable. The current option in effect is shown on the policy data page.
Option 1
The death benefit will be the greater of:
1. the Specified Amount on the date Death Proceeds become payable; or
2. the applicable percentage of the Cash Value on the date Death Proceeds
become payable.
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Option 2
The death benefit will be the greater of:
1. the Specified Amount plus the Cash Value on the date Death Proceeds
become payable; or
2. the applicable percentage of the Cash Value on the date Death Proceeds
become payable.
Option 3
The death benefit will be the greater of:
1. the Specified Amount plus the Accumulated Premium Amount on the date
Death Proceeds become payable; or
2. the applicable percentage of the Cash Value on the date Death Proceeds
become payable.
The Accumulated Premium Amount is all premium payments accumulated to the date
of death less any partial surrenders accumulated to the date of death. The
accumulations will be calculated based on the Option 3 interest rate shown on
the policy data page. In no event will the Accumulated Premium Account be less
than zero or greater than the Option 3 Maximum Increase shown on the policy data
page.
For any Death Benefit Option, the applicable percentages of Cash Value are shown
on the policy data page.
DEATH PROCEEDS: The actual amount of money payable to the Beneficiary if both
Insureds die while your policy is in force prior to the Maturity Date is called
the Death Proceeds. The Death Proceeds equals:
1. the death benefit provided by your policy; plus
2. any insurance that may be provided by riders to your policy; minus
3. any Indebtedness; minus
4. any due and unpaid monthly deductions accruing during a grace period.
We will pay the Death Proceeds to the Beneficiary after we receive at our Home
Office proofs of death for both Insureds satisfactory to us and such other
information as we may reasonably require. The Death Proceeds will be adjusted
under certain conditions. Refer to the Incontestability, Suicide, and Error in
Age or Sex Provisions.
MATURITY DATE EXTENSION: If an Insured is alive on the original Maturity Date of
the policy, you may extend the Maturity Date. Unless you elect otherwise, the
Maturity Date will be extended until the date that the second Insured dies and
the following will apply:
1. No premium payments will be allowed after the original Maturity
Date.
2. Increases to the Specified Amount will not be permitted after the
original Maturity Date.
3. Death Benefit Option Changes will not be permitted after the
original Maturity Date.
4. On the original Maturity Date, 100% of the Cash Value in the
Subaccounts will be transferred to the Fixed Account, which is
funded by the General Account of the Company, and transfers out of
the Fixed Account will not be permitted.
5. No further monthly deductions will be taken after the original
Maturity Date. The cost of insurance charges will be zero after the
original Maturity Date.
6. The Specified Amount for Maturity Date Extension will be equal to
the Specified Amount at the younger Insured's Attained Age 85, less
items (a) and (b) where:
(a) is any decrease to the Specified Amount after the younger
Insured's Attained Age 85; and
(b) is an adjustment for partial surrenders taken after the younger
Insured's Attained Age 85.
The amount of the adjustment varies based on the Death Benefit
Option and the younger Insured's Attained Age, and is defined within
the chart below.
Younger Insured's Attained Age
86-90 91 and Older
Death Benefit Option 1 Amount by which the Amount proportionate to
base policy Specified the ratio of the surrender
Amount is reduced due to the contract value prior
to the surrender. to the surrender.
Death Benefit Option 2 or 3 0 0
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DEATH BENEFIT OPTION CHANGES: After the first policy year, you may change the
Death Benefit Option under your policy. If the change is from Option 1 to Option
2, the Specified Amount will be decreased by the amount of the Cash Value. If
the change is from Option 2 to Option 1, the Specified Amount will be increased
by the amount of the Cash Value. If the change is from Option 3 to Option 1, the
Specified Amount will be increased by the Accumulated Premium Amount. If the
change is from Option 3 to Option 2, the Specified Amount will be adjusted by
the amount of the difference between Cash Value and the Accumulated Premium
Amount. If the Cash Value is greater than the Accumulated Premium Amount, this
will result in a decrease to the Specified Amount. If the Cash Value is less
than the Accumulated Premium Amount, the option change will result in an
increase to the Specified Amount. The effective date of change will be the
Monthly Anniversary Day on or next following the date we approve the request for
change. We will not allow Death Benefit Option changes from Option 1 to Option 3
or Option 2 to Option 3.
Only one change of Death Benefit Option is permitted in a policy year. We will
refuse a Death Benefit Option change which would reduce the Specified Amount to
a level where the total premiums already paid to date exceed the premium limit
established by law to qualify your policy as a contract for life insurance. In
order for a Death Benefit Option change to become effective, the Cash Surrender
Value, after the change, must be sufficient to keep the policy in force for at
least 3 months.
SPECIFIED AMOUNT INCREASES: At any time after the first policy year, you may
request an increase in the Specified Amount. Your request must be in writing to
our Home Office on our official forms. Any increase shall be subject to the
following conditions:
1. you provide evidence of insurability of both Insureds satisfactory to us;
2. the increase is for at least $10,000;
3. the Cash Surrender Value is sufficient to keep this policy in force for at
least 3 months; and
4. age limits are the same as for a new issue.
An approved increase will have an effective date of the Monthly Anniversary Day
on or next following the date we approve the supplemental application. We
reserve the right to limit the number of increases in Specified Amount to one
each policy year.
SPECIFIED AMOUNT DECREASES: At any time after the first policy year, you may
request a decrease in the Specified Amount. Any decrease will be effective on
the Monthly Anniversary Day on or next following our receipt of your request. We
will decrease insurance in the following order:
1. insurance provided by the most recent increase;
2. the next most recent increases successively; and
3. insurance provided under the original application.
We reserve the right to limit the number of decreases in the Specified Amount to
one each policy year. We will refuse a request for a decrease which would:
1. reduce the Specified Amount to less than the minimum issue amount, which
is shown on the policy data page; or
2. disqualify this policy as a contract for life insurance.
NONFORFEITURE PROVISIONS
CASH VALUE: The Cash Value of your policy is the sum of the Cash Value in each
Subaccount, the Fixed Account and the Policy Loan Account. The Cash Value in
each Subaccount on the Initial Investment Date is equal to the portion of the
Net Premium allocated to the Subaccount minus a pro-rata monthly deduction for
the month following the Policy Date.
The Cash Value in each Subaccount on each subsequent Valuation Day is equal to:
1. the Cash Value in the Subaccount on the preceding Valuation Day multiplied
by its net investment factor for the current Valuation Period; plus
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2. any Net Premiums or other amounts allocated to the Subaccount during the
current Valuation Period; plus
3. any amounts transferred to the Subaccount during the current Valuation
Period; minus
4. any amounts transferred from the Subaccount during the current Valuation
Period; minus
5. the portion of any monthly deductions which are due and charged to the
Subaccount during the current Valuation Period; minus
6. any partial surrender amounts allocated to the Subaccount during the
current Valuation Period.
The Cash Value in the Policy Loan Account is zero, unless you take a policy
loan. If you take a policy loan, then the Cash Value in the Policy Loan Account
on the loan date is equal to the amount of the loan. The loan amount is
transferred from a Variable Account in proportion to the Cash Value in each
Subaccount on the date of the loan. Loan amounts will be transferred from the
Fixed Account only when insufficient amounts are available in the Subaccounts.
The Cash Value in the Policy Loan Account on each subsequent Valuation Day is
equal to:
1. the Cash Value in the Policy Loan Account on the preceding Valuation Day;
plus
2. any interest credited to the Policy Loan Account during the current
Valuation Period; plus
3. any amounts transferred to the Policy Loan Account because of additional
policy loans and any due and unpaid loan interest during the current
Valuation Period; minus
4. the amount of any loan repayments you make during the current Valuation
Period; minus
5. any amount of interest transferred from the Policy Loan Account to a
Variable Account or the Fixed Account during the current Valuation Period.
The Cash Value in the Fixed Account is zero unless some or all of the Cash Value
is allocated to the Fixed Account. The Cash Value in the Fixed Account on the
Initial Investment Date is equal to the portion of the Net Premium allocated to
the Fixed Account minus a pro-rata monthly deduction for the month following the
Policy Date. The Cash Value in the Fixed Account on each subsequent Valuation
Day is equal to:
1. the Cash Value in the Fixed Account on the preceding Valuation Day; plus
2. any interest credited to the Fixed Account during the current Valuation
Period; plus
3. any Net Premiums or other amounts allocated to the Fixed Account during
the current Valuation Period; minus
4. any amounts transferred from the Fixed Account during the current
Valuation Period; minus
5. the portion of any monthly deductions which are due and charged to the
Fixed Account during the current Valuation Period; minus
6. any partial surrender amounts allocated to the Fixed Account during the
current Valuation Period.
MONTHLY DEDUCTION: The monthly deduction for each policy month shall be
calculated as:
1. the monthly cost of insurance; plus
2. the monthly cost of any additional benefits provided by riders; plus
3. the mortality and expense risk charges, which are shown on the policy data
page; plus
4. the monthly expense charges, which will not exceed the maximum monthly
policy expense charges shown on the policy data page.
The monthly deductions, other than the mortality and expense risk charge, will
be charged proportionately to the Cash Values in each Subaccount and the Fixed
Account, unless otherwise elected. The mortality and expense risk charge will be
charged proportionately to the Cash Values in each Subaccount only, unless
otherwise elected.
MONTHLY COST OF INSURANCE: A deduction will be made on the Policy Date and each
Monthly Anniversary Day for the monthly cost of insurance. This monthly
deduction will be charged proportionately to the Cash Values in each Subaccount
and the Fixed Account unless otherwise elected. The monthly cost of insurance
for each policy month is determined by multiplying the monthly cost of insurance
rate by the Net Amount at Risk. The monthly cost of insurance rate is described
under the Cost of Insurance Rates Provision.
If there have been increases in the Specified Amount, then the Cash Value shall
be first considered a part of the initial Specified Amount. If the Cash Value
exceeds the initial Specified Amount, it shall then be considered a part of the
increases in Specified Amounts in the order of the increases.
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COST OF INSURANCE RATES: A separate monthly cost of insurance rate is used to
obtain the monthly cost of insurance for the initial Specified Amount and each
increase in Specified Amount. Each rate is based on the Insured's ages, sexes,
underwriting classes, and any substandard ratings at the time the initial
Specified Amount was issued or increase took effect, and on the duration since
that time.
Monthly cost of insurance rates will be determined by us from time to time,
based on our expectations as to future experience. Any change in cost of
insurance rates will be on a uniform basis for Insureds of the same Issue Ages,
sexes, underwriting classes, and any substandard ratings whose policies have
been in force for the same length of time. These rates will never be greater
than the guaranteed maximum monthly cost of insurance rates shown on the policy
data page. The basis for these guaranteed maximum cost of insurance rates is
shown in the Basis of Computation on the policy data page.
INTEREST CREDITING: Any Cash Value allocated to the Policy Loan Account will be
credited interest daily, based on the policy loan interest crediting rate. The
guaranteed minimum annual effective rate is shown on the policy data page.
Interest in excess of the minimum guaranteed rate may be credited.
Any Cash Value allocated to the Fixed Account will be credited interest daily,
based on the Fixed Account interest crediting rate. The guaranteed minimum
annual effective rate is shown on the policy data page. Interest in excess of
the minimum guaranteed rate may be credited. The current interest rate in effect
at the time of transfer to the Fixed Account will be guaranteed through the end
of the calendar quarter in which such transfer was made. Thereafter, any excess
interest rates will be guaranteed for the following three months. Where
required, we have filed our method for determining current interest rates with
the Insurance Department of the state in which this policy was delivered.
MINIMUM LEGAL VALUES: The cash surrender, loan and other values in your policy
are at least as large as those set by law in the state where it is delivered.
Where required, we have given the insurance regulator a detailed statement of
how we compute values and benefits.
SURRENDER CHARGE: When this policy lapses or is surrendered, a surrender charge
is deducted from the Cash Value. Surrender charges are calculated separately for
the Initial Specified Amount and each increase in Specified Amount. The amount
and duration of the surrender charges for each segment of coverage are shown in
the Table of Surrender Charges on the policy data page.
CONTINUATION OF INSURANCE: If the premium payments are not made, insurance
coverage under this policy and any benefits provided by a rider will be
continued in force. Such coverage will be continued as provided in the Grace
Period Provision. This provision will not continue the policy beyond the
Maturity Date nor continue any rider beyond the date of its termination, as
provided in such rider.
COMPLETE SURRENDER: Your policy may be surrendered for its Cash Surrender Value
at any time while it is in force. You must submit a written request on a form
acceptable to us. We may also require the return of your policy. The date of
surrender will be the date we receive your written request at our Home Office.
The Cash Surrender Value will be determined as of the end of the Valuation
Period during which your request is received. All coverage will end on the date
of surrender.
PARTIAL SURRENDER: A partial surrender may be made at any time after the first
policy year while this policy is in force. You must submit a written request. We
may also require that this policy be sent to us. We reserve the right to limit
the number of partial surrenders in a policy year to one. In addition, a partial
surrender will be allowed only if after the partial surrender, this policy
continues to qualify as a contract for life insurance. We reserve the right to
deduct a fee from the partial surrender amount. The maximum fee is shown on the
policy data page.
When a partial surrender is made, we will reduce the Cash Value by the partial
surrender amount. We will also reduce the Specified Amount by the amount
necessary to prevent an increase in the Net Amount at Risk. Any such
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decrease will reduce insurance in the following order:
1. against the insurance provided by the most recent increase;
2. against the next most recent increase successively; and
3. against the insurance under the original application.
The amount of any partial surrender is subject to the following conditions:
1. the minimum amount of a partial surrender is $200;
2. during the first 10 policy years, the amount of a partial surrender cannot
exceed 10% of the Cash Surrender Value as of the beginning of the policy
year;
3. after the completion of 10 policy years, the maximum amount of a partial
surrender is the Cash Surrender Value less the greater of $500 or 3
monthly deductions; and
4. a partial surrender may not reduce the Specified Amount below the Minimum
Issue Amount, as shown on the policy data page.
In addition, the partial surrender will be allowed only if after the surrender
this policy continues to qualify as a contract for life insurance.
CHANGES IN POLICY COST FACTORS: Changes in cost of insurance rates, credited
interest rates, mortality and expense risk charges, percent of premium charges
or other policy expense charges will be by class and will be based on changes in
future expectations for factors such as:
1. investment earnings;
2. mortality;
3. persistency;
4. expenses; and
5. taxes
Any changes will be determined in accordance with the procedures on file, if
required, with the insurance regulator in the state in which this policy was
delivered.
LOAN PROVISIONS
POLICY LOAN: After the first policy year, you may request a loan at any time
while your policy is in force. The loan must be requested in writing on a form
acceptable to us. The amount of the loan and all existing loans may not be more
than the maximum loan value as of the loan date. The loan date is the date we
process the loan. The minimum loan amount is $200. The loan will be made upon
the sole security of the policy and proper assignment of your policy to us.
MAXIMUM LOAN VALUE: The maximum loan value is:
1. 90% of the Cash Value in any Subaccount of the Variable Account; plus
2. 100% of the Cash Value in the Fixed Account; plus
3. 100% of the Cash Value in the Policy Loan Account; minus
4. 100% of the Surrender Charge on the loan date.
LOAN INTEREST: The loan interest rate is shown on the policy data page. Interest
is charged daily and payable at the end of each policy year. Unpaid interest
will be added to the existing Indebtedness as of the due date and will be
charged interest at the same rate as the rest of the loan.
LOAN REPAYMENT: All or part of a loan may be repaid to us at any time while your
policy is in force during either Insured's lifetime. Any payment intended as a
loan repayment, rather than a premium payment, must be identified as such. Any
Indebtedness that exists at the end of the grace period may not be repaid unless
this policy is reinstated.
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EFFECT OF LOAN: When you take a loan, we will transfer an amount equal to the
policy loan from a Subaccount or the Fixed Account to the Policy Loan Account.
Any loan interest that becomes due and is unpaid will also be so transferred.
Amounts transferred to the Policy Loan Account will earn interest daily from the
date of transfer. When you repay part or all of a loan, we will transfer an
amount equal to the amount you repay from the Policy Loan Account to a
Subaccount or the Fixed Account. We reserve the right to require that any loan
repayments resulting from loans transferred from the Fixed Account must be
allocated to the Fixed Account.
Unless otherwise specified, transfers from the Subaccounts to the Policy Loan
Account will be in proportion to the Cash Value in each Subaccount as of the
loan date. Loan amounts will be transferred from the Fixed Account only when
insufficient amounts are available in the Subaccounts. Any loan interest which
becomes due and is unpaid will be transferred to the Policy Loan Account in
proportion to the Cash Values in each Subaccount and the Fixed Account. Unless
specified, loan repayments will be allocated among the Subaccounts using the
Fund allocation factors in effect on the date of the repayment subject to any
other restrictions the Company may impose.
Since the amount you borrow is removed from a Subaccount or the Fixed Account, a
loan will have a permanent effect on any death benefit and Cash Surrender Value
of this policy. The effect may be favorable or unfavorable. This is true whether
you repay the loan or not. If not repaid, Indebtedness will reduce the amount of
any Death Proceeds or Maturity Proceeds.
If the total Indebtedness ever equals or exceeds the Cash Value less the
Surrender Charge, your policy will terminate without value, as described in the
Grace Period Provision.
VALUATION OF ASSETS IN A VARIABLE ACCOUNT
DETERMINING INVESTMENT RESULTS: The Cash Value will change with a change in the
investment results of the Subaccounts. An index called an accumulation unit
value measures changes in a Subaccount's investment experience. Each Subaccount
has its own accumulation unit value.
For each Subaccount, the accumulation unit value was initially set at $10.00.
The accumulation unit value for a Subaccount in each subsequent Valuation Period
is equal to:
1. the Subaccount's accumulation unit value for the preceding Valuation
Period; multiplied by
2. the Subaccount's net investment factor for the subsequent Valuation
Period.
A net investment factor is defined below.
Because the net investment factor may be greater than or less than one, the
accumulation unit value may increase or decrease from one Valuation Period to
the next; however, the accumulation unit value remains constant throughout a
Valuation Period.
NET INVESTMENT FACTOR: The net investment factor for a Subaccount for a
Valuation Period is obtained by dividing (1) by (2) where:
1. is the net of:
(a) the net asset value per share of the Fund held in the Subaccount at
the end of the current Valuation Period;
plus
(b) the per share amount of any dividend and/or income distributions made
by the Fund held in the Subaccount if the dividend date or income
distribution occurs during the current Valuation Period; plus or minus
(c) a per share charge or credit for taxes reserved for, if any, which is
determined by the Company to have resulted from the investment
operations of the Subaccount.
2. is the net of:
(a) the net asset value per share of the Fund held in the Subaccount
determined as of the end of the immediately preceding Valuation
Period; plus or minus
(b) the per share charge or credit for taxes reserved for in the
immediately preceding Valuation Period.
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VARIABLE ACCOUNT PROVISIONS
VARIABLE ACCOUNT: A Variable Account is a separate investment account of the
Company. One or more are named on the policy data page. A Variable Account is
also subject to the laws of Ohio.
We own the assets of any Variable Account; we keep them separate from the assets
of our General Account. We maintain assets which are at least equal to the
reserves and other liabilities of a Variable Account. Such assets will not be
charged with liabilities that arise from any other business we conduct. We may
transfer to our General Account assets which exceed the reserves and other
liabilities of a Variable Account.
We will determine the value of the assets in a Variable Account at the end of
each Valuation Day.
SUBACCOUNTS: A Variable Account may have several Subaccounts. We list them on
the policy data page. You determine, using Fund allocation factors, how Net
Premiums will be allocated among the Subaccounts. You may choose to allocate
nothing to a particular Subaccount. But any allocation you make must be at least
1%; you may not choose a fractional percent. The sum of the Fund allocation
factors must equal 100%.
In states that require a full refund of premiums during the "Right to Examine
Policy" period, Net Premiums will be allocated to the Subaccount that invests in
a money market Fund or to the Fixed Account. At the end of this period, the Cash
Value in that Subaccount will be transferred to the Subaccounts according to
your chosen Fund allocation factors. Also, any subsequent Net Premiums will be
allocated according to your chosen factors. Fund allocation factors during and
immediately after the "Right to Examine Policy" period, are shown on the policy
data page. After the "Right to Examine Policy" period has expired, you may
transfer amounts among the Subaccounts. Transfers will take effect on the date
your written request is received at our Home Office, subject to any restrictions
imposed by a Fund.
You may change the allocation for future Net Premiums at any time while your
policy is in force. To do so, you must notify us in writing in a form that meets
our approval. The change will take effect on the date we receive your written
request at our Home Office.
Income and realized and unrealized gains and losses from assets in each
Subaccount are credited to, or charged against, the Subaccount. This is without
regard to income, gains, or losses in our other Subaccounts, separate investment
accounts, or our General Account.
CHANGES OF FUND: A Fund might, in our judgment, become unsuitable for investment
by a Subaccount. This might happen because of a change in investment policy, a
change in the laws or regulations, the shares are no longer available for
investment, or for some other reason. If that occurs, we have the right to
substitute another Fund. But we would first notify you and seek approval from
the SEC and the Superintendent of Insurance of the State of Ohio. We would also
get any other required approvals.
OTHER CHANGES: To the extent permitted by applicable laws and regulations
(including any order of the SEC), we may make changes as follows:
1. A Variable Account may be operated as a management company under the
Investment Company Act of 1940, or in any other form permitted by law, if
we deem it to be in the best interest of the policyowners.
2. A Variable Account may be deregistered under the Investment Company Act of
1940 in the event registration is no longer required.
3. A Variable Account may be combined with other separate investment
accounts.
4. The provisions of this and other policies may be modified to comply with
any other applicable federal or state laws.
In the event of such changes, we may make appropriate endorsement on this and
other policies having an interest in a Variable Account and take other actions
as may be necessary to effect such a change.
FIXED ACCOUNT PROVISIONS
FIXED ACCOUNT: The Fixed Account is funded by the General Account of the
Company. The Fixed Account is credited with interest as described under the
Nonforfeiture Provisions. In addition to allocating your Net Premiums
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to one or more of the Subaccounts described above, you may direct all or part of
your Net Premiums into the Fixed Account.
RIGHT TO TRANSFER: You may annually transfer a portion of the Cash Value between
the Fixed Account and the Subaccounts without penalty or adjustment. We reserve
the right to limit the amount of Cash Value transferred out of the Fixed Account
each policy year. Transfers from the Fixed Account must be made within 30 days
following the termination date of the Interest Rate Guaranteed Period.
You may request a transfer of up to 100% of the Cash Value from the Subaccounts
to the Fixed Account. Transfers to the Fixed Account may not be made prior to
the first Policy Anniversary or within 12 months of any prior transfer. The Cash
Value in each Subaccount will be determined as of the date the transfer request
is received in our Home Office in good order. We reserve the right to restrict
transfers to the Fixed Account to 25% of the Cash Value.
RIGHT OF CONVERSION: At any time upon written request within 24 months of the
Policy Date, you may elect to transfer all Subaccount Cash Values to the Fixed
Account. No transfer charge will be assessed.
OPTIONAL MODES OF SETTLEMENT PROVISIONS
Proceeds may be paid in a lump sum. Optional modes of settlement are also
available. After the Proceeds are applied under such optional modes, any amounts
payable are paid from our General Account and will not be affected by the
investment experience of any separate investment account.
One or a combination of settlement options may be chosen. A settlement option
may be chosen only if the total amount placed under the option is at least
$2,000.00 and each payment is at least $20.00.
A settlement option election may be changed at any time by proper written
request to our Home Office. Once recorded, it will become effective on the date
it was requested. We may require proof of the age and sex of any person to be
paid under a settlement option. While this policy is in force, you may choose or
change settlement options at any time. If no settlement option has been chosen
prior to the date the Death Proceeds become payable, the Beneficiary may choose
one. A change of Beneficiary automatically revokes any option in effect.
When Proceeds become payable under any option, a settlement contract is issued
in exchange for this policy. The new contract's effective date is the date Death
Proceeds become payable or the date this policy is surrendered.
Settlement option payments are not assignable. To the extent allowed by law,
settlement option payments are not subject to the claims of creditors or to
legal process.
Under Options 2, 3, 4, and 5, payments will be made at the beginning of each 12,
6, 3, or 1 month interval beginning on the effective date of the settlement
contract. Under Options 1 and 6, payments will be made at the end of every 12,
6, 3, or 1 month interval from the effective date of the settlement contract.
Under Options 1, 2, and 4, withdrawal of any outstanding balance may be made by
written request to our Home Office. No amount left with us under Options 3, 5,
or 6 may be withdrawn.
Options 1, 2, 4, and the guaranteed period of Option 3, provide for payment of
interest at a guaranteed minimum interest rate of 2.5% per year, compounded
annually. Any interest to be paid in excess of this rate will be determined once
a year.
1. INTEREST INCOME: The Proceeds remain with us to earn interest. This interest
may be left to accumulate or be paid periodically as stated above.
2. INCOME FOR A FIXED PERIOD: Proceeds remaining with us will be paid over a
specified number of years (not exceeding 30 years). Each payment consists of a
portion of the Proceeds plus a portion of the interest credited on the
outstanding balance. The amount payable monthly for each $1,000 left with us
will be at least the amount shown in the Option 2 Table, located on the policy
data page.
3. LIFE INCOME WITH PAYMENTS GUARANTEED: Payments are made for a guaranteed
period of 10, 15, or 20 years, and thereafter for the remainder of a payee's
lifetime. The amount payable monthly for each $1,000 left
17
with us will be at least the amount shown in the Option 3 Table (located on the
policy data page), according to the payee's sex and age on the effective date of
the option.
4. FIXED INCOME FOR VARYING PERIODS: The Proceeds may be left on deposit with us
at interest with payments of a fixed amount being paid at specified intervals
until principal and interest have been exhausted. The last payment will be for
the balance only. The total amount payable each year may not be less than 5% of
the original proceeds. (i.e., not less than $50 per annum of each $1,000 of
original proceeds.)
5. JOINT AND SURVIVOR LIFE INCOME: Equal payments will be made for the longer of
the lives of two named payees. In other words, when one payee dies, the same
payment continues to be paid for the remainder of the surviving payee's life. We
will furnish values for other age combinations (than those shown in Option 5
Table-located on the policy data page) upon request.
6. ALTERNATE LIFE INCOME: We will use the Proceeds to purchase an annuity. The
amount payable will be 102% of our current individual immediate annuity purchase
rate on the effective date of the settlement contract. We reserve the right to
change our current annuity rates at any time. However, once this option has been
selected and the settlement contract issued, any revision in rates will not
affect payment to a payee or payees. Upon request, we will quote the amount
currently payable under this settlement option.
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NATIONWIDE LIFE INSURANCE COMPANY
ENDORSEMENTS (Endorsements may be made only by the Company at the Home Office)
ABCD
LAST SURVIVOR FLEXIBLE PREMIUM VARIABLE UNIVERSAL
LIFE INSURANCE POLICY
Adjustable Death Benefit
Flexible premiums payable during either Insured's lifetime until the Maturity
Date Death Proceeds payable at death
of both Insureds
Maturity Proceeds payable on the Maturity Date
Non-Participating
Not eligible for dividends
Investment experience reflected in benefits
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