0000839759-17-000030 Sample Contracts

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Reinsurance Agreement I615296US-15
Reinsurance Agreement • March 17th, 2017 • Allstate Life of N Y Var Life Sep Acct A • New York
INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ADJUSTABLE LIFE INSURANCE POLICY
Individual Flexible Premium Variable Adjustable Life Insurance Policy • March 17th, 2017 • Allstate Life of N Y Var Life Sep Acct A

Insured: {John Doe} Payment Class: {Standard Non-Smoker} Issue Age: {35} Face Amount: {$100,000} Sex: {Male} Issue Date: {01/01/2016} Policy Number: {Specimen} Monthly Activity Day: {1st Day of the Month}

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