CONTRACT INFORMATION First Insured [John Doe] Certificate Number [NV-12345678] Issue Age/Sex [65 ] [Male] Contract Date [January 1, 1999] Rating Class [Standard] [Non-Tobacco] Second Insured [Jane Doe] Initial Death Benefit [$60,252.00] Issue Age/Sex...Llac Variable Account • October 24th, 2001
Additional Agreements [Last Survivor Death Benefit Agreement] LIBERTY LIFE ASSURANCE COMPANY OF BOSTON LAST SURVIVOR This is a Joint and Last Survivor Benefit Agreement for the DEATH BENEFIT Certificate which summarizes changes in coverage under the AGREEMENT Group Contact. The provisions summarized herein modify those in Your Certificate of coverage. If this Agreement is attached to Your Certificate, coverage is extended to two Insureds. The Insured individuals are those shown on the Contract Information page of the Certificate. The Death Benefit under a Certificate is payable if the surviving Insured dies while coverage under the Group Contract is in force and before the Maturity Date. The surviving Insured is the Insured who is living upon the death of the other Insured under this Certificate. No Death Benefit is payable upon the death of the first Insured to die. DEFINITIONS The Attained Age is an Insured's age on his or her last birthday. THE BENEFIT In determining the Death Benef
