ENDORSEMENTS (Only we can endorse this contract.)Pruco Life Variable Insurance Account • April 30th, 1997
Insured Policy Number JOHN DOE XX XXX XXX Contract Date Face Amount NOV 15, 198 $25,000-- Premium Period Agency LIFE R-NK 1Pruco Life Variable Insurance Account • April 30th, 1997
WITNESSETH:Distribution Agreement • April 30th, 1997 • Pruco Life Variable Insurance Account • Arizona
Insured | Rider for Policy No. | JOHN DOE | XX XXX XXX |_____________________________________ |___________________________________ VARIABLE REDUCED PAID-UP INSURANCE This contract is no longer in force on a premium paying basis. It is being kept in...Pruco Life Variable Insurance Account • April 30th, 1997
WITNESSETH:Selected Broker Agreement • April 30th, 1997 • Pruco Life Variable Insurance Account • New Jersey
Rider attached to and made a part of this contract | | | Signed by the Company, | | | By /s/ ISABELLE L. KIRCHNER | ----------------------------- | Secretary | | | Date Attest |____________________________________________________Pruco Life Variable Insurance Account • April 30th, 1997
Rider attached to and made a part of this contract | | |Signed for the company, | | | By /s/ DOROTHY K. LIGHT | Secretary | | | Date Attest |____________________________________________________ II-215Pruco Life Variable Insurance Account • April 30th, 1997
Insured | Rider for Policy No. | | | John Doe | XX XXX XXX |_____________________________________ |___________________________________ This contract is issued as a conversion from an earlier contract. The period we state under Incontestability in this...Pruco Life Variable Insurance Account • April 30th, 1997
Insured | Rider for Policy No. | John Doe | XX XXX XXX |_____________________________________ |___________________________________Pruco Life Variable Insurance Account • April 30th, 1997
Insured | Rider for Policy No. | | |_____________________________________ |___________________________________ TERMINATION OF BENEFIT We agree that the benefit ______________________________________________________ ______________________, will end as...Pruco Life Variable Insurance Account • April 30th, 1997
RIDER ATTACHED TO AND MADE A PART OF THIS CONTRACT | | | PRUCO LIFE INSURANCE COMPANY, | | | By /s/ DOROTHY K. LIGHT | ----------------------------- | Secretary | | | Date Attest |____________________________________________________Pruco Life Variable Insurance Account • April 30th, 1997
Insured | Rider for Policy No. | | | John Doe | XX XXX XXX |_____________________________________ |__________________________________ This contract is issued as a conversion from an earlier contract. The period we state under Incontestability in this...Pruco Life Variable Insurance Account • April 30th, 1997
Insured | Rider for Policy No. | | |_____________________________________ |___________________________________ This contract was reinstated on the date of this rider. But we did not have the facts we needed to satisfy us that the child,...Pruco Life Variable Insurance Account • April 30th, 1997
3. [ ] Single [ ] Married [ ] Widowed [ ] Separated [ ] Divorced 4. Social Security No. / / -------------------------------------------------------------- --------------------------------------------------------------------- 5a. Occupation(s) 5b....Pruco Life Variable Insurance Account • April 30th, 1997
Submitted By ------------------------------------------------------------------ ----------------------------------------------------------------- ----------------------- -------------------- ------------------------------ ----------------------...Prudential - • April 30th, 1997 • Pruco Life Variable Insurance Account
EXHIBIT A(13)(u) (Continued from Preceding Page) MISCELLANEOUS PROVISIONS Beneficiary.--The word beneficiary where we use it in this contract without qualification means the beneficiary for insurance payable upon the death of the Insured. Unless we...Pruco Life Variable Insurance Account • April 30th, 1997
EXHIBIT A(10)(e) Prudential --------------------------------------------------- ------------------------------------------------------------------------------- - APPLICATION FOR LIFE INSURANCEPruco Life Variable Insurance Account • April 30th, 1997
Insured | Rider for Policy No. | | | John Doe | XX XXX XXX |_____________________________________ |___________________________________ This contract is issued as a conversion from an earlier contract. The period we state under Incontestability in this...Pruco Life Variable Insurance Account • April 30th, 1997
