WITNESSETH:Distribution Agreement • April 30th, 1997 • Pruco Life Variable Insurance Account • Arizona
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...Insurance Contract • April 30th, 1997 • Pruco Life Variable Insurance Account
Insured Policy Number JOHN DOE XX XXX XXX Contract Date Face Amount NOV 15, 198 $25,000-- Premium Period Agency LIFE R-NK 1Life Insurance Policy • April 30th, 1997 • Pruco Life Variable Insurance Account
WITNESSETH:Selected Broker Agreement • April 30th, 1997 • Pruco Life Variable Insurance Account • New Jersey
EXHIBIT A(5)(aa) (Only we can endorse this contract.) ALTERATION OF TEXT The provision of this policy entitled "Ownership and Control" is replaced at issue by the following: Ownership and Control.--Unless we endorse this contract to say otherwise,...Insurance Policy • April 30th, 1997 • Pruco Life Variable Insurance Account
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,...Rider for Policy • April 30th, 1997 • Pruco Life Variable Insurance Account
Rider attached to and made a part of this contract | | | Signed by the Company, | | | By /s/ ISABELLE L. KIRCHNER | ----------------------------- | Secretary | | | Date Attest |____________________________________________________Accidental Death Benefit Rider • April 30th, 1997 • Pruco Life Variable Insurance Account
Submitted By ------------------------------------------------------------------ ----------------------------------------------------------------- ----------------------- -------------------- ------------------------------ ----------------------...Application for Life Insurance • April 30th, 1997 • Pruco Life Variable Insurance Account
Insured | Rider for Policy No. | | |_____________________________________ |___________________________________ TERMINATION OF BENEFIT We agree that the benefit ______________________________________________________ ______________________, will end as...Rider Agreement • April 30th, 1997 • Pruco Life Variable Insurance Account
3. [ ] Single [ ] Married [ ] Widowed [ ] Separated [ ] Divorced 4. Social Security No. / / -------------------------------------------------------------- --------------------------------------------------------------------- 5a. Occupation(s) 5b....Life Insurance Application • April 30th, 1997 • Pruco Life Variable Insurance Account
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...Variable Reduced Paid-Up Insurance Agreement • April 30th, 1997 • Pruco Life Variable Insurance Account
RIDER ATTACHED TO AND MADE A PART OF THIS CONTRACT | | | PRUCO LIFE INSURANCE COMPANY, | | | By /s/ DOROTHY K. LIGHT | ----------------------------- | Secretary | | | Date Attest |____________________________________________________Reduced Paid-Up Insurance Agreement • 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...Insurance Contract • April 30th, 1997 • Pruco Life Variable Insurance Account
Insured | Rider for Policy No. | John Doe | XX XXX XXX |_____________________________________ |___________________________________Insured's Waiver of Premium Benefit • April 30th, 1997 • Pruco Life Variable Insurance Account
