EXHIBIT (4)(a)
[LOGO OF PACIFIC LIFE]
Pacific Life Insurance Company.700 Xxxxxxx Xxxxxx Xxxxx.Xxxxxxx Xxxxx, XX 00000
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READ YOUR POLICY CAREFULLY. This is a legal contract between you, the Owner, and
us, Pacific Life Insurance Company, a stock insurance company. We agree to pay
the benefits of this policy according to its provisions. The consideration for
this policy is the application for it, a copy of which is attached, and payment
of the premiums.
PREMIUMS ARE FLEXIBLE, SUBJECT TO MINIMUMS REQUIRED TO KEEP THE POLICY IN FORCE.
VARIABLE ACCOUNT VALUES ARE NOT GUARANTEED, AND MAY INCREASE OR DECREASE
DEPENDING UPON VARIABLE ACCOUNT INVESTMENT EXPERIENCE. POLICY LOAN VALUE IS LESS
THAN ONE HUNDRED PERCENT (100%) OF THE POLICY'S CASH SURRENDER VALUE.
THE METHOD FOR DETERMINING THE DEATH BENEFIT IS DESCRIBED IN THE DEATH BENEFIT
SECTION OF THIS POLICY. THE AMOUNT OF THE DEATH BENEFIT MAY BE FIXED OR VARIABLE
ACCORDING TO THE DEATH BENEFIT OPTION SELECTED AND MAY INCREASE OR DECREASE. THE
DURATION THIS POLICY REMAINS IN FORCE MAY VARY, DEPENDING ON THE PREMIUMS PAID
AND THE INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNTS.
FREE LOOK RIGHT - You may return this policy within 10 days after you receive
it. To do so, deliver or mail it to us or to our agent. This policy will then be
deemed void from the beginning and we will refund:
.. any Premium Load deducted from premiums received; plus
.. any Net Premium allocated to the Fixed Options; plus
.. the Variable Accumulated Value as of the end of the Valuation Period when we
receive the policy; plus
.. any policy charges and fees deducted from the Variable Accounts.
Signed for Pacific Life Insurance Company,
/s/ XXXXXX X. XXXXXX /s/ XXXXXX X. MILFS
Chairman and Chief Executive Officer Secretary
FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE
.. Death Benefit Payable On The Death Of The Insured While The Policy Is In Force
.. Net Cash Surrender Value Payable Upon Surrender While The Policy Is In Force
.. Adjustable Face Amount
.. Benefits May Vary Based On Investment Experience
.. Non-Participating
POLICY NUMBER: VP99999990 OWNER: XXXXXX XXXXXXXX
POLICY DATE: JAN 10, 1998 INSURED: XXXXXX XXXXXXXX
RISK CLASS: MALE NONSMOKER AGE ON POLICY DATE: 35
INITIAL FACE AMOUNT: $100,000
NOTE: IT IS POSSIBLE THAT COVERAGE WILL LAPSE IF THE ACCUMULATED VALUE IS
INSUFFICIENT TO PAY THE CHARGES ASSESSED ON A MONTHLY PAYMENT DATE. BECAUSE
THE ACCUMULATED VALUE MAY BE BASED ON THE INVESTMENT RESULTS OF THE VARIABLE
ACCOUNTS, THE PAYMENT OF INITIAL AND PLANNED PREMIUMS MAY NOT BE ADEQUATE TO
GUARANTEE THAT THE POLICY WILL REMAIN IN FORCE. IF THE POLICY DOES NOT REMAIN
IN FORCE, THERE WILL BE NO DEATH BENEFIT OR ACCUMULATED VALUE.
POLICY NUMBER: VP999999990
POLICY SPECIFICATIONS
BASIC POLICY: FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE
PREMIUMS: PLANNED PERIODIC PREMIUM PAYMENT = $ X,XXX.XX
GUIDELINE SINGLE PREMIUM = $ XX,XXX.XX
GUIDELINE LEVEL PREMIUM = $ X,XXX.XX
DEATH BENEFIT QUALIFICATION TEST: GUIDELINE PREMIUM TEST
(THIS ELECTION IS IRREVOCABLE FOR THE LIFE OF THE CONTRACT)
DEATH BENEFIT OPTION: A
INTEREST ON EACH FIXED OPTION IS GUARANTEED TO BE NOT LESS THAN 3.00% ANNUALLY.
IN ADDITION, ANY EXCESS INTEREST DECLARED BY US WILL BE GUARANTEED FOR ONE YEAR.
PREMIUM LOAD: SEE POLICY CHARGE SPECIFICATIONS PAGE
ADMINISTRATIVE CHARGE: $10.00 PER MONTH
M&E RISK CHARGE RATE: SEE POLICY CHARGE SPECIFICATIONS PAGE
POLICY NUMBER: VP99999990 OWNER: XXXXXX XXXXXXXX
POLICY DATE: JAN 10, 1998 INSURED: XXXXXX XXXXXXXX
RISK CLASS: MALE NONSMOKER AGE ON POLICY DATE: 35
INITIAL FACE AMOUNT: $100,000
NOTE: IT IS POSSIBLE THAT COVERAGE WILL LAPSE IF THE ACCUMULATED VALUE IS
INSUFFICIENT TO PAY THE CHARGES ASSESSED ON A MONTHLY PAYMENT DATE. BECAUSE THE
ACCUMULATED VALUE MAY BE BASED ON THE INVESTMENT RESULTS OF THE VARIABLE
ACCOUNTS, THE PAYMENT OF INITIAL AND PLANNED PREMIUMS MAY NOT BE ADEQUATE TO
GUARANTEE THAT THE POLICY WILL REMAIN IN FORCE. IF THE POLICY DOES NOT REMAIN IN
FORCE, THERE WILL BE NO DEATH BENEFIT OR ACCUMULATED VALUE.
PAGE 3.0
POLICY NUMBER: VP999999990
SUMMARY OF COVERAGES EFFECTIVE ON THE POLICY DATE
BASIC COVERAGE
FACE AMOUNT: $100,000
AGE ON POLICY DATE: 35
RISK CLASSIFICATION: MALE NONSMOKER
COVERED PERSON: XXXXXX XXXXXXXX
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Page 3.1
POLICY NUMBER: VP999999990
POLICY CHARGE SPECIFICATIONS PAGE
PREMIUM LOAD:
POLICY YEAR PREMIUM LOAD RATE
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1 (FOR THE FIRST $XX,XXX OF PREMIUM PAID) 5.25%
1 (FOR ANY PREMIUM PAID IN EXCESS OF $XX,XXX) 14.85%
2 11.85%
3 17.85%
4 TO 5 19.85%
6 TO 10 10.85%
11 AND LATER 3.85%
M&E RISK CHARGE RATE: 0.000625 (0.75% ANNUALLY) IN THE FIRST 10 POLICY YEARS;
0.000375 (0.45% ANNUALLY) IN YEARS 11-20;
THEN .0.00009167 (0.11% ANNUALLY) THEREAFTER.
Page 3.2
POLICY NUMBER: VP999999990
TABLE OF INSURANCE CHARGES - BASIC POLICY
GUARANTEED MAXIMUM MONTHLY COST OF INSURANCE RATES PER $1000 OF COVERAGE
APPLICABLE TO XXXXXX XXXXXXXX.
MONTHLY MONTHLY MONTHLY
AGE RATE AGE RATE AGE RATE
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35 0.17600 60 1.34998 85 13.73773
36 0.18686 61 1.47355 86 15.02185
37 0.20022 62 1.61341 87 16.35661
38 0.21526 63 1.77217 88 17.73798
39 0.23280 64 1.94909 89 19.17199
40 0.25202 65 2.14342 90 20.67766
41 0.27458 66 2.35100 91 22.28714
42 0.29715 67 2.57276 92 24.06347
43 0.32307 68 2.80882 93 26.11993
44 0.34984 69 3.06532 94 28.81300
45 0.37996 70 3.35367 95 32.81758
46 0.41093 71 3.68199 96 39.64295
47 0.44442 72 4.06029 97 53.06605
48 0.47960 73 4.49620 98+ 83.33300
49 0.51898 74 4.98352
50 0.56089 75 5.51331
51 0.61038 76 6.07653
52 0.66577 77 6.66569
53 0.72875 78 7.27588
54 0.80018 79 7.92387
55 0.87672 80 8.63521
56 0.96005 81 9.43078
57 1.04684 82 10.33895
58 1.13962 83 11.37350
59 1.23925 84 12.51385
Page 4.0
DEFINITIONS
In this section, we define certain terms used throughout this policy. Other
terms may be defined in other parts of the policy. Defined terms are usually
capitalized for emphasis.
Age - means the Insured's Age to the nearest birthday as of the Policy Date,
increased by the number of complete policy years elapsed.
Code - is the U.S. Internal Revenue Code, as amended, and the rules and
regulations issued thereunder.
Evidence of Insurability - is information, including medical information,
satisfactory to us that is used to determine insurability and the Insured's risk
class.
Face Amount - is used in determining the death benefit under this policy,
including any increases or decreases. The Face Amount is shown in the Policy
Specifications.
Fixed Options - consist of the Fixed Account and the Fixed LT Account, which are
part of our general account.
Home Office - means our Life Insurance Operations Center
Insured - is the person insured under this policy. The Insured is shown in the
Policy Specifications as the Covered Person.
Investment Options - consist of the Variable Accounts and the Fixed Options.
Monthly Payment Date - is the day each month on which certain policy charges are
deducted from the Accumulated Value. This first Monthly Payment Date is the
Policy Date. Later Monthly Payment Dates occur each month after the Policy Date
on the same day of the month as the Policy Date.
Net Premium - is the premium we receive reduced by any Premium Load.
PL, the Company, we, our, ours and us - refer to Pacific Life Insurance Company.
Policy Date - is shown on page 3. Policy months, quarters, years and
anniversaries are measured from this date.
Policy Debt - is the sum of outstanding policy loans plus accrued Loan Interest.
Policy Specifications -is a section of your policy containing information
generally unique to your policy.
Separate Account -is the Pacific Select Exec Separate Account, which is a
separate account of ours that consists of subaccounts, also called Variable
Accounts. Each Variable Account may invest its assets in a separate class of
shares of a designated investment company or companies.
Valuation Date - is each day required by applicable law and currently includes
each day the New York Stock Exchange is open for trading and our Home Office is
open. If any transaction or event is scheduled to occur on a day that is not a
Valuation Date, such transaction or event will be deemed to occur on the next
following Valuation Date unless otherwise specified.
Valuation Period - is the period of time between successive Valuation Dates.
Variable Account - is a subaccount of a separate account of ours in which assets
are segregated from assets in our general account and from assets in other
subaccounts. Premiums and Accumulated Value under this policy may be allocated
to a Variable Account for variable accumulation.
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Written Request - is a request in writing, signed by you, and received by us at
our Home Office, containing such information that we need to act on the request.
You, your or Owner - refer to the Owner of this policy.
OWNER AND BENEFICIARY
Owner - The Owner of this policy is as shown in the Policy Specifications or in
a later Written Request. If you change the Owner, the change is effective on the
date the Written Request is signed, subject to our receipt of it. If there are
two or more Owners, they will own this contract as joint tenants with right of
survivorship.
Assignment - You may assign this policy by Written Request, subject to the
following. An assignment will take place only when recorded at our Home Office.
When recorded, the assignment will take effect as of the date the Written
Request was signed. Any rights created by the assignment will be subject to any
payments made or actions taken by us before we record the change. We will not be
responsible for the validity of any assignment.
Beneficiary - The beneficiary is named by you in the application to receive the
death benefit proceeds. The beneficiary may be one or more persons. If the
beneficiary is more than one person, they will share the death benefit proceeds
equally or as you may otherwise specify by Written Request. The interest of any
beneficiary will be subject to any assignment. If you have named a contingent
beneficiary, that person becomes the beneficiary if the beneficiary dies before
the Insured. A beneficiary may not, at or after the Insured's death, assign,
transfer or encumber any benefit payable. To the extent allowed by law, policy
benefits will not be subject to the claims of any creditor of any beneficiary.
You may make a change of beneficiary by Written Request on a form provided by us
while the Insured is living. The change will take place as of the date the
request is signed. Any rights created by the change will be subject to any
payments made or actions taken by us before the Written Request is received. You
may designate a permanent beneficiary whose rights under the policy cannot be
changed without his or her consent.
The interest of a beneficiary who does not survive to receive payment will pass
to the surviving beneficiaries in proportion to their share in the proceeds,
unless otherwise provided. If no beneficiaries survive to receive payment, the
death proceeds will pass to the Owner, or the Owner's estate if the Owner does
not survive to receive payment.
PREMIUMS
Premiums - This policy will not be in force until the initial premium is paid.
The initial premium is payable either at our Home Office or to our agent.
Additional premiums, if any, are payable in advance at our Home Office. At your
request, a premium receipt signed by one of our officers will be given to you.
No premium may be less than $50. Premiums may be paid at any time, subject to
the premium limitations shown later in this section.
Planned Premium - is the amount of premium you plan to pay. It is shown in the
Policy Specifications and may be changed by Written Request. Payment of the
Planned Premium does not guarantee that the policy will continue in force.
Premium Allocation - Allocation of the initial Net Premium will be done on the
issue date or, if later, the date the premium is received and accepted by us.
Any Net Premiums received before your policy has been placed in force, due to
the presence of outstanding requirements, will be allocated to the Money Market
Variable Account until the requirements are satisfied. At such time, the
Accumulated Value in the
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Money Market Variable Account will be transferred to the Investment Options
according to the premium allocation specified in the application or your most
recent allocation instructions received by us, if any. Net Premiums received
after your policy has been placed in force will be allocated to the Investment
Options according to the premium allocation specified in the application or your
most recent allocation instructions received by us, if any. Upon Written
Request, you may change the premium allocation. Subsequently, Net Premiums will
be allocated to the Investment Options according to your most recent allocation
instructions.
Premium Limitation - We will not accept premiums after the Insured's Age 100,
although you may make a loan repayment at any time. We reserve the right to
require Evidence of Insurability, satisfactory to us, for any unscheduled
premium payment that would result in an immediate increase in the difference
between the death benefit and the Accumulated Value.
Guideline Premium Limitation - This subsection applies only if you have elected
the Guideline Premium Test as the Death Benefit Qualification Test. In order for
this policy to be treated as life insurance under the Code, the sum of the
premiums paid less a portion of any withdrawals, as defined in the Code, may not
exceed the greater of:
.. The Guideline Single Premium; or
.. The sum of the annual Guideline Level Premiums to the date of payment.
The Guideline Premiums are shown in the Policy Specifications. The Guideline
Premiums may change whenever there is a change in the Face Amount of insurance
or in other policy benefits. Any such Guideline Premium change will be shown in
a supplemental schedule that we will send to you at the time of the change.
The Guideline Premiums are determined by the rules, which apply to this policy
as set forth in the Code. The Guideline Premiums will be adjusted to conform to
any changes in the Code. In the event that a premium payment would exceed such
revised limits, we reserve the right to refund the excess payment to you,
provided that we may not refuse any premium payment necessary to keep this
policy in force. Further, we reserve the right to make distributions from the
policy to the extent we deem it necessary to continue to qualify this policy as
life insurance under the Code.
DEATH BENEFIT
Death Benefit - This policy provides a death benefit on the death of the Insured
while this policy is in force. This section describes how the death benefit is
calculated. On the date of death, the death benefit is the larger of:
.. The death benefit as calculated under the Death Benefit Option in effect; or
.. The Minimum Death Benefit calculated under the Death Benefit Qualification
Test elected.
Death Benefit Options - You have elected the Death Benefit Option in the
application. The Death Benefit Option for this policy appears in the Policy
Specifications. The Death Benefit Options are explained below.
.. Option A - The death benefit equals the Face Amount.
.. Option B - The death benefit equals the Face Amount plus the Accumulated Value
at death.
.. Option C - The death benefit equals the Face Amount plus the sum of the
premiums paid minus the sum of any withdrawals taken and any other
distribution of the Accumulated Value to the date of death. If the sum of the
withdrawals is greater than the sum of the premiums paid, then the death
benefit will be less than the Face Amount.
Change of Death Benefit Option - The Death Benefit Option may be changed to
Option A or B upon Written Request at a maximum of once per year. Changes to
Option C are not permitted. After any such
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change, the Face Amount will be that amount which results in the death benefit
after the change being equal to the death benefit before the change. The change
will be effective on the Monthly Payment Date on or next following the day we
receive your Written Request at our Home Office.
Death Benefit Qualification Test - In order for your policy to be classified as
life insurance under the Code, it must satisfy one of two Death Benefit
Qualification Tests. Unless you have elected otherwise, the Death Benefit
Qualification Test for this policy is the Guideline Premium Test. The Death
Benefit Qualification Test for this policy appears in the Policy Specifications.
It may not be changed for the life of the contract. The two Death Benefit
Qualification Tests are explained in this subsection.
1. Cash Value Accumulation Test (CVAT) - The Minimum Death Benefit will be the
amount required for this policy to be deemed "life insurance" according to
the Code, but not less than 101% of the Accumulated Value.
2. Guideline Premium Test (GPT) - The Minimum Death Benefit at any time is the
Accumulated Value multiplied by the death benefit percentage for the Age of
the Insured as shown in the following table.
Death Benefit Death Benefit Death Benefit Death Benefit
Age Percentage Age Percentage Age Percentage Age Percentage
0-40 250% 50 185% 60 130% 70 115%
41 243 51 178 61 128 71 113
42 236 52 171 62 126 72 111
43 229 53 164 63 124 73 109
44 222 54 157 64 122 74 107
45 215 55 150 65 120 75-90 105
46 209 56 146 66 119 91 104
47 203 57 142 67 118 92 103
48 197 58 138 68 117 93 102
49 191 59 134 69 116 Over 93 101
Death Benefit Proceeds - The death benefit proceeds are the actual amount
payable if the Insured dies while this policy is in force. The death benefit
proceeds are equal to the death benefit, as of the date of the Insured's death,
less any Policy Debt and less any due and unpaid monthly deductions occurring
during a grace period.
We will pay the death benefit proceeds to the beneficiary within 2 months after
we receive, at our Home Office, due proof of the Insured's death (certified
copies of the death certificate or, if unavailable, other legal documentation
which we accept) and information sufficient to identify the beneficiary. The
death benefit proceeds paid are subject to the conditions and adjustments
defined in other policy provisions, such as General Provisions, Withdrawals,
Policy Loans, and Timing of Payments and Transfers. We will pay interest on
Death Benefit Proceeds from the date of death to the date payment is made at a
rate of interest not less than the guaranteed interest rate used for the Fixed
Account under this policy. If state law requires payment of a greater amount of
interest, we will pay that amount.
Face Amount Decrease - Starting on the fifth policy anniversary, you may make a
request to decrease the Face Amount by an amount not less than the minimum we
allow at such time. The Face Amount may not be decreased to less than $12,000.
The effective date of the decreased Face Amount will be the first Monthly
Payment Date on or following the date we receive your Written Request. We
recommend you consult your tax advisor before requesting a decrease in policy
Face Amount. Upon approval of any unscheduled decrease, we will send you a
supplemental schedule of coverage, which will include the decreased Face Amount
and the effective date of the decrease.
The request for a decrease in the Face Amount will be subject to the Guideline
Premium Limit as defined in the Code. This may result in a refund of premiums
and/or the distribution of Accumulated Value in order to maintain compliance
with such limit. Such request will not be allowed if the resulting Guideline
Page 8
Premium limit could cause an amount in excess of the Net Cash Surrender Value to
be distributed from the policy.
Change in Benefits - Under the Guideline Premium Test, any change in policy or
rider benefits will require an adjustment to the Guideline Premium Limit. See
the Tax Qualification as Life Insurance subsection of the General Provisions
section for details.
ACCUMULATED VALUE
Accumulated Value - is defined on each Valuation Date and is the sum of the
Fixed Accumulated Value plus the Variable Accumulated Value plus the Loan
Account.
Fixed Accumulated Value - The Fixed Accumulated Value is the sum of the
Accumulated Value in each Fixed Option. The Fixed Options consist of the Fixed
Account and the Fixed LT Account.
This subsection describes how we calculate the Accumulated Value in each Fixed
Option. We credit interest on a daily basis, using a 365-day year, at a rate not
less than an annual effective rate of 3%. At our discretion, we may credit a
higher rate of interest. Each Fixed Option may have its own unique rate. The
interest rate in effect at the beginning of the policy year will be effective
for the duration of that year. The Accumulated Value for each Fixed Option on
any Valuation Date is the following, including interest on each:
.. the Accumulated Value for the Fixed Option on the prior Monthly Payment Date;
.. plus the amount of any Net Premium received and allocated to the Fixed Option
since the last Monthly Payment Date;
.. plus the amount of any transfer to the Fixed Option, including transfers from
the Loan Account, since the last Monthly Payment Date;
.. minus the Monthly Deduction and other deductions due, if any, and assessed
against the Fixed Option; and
.. minus the amount of any withdrawals, or transfers from the Fixed Option,
including transfers to the Loan Account, since the last Monthly Payment Date.
Variable Accumulated Value - The Variable Accumulated Value is the sum of your
policy's Accumulated Value in each Variable Account.
This subsection describes how we calculate your policy's Accumulated Value in
each Variable Account. Assets in each Variable Account are divided into
Accumulation Units, which are a measure of value used for bookkeeping purposes.
We credit your policy with Accumulation Units in each Variable Account as a
result of:
.. the amount of any Net Premium received and allocated to the Variable Account;
and
.. transfers of Accumulated Value to the Variable Account, including transfers
from the Loan Account.
We debit Accumulation Units in each Variable Account as a result of:
.. transfers from the Variable Account, including transfers to the Loan Account;
.. Surrenders and withdrawals from the Variable Account; and
.. the monthly deduction and other deductions due, if any, and assessed against
the Variable Account.
To determine the number of Accumulation Units debited or credited for a
transaction, we divide the dollar amount of the transaction by the Unit Value of
the affected Variable Account.
To determine your policy's Accumulated Value in each Variable Account, we
multiply the number of Accumulation Units in the Variable Account by the Unit
Value of the Variable Account. The number of
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Accumulation Units in each Variable Account will not change because of
subsequent changes in Unit Value.
The Unit Value of each Variable Account initially was $10. The Unit Value of
each Variable Account is determined on each Valuation Date. To calculate the
Unit Value of a Variable Account on any Valuation Date, we adjust the Unit Value
from the previous Valuation Date for:
.. any dividends or distributions paid to the Variable Account;
.. the investment performance of the Variable Account, which is based on the
investment performance of the corresponding portfolio and includes expenses
related to the portfolio's management;
.. charges, if any, that may be assessed by us for income taxes attributable to
the operation of the Variable Account.
Loan Account - The Loan Account is the amount set aside to secure Policy Debt.
We will credit interest to the Loan Account on a daily basis, using a 365-day
year, and the daily equivalent of an annual effective rate, which we guarantee
to be at least 3.00%. At our discretion, we may credit a higher rate of interest
on the Loan Account. The amount in the Loan Account on any Valuation Date is the
following, including interest on each:
.. the amount in the Loan Account as of the end of the prior Monthly Payment
Date;
.. plus any loan taken since the prior Monthly Payment Date; and
.. minus any loan amount repaid since the prior Monthly Payment Date.
On each policy anniversary, if the amount in the Loan Account exceeds policy
debt, the excess will be transferred from the Loan Account to the Investment
Options according to your most recent premium allocation instructions, and if
policy debt exceeds the amount in the Loan Account, the excess will be
transferred from the Investment Options on a proportionate basis to the Loan
Account.
POLICY CHARGES
Monthly Deduction - A Monthly Deduction for a policy month is due on each
Monthly Payment Date and is equal to the sum of the following items:
.. the monthly Cost of Insurance Charge;
.. the M&E Risk Charge;
.. the Administrative Charge; and
.. rider or benefit charges, if any.
Unless you have made a Written Request to the contrary, the Monthly Deduction
will be charged on the Monthly Payment Date proportionately to the Accumulated
Value in each Investment Option.
Cost of Insurance Charge - Beginning on the Policy Date and monthly thereafter,
there will be a monthly Cost of Insurance Charge for the death benefit payable
under this policy equal to (1) multiplied by (2), with the result divided by
1000, where:
(1) is the applicable monthly Cost of Insurance Rate; and
(2) is the Net Amount at Risk.
Net Amount at Risk - The Net Amount at Risk is equal to the death benefit as of
the most recent Monthly Payment Date divided by the Monthly Guaranteed Interest
Rate Factor, then reduced by the Accumulated Value at the beginning of the
policy month before the Monthly Deduction is due. The Monthly Guaranteed
Interest Rate Factor is 1.002466.
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Cost of Insurance Rates - The current monthly Cost of Insurance Rates will be
determined by us. These rates will not exceed the Guaranteed Maximum Monthly
Cost of Insurance Rates shown in the Policy Specifications. Cost of Insurance
Rates will apply uniformly to all members of the same class. Class is determined
by a number of factors, including the Insured's Age, Risk Classification, death
benefit, Policy Date and policy duration. Any changes in the Cost of Insurance
Rates will apply uniformly to all members of the same class.
Mortality and Expense (M&E) Risk Charge - Beginning on the Policy Date and
monthly thereafter, we will deduct a M&E Risk Charge from the Accumulated Value
to compensate us for the risk we assume that mortality, expenses and other costs
of providing your policy will be greater than estimated. The M&E Risk Charge is
equal to the M&E Risk Charge Rate shown in the Policy Specifications, multiplied
by the Accumulated Value less Policy Debt at the beginning of the policy month
less the Cost of Insurance Charge and less the monthly charge for rider
benefits, if any.
Administrative Charge - Beginning on the Policy Date and monthly thereafter,
there will be an Administrative Charge. The amount of the charge is shown in the
Policy Specifications.
Premium Load - A Premium Load will be charged each time that a premium is paid
to cover certain local, state and federal tax and certain sales and distribution
costs. The Premium Load will equal the premium paid multiplied by the Premium
Load rate shown in the Policy Specifications. The Premium Load associated with
each premium will be immediately deducted from the premium paid. We reserve the
right to increase the Premium Load with respect to the charge for local, state
and federal tax. We will notify you of any such change.
Other Taxes - In addition to the charges imposed under Premium Load and
elsewhere, we reserve the right to make a charge for federal, state or local
taxes that may be attributable to the Variable Accounts or to our operations
with respect to this policy if we incur any such taxes.
POLICY LAPSE AND REINSTATEMENT
Grace Period and Lapse - If the Accumulated Value less Policy Debt on a Monthly
Payment Date is not sufficient to cover the current monthly deduction, a grace
period of 61 days will be allowed for the payment of sufficient premium to keep
your policy in force.
The grace period begins on the Monthly Payment Date on which the insufficiency
occurred and ends 61 days thereafter. At the start of the grace period, we will
notify you and any assignee of record at the last known address. The notice will
state the due date and the amount of premium required for your policy to remain
in force. A minimum of three times the monthly deduction due when the
insufficiency occurred, plus Premium Load, must be paid. There is no penalty for
paying a premium during the grace period. Your policy will remain in force
during the grace period. If sufficient premium is not paid by the end of the
grace period, a lapse will occur. Thirty-one days prior to lapse, we will send
you and any assignee of record a notice containing the lapse date and the
required premium to keep your policy in force. If the Insured dies during the
grace period, the death benefit proceeds will be reduced by any overdue charges.
Upon lapse, the policy will terminate with no value.
Reinstatement - If it has not been surrendered, this policy may be reinstated
not more than five years after the end of the grace period. To reinstate this
policy you must provide us with the following:
.. A written application;
.. Evidence of Insurability;
.. Sufficient premium to cover all monthly deductions that were due and unpaid
during the grace period; plus
.. Sufficient premium to keep the policy in force for three months after the date
of reinstatement.
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The effective date of the reinstated policy will be the first Monthly Payment
Date on or following the date we approve your reinstatement application. If the
policy is reinstated on the first Monthly Payment Date following lapse, any
Policy Debt on the date of lapse will also be reinstated. If the policy is
reinstated after the first Monthly Payment Date following lapse, any Policy Debt
outstanding on the date of lapse will be extinguished, except that you may
instruct us by Written Request to reinstate the Policy Debt in such case.
TRANSFERS
Transfers - After your initial Net Premium has been allocated according to your
instructions and while your policy is in force, you may, upon Written Request,
transfer your Accumulated Value, or a part of it, among the Investment Options
as provided in this section. No transfer may be made if the policy is in a grace
period and the required premium has not been paid.
We reserve the right:
.. to limit the size of transfers so that each transfer is at least $500;
.. to require that the remaining balance in any account as a result of a transfer
be at least $500;
.. to assess a charge of $50 for each transfer exceeding 6 per policy year; and
.. to otherwise waive or reduce the restrictions on the transfer provisions
described in this section.
Transfers To The Fixed Options - You may transfer to the Fixed Options only
during the policy month preceding each policy anniversary.
Transfers From The Fixed Account - You may transfer from the Fixed Account an
amount up to the greater of $5,000 or 25% of the Accumulated Value in the Fixed
Account, but only one such transfer may be made in any twelve-month period
Transfers From The Fixed LT Account - You may transfer from the Fixed LT Account
an amount up to the greater of $5,000 or 10% of the Accumulated Value in the
Fixed LT Account, but only one such transfer may be made in any twelve-month
period.
Allocations To The Fixed Options - We reserve the right to limit the amount
allocated to the Fixed Options to $1,000,000 during the most recent 12 months
for all policies in which you have an ownership interest or to which payments
are made by a single payor. Policies that are MEC's may not make any allocations
to the Fixed LT Account. Allocations include Net Premium payments, transfers and
loan repayments. Any excess over $1,000,000 will be allocated to your other
Investment Options according to your most recent instructions. We may increase
the $1,000,000 limit at any time at our sole discretion. You may contact us to
find out if a higher limit is in effect.
SURRENDER AND WITHDRAWAL OF VALUES
Surrender - Upon Written Request while the Insured is living you may surrender
this policy for its Net Cash Surrender Value. The policy will terminate on the
date the request is received.
Net Cash Surrender Value - The Net Cash Surrender Value is the Cash Surrender
Value less any Policy Debt.
Cash Surrender Value - The Cash Surrender Value is the Accumulated Value.
Withdrawals - Upon Written Request on or after the first policy anniversary
while the Insured is living, you may withdraw a portion of the Net Cash
Surrender Value of this policy. Withdrawals will be subject to the following
conditions: The amount of each withdrawal must be at least $200 and the Net Cash
Surrender Value remaining after each withdrawal must be at least $500. Also, if
there is any Policy Debt
Page 12
at the time of each withdrawal, the amount of the withdrawal is limited to the
excess, if any, of the Cash Surrender Value immediately prior to the withdrawal
over the result of the Policy Debt divided by 90%.
The amount of each withdrawal will be allocated proportionately to the
Accumulated Value in the Investment Options unless you request otherwise. If the
Insured dies after the request for a withdrawal is sent to us and prior to the
withdrawal being effected, the amount of the withdrawal will be deducted from
the death benefit proceeds, which will be determined without taking the
withdrawal into account.
Withdrawals may also affect the Face Amount. A withdrawal will reduce the Face
Amount, but only for policies having Death Benefit Option A. In such case, a
withdrawal in excess of the difference between the Minimum Death Benefit and the
Face Amount will reduce the Face Amount by the amount of the excess. A
withdrawal will not be allowed if it causes the Face Amount to drop below our
minimum issue limit of $12,000
TIMING OF PAYMENTS AND TRANSFERS
Variable Accounts - With respect to allocations made to the Variable Accounts,
we will calculate values for surrenders, withdrawals, loans and, unless
transfers are restricted, transfers as of the end of the Valuation Date on or
next following the day on which we receive your instructions. For any portion of
death benefit depending on the Variable Accumulated Value, we will calculate
such value as of the end of the Valuation Date on or next following the day on
which the Insured's death occurs. We will pay such amounts and will process such
transfers within seven days after we receive all the information needed for the
transaction. However, we may postpone the calculation, payment or transfer of
any amounts that are based on the investment performance of the Variable
Accounts, if:
.. the New York Stock Exchange is closed on other than customary weekend and
holiday closings; or
.. trading on the New York Stock Exchange is restricted as determined by the
Securities and Exchange Commission (SEC); or
.. an emergency exists, as determined by the SEC, as a result of which it is not
reasonably practicable to determine the value of the Account assets or to
dispose of Account securities; or
.. The SEC by order permits postponement for the protection of policy owners.
Fixed Options - With respect to allocations made to the Fixed Options, we may
defer surrenders, withdrawals, loans (except for loans to pay a premium on any
policy issued by us), and transfers from the Fixed Options, for up to six months
after we receive your request. If we defer any such payment for more than 30
days after we receive your request, we will pay interest at the rate required by
the state in which this policy is delivered, but not less than an annual rate of
3%.
INCOME BENEFITS
Income Benefits - Surrender or withdrawal benefits may be used to buy a lifetime
monthly income as long as the monthly income is at least $100. Death benefits
may be used to buy a monthly income for the lifetime of the beneficiary. The
monthly income is guaranteed to continue for at least ten years, unless another
form of payment is requested. Under the automatic form of payment, if the income
recipient dies before the end of the ten-year period, payments will continue to
the end of the ten-year period to a person designated by the income recipient in
writing.
The purchase rates for the monthly income will be set periodically by the
Company. However, under the automatic form, the monthly income bought by each
$1,000 of benefit amount will always be at least as large as that shown below.
Page 13
Monthly Monthly Monthly Monthly Monthly
Age Income Age Income Age Income Age Income Age Income
0-30 3.09 40 3.37 50 3.81 60 4.54 70 5.78
32 3.14 42 3.44 52 3.93 62 4.73 72 6.11
34 3.19 44 3.52 54 4.06 64 4.95 74 6.48
36 3.24 46 3.61 56 4.20 66 5.20 75+ 6.67
38 3.30 48 3.71 58 4.36 68 5.47
Monthly income amount for ages not shown are halfway between the two amounts for
the nearest two ages that are shown. Amounts shown are based on the Annuity 2000
table with interest at 3.00%. We may require evidence of survival for incomes
that last more than ten years.
Other Income Options - Surrender, withdrawal or death benefits may be used under
any other payment plans that we make available at that time.
POLICY LOANS
Policy Loans - You may obtain loans by Written Request on the sole security of
the Loan Account of this policy.
Loan Amount Available - The amount available for a loan is equal to 90% of Net
Cash Surrender Value or, if greater, the Net Cash Surrender Value less 12 times
the most recent monthly deduction. The amount of a loan must be at least $200.
Loan Interest - Interest will accrue daily and is payable in arrears at the
annual rate of 3.75% for policy years 1-10, 3.50% for policy years 11-20, and
3.25% thereafter. Interest not paid when due will be added to the loan principal
and bear interest at the same rate of interest.
Loan Account - When a loan is taken, an amount equal to the loan is transferred
out of the Accumulated Value in the Investment Options into the Loan Account to
secure the loan. Unless you request otherwise, loan amounts will be deducted
from the Investment Options on a pro rata basis, up to the amount available. We
will credit interest to the Loan Account as described in the Accumulated Value
section.
On each policy anniversary, if the amount in the Loan Account exceeds Policy
Debt, the excess will be transferred from the Loan Account to the Investment
Options according to your most recent instructions. If Policy Debt exceeds the
amount in the Loan Account, an amount equal to such excess will be transferred
from the Investment Options on a proportionate basis to the Loan Account.
Loan Repayment - Loans may be repaid at any time prior to lapse of this policy.
An amount equal to the portion of any loan repaid, but not more than the amount
in the Loan Account, will be transferred from the Loan Account to the Investment
Options according to your most recent instructions. We reserve the right to
first transfer repayments from the Loan Account to each Fixed Option up to the
amount that was originally borrowed. Any excess over such amount will be
transferred to the Variable Accounts according to your most recent instructions.
Any payment we receive from you while you have a loan will be first considered a
loan repayment, unless you tell us in writing it is a premium payment.
Page 14
SEPARATE ACCOUNT PROVISIONS
Separate Account - We established the Separate Account and maintain it under the
laws and regulations of California. The assets of the Separate Account shall be
valued at least as often as any policy benefits vary, but at least monthly. The
Separate Account is divided into subaccounts, called Variable Accounts. Income
and realized and unrealized gains and losses from the assets of each Variable
Account are credited or charged against it without regard to our other income,
gains or losses. Assets may be put in our Separate Account to support this
policy and other variable life policies. Assets may be put in our Separate
Account for other purposes, but not to support contracts or policies other than
variable life contracts or policies.
The assets of our Separate Account are our property. The portion of its assets
equal to the reserves and other policy liabilities with respect to our Separate
Account will not be chargeable with liabilities arising out of any other
business we conduct. We may transfer assets of a Variable Account in excess of
the reserves and other liabilities with respect to that Variable Account to
another Variable Account or to our general account. All obligations arising
under the policy are general corporate obligations of ours. We do not hold
ourselves out to be trustees of the Separate Account assets.
Variable Accounts - Each Variable Account may invest its assets in a separate
class of shares of a designated investment company or companies. The Variable
Accounts of our Separate Account that were available for your initial
allocations are shown in your application for this policy. From time to time, we
may make other Variable Accounts available to you. We will provide you with
written notice of all material details including investment objectives and all
charges.
We reserve the right, subject to compliance with the law then in effect, to:
.. change or add designated investment companies;
.. add, remove or combine Variable Accounts;
.. add, delete or make substitutions for the securities that are held or
purchased by the Separate Account or any Variable Account;
.. register or deregister any Variable Account under the Investment Company Act
of 1940;
.. change the classification of any Variable Account;
.. operate any Variable Account as a managed investment company or as a unit
investment trust;
.. combine the assets of any Variable Account with other separate accounts or
subaccounts of ours or our affiliates;
.. transfer the assets of any Variable Account to other separate accounts or
subaccounts of ours or our affiliates;
.. run any Variable Account under the direction of a committee, board, or other
group;
.. restrict or eliminate any voting rights of policy Owners with respect to
any Variable Account, or other persons who have voting rights as to any
Variable Account;
.. change the allocations permitted under the policy;
.. terminate and liquidate any Variable Account; and
.. make any other change needed to comply with law.
If any of these changes result in a material change in the underlying investment
of a Variable Account of our Separate Account, we will notify you of such
change.
Unless required by law or regulation, an investment policy may not be changed
without our consent. We will not change the investment policy of the Separate
Account without the approval of the Insurance Commissioner in the state of
California, and the approval process is on file with the Commissioner.
Page 15
SUBSTITUTION OF INSURED
Benefit - Subject to our approval, you may request a substitution of the Insured
under this policy for a new Insured after the first policy year. We will require
the following before we substitute the Insured:
.. The new Insured must submit Evidence of Insurability.
.. You must submit a written application for the substitution.
We may adjust the Face Amount, Accumulated Value and any policy fees and charges
to reflect the new Insured. A revised schedule of benefits will be sent to you
outlining the benefits for the new Insured. Riders on the new Insured will be
added only with our consent and subject to our requirements for those riders. If
approved, the substitution will be effective on the next Monthly Payment Date on
or next following our approval.
With respect to the substituted Insured, the incontestability and suicide
exclusion periods will begin on the substitution date, or any later
reinstatement date. If the Substituted Insured commits suicide, while sane or
insane, within 2 years of the effective date of the substitution, no death
benefit proceeds will be paid. Instead, we will return the Net Cash Surrender
Value as of the Substitution Date, plus any premiums paid and less any loans and
Withdrawals taken, or any dividends paid in cash, all since the substitution
date.
GENERAL PROVISIONS
Entire Contract - This policy is a contract between you and us. This policy, any
attached endorsements, benefits and riders and the attached copy of the initial
application are the entire contract, except as follows. Any written application
for a change in policy terms allowed by the policy after issue or written notice
of exercise of policy options made after the policy has been issued will also
become part of the contract upon our acceptance of such application or notice
and our mailing of same to your address last known to us. Only an authorized
officer is permitted to change this contract or extend the time for paying
premiums. Any such change must be in writing.
All statements in the application shall, in the absence of fraud, be deemed
representations and not warranties. We will not use any statement to contest
this policy or defend a claim on grounds of misrepresentation unless the
statement is in an application.
Incontestability - We will not contest this policy unless there was a material
misrepresentation in an application, including any reinstatement application.
The policy will terminate upon successful contest. Except for failure to pay
premiums, this policy cannot be contested after the expiration of the following
time periods:
.. If this policy has not been reinstated, we cannot contest this policy after
it has been in force during the Insured's lifetime for two years from the
Policy Date; and
.. Following a reinstatement, we cannot contest this policy after it has been
in force during the Insured's lifetime for two years from the reinstatement
date.
Non-Participating - This policy will not share in any of our surplus earnings.
Juvenile Insured - If an Insured's Age on the Policy Date is less than 20, the
Insured may apply for Nonsmoker risk status on attaining Age 20. This option
must be requested in writing and accompanied by satisfactory evidence of
nonsmoking.
Suicide Exclusion - If the Insured dies by suicide, while sane or insane, within
two years of the Policy Date, no death benefit proceeds will be paid. Instead,
we will return the sum of the premiums paid, less the sum of any Policy Debt and
withdrawals.
Misstatement - If it is discovered after the Insured dies that the Insured's age
was misstated on the application, the amount of the death benefit shall be the
greater of that which would be purchased by the
Page 16
most recent Cost of Insurance Charge at the correct age, or the Minimum Death
Benefit for the correct age.
Reports - A report will be mailed to you at the end of each policy year to your
last known address. This report will include the following information for the
policy year:
.. the Accumulated Value;
.. the Cash Surrender Value;
.. the current death benefit;
.. any existing Policy Debt;
.. transactions that occurred during the policy year;
.. changes in the Guideline Premiums, if applicable; and
.. any information required by law.
In addition to the above reports, an annual report will also be mailed to you.
The report will contain financial statements for the Separate Account and the
designated investment company or companies or other designated portfolio(s) in
which the Separate Account invests, the latter of which will include a list of
the portfolio securities of the investment company, as required by the
Investment Company Act of 1940, and of any other designated portfolio. We will
also send any other reports as required by federal securities law.
Policy Illustrations - Upon request we will give you an illustration of the
future benefits under this policy based upon both guaranteed and current cost
factor assumptions. However, if you ask us to do this more than once in any
policy year, we reserve the right to charge you a fee not to exceed $25 per
request for this service. Illustrated benefits that are not guaranteed, such as
benefits based on the current cost factor assumptions, will vary depending upon
a number of factors, including but not limited to, changes in future investment
performance.
Basis of Values - A detailed statement showing how values are determined has
been filed with the state insurance department, if required. All values are at
least equal to the minimums required by the law of the state in which this
policy is delivered. The values are based on the Commissioner's 1980 Standard
Ordinary Mortality Table and interest at the rate of 3%, except for unisex
issues which are based on the 1980 CSO Table B and interest at the rate of 3%.
Ownership of Assets - We have the exclusive and absolute control of our assets,
including all assets in the Separate or Variable Accounts.
Tax Qualification as Life Insurance - This policy is intended to qualify as a
life insurance contract for federal tax purposes, and the death benefit under
this policy is intended to qualify for federal income tax exclusion. The policy,
including any other rider, benefit or endorsement, shall be interpreted to
ensure and maintain such tax qualification, despite any other provision to the
contrary. We will not accept a premium payment, which would cause the policy to
fail to qualify as a life insurance contract for federal tax purposes.
If at any time the premiums paid under the policy exceed the amount allowable
for such tax qualification, the excess amount, including any associated
investment gains or losses, shall be removed from the policy as of the date of
its payment, and any appropriate adjustment in the death benefit shall be made
as of such date. The excess amount, as determined under federal tax law,
including any associated investment gains or losses, shall be refunded no later
than 60 days after the end of the applicable contract year. For any such refund,
any premium load originally assessed will be refunded and no surrender charges
will apply.
If this excess amount is not refunded by the end of such 60-day period, the
death benefit shall be increased retroactively to the minimum extent necessary
so that at no time is the death benefit ever less than the amount necessary to
ensure or maintain such tax qualification, and the Accumulated Value will be
reduced to reflect the increased Monthly Deductions as a result of such death
benefit increase.
Page 17
If you request a decrease in policy or rider benefits, it may cause a reduction
in any applicable limitations on premiums or cash values for the policy under
federal tax law. Such a reduction in these limits may require us to make a
distribution from the policy equal to the greatest amount by which the premiums
paid or cash values for the policy, as determined under federal tax law, exceed
any such reduced limits, in order to maintain the policy's tax qualification. If
such a distribution is made, the distribution will be paid to you and the
Accumulated Value will be reduced by the amount of the distribution. However, no
request for a decrease in policy or rider benefits will be allowed to the extent
that the resulting reduction in such tax limits would require us to distribute
more than the Net Cash Surrender Value for the policy.
MEC Status - MEC stands for Modified Endowment Contract. Unless you have given
us Written Notice to the contrary, the provisions of this MEC Status subsection
apply. Under federal tax law, if the funding of a life insurance contract occurs
too rapidly, it becomes a MEC and fails to qualify for certain favorable
treatment as a result. This policy is intended to qualify as a life insurance
contract that is not a MEC for federal tax purposes. This policy, including any
other rider, benefit or endorsement, shall be interpreted to prevent the policy
from being subject to such MEC treatment, despite any other provision to the
contrary. We will not accept a payment as premium or otherwise which would cause
the policy to become a MEC.
If at any time the amounts paid under the policy exceed the limit for avoiding
such MEC treatment, the excess amount, including any associated investment gains
or losses, shall be removed from the policy as of the date of its payment, and
any appropriate adjustment in the death benefit shall be made as of such date.
The excess amount, as determined under federal tax law, including any associated
investment gains or losses, shall be refunded no later than 60 days after the
end of the applicable contract year. For any such refund, any premium load
originally assessed will be refunded and no surrender charges will apply.
If this excess amount is not refunded by the end of such 60-day period, the
death benefit shall be increased retroactively to the minimum extent necessary
so that at no time is the death benefit ever less than the amount necessary to
avoid such MEC treatment, and the Accumulated Value will be reduced to reflect
the increased Monthly Deductions as a result of such death benefit increase.
Any request that would change the death benefits under the policy and riders
will not be processed if the change would cause the policy to be treated as a
MEC. Such changes include a reduction in the Face Amount, a change in death
benefit option, and a reduction in Face Amount due to a withdrawal.
Other Distributions of Accumulated Value - If the Net Amount at Risk ever
exceeds three times the original Face Amount, we reserve the right to make a
distribution of Accumulated Value to make the Net Amount at Risk equal three
times the original Face Amount. In such case, the distribution will be treated
as a premium refund and no surrender charge will be imposed. By treating the
distribution as a premium refund, we mean that, in addition to the distribution
of Accumulated Value, which you will receive, we will also pay you an amount
representing a return of premium load associated with the distribution. The
amount representing the return of premium load will be equal to the reduction in
Accumulated Value multiplied by (1/(1-premium load rate))-1, provided that such
amount can never exceed the total premium load paid under the policy.
Compliance - We reserve the right to make any change to the provisions of this
policy to comply with, or give you the benefit of, any Federal or state statute,
rule, or regulation, including but not limited to requirements for life
insurance contracts under the Code or any state. We will provide you with a copy
of any such change, and file such a change with the insurance supervisory
official of the state in which this policy is delivered. You have the right to
refuse any such change.
Termination - This policy terminates on the earliest of:
.. the death of the insured;
.. lapse of the policy; or
.. surrender of the policy.
Page 18
INDEX
Accumulated Value 9
Administrative Charge 11
Age 5
Assignment 6
Basis of Values 17
Beneficiary 6
Cash Surrender Value 12
Cash Value Accumulation Test (CVAT) 8
Change of Death Benefit Option 7
Code 5
Compliance 18
Cost of Insurance Charge 10
Cost of Insurance Rates 11
Death Benefit 7
Death Benefit Options 7
Death Benefit Proceeds 8
Death Benefit Qualification Test 8
Definitions 5
Entire Contract 16
Evidence of Insurability 5
Face Amount 5
Face Amount Decrease 8
Fixed Accumulated Value 9
Fixed Options 5, 13
General Provisions 16
Grace Period 11
Guideline Premium Limitation 7
Guideline Premium Test (GPT) 8
Home Office 5
Income Benefits 13
Incontestability 16
Insured 5
Investment Options 5
Juvenile Insured 16
Lapse 11
Loan Account 10, 14
Loan Amount Available 14
Loan Interest 14
Loan Repayment 14
M&E Risk Charge 11
MEC 18
MEC Status 18
Misstatement 16
Modified Endowment Contract 18
Monthly Deduction 10
Monthly Guaranteed Interest Rate Factor 10
Monthly Payment Date 5
Mortality and Expense Risk Charge 10, 11
Net Amount at Risk 10
Net Cash Surrender Value 12
Net Premium 5
Non-Participating 16
Owner 6
Planned Premium 6
Policy Charges 10
Policy Date 5
Policy Debt 5
Policy Illustrations 17
Policy Loans 14
Policy Specifications 3
Premium Allocation 6
Premium Limitation 7
Premium Load 11
Premiums 6
Reinstatement 11
Reports 17
Risk Class 3
Separate Account 5, 15
Substitution of Insured 16
Suicide Exclusion 16
Surrender 12
Tax Qualification as Life Insurance 17
Termination 18
Timing of Payments 13
Transfers 12
Valuation Date 5
Valuation Period 5
Variable Account 5, 15
Variable Accumulated Value 9
Withdrawals 12
Written Request 6
Page 19
[LOGO OF PACIFIC LIFE]
Pacific Life Insurance Company.700 Xxxxxxx Xxxxxx Xxxxx.Xxxxxxx Xxxxx, XX 00000
-------------------------------------------------------------------------------
FLEXIBLE PREMIUM
VARIABLE LIFE
INSURANCE POLICY
FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE
.. Death Benefit Payable On The Death Of The Insured While The Policy Is In Force
.. Net Cash Surrender Value Payable Upon Surrender While The Policy Is In Force
.. Adjustable Face Amount
.. Benefits May Vary Based On Investment Experience
.. Non-Participating
