NOW APPLYING FOR Clause Samples

NOW APPLYING FOR. OF WHICH WE WILL RETAIN: ------------------------------------------------------------------------------------------------------------------ REINS. AMOUNT APPLIED FOR: ------------------------------------------------------------------------------------------------------------------ IN EXCESS OF JUMBO: YES _________ NO _________ IF REPLACEMENT: INTERNAL _________ EXTERNAL _________ OUR MORTALITY ASSESSMENT: _______________________ SPECIAL RISK FEATURES: __________ AVIATION (TABLE &/OR FLAT EXTRA) __________ FOREIGN/TRAVEL __________ OCCUPATION/AVOCATION ------------------------------------------------------- --------------------------------------------------------- ENCLOSED REQUIREMENTS REQUIREMENTS TO FOLLOW ------------------------------------------------------- --------------------------------------------------------- ------------------------------------------------------- --------------------------------------------------------- ------------------------------------------------------- --------------------------------------------------------- ------------------------------------------------------- --------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------ REMARKS ------------------------------------------------------------------------------------------------------------------ UNDERWRITING CONTACT: _____________________________________ TEL #: _____________________________________

NOW APPLYING FOR. OF WHICH WE WILL RETAIN: -------------------------------------------------------------------------------------------------- REINS. AMOUNT APPLIED FOR: -------------------------------------------------------------------------------------------------- IN EXCESS OF JUMBO: YES NO IF REPLACEMENT: INTERNAL EXTERNAL ------ ------ ------- ------- OUR MORTALITY ASSESSMENT: SPECIAL RISK FEATURES: AVIATION (TABLE &/OR FLAT EXTRA) ------------------ ------ FOREIGN/TRAVEL ------ OCCUPATION/AVOCATION ------ --------------------------------------- --------------------------------------- ENCLOSED REQUIREMENTS REQUIREMENTS TO FOLLOW --------------------------------------- --------------------------------------- --------------------------------------- ---------------------------------------