Exhibit A5K
Rider - Flexible Period -Supplemental
A001455R
Term Insurance Agreement
The Penn Mutual Life Insurance Company agrees, subject to the provisions of this
supplemental agreement, to provide the Term Insurance Benefit. The Company also
agrees to provide all of the other benefits which are stated in this agreement.
This agreement is a part of the policy to which it is attached. It is subject to
all of the provisions of the policy unless stated otherwise in this agreement.
Term Insurance Benefit -- The Company will pay the Term Insurance Benefit upon
receipt of due proof of the death of the Insured while this agreement is in
force. The amount of the Term Insurance Benefit is the Specified Amount for
Flexible Period Term Insurance as shown in the Additional Policy Specifications.
The amount of the Term Insurance Benefit may not at any time exceed four times
the Specified Amount for this policy.
The Term Insurance Benefit payable on the death of the Insured will be paid to
the beneficiary in one sum or, if elected, under an income payment option. If
part or all of the benefit is paid in one sum, the Company will pay interest on
this sum from the date of death to the date of payment. The interest rate will
be determined each year by the Company, but will not be less than a rate of 3%
per year compounded annually, or such higher rate as may be required by state
law.
Suicide Exclusion--If the Insured dies by suicide while sane or insane within
two years from the effective date of this agreement, the Term Insurance Benefit
will be limited to the cost of such benefit.
If the Insured dies by suicide, while sane or insane, within two years from the
effective date of any increase in the Specified Amount for Term Insurance, the
Term Insurance Benefit with respect to that increase will be limited to the cost
for that increase.
Change in Specified Amount--The Specified Amount for Term Insurance may be
changed subject to the following conditions:
(a) Any change in the Specified Amount for Term Insurance must be at least
$5,000.
(b) Any increase in the Specified Amount for Term Insurance must be applied for
on a written application provided by the Company. Evidence of insurability
satisfactory to the Company must be provided.
(c) The Specified Amount for Term Insurance may not be increased to an amount
which is greater than four times the Specified Amount for this policy.
(d) The Specified Amount for Flexible Period Term Insurance may not be decreased
to less than $10,000
(e) Any decrease in the Specified Amount for Term Insurance will successively
decrease, in reverse order, the most recent increases, if any.
Monthly Deduction--While this agreement is in force, the Monthly Deduction under
this policy will include the Monthly Deduction for this agreement. The Monthly
Deduction for this agreement is the sum of
(a) the Cost of Insurance for the policy month for the Term Insurance Benefit
under this agreement;
(b) the Cost of Insurance for the policy month for Waiver of Monthly Deduction
for this agreement if a Waiver of Monthly Deduction Agreement is attached to
this policy;
(c) a monthly charge of $0.10 per $1,000 of Specified Amount for Term Insurance
for the first 12 months following the effective date of this agreement; and
(d) a monthly charge of $0.10 for each $1,000 of increase in the Specified
Amount for Term Insurance for the first 12 months following the effective
date of such increase.
Cost of Insurance--The Cost of Insurance for the Term Insurance under this
agreement is determined on a monthly basis. It is calculated as (a) multiplied
by (b) where:
(a) is the Cost of Insurance Rate divided by $1,000 for Term Insurance
applicable to this policy, and
(b) is the Specified Amount for Term Insurance under this agreement.
The Cost of Insurance Rate for the Term Insurance is based on the attained age,
sex and rate class of the Insured. Cost of Insurance Rates will be determined by
the Company based on expectations as to future mortality, investment, expense
and persistency experience. However, these rates will not exceed those shown for
this agreement in the Additional Policy Specifications.
Flexible Period- Supplemental
A001456R
Term Insurance Agreement (continued)
Cost of Insurance Rates will not be adjusted by the Company as a means of
recovering prior losses nor as a means of distributing prior profits.
Computation of Values--All values and benefits in this agreement are equal to or
greater than those required by the law of the jurisdiction in which this policy
is delivered.
Incontestability--This agreement will be incontestable after it has been in
force during the life of the Insured for two years from the effective date.
Any increase in the Specified Amount for Term Insurance will be incontestable
with respect to statements made in the evidence of insurability for that
increase after the increase has been in force during the life of the Insured for
two years from its effective date.
This agreement will be incontestable with respect to statements made in an
application for reinstatement after it has been in force during the life of the
Insured for two years from the effective date of the reinstatement.
Attained Age -- The attained age of the Insured under this agreement is the age
nearest birthday of the Insured on the most recent policy anniversary.
Misstatement of Age or Sex -- If the age or sex of the Insured has been
misstated, the Term Insurance benefit will be the amount which would have been
provided by the most recent Cost of Insurance charge at the correct age and sex.
Right to Convert Term Insurance--The term insurance under this agreement may be
converted to a life or endowment policy without evidence of insurability at any
time while such insurance is in force before the earlier of (i) the policy
anniversary nearest to the Insured's 70th birthday, and (ii) the policy
anniversary which is three years prior to the Termination Date for this
agreement shown in the Additional Policy Specifications. The Owner must make a
written request for the conversion. On or before the date of conversion, the
Owner must pay the first premium for the new policy.
The new policy will be:
(a) on a plan which insures only the life of the Insured;
(b) in the same rate class and subject to the same limitations of risk as the
term insurance under this agreement;
(c) issued at the age of the Insured on the birthday which is nearest to the
date of the conversion;
(d) on the policy form and at the premium rates in use by the Company on the
date of the conversion; and
(e) subject to the Company's rules as to minimum amount, plan of insurance and
age at issue which are in effect on the date of the conversion.
The inclusion of any supplemental agreements in the new policy will be subject
to the consent of the Company and must comply with the rules of the Company.
Termination of Agreement--This agreement will terminate upon :
(a) the Termination Date for this agreement shown in the Additional Policy
Specifications;
(b) lapse of this policy;
(c) surrender of this policy;
(d) conversion of the term insurance under this agreement; or
(e) the Monthly Anniversary which coincides with or next follows (i) receipt by
the Company of a written request by the Owner to terminate this agreement,
and (ii) return of this policy for appropriate endorsement.
Effective Date--The effective date of this agreement is the same as the Date of
Issue of this policy unless another effective date is shown below.
/s/ ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇▇
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Chairman and
Chief Executive Officer
