EXHIBIT A.(5)(i)
SHORT TERM PREMIUM AGREEMENT
--------------------------------------------------------------------------------
AGREEMENT DATE:
---------------
APPLICABLE COVERAGE: ENTIRE POLICY
--------------------
SHORT TERM PREMIUM:
-------------------
GENERAL
This agreement applies to the life coverage on the lives of all Insured Persons.
In consideration of the payment of the Short Term Premium shown above, we agree
to pay the death benefit provided by this agreement when we receive due proof
that an Insured Person has died while this agreement is in effect.
APPLICABLE COVERAGE
This short term agreement provides temporary protection preceding another
coverage which shall be known as the Applicable Coverage. The Applicable
Coverage shall be identified by the words "Entire Policy" in the space above.
INSURED PERSON
An Insured Person shall be that person or those persons to be insured under the
Applicable Coverage.
SHORT TERM PERIOD
This agreement shall take effect on the agreement date noted above. It will be
subject to the same conditions as those stated in the application for the
Applicable Coverage, provided that wherever the words "first premium" appear
therein, the words "Short Term Premium" are substituted. This agreement shall
terminate on the day preceding the date of issue of the Applicable Coverage.
However, a grace period of 31 days will be allowed for payment of the first
regular premium required under the Applicable Coverage. This agreement shall
continue in force during the grace period. If death occurs during the grace
period, the unpaid premium shall be deducted from the amount otherwise payable.
DEATH BENEFIT
The death benefit provided by this agreement shall be the benefit which would
have been payable under the Applicable Coverage, except that if an infant
Insured dies before attaining the age of 14 days, no death benefit is payable.
99-324 Short Term Agreement - Life
DISABILITY
Any total and permanent disability benefits provided under the Applicable
Coverage shall be included under this agreement.
CONTESTABLE AND SUICIDE PERIODS
The contestable and suicide periods for the Applicable Coverage shall be
measured from the date of this agreement.
/s/ Xxxxxx X. Xxxxxxxxx /s/ Xxxxxx X. Xxxxxxx
Secretary President
Registrar
99-324 Short Term Agreement - Life
