EXHIBIT 1.A.(13)(c)
--------------------------------------------------------------------------------
XXXXX FOR INSURED'S ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT
This benefit is a part of this contract only if it is included in the list
of supplementary benefits on the contract data page(s).
BENEFIT FOR ACCIDENTAL DEATH
We will pay twice the face amount for the Insured's accidental loss of
life. But our payment is subject to all the provisions of this benefit and of
the rest of this contract.
CONDITIONS
Both of these conditions must be met: (1) We must receive due proof that
the Insured's death was the direct result, independent of all other causes, of
accidental bodily injury that occurred on or after the contract date. (2) The
loss must occur (a) no more than 90 days after the injury; and (b) while the
contract is in force.
EXCLUSIONS
We will not pay for death caused or contributed to by: (1) suicide or
attempted suicide while sane or insane; or (2) infirmity or disease of mind or
body or treatment for it; or (3) any infection other than one caused by an
accidental cut or wound.
Even if death is caused by accidental bodily injury, we will not pay for it
under this benefit if it is caused or contributed to by: (1) service in the
armed forces of any country(ies) at war; or (2) war or any act of war; or (3)
travel by, or descent from, any aircraft if the Insured had any duties or acted
in any capacity other than as a passenger at any time during the flight. But we
will ignore (3) if all these statements are true of the aircraft: (a) It has
fixed wings and a permitted gross takeoff weight of at least 75,000 pounds. (b)
It is operated by an air carrier that is certificated under the laws of the
United States or Canada to carry passengers to or from places in those
countries. (c) It is not being operated for any armed forces for training or
other purposes. As used here, the word aircraft includes rocket craft or any
other vehicle for flight in or beyond the earth's atmosphere. The word war means
declared or undeclared war and includes resistance to armed aggression.
BENEFIT FOR ACCIDENTAL DISMEMBERMENT
We will pay the amount(s) we show below for any of the listed losses. But
our payments are subject to all the provisions of this benefit and of the rest
of this contract.
For the Insured's
Accidental Loss of: Payment:
Life. Twice the face amount
Both hands;
Both feet;
Sight of both eyes;
One hand and one foot; The face amount
One hand and sight of one eye;
One foot and sight of one eye.
One hand;
One foot; One-half the face amount
Sight of one eye.
As used here, loss of a hand means physical severance at or above the
wrist. Loss of a foot means physical severance at or above the ankle. Loss of
sight means permanent and complete blindness.
CONDITIONS
The following conditions must be met: (1) We must receive due proof that
the Insured's loss was the direct result, independent of all other causes, of
accidental bodily injury that occurred on or after the contract date. (2) The
injury must occur while the contract is in force.
VL 220A NY
II-62
EXCLUSIONS
We will not pay for any loss caused or contributed to by: (1) suicide or
attempted suicide; or (2) infirmity or disease of mind or body or treatment for
it; or (3) any infection other than one caused by an accidental cut or wound.
Even if a loss is caused by accidental bodily injury, we will not pay for
it under this benefit if it is caused or contributed to by: (1) service in the
armed forces of any country(ies) at-war; or (2) war or any act of war; or (3)
travel by, or descent from, any aircraft if the Insured had any duties or acted
in any capacity other than as a passenger at any time during the flight. But we
will ignore (3) if all these statements are true of the aircraft: (a) It has
fixed wings and a permitted gross takeoff weight of at least 75,000 pounds. (b)
It is operated by an air carrier that is certificated under the laws of the
United States or Canada to carry passengers to or from places in those
countries. (c) It is not being operated for any armed forces for training or
other purposes. As used here, the word aircraft includes rocket craft or any
other vehicle for flight in or beyond the earth's atmosphere. The word war means
declared or undeclared war and includes resistance to armed aggression.
MISCELLANEOUS PROVISIONS
AMOUNT LIMITATION
We will not pay a total of more than twice the face amount for all losses
caused by the same accident.
MANNER OF PAYMENT
We will include in the proceeds of this contract any payment under this
rider for loss of life. For any other loss, we will make payment to whoever is
the owner as of the date of loss. If a payment is due the Insured under this
rider and he or she is not living when we pay, we have the choice of paying the
beneficiary for insurance payable upon the death of the Insured or the Insured's
estate.
PREMIUMS
We show the premiums for this rider on the contract data page(s).
Termination
This rider will end on the earliest of:
1. the end of the last day of grace if the contract is in default; it
will not continue if a benefit takes effect under any contract value
options provision that may be in the contract;
2. the date the contract is surrendered under its Cash Value Option,
if it has one; and
3. the date the contract ends for any other reason.
Further, if you ask us in writing, we will cancel the rider as of the first
monthly date on or after we receive your request. Contract premiums and monthly
charges due then and later will be reduced accordingly.
This Supplementary Benefit rider attached to this contract on the Contract
Date
Pruco Life Insurance Company of New Jersey,
By /s/ SPECIMEN
-----------------------------------
Secretary
VL 220A NY
II-63
