EXHIBIT 99.d(5)
COUNTRY INVESTORS LIFE ASSURANCE COMPANY GUARANTEED INSURANCE
0000 X. Xxxxxxx Xxxxxx OPTION AGREEMENT
X.X. Xxx 0000, Xxxxxxxxxxx, Xxxxxxxx 00000-0000
Supplemental Agreement attached to and made a part of this policy in
consideration of the application and payment of its cost of insurance. The cost
of insurance for this benefit is the monthly deduction shown on the Policy
Schedule for this Agreement. This Agreement will remain in force only as long as
the monthly deductions for this policy continue to include the cost of insurance
for this benefit.
1. BENEFIT: The Company agrees to increase the Insured's Specified Amount,
without evidence of insurability, as of each of the following Option Dates.
2. OPTION DATES: The Option Dates shall be the policy anniversaries coincident
with or following the Insured's 22nd, 25th, 28th, 31st, 34th, 40th and 43rd
birthdays.
3. OPTION AMOUNT: The Option Amount of this Agreement is the Guaranteed
Insurance Option Amount shown of the Specification Page of this policy.
4. SPECIFIED AMOUNT INCREASE: On each of the above Option Dates, if this
Supplemental Agreement is then in force, the Company will permit an increase in
the Insured's Specified Amount, without evidence of insurability. The amount of
such increase shall not be greater than the Option Amount nor less than $20,000
subject to the following conditions:
a) Proper written application must be received by the Company at its
Home Office not more than three (3) months prior to the Option
Date nor less than one (1) month prior to the Option Date.
b) The effective date of the increase shall be the Option Date. In
no instance shall the increase become effective prior to such
date.
c) Failure on any Option Date to exercise the right under this
Agreement to increase the Insured's Specified Amount shall not
affect the right to increase the Insured's Specified Amount on
any subsequent Option Date.
5. GENERAL PROVISIONS: This Supplemental Agreement shall be subject to the
provisions of the policy to which it is attached, insofar as they are applicable
to and not in conflict with this Supplemental Agreement.
Incontestability Provisions regarding any increase in the Insured's Specified
Amount under this Agreement shall be modified so that the period of
contestability begins with the effective date of this Agreement.
Nothing herein contained shall be deemed to waive evidence of insurability which
may be required by the terms and provisions of any policy for purpose of its
reinstatement.
6. TERMINATIONS: This Agreement terminates:
a) Upon exercise of expiry of the last of the above Option Dates;
b) On the Monthly Deduction Day on or next following the date we
receive written request of the Owner and presentation of the
policy at the Home Office of the Company for endorsement;
c) Upon termination of this policy; or
d) When this policy matures.
When coverage is schedules to terminate on a given date, it will terminate at
12:00 midnight on that date.
This agreement is effective on the policy Date of Issue of this policy unless
another effective date is stated below.
Effective Date: _______________ COUNTRY INVESTORS LIFE ASSURANCE COMPANY
(if other than Policy Date of Issue) BLOOMINGTON, ILLINOIS
