EXHIBIT 4(a)
[LOGO OF PACIFIC LIFE]
Pacific Life Insurance Company . 000 Xxxxxxx Xxxxxx Xxxxx . Xxxxxxx Xxxxx, XX 00000
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READ YOUR POLICY CAREFULLY. This is a legal contract between you, the Owner, and
us, Pacific Life Insurance Company, a stock insurance company. We agree to pay
the benefits of this policy according to its provisions. The consideration for
this policy is the application for it, a copy of which is attached, and payment
of the premiums.
PREMIUMS ARE FLEXIBLE, SUBJECT TO MINIMUMS REQUIRED TO KEEP THE POLICY IN FORCE.
VARIABLE ACCOUNT VALUES ARE NOT GUARANTEED, AND MAY INCREASE OR DECREASE
DEPENDING UPON VARIABLE ACCOUNT INVESTMENT EXPERIENCE. POLICY LOAN VALUE IS LESS
THAN ONE HUNDRED PERCENT (100%) OF THE POLICY'S CASH SURRENDER VALUE.
THE METHOD FOR DETERMINING THE DEATH BENEFIT IS DESCRIBED IN THE DEATH BENEFIT
SECTION OF THIS POLICY. THE AMOUNT OF THE DEATH BENEFIT MAY BE FIXED OR VARIABLE
ACCORDING TO THE DEATH BENEFIT OPTION SELECTED AND MAY INCREASE OR DECREASE. THE
DURATION THIS POLICY REMAINS IN FORCE MAY VARY, DEPENDING ON THE PREMIUMS PAID
AND THE INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNTS.
Free Look Right - You may return this policy within 10 days after you receive
it. To do so, deliver or mail it to us or to our agent. This policy will then be
deemed void from the beginning and we will refund:
.. any Premium Load deducted from premiums received; plus
.. any Net Premium allocated to the Fixed Options; plus
.. the Variable Accumulated Value as of the end of the Valuation Period when
we receive the policy; plus
.. any policy charges and fees deducted from the Variable Accounts.
Signed for Pacific Life Insurance Company,
/s/ XXXXXX X. XXXXXX /s/ XXXXXX X. MILFS
Chairman and Chief Executive Officer Secretary
LAST SURVIVOR FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE
.. Death Benefit Payable When Both Insureds Have Died While The Policy Is In
Force
(There Is No Death Benefit When The First Insured Dies)
.. Net Cash Surrender Value Payable Upon Surrender While The Policy Is In Force
.. Adjustable Face Amount
.. Benefits May Vary Based On Investment Experience
.. Non-Participating
POLICY NUMBER: VF99999990 INSURED #1: XXXXXX XXXXXXXX
POLICY DATE: JAN. 1, 2001 RISK CLASSIFICATION: MALE/NONSMOKER
INITIAL FACE AMOUNT: $200,000 AGE ON POLICY DATE: 35
OWNER: XXXXXX XXXXXXXX INSURED #2: XXXX XXXXXXXX
RISK CLASSIFICATION: FEMALE/NONSMOKER
AGE ON POLICY DATE: 35
NOTE: EVEN IF PLANNED PREMIUMS ARE PAID, IT IS POSSIBLE THAT THE POLICY MAY NOT
CONTINUE IN FORCE (THAT IS, IT MAY LAPSE BEFORE THE DEATH OF THE SURVIVOR) DUE
TO CHANGES IN INTEREST CREDITED ON THE FIXED OPTIONS, INVESTMENT PERFORMANCE OF
THE VARIABLE ACCOUNTS, EXPENSE LOADS, AND COST OF INSURANCE RATES. ADDITIONALLY,
LOANS, WITHDRAWALS, AND DEATH BENEFIT OPTION CHANGES WILL AFFECT THE LENGTH OF
TIME THE POLICY STAYS IN FORCE.
P03S5M
GUIDE TO POLICY PROVISIONS
SECTION PAGE
POLICY SPECIFICATIONS ..................................................... 3
DEFINITIONS ............................................................... 5
OWNER AND BENEFICIARY ..................................................... 6
PREMIUMS .................................................................. 6
DEATH BENEFIT ............................................................. 7
ACCUMULATED VALUE ......................................................... 9
TRANSFERS ................................................................. 12
SURRENDER AND WITHDRAWAL OF VALUES ........................................ 13
TIMING OF PAYMENTS AND TRANSFERS .......................................... 14
INCOME BENEFITS ........................................................... 14
POLICY LOANS .............................................................. 15
SEPARATE ACCOUNT PROVISIONS ............................................... 16
GENERAL PROVISIONS ........................................................ 17
INDEX ..................................................................... 20
POLICY NUMBER: VP999999990
POLICY SPECIFICATIONS
BASE POLICY: LAST SURVIVOR FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE
PREMIUMS: PLANNED [ANNUAL] PREMIUM = $ 1,354.97
GUIDELINE SINGLE PREMIUM = 20,527.95
GUIDELINE LEVEL PREMIUM = 1,892.34
7 PAY PREMIUM = 5,111.22
FIXED LT ENHANCED GUARANTEE AMOUNT = 1,156.50
DEATH BENEFIT QUALIFICATION TEST: GUIDELINE PREMIUM TEST
(THIS ELECTION IS IRREVOCABLE FOR THE LIFE OF THE CONTRACT)
DEATH BENEFIT OPTION: A
PREMIUM LOAD RATE: CONSISTS OF A SALES LOAD RATE OF 4.25% FOR THE FIRST
$11,565.00 OF PREMIUM PAID AND 2.25% FOR PREMIUM PAID IN EXCESS OF SUCH AMOUNT
PLUS 2.35% FOR CERTAIN STATE AND LOCAL TAXES PLUS 1.50% FOR CERTAIN FEDERAL
TAXES.
ADMINISTRATIVE CHARGE: $10 PER MONTH UNTIL THE YOUNGER INSURED'S AGE 100; $0
THEREAFTER.
SURRENDER CHARGE: $539.00 FOR THE FIRST POLICY YEAR. IT THEN DECREASES BY 4.99
PER MONTH TO ZERO AT THE END OF THE 120TH MONTH.
MORTALITY AND EXPENSE RISK FACE AMOUNT CHARGE: $33.51 FOR POLICY YEARS 1-10,
$17.50 FOR POLICY YEARS 11-20, AND $0 THEREAFTER. REFER TO MORTALITY AND EXPENSE
RISK CHARGE PROVISION FOR DETAILS.
POLICY NUMBER: VF99999990 INSURED #1: XXXXXX XXXXXXXX
POLICY DATE: JAN. 1, 2001 RISK CLASSIFICATION: MALE/NONSMOKER
INITIAL FACE AMOUNT: $200,000 AGE ON POLICY DATE: 35
OWNER: XXXXXX XXXXXXXX INSURED #2: XXXX XXXXXXXX
RISK CLASSIFICATION: FEMALE/NONSMOKER
AGE ON POLICY DATE: 35
NOTE: EVEN IF PLANNED PREMIUMS ARE PAID, IT IS POSSIBLE THAT THE POLICY MAY NOT
CONTINUE IN FORCE (THAT IS, IT MAY LAPSE BEFORE THE DEATH OF THE SURVIVOR) DUE
TO CHANGES IN INTEREST CREDITED ON THE FIXED OPTIONS, INVESTMENT PERFORMANCE OF
THE VARIABLE ACCOUNTS, EXPENSE LOADS, AND COST OF INSURANCE RATES. ADDITIONALLY,
LOANS, WITHDRAWALS, AND DEATH BENEFIT OPTION CHANGES WILL AFFECT THE LENGTH OF
TIME THE POLICY STAYS IN FORCE.
P03S5M Page 3.0
POLICY NUMBER: VP999999990
POLICY SPECIFICATIONS
SUMMARY OF COVERAGES EFFECTIVE ON THE POLICY DATE
BASIC COVERAGE
FACE AMOUNT: $100,000
INSURED #1: XXXXXX XXXXXXXX
AGE ON POLICY DATE: 35
RISK CLASSIFICATION: MALE/NONSMOKER
INSURED #2: XXXX XXXXXXXX
AGE ON POLICY DATE: 35
RISK CLASSIFICATION: FEMALE/NONSMOKER
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Page 3.1
POLICY NUMBER: VP999999990
POLICY SPECIFICATIONS
TABLE OF COST OF INSURANCE RATES
GUARANTEED MAXIMUM MONTHLY COST OF INSURANCE RATES PER $1000.00 APPLICABLE TO
BASE POLICY COVERING BOTH LIVES. THE RATES BELOW INCLUDE A 10-YEAR GUARANTEE OF
OUR CURRENT RATES AS OF THE ISSUE DATE.
POLICY YEAR MONTHLY RATE POLICY YEAR MONTHLY RATE
1 0.00001 41 2.42313
2 0.00002 42 2.83191
3 0.00004 43 3.28732
4 0.00008 44 3.78906
5 0.00013 45 4.34789
6 0.00020 46 4.98290
7 0.00028 47 5.71389
8 0.00039 48 6.56426
9 0.00052 49 7.55141
10 0.00069 50 8.66656
11 0.01858 51 9.89906
12 0.02272 52 11.23693
13 0.02754 53 12.67302
14 0.03316 54 14.20425
15 0.03975 55 15.83604
16 0.04742 56 17.58447
17 0.05651 57 19.47971
18 0.06727 58 21.58283
19 0.08019 59 24.00871
20 0.09532 60 27.06405
21 0.11279 61 31.41825
22 0.13278 62 38.57529
23 0.15505 63 52.30724
24 0.17990 64 83.33333
25 0.20807 65 83.33333
26 0.24063 66+ 00.00000
27 0.27924
28 0.32573
29 0.38256
30 0.45033
31 0.52931
32 0.61934
33 0.72032
34 0.83185
35 0.95820
36 1.10541
37 1.28088
38 1.49413
39 1.75379
40 2.06346
DEFINITIONS
In this section, we define certain terms used throughout this policy. Other
terms may be defined in other parts of the policy. Defined terms are usually
capitalized to provide emphasis.
Age - means the Insured's Age to the nearest birthday as of the Policy Date,
increased by the number of complete policy years elapsed.
Code - is the U.S. Internal Revenue Code, and the rules and regulations issued
thereunder.
Coverage Segments - refers separately to the initial Face Amount shown in the
Policy Specifications and any increase in Face Amount, as shown in a
supplemental schedule of coverage.
Evidence of Insurability - is information, including medical information,
satisfactory to us that is used to determine insurability and the Insured's risk
classification.
Face Amount - is used in determining the death benefit under this policy. The
Face Amount as of the Policy Date is shown in the Policy Specifications. The
Face Amount may be changed, as provided for in the Death Benefit section.
Fixed Options - consist of the Fixed Account and the Fixed LT Account.
Home Office - means our Life Insurance Client Services offices.
Insureds - are the two persons insured under this policy. The Insureds are shown
in the Policy Specifications.
Investment Options - consist of the Variable Accounts and the Fixed Options.
Monthly Payment Date - is the day each month on which certain policy charges are
deducted from the Accumulated Value. The first Monthly Payment Date is the
Policy Date. Later Monthly Payment Dates occur each month after the Policy Date
on the same day of the month as the Policy Date.
Net Amount at Risk - is equal to the death benefit as of the most recent Monthly
Payment Date divided by 1.002466, then reduced by the Accumulated Value at the
beginning of the policy month before the Monthly Deduction is due. The
Accumulated Value section describes how the Net Amount at Risk is used to
calculate the Cost of Insurance Charge.
Net Premium - is the premium we receive reduced by any Premium Load.
PL, we, our, ours, us, and the Company - refers to Pacific Life Insurance
Company.
Policy Date - is shown on page 3. Policy months, quarters, years and
anniversaries are measured from this date.
Policy Debt - is the sum of outstanding policy loans plus accrued Loan Interest.
Separate Account -is the Pacific Select Exec Separate Account, which is a
separate account of ours that consists of subaccounts, also called Variable
Accounts. Each Variable Account may invest its assets in a separate class of
shares of a designated investment company or companies.
Survivor - is the Insured remaining alive after the first death of the two
Insureds that occurs while this policy is in force. If the two Insureds die in
close proximity such that it cannot be determined who died first, unless
otherwise provided, it shall be assumed that the younger survived the older.
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Valuation Date - is each day required by applicable law and currently includes
each day the New York Stock Exchange is open for trading and our Home Office is
open. If any transaction or event is scheduled to occur on a day that is not a
Valuation Date, such transaction or event will be deemed to occur on the next
following Valuation Date unless otherwise specified.
Valuation Period - is the period of time between successive Valuation Dates.
Variable Account - is a separate account or a subaccount of a separate account
of ours in which assets are segregated from assets in our general account and
from assets in other subaccounts. Premiums and Accumulated Value under this
policy may be allocated to a Variable Account for variable accumulation.
Written Request - is a request in writing, signed by you, and received by us at
our Home Office, containing such information that we need to act on the request.
You, your or Owner - refers to the Owner of this policy.
OWNER AND BENEFICIARY
Owner - The Owner of this policy is as shown in the Policy Specifications or in
a later Written Request. If you change the Owner, the change is effective on the
date the Written Request is signed, subject to our receipt of it. If there are
two or more Owners, they will own this contract as joint tenants with right of
survivorship.
Assignment - You may assign this policy by Written Request. An assignment will
take place only when recorded at our Home Office. When received, the assignment
will take effect as of the date the Written Request was signed. Any rights
created by the assignment will be subject to any payments made or actions taken
by us before the change is recorded. We will not be responsible for the validity
of any assignment.
Beneficiary - The beneficiary is named by you in the application to receive the
death benefit proceeds. The beneficiary may be one or more persons. If the
beneficiary is more than one person, they will share the death benefit proceeds
equally or as you may otherwise specify by Written Request. The interest of any
beneficiary will be subject to any assignment. If you have named a contingent
beneficiary, that person becomes the beneficiary if the beneficiary dies before
the Survivor. A beneficiary may not, at or after the Survivor's death, assign,
transfer or encumber any benefit payable. To the extent allowed by law, policy
benefits will not be subject to the claims of any creditor of any beneficiary.
You may make a change of beneficiary by Written Request on a form provided by us
while at least one Insured is living. The change will take place as of the date
the request is signed, subject to our receipt of the request. Any rights created
by the change will be subject to any payments made or actions taken by us before
the Written Request is received. You may designate a permanent beneficiary whose
rights under the policy cannot be changed without his or her written consent.
The interest of a beneficiary who does not survive to receive payment will pass
to any surviving beneficiaries in proportion to their share in the proceeds,
unless otherwise provided. If no beneficiary is named by you, or if none
survives to receive payment, the death benefit proceeds will pass to the Owner,
or the Owner's estate if the Owner does not survive to receive payment.
PREMIUMS
Premiums - This policy will not be in force until the initial premium is paid.
The initial premium is payable either at our Home Office or to our agent.
Additional premiums, if any, are payable in advance at our Home Office. At your
request, a premium receipt signed by one of our officers will be given to you.
No premium may be less than $50. Premiums may be paid at any time, subject to
the premium limitations below.
P03S5M Page 6
Planned Premium - is the amount of premium you plan to pay. It is shown in the
Policy Specifications and may be changed by Written Request. Payment of the
Planned Premium does not guarantee that the policy will continue in force.
Premium Allocation - Allocation of the initial Net Premium will be done on the
issue date or, if later, the date the premium is received and accepted by us.
Any Net Premiums received before your policy has been placed in force, due to
the presence of outstanding requirements, will be allocated to the Money Market
Variable Account until the requirements are satisfied. At such time, the
Accumulated Value in the Money Market Variable Account will be transferred to
the Investment Options according to the premium allocation specified in the
application or your most recent allocation instructions received by us, if any.
Net Premiums received after your policy has been placed in force will be
allocated to the Investment Options according to the premium allocation
specified in the application or your most recent allocation instructions
received by us, if any. Upon Written Request, you may change the premium
allocation. Subsequently, Net Premiums will be allocated to the Investment
Options according to your most recent allocation instructions.
Premium Limitation - We will not accept premiums after Age 100 of the younger
Insured, although you may make a loan repayment at any time. We reserve the
right to require Evidence of Insurability, satisfactory to us, for any
unscheduled premium payment that would result in an immediate increase in the
difference between the death benefit and the Accumulated Value.
Guideline Premium Limit - This subsection applies only if you have elected the
Guideline Premium Test (Guideline Premium Test) as the Death Benefit
Qualification Test. In order for this policy to be classified as life insurance
under Section 7702 of the Code, the sum of the premiums paid less a portion of
any withdrawals, as defined in the Code, may not exceed the greater of:
.. The Guideline Single Premium; or
.. The sum of the annual Guideline Level Premiums to the date of payment.
The Guideline Premiums are shown in the Policy Specifications. The Guideline
Premiums may change whenever there is a change in the Face Amount of insurance
or in other policy benefits. Any such Guideline Premium change will be shown in
a supplemental schedule that we will send to you at the time of the change.
The Guideline Premiums are determined by the rules, which apply to this policy
as set forth in the Code. The Guideline Premiums will be adjusted to conform to
any changes in the Code. In the event that a premium payment would exceed such
revised limits, we reserve the right to refund the excess payment to you,
provided that we may not refuse any premium payment necessary to keep this
policy in force. Further, we reserve the right to make distributions from the
policy to the extent we deem it necessary to continue to qualify this policy as
life insurance under the Code.
DEATH BENEFIT
Death Benefit - This policy provides a death benefit on the death of the
Survivor while this policy is in force. This section describes how the death
benefit is calculated. On the date of death, the death benefit is the larger of:
.. The death benefit as calculated under the Death Benefit Option in effect; or
.. The Minimum Death Benefit calculated under the Death Benefit Qualification
Test elected.
Death Benefit Options - You have elected the Death Benefit Option in the
application. The Death Benefit Option for this policy appears in the Policy
Specifications. The Death Benefit Options are explained below.
P03S5M Page 7
.. Option A - The death benefit equals the Face Amount.
.. Option B - The death benefit equals the Face Amount plus the Accumulated
Value at death.
.. Option C - The death benefit equals the Face Amount plus the sum of the
premiums paid minus the sum of any withdrawals taken and any other
distribution of the Accumulated Value to the date of death. If the sum of
the withdrawals is greater than the sum of the premiums paid, then the
death benefit will be less than the Face Amount.
.. Option D - The death benefit equals the Face Amount times the death benefit
factor for the current policy year. If you have elected Option D, the death
benefit factors are shown in the Policy Specifications.
Change of Death Benefit Option - On Written Request, the Death Benefit Option
may be changed to Option A or B a maximum of once per policy year. After Age 89
of the younger Insured, you may only change to Option A. Changes to Option C or
D are not permitted. After a Death Benefit Option change, the Face Amount will
be that which results in the death benefit after the change being equal to the
death benefit before the change. For this purpose, death benefit is the amount
calculated under the Death Benefit Options, disregarding the Minimum Death
Benefit. The change will be effective on the Monthly Payment Date on or next
following the day we receive your Written Request at our Home Office.
Death Benefit Qualification Test - In order for your policy to be classified as
life insurance under the Code, it must satisfy one of two Death Benefit
Qualification Tests. Unless you have elected otherwise, the Death Benefit
Qualification Test for this policy is the Guideline Premium Test. The Death
Benefit Qualification Test for this policy appears in the Policy Specifications.
The two Death Benefit Qualification Tests are explained in this subsection.
1. Cash Value Accumulation Test - The Minimum Death Benefit will be the amount
required for this policy to be deemed "life insurance" according to the
Code, but not less than 101% of the Accumulated Value.
2. Guideline Premium Test - The Minimum Death Benefit at any time is the
Accumulated Value multiplied by the death benefit percentage for the Age of
the younger Insured as shown in the following table.
Death Benefit Death Benefit Death Benefit Death Benefit
Age Percentage Age Percentage Age Percentage Age Percentage
0-40 250% 50 185% 60 130% 70 115%
41 243 51 178 61 128 71 113
42 236 52 171 62 126 72 111
43 229 53 164 63 124 73 109
44 222 54 157 64 122 74 107
45 215 55 150 65 120 75-90 105
46 209 56 146 66 119 91 104
47 203 57 142 67 118 92 103
48 197 58 138 68 117 93 102
49 191 59 134 69 116 Over 93 101
Death Benefit Proceeds - The death benefit proceeds are the actual amount
payable if the Survivor dies while this policy is in force. The death benefit
proceeds are equal to the death benefit, as of the date of the Survivor's death,
less any Policy Debt and less any due and unpaid monthly deductions occurring
during a grace period.
We will pay the death benefit proceeds to the beneficiary within 2 months after
we receive, at our Home Office, due proof of the Insureds' deaths (certified
copies of the death certificates or, if unavailable, other legal documentation
which we accept) and information sufficient to identify the beneficiary. The
death benefit proceeds paid are subject to the conditions and adjustments
defined in other policy provisions, such as General Provisions, Withdrawals,
Policy Loans, and Timing of Payments and Transfers. We will
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pay interest on Death Benefit Proceeds from the date of death to the date
payment is made at a rate of interest not less than the guaranteed interest rate
used for the Fixed Account under this policy. If state law requires payment of a
greater amount of interest, we will pay that amount.
Face Amount Increase - You may submit an application to increase the Face Amount
by an amount not less than $10,000. Both Insureds must be Age 90 or less and the
application must include evidence of insurability satisfactory to us. The
effective date of the increased Face Amount will be the first Monthly Payment
Date on or following the date all required conditions are met. We reserve the
right to limit increases to one per policy year and to charge a fee to evaluate
insurability, not to exceed $200, which will be deducted from the Accumulated
Value.
Upon approval of any unscheduled increase, we will send you a supplemental
schedule of coverage, which will include the following information:
.. the increased Face Amount and the effective date of the increase;
.. each Insured's risk classification for the increase; and
.. the Guaranteed Maximum Monthly Cost of Insurance Rates applicable to the
increase.
Face Amount Decrease - Starting on the first policy anniversary, you may make a
request to decrease the Face Amount by an amount not less than $10,000. The Face
Amount may not be decreased to less than our minimum issue limit of $100,000.
The effective date of the decreased Face Amount will be the first Monthly
Payment Date on or following the date we receive your Written Request. We
recommend you consult your tax advisor before requesting a decrease in policy
Face Amount. Upon approval of any unscheduled decrease, we will send you a
supplemental schedule of coverage, which will include the decreased Face Amount
and the effective date of the decrease.
The request for a decrease in the Face Amount will be subject to the Guideline
Premium Limit as defined in the Code. This may result in a refund of premiums
and/or the distribution of Accumulated Value in order to maintain compliance
with such limit. Such request will not be allowed if the resulting Guideline
Premium limit could cause an amount in excess of the Net Cash Surrender Value to
be distributed from the policy.
Change in Benefits - Under the Guideline Premium Test, any change in policy or
rider benefits will require an adjustment to the Guideline Premium Limit. See
the Tax Qualification as Life Insurance subsection of the General Provisions
section for details.
ACCUMULATED VALUE
Accumulated Value - is defined on each Valuation Date and is the sum of the
Fixed Accumulated Value plus the Variable Accumulated Value plus the Loan
Account.
Fixed Accumulated Value - The Fixed Accumulated Value is the sum of the
Accumulated Value in each Fixed Option. The Fixed Options consist of the Fixed
Account and the Fixed LT Account.
This subsection describes how we calculate the Accumulated Value in each Fixed
Option. We credit interest on a daily basis, using a 365-day year, at a rate not
less than an annual effective rate of 3%. For the Fixed LT Account only and for
the first 10 policy years only, we guarantee a rate of 4.5% for Accumulated
Value in the Fixed LT Account equal to the Fixed LT Enhanced Guarantee Amount
shown in the Policy Specifications multiplied by the current policy year. At our
discretion, we may credit a higher rate of interest. The interest rate in effect
at the beginning of the policy year will be effective for the duration of that
year. The Accumulated Value for each Fixed Option on any Valuation Date is the
following, including interest on each:
.. the Accumulated Value for the Fixed Option on the prior Monthly Payment Date;
.. plus the amount of any Net Premium received and allocated to the Fixed Option
since the last Monthly Payment Date;
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.. plus the amount of any transfer to the Fixed Option, including transfers from
the Loan Account, since the last Monthly Payment Date;
.. minus the monthly deduction and other deductions due, if any, and assessed
against the Fixed Option; and
.. minus the amount of any withdrawals, or transfers from the Fixed Option,
including transfers to the Loan Account, since the last Monthly Payment Date.
Variable Accumulated Value - The Variable Accumulated Value is the sum of your
policy's Accumulated Value in each Variable Account.
This subsection describes how we calculate your policy's Accumulated Value in
each Variable Account. Assets in each Variable Account are divided into
Accumulation Units, which are a measure of value used for bookkeeping purposes.
We credit your policy with Accumulation Units in each Variable Account as a
result of:
.. the amount of any Net Premium received and allocated to the Variable Account;
and
.. transfers of Accumulated Value to the Variable Account, including transfers
from the Loan Account.
We debit Accumulation Units in each Variable Account as a result of:
.. transfers from the Variable Account, including transfers to the Loan Account;
.. Surrenders and withdrawals from the Variable Account; and
.. the monthly deduction and other deductions due, if any, and assessed against
the Variable Account.
To determine the number of Accumulation Units debited or credited for a
transaction, we divide the dollar amount of the transaction by the Unit Value of
the affected Variable Account.
To determine your policy's Accumulated Value in each Variable Account, we
multiply the number of Accumulation Units in the Variable Account by the Unit
Value of the Variable Account. The number of Accumulation Units in each Variable
Account will not change because of subsequent changes in Unit Value.
The Unit Value of each Variable Account initially was $10. The Unit Value of
each Variable Account is determined on each Valuation Date. To calculate the
Unit Value of a Variable Account on any Valuation Date, we adjust the Unit Value
from the previous Valuation Date for:
.. any dividends or distributions paid to the Variable Account;
.. the investment performance of the Variable Account, which is based on the
investment performance of the corresponding portfolio and includes expenses
related to the portfolio's management;
.. charges, if any, that may be assessed by us for income taxes attributable to
the operation of the Variable Account.
Loan Account - The Loan Account is the amount set aside to secure Policy Debt.
We will credit interest to the Loan Account on a daily basis, using a 365-day
year, and the daily equivalent of an annual effective rate, which we guarantee
to be at least 3.00%. At our discretion, we may credit a higher rate of interest
on the Loan Account. The amount in the Loan Account on any Valuation Date is the
following, including interest on each:
.. the amount in the Loan Account as of the end of the prior Monthly Payment
Date;
.. plus any loan taken since the prior Monthly Payment Date; and
.. minus any loan amount repaid since the prior Monthly Payment Date.
On each policy anniversary, if the amount in the Loan Account exceeds policy
debt, the excess will be transferred from the Loan Account to the Investment
Options according to your most recent premium allocation instructions, and if
policy debt exceeds the amount in the Loan Account, the excess will be
transferred from the Investment Options on a proportionate basis to the Loan
Account.
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Monthly Deduction - A Monthly Deduction for a policy month is due on each
Monthly Payment Date prior to the younger Insured's Age 100 and is equal to the
sum of the following items:
.. the monthly Cost of Insurance Charge;
.. the Mortality and Expense Risk Charge;
.. the Administrative Charge; and
.. rider or benefit charges, if any.
Unless you have made a Written Request to the contrary, the Monthly Deduction
will be charged on the Monthly Payment Date proportionately to the Accumulated
Value in each Investment Option.
Cost of Insurance Charge - Beginning on the Policy Date and monthly thereafter,
there will be a monthly Cost of Insurance Charge for the death benefit payable
under this policy equal to (1) multiplied by (2), with the result divided by
1000, where:
(1) is the applicable monthly Cost of Insurance Rate; and
(2) is the Net Amount at Risk.
Net Amount at Risk - If there are multiple Coverage Segments, the Net Amount at
Risk will be allocated proportionately to each Coverage Segment according to
Face Amount.
Cost of Insurance Rates - The current monthly Cost of Insurance Rates will be
determined by us. These rates will not exceed the Guaranteed Maximum Monthly
Cost of Insurance Rates shown in the Policy Specifications. Cost of Insurance
Rates will apply uniformly to all members of the same class. Class is determined
by a number of factors, including the Insured's Age, Risk Classification, death
benefit, Policy Date and policy duration. Any changes in the Cost of Insurance
Rates will apply uniformly to all members of the same class.
Mortality and Expense Risk Charge - The Mortality and Expense Risk Charge is to
compensate us for the risk we assume that mortality, expenses and other costs of
providing your policy will be greater than estimated and for certain
distribution costs. Beginning on the Policy Date and monthly thereafter, the
Mortality and Expense Risk Charge will be the sum of the Mortality and Expense
Risk Face Amount Charge and the Mortality and Expense Risk Asset Charge.
The Mortality and Expense Risk Face Amount Charge will not exceed the guaranteed
maximum amount shown in the Policy Specifications, and is based on the Face
Amount at policy issue. This charge will continue for 10 policy years at the
level shown in the Policy Specifications and any supplemental schedule of
coverage even if the Face Amount is decreased. After 10 policy years, we may
charge less than the amount shown in the Policy Specifications.
The Mortality and Expense Risk Asset Charge is applied to the unloaned
Accumulated Value as of the Monthly Payment Date, but only until the younger
Insured's Age 100, as follows: A charge of 0.0375% (0.45% annually) applied to
the first $25,000 of unloaned Accumulated Value plus a charge of 0.0042% (0.05%
annually) applied to the unloaned Accumulated Value above $25,000.
Administrative Charge - The Administrative Charge is shown in the Policy
Specifications.
Premium Load - A Premium Load will be charged each time that a premium is paid
to cover certain local, state and federal tax and certain sales and distribution
costs. The Premium Load will equal the premium paid multiplied by the Premium
Load rate shown in the Policy Specifications. The Premium Load associated with
each premium will be immediately deducted from the premium paid. We reserve the
right to increase the Premium Load with respect to the charge for local, state
and federal tax. We will notify you of any such change.
P03S5M Page 11
Other Taxes - In addition to the charges imposed under Premium Load and
elsewhere, we reserve the right to make a charge for federal, state or local
taxes that may be attributable to the Variable Accounts or to our operations
with respect to this policy if we incur any such taxes.
Grace Period and Lapse - If the Accumulated Value less Policy Debt on a Monthly
Payment Date is not sufficient to cover the current monthly deduction, a grace
period of 61 days will be allowed for the payment of sufficient premium to keep
your policy in force.
The grace period begins on the Monthly Payment Date on which the insufficiency
occurred and ends 61 days thereafter. At the start of the grace period, we will
notify you and any assignee of record at the last known address. The notice will
state the due date and the amount of premium required for your policy to remain
in force. A minimum of three times the monthly deduction due when the
insufficiency occurred, plus Premium Load, must be paid. There is no penalty for
paying a premium during the grace period. Your policy will remain in force
during the grace period. If sufficient premium is not paid by the end of the
grace period, a lapse will occur. Thirty-one days prior to lapse, we will send
you and any assignee of record a notice containing the lapse date and the
required premium to keep your policy in force. If the Survivor dies during the
grace period, the death benefit proceeds will be reduced by any overdue charges.
Upon lapse, the policy will terminate with no value.
Reinstatement - If it has not been surrendered, this policy may be reinstated
not more than five years after the end of the grace period. To reinstate this
policy you must provide us with the following:
.. a written application;
.. evidence of Insurability satisfactory to us for each Insured who was alive on
the date of lapse;
.. sufficient premium to cover all monthly deductions due and
unpaid during the grace period; plus
.. sufficient premium to keep the policy in force for three months from the
reinstatement date.
The effective date of the reinstated policy will be the first Monthly Payment
Date on or following the date we approve your reinstatement application. If the
policy is reinstated on the first Monthly Payment Date following lapse, any
Policy Debt on the date of lapse will also be reinstated. If the policy is
reinstated after the first Monthly Payment Date following lapse, any Policy Debt
outstanding on the date of lapse will be extinguished, except that you may
instruct us by Written Request to reinstate the Policy Debt in such case.
TRANSFERS
Transfers - After your initial Net Premium has been allocated according to your
instructions and while your policy is in force, you may, upon Written Request,
transfer your Accumulated Value, or a part of it, among the Investment Options
as provided in this section. No transfer may be made if the policy is in a grace
period and the required premium has not been paid.
Limits on Transfers - No charges are currently imposed for transfers. We reserve
the right to:
.. limit the size of transfers so that each transfer is at least $500;
.. limit the frequency of transfers (however, at least one transfer per
month will be allowed);
.. disallow a transfer from any Investment Option if the remaining balance would
be less than $500; o assess a $25 charge for each transfer exceeding 12 per
policy year.
Limits on Transfers to the Fixed Options - Transfers into the Fixed Options can
be made only during the policy month prior to a policy anniversary.
Limits on Transfers from the Fixed Options - One transfer from either Fixed
Option may be made in any twelve-month period. Each transfer from the Fixed
Account will be limited to the greater of $5,000 or 25% of the Accumulated Value
in the Fixed Account. Each transfer from the Fixed LT Account will be limited to
the greater of $5,000 or 10% of the Accumulated Value in the Fixed LT Account.
Allocations to the Fixed LT Account - We reserve the right to limit the amount
allocated to the Fixed LT Account to $1,000,000 during the most recent 12 months
for all policies owned by you. Allocations include
P03S5M Page 12
Net Premium payments, transfers and loan repayments. We may increase the
$1,000,000 limit at any time at our sole discretion. You may contact us to find
out if a higher limit is in effect.
SURRENDER AND WITHDRAWAL OF VALUES
Surrender - Upon Written Request while either Insured is living you may
surrender this policy for its Net Cash Surrender Value. The policy will
terminate on the date the request is received.
Net Cash Surrender Value - The Net Cash Surrender Value is the Cash Surrender
Value less any Policy Debt.
Cash Surrender Value - The Cash Surrender Value is the Accumulated Value less
any Surrender Charge.
Surrender Charge - If you surrender your policy, a Surrender Charge will be
deducted from the Accumulated Value. The Surrender Charge is needed to help pay
for costs such as underwriting, policy issue and sales and distribution costs.
Each Coverage Segment has an associated Surrender Charge, which is shown in the
Policy Specifications (for the initial Coverage Segment) or in a supplemental
schedule of coverage (for subsequent Coverage Segments).
Surrender Charge on Face Amount Decrease - If you request to decrease the Face
Amount, we reserve the right to deduct a Surrender Charge from the Accumulated
Value. The Surrender Charge in such case will equal the Surrender Charge that
would be imposed if you were to surrender your policy at the time of the
decrease multiplied by the ratio of the amount of the decrease divided by the
Face Amount immediately before the decrease.
After a Face Amount decrease, the total Surrender Charge that would be imposed
upon a full surrender of your policy will be reduced by the Surrender Charge
deducted from the Accumulated Value at the time of the decrease.
Withdrawals - Upon Written Request on or after the first policy anniversary
while either Insured is living, you may withdraw a portion of the Net Cash
Surrender Value of this policy. We will deduct a withdrawal fee of $25 from the
Accumulated Value for each withdrawal. There is no Surrender Charge imposed for
a Withdrawal, even if the Face Amount is reduced as a result of the Withdrawal.
Withdrawals will be subject to the following conditions:
.. The amount of each withdrawal must be at least $500 and the Net Cash
Surrender Value remaining after a withdrawal must be at least $500; and
.. If there is any Policy Debt at the time of each withdrawal, the amount of
the withdrawal is limited to the excess, if any, of the Cash Surrender
Value immediately prior to the withdrawal over the result of the Policy
Debt divided by 90%.
The amount of each withdrawal, and its associated withdrawal fee, will be
allocated proportionately to the Accumulated Value in the Investment Options
unless you request otherwise. If the Survivor dies after the request for a
withdrawal is sent to us and prior to the withdrawal being effected, the amount
of the withdrawal will be deducted from the death benefit proceeds, which will
be determined without taking the withdrawal into account.
A withdrawal will affect the death benefit, depending on the Death Benefit
Option you have chosen. If your policy's death benefit is greater than the
Minimum Death Benefit, then the withdrawal may reduce the death benefit by the
amount of the withdrawal depending on the Death Benefit Option in effect.
However, if your policy's death benefit is equal to the Minimum Death Benefit,
the withdrawal may cause the death benefit to decrease by an amount greater than
the amount of the withdrawal. For Death Benefit Option C, if the sum of the
withdrawals and other distributions from the policy is greater than the
premiums, the death benefit will be less than the Face Amount.
Withdrawals May Change the Face Amount - A withdrawal will never increase the
Net Amount at Risk. A withdrawal will reduce the Face Amount, but only for
policies having Death Benefit Option A or D. In the
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case of Option A, the reduction of the Face Amount will equal the excess of the
Face Amount prior to the withdrawal over (a). In the case of Option D, the
reduction of the Face Amount will equal the excess of the Face Amount prior to
the withdrawal over (a) divided by (b), where:
(a) = the death benefit prior to the withdrawal minus the amount of withdrawal;
and
(b) = the Option D death benefit factor in the year of the withdrawal.
Regardless of the prior paragraph, you can make one withdrawal during each of
the first 15 policy years of $10,000 or 10% of the Net Cash Surrender Value,
whichever is less, without reducing the Face Amount. If you withdraw a larger
amount, or make more than 1 withdrawal per year in the first 15 policy years,
the Face Amount will be reduced by the amount, if any, by which the Face Amount
exceeds the death benefit immediately before the withdrawal, minus the amount of
the withdrawal.
TIMING OF PAYMENTS AND TRANSFERS
Variable Accounts - With respect to allocations made to the Variable Accounts,
we will calculate values for surrenders, withdrawals, loans and, unless
transfers are restricted, transfers as of the end of the Valuation Date on or
next following the day on which we receive your instructions. For any portion of
death benefit depending on the Variable Accumulated Value, we will calculate
such value as of the end of the Valuation Date on or next following the day on
which the Survivor's death occurs. We will pay such amounts and will process
such transfers within seven days after we receive all the information needed for
the transaction. However, we may postpone the calculation, payment or transfer
of any amounts that are based on the investment performance of the Variable
Accounts, if:
.. the New York Stock Exchange is closed on other than customary weekend and
holiday closings; or
.. trading on the New York Stock Exchange is restricted as determined by the
Securities and Exchange Commission (SEC); or o an emergency exists, as
determined by the SEC, as a result of which it is not reasonably practicable
to determine the value of the Account assets or to dispose of Account
securities; or
.. The SEC by order permits postponement for the protection of policy owners.
Fixed Options - With respect to allocations made to the Fixed Options, we may
defer surrenders, withdrawals, loans (except for loans to pay a premium on any
policy issued by us), and transfers from the Fixed Options, for up to six months
after we receive your request. If we defer any such payment for more than 30
days after we receive your request, we will pay interest at the rate required by
the state in which this policy is delivered, but not less than an annual rate of
3%.
INCOME BENEFITS
Income Benefits - Surrender or withdrawal benefits may be used to buy a lifetime
monthly income for either Insured as long as the monthly income is at least
$100. Death benefits may be used to buy a monthly income for the lifetime of the
beneficiary. The monthly income will automatically be guaranteed to continue for
at least ten years, unless another form of payment is requested. Under the
automatic form of payment, if the income recipient dies before the end of the
ten-year period, payments will continue to the end of the ten-year period to a
person designated by the income recipient in writing. The purchase rates for the
monthly income will be set periodically by the Company. However, under the
automatic income benefit, the monthly income bought by each $1,000 of benefit
will never be less than that shown below.
P03S5M Page 14
Monthly Income Monthly Income Monthly Income
Age Male Female Age Male Female Age Male Female
0-30 $3.20 $3.09 46 $3.81 $3.61 62 $5.10 $4.73
32 3.25 3.14 48 3.92 3.71 64 5.35 4.95
34 3.31 3.19 50 4.05 3.81 66 5.62 5.20
36 3.38 3.24 52 4.18 3.93 68 5.92 5.47
38 3.45 3.30 54 4.33 4.06 70 6.23 5.78
40 3.53 3.37 56 4.49 4.20 72 6.56 6.11
42 3.62 3.44 58 4.68 4.36 74 6.90 6.48
44 3.71 3.52 60 4.88 4.54 75+ 7.08 6.67
Monthly income amount for Ages not shown are halfway between the two amounts for
the nearest two Ages that are shown. Amounts shown are based on the Annuity 2000
table with interest at 3.00%. This benefit is not available if the income would
be less than $100 a month. We may require evidence of survival for incomes that
last more than ten years.
Other Income Options - Surrender, withdrawal or death benefits may be used under
any other payment plans that we make available at that time. There is an
Interest Settlement Option available under which we will credit interest
monthly. Amounts left on deposit under this plan, and credited interest, will be
accumulated until you request a withdrawal.
POLICY LOANS
Policy Loans - You may obtain loans by Written Request after the Free Look
Period, on the sole security of the Loan Account of this policy. We recommend
you consult your tax advisor before requesting a policy loan.
Loan Amount Available - The amount of a loan must be at least $200. The amount
available for a loan is equal to 90% of Accumulated Value, less any Policy Debt
and also less any Surrender Charge that would be imposed if the policy were
surrendered on the date the loan is taken or, if greater, the result of (a x
b/c)-d, where:
a = the Accumulated Value less 12 times the most recent monthly
deduction less any Surrender Charge on the date of the loan;
b = 1 + rate of interest credited on the Loan Account on the date of the loan;
c = 1.0325; and d = any existing Policy Debt.
Loan Interest - Interest will accrue daily and is payable in arrears at the
annual rate of 3.25%. Interest not paid when due will be added to the loan
principal and bear interest at the same rate of interest.
Loan Account - When a loan is taken, an amount equal to the loan is transferred
out of the Accumulated Value in the Investment Options into the Loan Account to
secure the loan. Such transfers will be done on a pro rata basis from your
Accumulated Value in the Investment Options, unless you request a specific
allocation. We will credit interest to the Loan Account as described in the
Accumulated Value section.
On each policy anniversary, if the amount in the Loan Account exceeds Policy
Debt, the excess will be transferred from the Loan Account to the Investment
Options according to your most recent allocation instructions for allocation of
premium. If Policy Debt exceeds the amount in the Loan Account, the excess will
be transferred from the Investment Options on a proportionate basis to the Loan
Account.
Loan Repayment - Loans may be repaid at any time prior to lapse of this policy.
An amount equal to the portion of any loan repaid, but not more than the amount
in the Loan Account, will be transferred from the Loan Account to the Investment
Options according to your most recent allocation instructions for allocation of
premium. We reserve the right to first transfer repayments from the Loan Account
to each
P03S5M Page 15
Fixed Option up to the amount that was originally borrowed. Any excess
over such amount will be transferred to the Variable Accounts relative to your
most recent allocation instructions. Any payment we receive from you while you
have a loan will be first considered a loan repayment, unless you tell us in
writing it is a premium payment.
SEPARATE ACCOUNT PROVISIONS
Separate Account - We established the Separate Account and maintain it under the
laws and regulations of California. The assets of the Separate Account shall be
valued at least as often as any policy benefits vary, but at least monthly. The
Separate Account is divided into subaccounts, called Variable Accounts. Income
and realized and unrealized gains and losses from the assets of each Variable
Account are credited or charged against it without regard to our other income,
gains or losses. Assets may be put in our Separate Account to support this
policy and other variable life policies. Assets may be put in our Separate
Account for other purposes, but not to support contracts or policies other than
variable life contracts or policies.
The assets of our Separate Account are our property. The portion of its assets
equal to the reserves and other policy liabilities with respect to our Separate
Account will not be chargeable with liabilities arising out of any other
business we conduct. We may transfer assets of a Variable Account in excess of
the reserves and other liabilities with respect to that Variable Account to
another Variable Account or to our general account. All obligations arising
under the policy are general corporate obligations of ours. We do not hold
ourselves out to be trustees of the Separate Account assets.
Variable Accounts - Each Variable Account may invest its assets in a separate
class of shares of a designated investment company or companies. The Variable
Accounts of our Separate Account that were available for your initial
allocations are shown in your application for this policy. From time to time, we
may make other Variable Accounts available to you. We will provide you with
written notice of all material details including investment objectives and all
charges.
We reserve the right, subject to compliance with the law then in effect, to:
.. change or add designated investment companies;
.. add, remove or combine Variable Accounts;
.. add, delete or make substitutions for the securities that are held or
purchased by the Separate Account or any Variable Account;
.. register or deregister any Variable Account under the Investment Company Act
of 1940;
.. change the classification of any Variable Account;
.. operate any Variable Account as a managed investment company or as a unit
investment trust;
.. combine the assets of any Variable Account with other separate accounts or
subaccounts of ours or our affiliates; o transfer the assets of any Variable
Account to other separate accounts or subaccounts of ours or our affiliates;
.. run any Variable Account under the direction of a committee, board, or other
group;
.. restrict or eliminate any voting rights of policy Owners with respect to any
Variable Account, or other persons who have voting rights as to any Variable
Account;
.. change the allocations permitted under the policy;
.. terminate and liquidate any Variable Account; and
.. make any other change needed to comply with law.
If any of these changes result in a material change in the underlying investment
of a Variable Account of our Separate Account, we will notify you of such
change.
Unless required by law or regulation, an investment policy may not be changed
without our consent. We will not change the investment policy of the Separate
Account without the approval of the Insurance Commissioner in the state of
California, and the approval process is on file with the Commissioner.
P03S5M Page 16
GENERAL PROVISIONS
Entire Contract - This policy is a contract between you and us. This policy, any
attached endorsements, benefits and riders and the attached copy of the initial
application are the entire contract, except as follows. Any written application
for a change in policy terms allowed by the policy after issue or written notice
of exercise of policy options made after the policy has been issued will also
become part of the contract upon our acceptance of such application or notice
and our mailing of same to your address last known to us. Only our president,
chief executive officer or secretary is authorized to change this contract or
extend the time for paying premiums. Any such change must be in writing.
All statements in the application, in the absence of fraud, shall be deemed
representations and not warranties. We will not use any statement to contest
this policy or defend a claim on grounds of misrepresentation unless the
statement is in an application.
Non-Participating - This policy will not share in any of our surplus earnings.
Incontestability - We will not contest this policy unless there was a material
misrepresentation in an application, including any reinstatement application.
The policy will terminate upon successful contest with respect to either
Insured. Except for failure to pay premiums, this policy cannot be contested
after the expiration of the following time periods:
.. If this policy has not been reinstated, we cannot contest this policy after
it has been in force during the lifetime of at least one of the Insureds for
two years from the Policy Date; and
.. Following a reinstatement, we cannot contest this policy after it has been
in force during the lifetime of at least one of the Insureds for two years
from the reinstatement date.
Suicide Exclusion - If the death of either, or both, Insureds is the result of
suicide, whether sane or insane, within two years of the policy date, no death
benefit proceeds will be paid. Instead, we will cancel the policy and return the
sum of the premiums paid, less the sum of any Policy Debt and withdrawals.
Misstatement - If either Insured's Age is misstated in the application, the
amount of the death benefit shall be the greater of that which would be
purchased by the most recent non-zero Cost of Insurance Charge at the correct
Age, or the Minimum Death Benefit for the correct Age.
Evidence of Insurability - We reserve the right to require Evidence of
Insurability for any policy change or any premium payment, which would result in
an increase in Net Amount at Risk.
Maturity - This policy does not mature, but will continue in force so long as at
least one Insured is alive and there is sufficient Accumulated Value to provide
for the Monthly Deduction due. After Age 100 of the younger Insured, no Monthly
Deduction is due.
Reports - A report will be mailed to you at no charge to your last known address
at the end of each policy year. This report will include the following
information for the policy year:
.. the Accumulated Value;
.. any Surrender Charge;
.. the Cash Surrender Value;
.. the current death benefit;
.. any existing Policy Debt;
.. transactions that occurred during the reporting period;
.. the Guideline Premiums, if applicable; and
.. any information required by law.
In addition to the above report, we will mail you annually a report containing
financial statements for the Separate Account and the designated investment
company or companies in which the Separate Account invests, the latter of which
will include a list of the portfolio securities of the investment company, as
P03S5M Page 17
required by the Investment Company Act of 1940. We will also send any other
reports as required by federal securities law.
Policy Illustrations - Upon request we will give you an illustration of the
future benefits under this policy based upon both guaranteed and current cost
factor assumptions. However, if you ask us to do this more than once in any
policy year, we reserve the right to charge you a fee not to exceed $25 per
request for this service. Illustrated benefits that are not guaranteed, such as
benefits based on the current cost factor assumptions, will vary depending upon
a number of factors, including but not limited to, changes in future investment
performance.
Basis of Values - A detailed statement showing how values are determined has
been filed with the state insurance department. All values are at least equal to
the minimums required by the law of the state in which this policy is delivered,
based on the guaranteed interest for the Fixed Options, as detailed in the Fixed
Accumulated Value provision, and 1980 CSO mortality, except for unisex issues
which are based on 1980 CSO Table B mortality (80% male and 20% female).
Ownership of Assets - We have the exclusive and absolute control of our assets,
including all assets in the Separate Account.
Tax Qualification as Life Insurance - This policy is intended to qualify as a
life insurance contract for federal tax purposes, and the death benefit under
this policy is intended to qualify for federal income tax exclusion. The policy,
including any other rider, benefit or endorsement, shall be interpreted to
ensure and maintain such tax qualification, despite any other provision to the
contrary. We will not accept a premium payment, which would cause the policy to
fail to qualify as a life insurance contract for federal tax purposes.
If at any time the premiums paid under the policy exceed the amount allowable
for such tax qualification, the excess amount, including any associated
investment gains or losses, shall be removed from the policy as of the date of
its payment, and any appropriate adjustment in the death benefit shall be made
as of such date. The excess amount, as determined under federal tax law,
including any associated investment gains or losses, shall be refunded no later
than 60 days after the end of the applicable contract year. For any such refund,
any premium load originally assessed will be refunded and no surrender charges
will apply.
If this excess amount is not refunded by the end of such 60-day period, the
death benefit shall be increased retroactively to the minimum extent necessary
so that at no time is the death benefit ever less than the amount necessary to
ensure or maintain such tax qualification, and the Accumulated Value will be
reduced to reflect the increased Monthly Deductions as a result of such death
benefit increase. If you request a decrease in policy or rider benefits, it may
cause a reduction in any applicable limitations on premiums or cash values for
the policy under federal tax law. Such a reduction in these limits may require
us to make a distribution from the policy equal to the greatest amount by which
the premiums paid or cash values for the policy, as determined under federal tax
law, exceed any such reduced limits, in order to maintain the policy's tax
qualification. If such a distribution is made, the distribution will be paid to
you and the Accumulated Value will be reduced by the amount of the distribution.
However, no request for a decrease in policy or rider benefits will be allowed
to the extent that the resulting reduction in such tax limits would require us
to distribute more than the Net Cash Surrender Value for the policy.
Modified Endowment Contract Status -Unless you have given us Written Notice to
the contrary, the provisions of this Modified Endowment Contract Status
subsection apply. Under federal tax law, if the funding of a life insurance
contract occurs too rapidly, it becomes a Modified Endowment Contract and fails
to qualify for certain favorable treatment as a result. This policy is intended
to qualify as a life insurance contract that is not a Modified Endowment
Contract for federal tax purposes. This policy, including any other rider,
benefit or endorsement, shall be interpreted to prevent the policy from being
subject to such Modified Endowment Contract treatment, despite any other
provision to the contrary. We will not accept a payment as premium or otherwise
which would cause the policy to become a Modified Endowment Contract.
P03S5M Page 18
If at any time the amounts paid under the policy exceed the limit for avoiding
such Modified Endowment Contract treatment, the excess amount, including any
associated investment gains or losses, shall be removed from the policy as of
the date of its payment, and any appropriate adjustment in the death benefit
shall be made as of such date. The excess amount, as determined under federal
tax law, including any associated investment gains or losses, shall be refunded
no later than 60 days after the end of the applicable contract year. For any
such refund, any premium load originally assessed will be refunded and no
surrender charges will apply.
If this excess amount is not refunded by the end of such 60-day period, the
death benefit shall be increased retroactively to the minimum extent necessary
so that at no time is the death benefit ever less than the amount necessary to
avoid such Modified Endowment Contract treatment, and the Accumulated Value will
be reduced to reflect the increased Monthly Deductions as a result of such death
benefit increase.
Any request that would change the death benefits under the policy and riders
will not be processed if the change would cause the policy to be treated as a
Modified Endowment Contract. Such changes include a reduction in the Face
Amount, a change in death benefit option, and a reduction in Face Amount due to
a withdrawal.
Other Distributions of Accumulated Value - If the Net Amount at Risk ever
exceeds three times the original Face Amount, we reserve the right to make a
distribution of Accumulated Value to make the Net Amount at Risk equal three
times the original Face Amount. In such case, the distribution will be treated
as a premium refund and no surrender charge will be imposed. By treating the
distribution as a premium refund, we mean that, in addition to the distribution
of Accumulated Value, which you will receive, we will also pay you an amount
representing a return of premium load associated with the distribution. The
amount representing the return of premium load will be equal to the reduction in
Accumulated Value multiplied by (1/(1-premium load rate))-1, provided that such
amount can never exceed the total premium load paid under the policy.
Termination - This policy will terminate on the earliest of:
.. the death of the Survivor; and
.. the lapse or surrender of this policy.
Compliance - We reserve the right to make any change to the provisions of this
policy to comply with, or give you the benefit of, any federal or state statute,
rule, or regulation, including but not limited to the requirements for life
insurance contracts under the Code or any state. We will provide you with a copy
of any such change, and file such a change with the insurance supervisory
official of the state in which this policy is delivered. You have the right to
refuse any such change.
P03S5M Page 19
INDEX
Accumulated Value 7 Loan Repayment 13
Administrative Charge 9 Maturity 15
Age 5 Misstatement 15
Assignment 6 Modified Endowment Contract Status 16
Basis of Values 16 Monthly Deduction 9
Beneficiary 6 Monthly Payment Date 5
Cash Surrender Value 11 Mortality and Expense Risk Charge 9
Cash Value Accumulation Test 6 Net Amount at Risk 5, 9
Change of Death Benefit Option 6 Net Cash Surrender Value 11
Code 5 Net Premium 5
Compliance 17 Non-Participating 15
Cost of Insurance Charge 9 Owner 6
Cost of Insurance Rates 9 Planned Premium 7
Coverage Segments 5 Policy Date 5
Death Benefit 7 Policy Debt 5
Death Benefit Options 7 Policy Illustrations 16
Death Benefit Proceeds 6 Policy Loans 13
Death Benefit Qualification Test 6 Premium Allocation 7
Entire Contract 15 Premium Limitation 7
Evidence of Insurability 5, 15 Premium Load 9
Face Amount 5 Premiums 6
Face Amount Decrease 7 Reinstatement 10
Face Amount Increase 7 Reports 15
Fixed Accumulated Value 7 Separate Account 5, 14
Fixed Options 5, 12 Suicide Exclusion 15
Grace Period 10 Surrender 11
Guideline Premium Limit 7 Surrender Charge 11
Guideline Premium Test 6 Survivor 5
Home Office 5 Tax Qualification as Life Insurance 16
Income Benefits 12 Termination 17
Incontestability 15 Transfers 10
Insureds 5 Valuation Date 6
Interest Settlement Option 13 Valuation Period 6
Investment Options 5 Variable Account 6, 14
Lapse 10 Variable Accumulated Value 8
Loan Account 8, 13 Withdrawals 11
Loan Amount Available 13 Written Request 6
Loan Interest 13
P03S5M Page 20
[LOGO OF PACIFIC LIFE]
Pacific Life Insurance Company . 000 Xxxxxxx Xxxxxx Xxxxx . Xxxxxxx Xxxxx, XX 00000
-----------------------------------------------------------------------------------
LAST SURVIVOR
FLEXIBLE PREMIUM
VARIABLE LIFE
INSURANCE POLICY
.. Death Benefit Payable When Both Insureds Have Died While the Policy is in Force
(There Is No Death Benefit When The First Insured Dies)
.. Net Cash Surrender Value Payable upon Surrender While the Policy is in Force
.. Adjustable Face Amount
.. Benefits May Vary Based on Investment Experience
.. Non-Participating
P03S5M
