Exhibit

Exhibit 26 (e)(ii)

ABC COMPANY ABC COMPANY CONTROL NUMBER

GROUP VARIABLE UNIVERSAL LIFE ABC COMPANY BRANCH NUMBER(S)
ENROLLMENT FORM

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SECTION 1--EMPLOYEE/MEMBER INFORMATION Social Security Number Sex

_______-______-____ [ ] Male [ ] Female

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Employee/Member First Name Middle Initial Last Name

____________________________________________________________________

Date of Birth Marital Status

(mm-dd-yy) [ ] Single [ ] Married [ ] Divorced

____/____/_____ [ ] Separated [ ] Widowed

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Home Street Address Employment Date Employment Location

(mm-dd-yy) (City, State, Zip Code)

______________________________________ ------------------------------------------------------------

City State Zip Code Annual Salary Payroll Frequency

[ ] Weekly [ ] Bi-weekly [ ] Monthly

$___________ [ ] Semi-monthly

_________________________________________

Daytime Telephone Number Home Telephone Number

Salary Level -- [ ] Hourly [ ] Salaried Employee/Member/Payroll Number

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SECTION 2--COMPLETE IF ELECTING EMPLOYEE/MEMBER COVERAGE

(Please refer to the enclosed Coverage Information Sheet for plan specifics)

A) SELECT COVERAGE AMOUNT: Multiple of Salary ___1x, ___2x, ___3x, ___4x, ___5x

B) CALCULATE MONTHLY COST OF INSURANCE:

Face Amount Chosen: $__________DIV 1,000 x __________= Monthly Cost of Insurance $____(2B)

(Round face amount (Insert rate from

to next higher 5,000) rate sheet)

C) ADD MONTHLY ADMINISTRATIVE FEE (IF APPLICABLE) $___(2C)

D) SELECT EXTRA MONTHLY CONTRIBUTION TO CASH ACCUMULATION FUND: $___(2D)

E) TOTAL MONTHLY COST OF EMPLOYEE COVERAGE (2B + 2C + 2D): $___(2E)

F) ANSWER IMPORTANT MEDICAL QUESTION:

Have you ever smoked cigarettes or used other forms of tobacco in the last 12 months? [ ] Yes [ ] No

G) COMPLETE IF ELECTING ADDITIONAL EMPLOYEE COVERAGE:

Extended Death Protection During Total Disability? [ ] Yes [ ] No

Accidental Death & Dismemberment Coverage? [ ] Yes [ ] No

Automatic Increases in Coverage? [ ] Yes [ ] No

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SECTION 3--COMPLETE IF ELECTING SPOUSE COVERAGE

(Please refer to the enclosed Coverage Information Sheet for plan specifics)

Spouse First Name Middle Initial Last Name Spouse Social Security Number Spouse Date of Birth

(mm-dd-year)

___________________________________________________-__________-___________________/______/______

A) SELECT COVERAGE AMOUNT: [ ] $10,000 [ ] $25,000 [ ] $50,000 [ ] $100,000

B) CALCULATE MONTHLY COST OF INSURANCE:

Face Amount Chosen: $__________DIV 1,000 x __________= Monthly Cost of Insurance $____(3B)

(Round face amount (Insert rate from

to next higher 5,000) rate sheet)

C) ADD MONTHLY ADMINISTRATIVE FEE (IF APPLICABLE) $___(3C)

D) SELECT EXTRA MONTHLY CONTRIBUTION TO CASH ACCUMULATION FUND: $___(3D)

E) TOTAL MONTHLY COST OF SPOUSE COVERAGE (3B + 3C + 3D): $___(3E)

F) ANSWER IMPORTANT MEDICAL QUESTION:

Has your spouse ever smoked cigarettes or used other forms of tobacco in the last 12 months? [ ] Yes [ ] No

G) COMPLETE IF ELECTING ADDITIONAL SPOUSE OPTION:
Accidental Death & Dismemberment Coverage? [ ] Yes [ ] No

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SECTION 4--COMPLETE IF ELECTING DEPENDENT CHILD(REN) COVERAGE

Youngest Child's Date of Birth (mm-dd-year) _____/_____/_______

A) SELECT COVERAGE AMOUNT(S) & NUMBER OF DEPENDENTS:

[ ] $10,000________ # of Dependents Enrolled [ ] $5,000 ________ # of Dependents Enrolled

B) CALCULATE MONTHLY COST OF INSURANCE:

$10,000 DIV 1,000 x __________ x___________= Monthly Cost of Insurance $____(4A)

(Insert rate from (# of dependents)

rate sheet)

$5,000 DIV 1,000 x __________ x___________= Monthly Cost of Insurance $____(4B)

(Insert rate from (# of dependents)

rate sheet)

C) TOTAL MONTHLY COST OF DEPENDENT COVERAGE (4A AND/OR 4B) $____(4C)

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SECTION 5--TOTAL EXPECTED MONTHLY PREMIUMS

COST OF EMPLOYEE, SPOUSE AND DEPENDENT COVERAGE
(2E + 3E + 4C) = TOTAL EXPECTED MONTHLY PREMIUM $_______________

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SECTION 6--BENEFICIARY DESIGNATIONS

Beneficiary First Name Middle Initial Last Name Beneficiary Social Security Number

____________________________________________________________________-________-_______________

Home Street Address Beneficiary Relationship to Employee

____________________________________________________ _____________________________________

City State Zip Code Beneficiary Date of Birth (mm-dd-year)

______/______/_____

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Contingent Beneficiary First Name Middle Initial Last Name Beneficiary Social Security Number

____________________________________________________ ____________-________-_______________

Home Street Address Beneficiary Relationship to Employee

____________________________________________________ _____________________________________

City State Zip Code Beneficiary Date of Birth (mm-dd-year)

______/______/_____

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SECTION 8--EMPLOYEE/MEMBER SIGNATURE

I request to elect Group Variable Universal Life coverage for which I am or may become eligible, and authorize deductions from my earnings of the required contributions. If I decide to elect this coverage after the initial enrollment period, I understand that evidence of good health will be requested. I certify that information contained in this form is complete and accurate.

Employee/Member Signature Date (mm-dd-year)

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SECTION 7--BENEFIT ADMINISTRATOR'S SIGNATURE

Benefit Administrator's Signature Business Phone Number Date (mm-dd-year)

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