EX-99.A.1.A.5.I 2 w45785ex99-a_1a5i.txt FORM OF ILLUSTRATION OF DEATH BENEFITS, ET AL. 1 EXHIBIT 1.A.5.i FORM OF ILLUSTRATIONS OF DEATH BENEFITS, CASH SURRENDER VALUES AND ACCUMULATED PREMIUMS Tables on Pages A-3 to A-12 illustrate the Death Benefit and Cash Surrender Value of the Policy and are provided to assist in the comparison of the Policy with other variable life policies issued by PMLIC or other companies. The illustrations show how the Death Benefit and the cash surrender value (reflecting the deduction of the Premium Expense Charge and the Surrender Charge, if any), may vary over an extended period of time for different issue ages and premium classes, assuming hypothetical rates of investment return of the Subaccounts equivalent to constant gross annual rates of 0%, 6% and 12%. The tables on Pages A-3 to A-12 are for males and females at certain ages, for various Face Amounts and Non-Smoker premium class. These illustrations assume the payment of scheduled premiums only and thus are applicable for Policies with either the Basic Death Benefit or Increasing Death Benefit. The amounts shown are as of the end of each Policy Year. The tables on Pages A-3 to A-6, A-11 and A-12 assume that the current monthly cost of insurance rates and the current transaction charge for the Zero Coupon Bond Subaccount will be charged for the entire period illustrated while the tables on Pages A-7 to A-10 are based on guaranteed (maximum) cost of insurance rates and the maximum transaction charge for the Zero Coupon Bond Subaccount. The amounts shown in all tables reflect daily charges for mortality and expense risks equivalent to an effective annual charge of 0.60%, and in addition, reflect an averaging of certain other asset charges that may be assessed under the Policy, depending upon how premiums are allocated. The total of the asset charges reflected in the illustrations, including the 0.60% mortality and expense risk charge listed above, is 1.39% for the illustrations on Pages A-3 to A-6, A-11 and A-12 and 1.40% for the Illustrations on Pages A-7 to A-10. The total charge is based on an assumption that an Owner allocates the Policy values equally among each available Subaccount. These asset charges reflect an investment advisory fee of 0.62% which represents an average of the fees incurred by the Portfolios during the most recent fiscal year and expenses of 0.17% which is based on an average of the actual expenses incurred by the Portfolios during the most recent fiscal year. For certain Portfolios, certain expenses were reimbursed or fees waived during 1999. It is anticipated that expense reimbursement and fee waiver arrangements will continue past the current year. Absent the expense reimbursement, the 1999 Total Annual Expenses would have been 1.21%, for the Market Street Fund All Pro Small Cap Value Portfolio, 0.57% for the VIP Fund Equity-Income Portfolio, 0.66% for the VIP Fund Growth Portfolio, 0.91% for the VIP Fund Overseas Portfolio, 0.63% for the VIP II Fund Asset Manager Portfolio, 0.67% for the VIP II Fund Contrafund(R) Portfolio, and 3.23%, for the Van Eck Worldwide Real Estate Portfolio. Similar expense reimbursement and fee waiver arrangements were also in place for the other Portfolios and it is anticipated that such arrangements will continue past the current year. However, no expenses were reimbursed or fees waived during 1999 for these Portfolios because the level of actual expenses and fees never exceeded the thresholds at which the reimbursement and waiver arrangements would have become operative. In the event that reimbursements or fee waivers do not continue for any Portfolio in future years, the Portfolio's actual expenses would increase and this would likely increase the average expense figure on which the illustrations are based. See "Table of Fund Fees and Expenses", for more information about such reimbursements. The tables also reflect the fact that no charges for Federal or state income taxes are currently made against the Subaccounts. If such a charge is made in the future, it would take a higher gross annual rate of return to produce the same Policy values. The second column of each table shows the amount to which the premiums would accumulate if an amount equal to those premiums were invested to earn interest, after taxes, at 5% compounded annually. The illustrations also provide information about the premiums payable on and after the Premium Change Date. The tables illustrate the Policy values that would result if scheduled premiums are paid when due and the year, if any, in which the Special Premium Payment Provision initially goes into effect. 1 2 That year is shown by use of an asterisk (*). If the Special Premium Payment Provision goes into effect for a Policy Year not shown in the illustration, the asterisk is shown for the first Policy Year illustrated after it goes into effect. The Tables on Pages A-11 and A-12 illustrate the Death Benefit and cash surrender value of the Policy with the Basic Death Benefit and the Increasing Death Benefit, respectively. In addition to the assumptions regarding hypothetical rates of investment return for the Subaccounts and charges and expenses, these illustrations are for a male, age 35 having a Policy with a $100,000 Face Amount and an unscheduled premium of $10,000 when the Policy is purchased. The year in which the Special Premium Payment Provision goes into effect under each Death Benefit Option is also shown. Upon request, PMLIC will provide a comparable illustration of future benefits under the Policy based upon the Insured's Age, sex, if applicable, Premium Class, and frequency of premium payments requested. For Policies issued in states requiring "unisex" policies (currently Montana) or in conjunction with employee benefit plans, PMLIC will furnish upon request illustrations based on unisex cost of insurance rates, and the Insured's age. PMLIC reserves the right to charge a reasonable fee for this service to persons who request more than one policy illustration during a policy year. 2 3 PROVIDENT MUTUAL -- MODIFIED PREMIUM VARIABLE LIFE INSURANCE POLICY MALE ISSUE AGE 25 $100,000 FACE AMOUNT (GUARANTEED DEATH BENEFIT) $765 INITIAL SCHEDULED PREMIUM FOR NON-SMOKERS(1) USING CURRENT COST OF INSURANCE CHARGES
DEATH BENEFIT CASH SURRENDER VALUE ------------------------------------------- ------------------------------------------- PREMIUMS ASSUMING HYPOTHETICAL GROSS(3) ASSUMING HYPOTHETICAL GROSS(3) END OF ACCUMULATED ANNUAL INVESTMENT RETURN OF ANNUAL INVESTMENT RETURN OF POLICY AT 5 PCT. INT. ------------------------------------------- ------------------------------------------- YEAR PER YEAR(2) 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS ------ -------------- ------------ ------------ ------------- ------------ ------------ ------------- 1 803 100,000 100,000 100,000 0 0 0 2 1,647 100,000 100,000 100,000 170 264 363 3 2,532 100,000 100,000 100,000 606 793 996 4 3,462 100,000 100,000 100,000 1,038 1,350 1,703 5 4,438 100,000 100,000 100,000 1,464 1,936 2,488 6 5,464 100,000 100,000 100,000 2,061 2,727 3,538 7 6,540 100,000 100,000 100,000 2,688 3,583 4,719 8 7,670 100,000 100,000 100,000 3,306 4,469 6,004 9 8,857 100,000 100,000 100,000 3,914 5,383 7,401 10 10,103 100,000 100,000 100,248 4,511 6,326 8,923 11 11,412 100,000 100,000 101,300 4,919 7,121 10,402 12 12,785 100,000 100,000 102,473 5,315 7,946 12,028* 13 14,228 100,000 100,000 103,780 5,695 8,799 13,815 14 15,743 100,000 100,000 105,236 6,060 9,682 15,778 15 17,333 100,000 100,000 106,858 6,407 10,594 17,935 16 19,003 100,000 100,000 108,664 6,737 11,536 20,304 17 20,756 100,000 100,273 110,672 7,047 12,506 22,905 18 22,597 100,000 100,650 112,907 7,336 13,506 25,763 19 24,530 100,000 101,023 115,392 7,603 14,534 28,903 20 26,560 100,000 101,394 118,156 7,849 15,593* 32,354 25 38,337 100,000 103,146 150,145 8,666 21,316 55,404 30 53,367 100,000 104,564 212,243 8,551 27,680 91,484 35 72,550 100,000 105,409 293,959 6,892 34,399 146,979 40 97,032 100,000 105,372 405,221 2,863 41,216 231,555 45 128,279 100,000 104,101 555,967 0 47,549 358,688 50 175,144 100,000 107,537 766,990 0 59,144 547,849 55 234,957 100,000 110,581 1,065,157 0 70,231 825,702
(1) If premiums are paid more frequently than annually the payments would be $393.98 semiannually, $200.43 quarterly, or $67.32 monthly. The death benefits and cash surrender values shown would be affected by the more frequent premium payments. The annual premium on the Premium Change Date assuming current cost of insurance charges will be as follows: $2,105 assuming a 0 pct. rate of return; $1,969 assuming a 6 pct. rate of return; and $765 assuming a 12 pct. rate of return. (2) The premiums accumulated at 5% interest in Column 2 are those payable if the gross investment return is 6%. (3) Assumes no Policy loan has been made. It is emphasized that the hypothetical investment rates of return shown above and elsewhere in this prospectus are illustrative only and should not be deemed a representation of past or future investment rates of return. Actual rates of return may be more or less than those shown and will depend on a number of factors, including the separate accounts chosen by an owner. The Death Benefit, Cash Surrender Value and premium on the premium change date for a Policy would be different from those shown if the actual rates of return average 0%, 6%, and 12% over a period of years, but also fluctuated above or below those averages for individual Policy years. No representations can be made by PMLIC that these hypothetical rates of return can be achieved for any one year or sustained over any period of time. 3 4 PROVIDENT MUTUAL -- MODIFIED PREMIUM VARIABLE LIFE INSURANCE POLICY FEMALE ISSUE AGE 35 $100,000 FACE AMOUNT (GUARANTEED DEATH BENEFIT) $991 INITIAL SCHEDULED PREMIUM FOR NON-SMOKERS(1) USING CURRENT COST OF INSURANCE CHARGES
DEATH BENEFIT CASH SURRENDER VALUE ------------------------------------------- ------------------------------------------- PREMIUMS ASSUMING HYPOTHETICAL GROSS(3) ASSUMING HYPOTHETICAL GROSS(3) END OF ACCUMULATED ANNUAL INVESTMENT RETURN OF ANNUAL INVESTMENT RETURN OF POLICY AT 5 PCT. INT. ------------------------------------------- ------------------------------------------- YEAR PER YEAR(2) 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS ------ -------------- ------------ ------------ ------------- ------------ ------------ ------------- 1 1,041 100,000 100,000 100,000 0 0 0 2 2,133 100,000 100,000 100,000 509 641 779 3 3,280 100,000 100,000 100,000 1,115 1,378 1,662 4 4,485 100,000 100,000 100,000 1,702 2,139 2,633 5 5,750 100,000 100,000 100,000 2,267 2,925 3,697 6 7,078 100,000 100,000 100,000 3,010 3,936 5,065 7 8,472 100,000 100,000 100,000 3,779 5,019 6,595 8 9,936 100,000 100,000 100,000 4,524 6,127 8,249 9 11,474 100,000 100,000 100,000 5,246 7,262 10,043 10 13,088 100,000 100,000 100,429 5,945 8,425 11,991 11 14,783 100,000 100,000 101,805 6,423 9,417 13,907 12 16,563 100,000 100,000 103,342 6,879 10,443 16,009* 13 18,431 100,000 100,000 105,056 7,316 11,503 18,318 14 20,393 100,000 100,000 106,966 7,732 12,600 20,854 15 22,454 100,000 100,000 109,094 8,127 13,733 23,641 16 24,617 100,000 100,000 111,461 8,499 14,905 26,704 17 26,888 100,000 100,140 114,095 8,848 16,115 30,069 18 29,273 100,000 100,617 117,023 9,171 17,362 33,769 19 31,777 100,000 101,090 120,277 9,465 18,645 37,833 20 34,407 100,000 101,561 123,895 9,732 19,967* 42,302 25 49,662 100,000 103,812 162,447 10,571 27,166 72,198 30 69,133 100,000 105,645 232,224 10,268 35,320 119,089 35 93,983 100,000 106,733 324,850 7,684 43,959 191,088 40 128,506 100,000 109,183 450,836 4,817 55,295 300,557 45 172,568 100,000 110,621 624,069 0 66,034 462,273
(1) If premiums are paid more frequently than annually the payments would be $510.37 semiannually, $259.64 quarterly, or $87.21 monthly. The death benefits and cash surrender values shown would be affected by the more frequent premium payments. The annual premium on the Premium Change Date assuming current cost of insurance charges will be as follows: $1,767 assuming a 0 pct. rate of return; $1,475 assuming a 6 pct. rate of return; and $991 assuming a 12 pct. rate of return. (2) The premiums accumulated at 5% interest in Column 2 are those payable if the gross investment return is 6%. (3) Assumes no Policy loan has been made. It is emphasized that the hypothetical investment rates of return shown above and elsewhere in this prospectus are illustrative only and should not be deemed a representation of past or future investment rates of return. Actual rates of return may be more or less than those shown and will depend on a number of factors, including the separate accounts chosen by an owner. The Death Benefit, Cash Surrender Value and premium on the premium change date for a Policy would be different from those shown if the actual rates of return average 0%, 6%, and 12% over a period of years, but also fluctuated above or below those averages for individual Policy years. No representations can be made by PMLIC that these hypothetical rates of return can be achieved for any one year or sustained over any period of time. 4 5 PROVIDENT MUTUAL -- MODIFIED PREMIUM VARIABLE LIFE INSURANCE POLICY MALE ISSUE AGE 45 $100,000 FACE AMOUNT (GUARANTEED DEATH BENEFIT) $1,783 INITIAL SCHEDULED PREMIUM FOR NON-SMOKERS(1) USING CURRENT COST OF INSURANCE CHARGES
DEATH BENEFIT CASH SURRENDER VALUE PREMIUMS ------------------------------------------- ------------------------------------------- END OF ACCUMULATED ASSUMING HYPOTHETICAL GROSS(3) ASSUMING HYPOTHETICAL GROSS(3) POLICY AT 5 PCT. INT. ANNUAL INVESTMENT RETURN OF ANNUAL INVESTMENT RETURN OF YEAR PER YEAR(2) 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS ---- ----------- ------------ ------------ ------------- ------------ ------------ ------------- 1 1,872 100,000 100,000 100,000 230 313 397 2 3,838 100,000 100,000 100,000 1,337 1,579 1,831 3 5,902 100,000 100,000 100,000 2,405 2,883 3,401 4 8,069 100,000 100,000 100,000 3,432 4,226 5,121 5 10,345 100,000 100,000 100,000 4,416 5,606 7,004 6 12,734 100,000 100,000 100,000 5,634 7,304 9,347 7 15,243 100,000 100,000 100,000 6,891 9,127 11,975 8 17,877 100,000 100,000 100,000 8,095 10,982 14,817 9 20,643 100,000 100,000 100,000 9,240 12,869 17,894 10 23,548 100,000 100,000 100,000 10,321 14,781 21,227 11 26,597 100,000 100,000 100,349 11,054 16,439 24,567 12 29,799 100,000 100,000 102,857 11,716 18,122 28,210 13 33,161 100,000 100,000 105,662 12,309 19,833 32,186* 14 36,692 100,000 100,000 108,792 12,830 21,574 36,528 15 40,398 100,000 100,000 112,279 13,271 23,342 41,270 16 44,290 100,000 100,000 116,163 13,627 25,133 46,448 17 48,377 100,000 100,000 120,487 13,888 26,945 52,106 18 52,668 100,000 100,000 125,294 14,044 28,774 58,287 19 57,174 100,000 100,000 130,636 14,082 30,613 65,039 20 61,904 100,000 100,000 136,571 13,987 32,457 72,415 25 89,352 100,000 100,000 187,230 11,086 41,694 120,793 30 129,559 100,000 103,936 270,645 7,726 55,543* 193,318 35 180,874 100,000 109,822 387,075 0 69,471 300,058
(1) If premiums are paid more frequently than annually the payments would be $918.25 semiannually, $467.15 quarterly, or $156.90 monthly. The death benefits and cash surrender values shown would be affected by the more frequent premium payments. The annual premium on the Premium Change Date assuming current cost of insurance charges will be as follows: $2,947 assuming a 0 pct. rate of return; $2,675 assuming a 6 pct. rate of return; and $1,783 assuming a 12 pct. rate of return. (2) The premiums accumulated at 5% interest in Column 2 are those payable if the gross investment return is 6%. (3) Assumes no Policy loan has been made. It is emphasized that the hypothetical investment rates of return shown above and elsewhere in this prospectus are illustrative only and should not be deemed a representation of past or future investment rates of return. Actual rates of return may be more or less than those shown and will depend on a number of factors, including the separate accounts chosen by an owner. The Death Benefit, Cash Surrender Value and premium on the premium change date for a Policy would be different from those shown if the actual rates of return average 0%, 6%, and 12% over a period of years, but also fluctuated above or below those averages for individual Policy years. No representations can be made by PMLIC that these hypothetical rates of return can be achieved for any one year or sustained over any period of time. 5 6 PROVIDENT MUTUAL -- MODIFIED PREMIUM VARIABLE LIFE INSURANCE POLICY FEMALE ISSUE AGE 55 $100,000 FACE AMOUNT (GUARANTEED DEATH BENEFIT) $2,445 INITIAL SCHEDULED PREMIUM FOR NON-SMOKERS(1) USING CURRENT COST OF INSURANCE CHARGES
DEATH BENEFIT CASH SURRENDER VALUE PREMIUMS ------------------------------------------- ------------------------------------------- END OF ACCUMULATED ASSUMING HYPOTHETICAL GROSS(3) ASSUMING HYPOTHETICAL GROSS(3) POLICY AT 5 PCT. INT. ANNUAL INVESTMENT RETURN OF ANNUAL INVESTMENT RETURN OF YEAR PER YEAR(2) 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS ---- ----------- ------------ ------------ ------------- ------------ ------------ ------------- 1 2,567 100,000 100,000 100,000 485 599 713 2 5,263 100,000 100,000 100,000 1,969 2,298 2,641 3 8,093 100,000 100,000 100,000 3,403 4,053 4,758 4 11,065 100,000 100,000 100,000 4,792 5,871 7,090 5 14,186 100,000 100,000 100,000 6,135 7,755 9,659 6 17,462 100,000 100,000 100,000 7,772 10,048 12,833 7 20,903 100,000 100,000 100,000 9,474 12,525 16,415 8 24,515 100,000 100,000 100,000 11,110 15,059 20,306 9 28,308 100,000 100,000 100,000 12,667 17,641 24,534 10 32,291 100,000 100,000 100,000 14,134 20,264 29,130 11 36,472 100,000 100,000 102,692 15,162 22,585 33,782 12 40,863 100,000 100,000 106,303 16,090 24,948 38,854* 13 45,474 100,000 100,000 110,337 16,919 27,359 44,393 14 50,315 100,000 100,000 114,839 17,650 29,827 50,451 15 55,398 100,000 100,000 119,857 18,277 32,356 57,083 16 60,991 100,000 100,000 125,438 19,339 35,183 64,341 17 66,864 100,000 100,000 131,638 20,264 38,077 72,279 18 73,031 100,000 100,000 138,519 21,024 41,026 80,950 19 79,506 100,000 100,000 146,153 21,582 44,021 90,412 20 86,304 100,000 100,925 154,621 21,903 47,037 100,733 25 125,750 100,000 106,736 225,721 18,924 62,149* 167,201
(1) If premiums are paid more frequently than annually the payments would be $1,259.18 semiannually, $640.59 quarterly, or $215.16 monthly. The death benefits and cash surrender values shown would be affected by the more frequent premium payments. The annual premium on the Premium Change Date assuming current cost of insurance charges will be as follows: $3,039 assuming a 0 pct. rate of return; $2,689 assuming a 6 pct. rate of return; and $2,445 assuming a 12 pct. rate of return. (2) The premiums accumulated at 5% interest in Column 2 are those payable if the gross investment return is 6%. (3) Assumes no Policy loan has been made. It is emphasized that the hypothetical investment rates of return shown above and elsewhere in this prospectus are illustrative only and should not be deemed a representation of past or future investment rates of return. Actual rates of return may be more or less than those shown and will depend on a number of factors, including the separate accounts chosen by an owner. The Death Benefit, Cash Surrender Value and premium on the premium change date for a Policy would be different from those shown if the actual rates of return average 0%, 6%, and 12% over a period of years, but also fluctuated above or below those averages for individual Policy years. No representations can be made by PMLIC that these hypothetical rates of return can be achieved for any one year or sustained over any period of time. 6 7 PROVIDENT MUTUAL -- MODIFIED PREMIUM VARIABLE LIFE INSURANCE POLICY MALE ISSUE AGE 25 $100,000 FACE AMOUNT (GUARANTEED DEATH BENEFIT) $765 INITIAL SCHEDULED PREMIUM FOR NON-SMOKERS(1) USING GUARANTEED MAXIMUM COST OF INSURANCE CHARGES
DEATH BENEFIT CASH SURRENDER VALUE PREMIUMS ------------------------------------------- ------------------------------------------- END OF ACCUMULATED ASSUMING HYPOTHETICAL GROSS(3) ASSUMING HYPOTHETICAL GROSS(3) POLICY AT 5 PCT. INT. ANNUAL INVESTMENT RETURN OF ANNUAL INVESTMENT RETURN OF YEAR PER YEAR(2) 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS ---- ----------- ------------ ------------ ------------- ------------ ------------ ------------- 1 803 100,000 100,000 100,000 0 0 0 2 1,647 100,000 100,000 100,000 168 262 361 3 2,532 100,000 100,000 100,000 603 790 993 4 3,462 100,000 100,000 100,000 1,035 1,347 1,698 5 4,438 100,000 100,000 100,000 1,460 1,931 2,482 6 5,464 100,000 100,000 100,000 2,056 2,720 3,530 7 6,540 100,000 100,000 100,000 2,682 3,576 4,709 8 7,670 100,000 100,000 100,000 3,299 4,460 5,992 9 8,857 100,000 100,000 100,000 3,906 5,372 7,386 10 10,103 100,000 100,000 100,000 4,502 6,313 8,904 11 11,412 100,000 100,000 100,896 4,908 7,106 10,380 12 12,785 100,000 100,000 102,038 5,303 7,928 12,003* 13 14,228 100,000 100,000 103,310 5,682 8,779 13,786 14 15,743 100,000 100,000 104,729 6,045 9,659 15,745 15 17,333 100,000 100,000 106,309 6,391 10,568 17,896 16 19,003 100,000 100,000 108,071 6,720 11,506 20,259 17 20,756 100,000 100,000 110,031 7,027 12,473 22,854 18 22,597 100,000 100,000 112,215 7,315 13,469 25,705 19 24,530 100,000 100,302 114,643 7,580 14,495 28,836 20 26,560 100,000 100,619 117,345 7,824 15,552 32,278 25 38,337 100,000 102,031 149,742 8,629 21,265* 55,255 30 53,367 100,000 102,961 211,549 8,499 27,635 91,185 35 72,550 100,000 103,076 292,543 6,737 34,346 146,271 40 97,032 100,000 101,962 401,256 2,168 40,963 229,289 45 128,279 100,000 100,000 545,003 0 46,669 351,614 50 175,742 100,000 100,984 739,187 0 57,532 527,991 55 236,318 100,000 102,059 1,001,100 0 67,159 776,046
(1) If premiums are paid more frequently than annually the payments would be $393.98 semiannually, $200.43 quarterly, or $67.32 monthly. The death benefits and cash surrender values shown would be affected by the more frequent premium payments. The annual premium on the Premium Change Date assuming current cost of insurance charges will be as follows: $2,105 assuming a 0 pct. rate of return; $2,072 assuming a 6 pct. rate of return; and $765 assuming a 12 pct. rate of return. (2) The premiums accumulated at 5% interest in Column 2 are those payable if the gross investment return is 6%. (3) Assumes no Policy loan has been made. It is emphasized that the hypothetical investment rates of return shown above and elsewhere in this prospectus are illustrative only and should not be deemed a representation of past or future investment rates of return. Actual rates of return may be more or less than those shown and will depend on a number of factors, including the separate accounts chosen by an owner. The Death Benefit, Cash Surrender Value and premium on the premium change date for a Policy would be different from those shown if the actual rates of return average 0%, 6%, and 12% over a period of years, but also fluctuated above or below those averages for individual Policy years. No representations can be made by PMLIC that these hypothetical rates of return can be achieved for any one year or sustained over any period of time. 7 8 PROVIDENT MUTUAL -- MODIFIED PREMIUM VARIABLE LIFE INSURANCE POLICY FEMALE ISSUE AGE 35 $100,000 FACE AMOUNT (GUARANTEED DEATH BENEFIT) $991 INITIAL SCHEDULED PREMIUM FOR NON-SMOKERS(1) USING GUARANTEED MAXIMUM COST OF INSURANCE CHARGES
DEATH BENEFIT CASH SURRENDER VALUE PREMIUMS ------------------------------------------- ------------------------------------------- END OF ACCUMULATED ASSUMING HYPOTHETICAL GROSS(3) ASSUMING HYPOTHETICAL GROSS(3) POLICY AT 5 PCT. INT. ANNUAL INVESTMENT RETURN OF ANNUAL INVESTMENT RETURN OF YEAR PER YEAR(2) 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS ---- ----------- ------------ ------------ ------------- ------------ ------------ ------------- 1 1,041 100,000 100,000 100,000 0 0 0 2 2,133 100,000 100,000 100,000 507 639 777 3 3,280 100,000 100,000 100,000 1,112 1,375 1,659 4 4,485 100,000 100,000 100,000 1,698 2,135 2,628 5 5,750 100,000 100,000 100,000 2,262 2,920 3,691 6 7,078 100,000 100,000 100,000 3,004 3,928 5,056 7 8,472 100,000 100,000 100,000 3,771 5,009 6,583 8 9,936 100,000 100,000 100,000 4,514 6,115 8,234 9 11,474 100,000 100,000 100,000 5,235 7,247 10,023 10 13,088 100,000 100,000 100,000 5,932 8,407 11,967 11 14,783 100,000 100,000 100,696 6,408 9,397 13,881 12 16,563 100,000 100,000 102,145 6,860 10,416 15,978 13 18,431 100,000 100,000 103,763 7,286 11,465 18,277* 14 20,393 100,000 100,000 105,567 7,687 12,543 20,797 15 22,454 100,000 100,000 107,580 8,060 13,652 23,561 16 24,617 100,000 100,000 109,822 8,404 14,790 26,591 17 26,888 100,000 100,000 112,320 8,716 15,958 29,914 18 29,273 100,000 100,000 115,099 8,994 17,155 33,558 19 31,777 100,000 100,000 118,189 9,233 18,377 37,552 20 34,407 100,000 100,000 121,627 9,431 19,627 41,932 25 49,662 100,000 100,636 159,900 9,801 26,331 71,066 30 69,133 100,000 101,222 226,682 8,771 33,736 116,247 35 93,983 100,000 100,671 313,741 4,895 41,229 184,553 40 130,148 100,000 102,490 429,975 0 52,467* 286,650 45 176,306 100,000 103,046 585,369 0 62,845 433,607
(1) If premiums are paid more frequently than annually the payments would be $510.37 semiannually, $259.64 quarterly, or $87.21 monthly. The death benefits and cash surrender values shown would be affected by the more frequent premium payments. The annual premium on the Premium Change Date assuming current cost of insurance charges will be as follows: $1,767 assuming a 0 pct. rate of return; $1,758 assuming a 6 pct. rate of return; and $991 assuming a 12 pct. rate of return. (2) The premiums accumulated at 5% interest in Column 2 are those payable if the gross investment return is 6%. (3) Assumes no Policy loan has been made. It is emphasized that the hypothetical investment rates of return shown above and elsewhere in this prospectus are illustrative only and should not be deemed a representation of past or future investment rates of return. Actual rates of return may be more or less than those shown and will depend on a number of factors, including the separate accounts chosen by an owner. The Death Benefit, Cash Surrender Value and premium on the premium change date for a Policy would be different from those shown if the actual rates of return average 0%, 6%, and 12% over a period of years, but also fluctuated above or below those averages for individual Policy years. No representations can be made by PMLIC that these hypothetical rates of return can be achieved for any one year or sustained over any period of time. 8 9 PROVIDENT MUTUAL -- MODIFIED PREMIUM VARIABLE LIFE INSURANCE POLICY MALE ISSUE AGE 45 $100,000 FACE AMOUNT (GUARANTEED DEATH BENEFIT) $1783 INITIAL SCHEDULED PREMIUM FOR NON-SMOKERS(1) USING GUARANTEED MAXIMUM COST OF INSURANCE CHARGES
DEATH BENEFIT CASH SURRENDER VALUE PREMIUMS ------------------------------------------- ------------------------------------------- END OF ACCUMULATED ASSUMING HYPOTHETICAL GROSS(3) ASSUMING HYPOTHETICAL GROSS(3) POLICY AT 5 PCT. INT. ANNUAL INVESTMENT RETURN OF ANNUAL INVESTMENT RETURN OF YEAR PER YEAR(2) 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS ------ -------------- ------------ ------------ ------------- ------------ ------------ ------------- 1 1,872 100,000 100,000 100,000 228 311 395 2 3,838 100,000 100,000 100,000 1,334 1,575 1,826 3 5,902 100,000 100,000 100,000 2,399 2,876 3,394 4 8,069 100,000 100,000 100,000 3,424 4,216 5,110 5 10,345 100,000 100,000 100,000 4,405 5,594 6,990 6 12,734 100,000 100,000 100,000 5,620 7,288 9,327 7 15,243 100,000 100,000 100,000 6,874 9,106 11,949 8 17,877 100,000 100,000 100,000 8,075 10,957 14,784 9 20,643 100,000 100,000 100,000 9,216 12,837 17,852 10 23,548 100,000 100,000 100,000 10,293 14,743 21,176 11 26,597 100,000 100,000 100,000 11,021 16,394 24,505 12 29,799 100,000 100,000 100,971 11,675 18,065 28,145 13 33,161 100,000 100,000 103,624 12,250 19,756 32,116 14 36,692 100,000 100,000 106,590 12,743 21,466 36,446* 15 40,398 100,000 100,000 109,898 13,144 23,188 41,168 16 44,290 100,000 100,000 113,588 13,444 24,919 46,318 17 48,377 100,000 100,000 117,700 13,633 26,653 51,935 18 52,668 100,000 100,000 122,276 13,696 28,382 58,062 19 57,174 100,000 100,000 127,367 13,615 30,095 64,743 20 61,904 100,000 100,000 133,027 13,370 31,782 72,028 25 89,352 100,000 100,000 184,724 9,012 39,563 119,176 30 131,009 100,000 100,000 262,736 1,765 51,827 187,668 35 184,175 100,000 100,000 366,848 0 63,494 284,378
(1) If premiums are paid more frequently than annually the payments would be $918.25 semiannually, $467.15 quarterly, or $156.90 monthly. The death benefits and cash surrender values shown would be affected by the more frequent premium payments. The annual premium on the Premium Change Date assuming current cost of insurance charges will be as follows: $2,947 assuming a 0 pct. rate of return; $2,925 assuming a 6 pct. rate of return; and $1,783 assuming a 12 pct. rate of return. (2) The premiums accumulated at 5% interest in Column 2 are those payable if the gross investment return is 6%. (3) Assumes no Policy loan has been made. It is emphasized that the hypothetical investment rates of return shown above and elsewhere in this prospectus are illustrative only and should not be deemed a representation of past or future investment rates of return. Actual rates of return may be more or less than those shown and will depend on a number of factors, including the separate accounts chosen by an owner. The Death Benefit, Cash Surrender Value and premium on the premium change date for a Policy would be different from those shown if the actual rates of return average 0%, 6%, and 12% over a period of years, but also fluctuated above or below those averages for individual Policy years. No representations can be made by PMLIC that these hypothetical rates of return can be achieved for any one year or sustained over any period of time. 9 10 PROVIDENT MUTUAL -- MODIFIED PREMIUM VARIABLE LIFE INSURANCE POLICY FEMALE ISSUE AGE 55 $100,000 FACE AMOUNT (GUARANTEED DEATH BENEFIT) $2,445 INITIAL SCHEDULED PREMIUM FOR NON-SMOKERS(1) USING GUARANTEED MAXIMUM COST OF INSURANCE CHARGES
DEATH BENEFIT CASH SURRENDER VALUE PREMIUMS ------------------------------------------- ------------------------------------------- END OF ACCUMULATED ASSUMING HYPOTHETICAL GROSS(3) ASSUMING HYPOTHETICAL GROSS(3) POLICY AT 5 PCT. INT. ANNUAL INVESTMENT RETURN OF ANNUAL INVESTMENT RETURN OF YEAR PER YEAR(2) 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS ------ -------------- ------------ ------------ ------------- ------------ ------------ ------------- 1 2,567 100,000 100,000 100,000 395 506 618 2 5,263 100,000 100,000 100,000 1,783 2,101 2,433 3 8,093 100,000 100,000 100,000 3,117 3,741 4,419 4 11,065 100,000 100,000 100,000 4,399 5,431 6,598 5 14,186 100,000 100,000 100,000 5,628 7,174 8,993 6 17,462 100,000 100,000 100,000 7,145 9,310 11,966 7 20,903 100,000 100,000 100,000 8,718 11,615 15,316 8 24,515 100,000 100,000 100,000 10,213 13,955 18,940 9 28,308 100,000 100,000 100,000 11,614 16,318 22,859 10 32,291 100,000 100,000 100,000 12,907 18,694 27,099 11 36,472 100,000 100,000 100,000 13,742 20,736 31,356 12 40,863 100,000 100,000 100,436 14,456 22,787 36,023 13 45,474 100,000 100,000 103,933 15,050 24,852 41,123 14 50,315 100,000 100,000 107,846 15,524 26,937 46,690* 15 55,398 100,000 100,000 112,215 15,872 29,042 52,773 16 61,350 100,000 100,000 117,082 16,627 31,737 59,420 17 67,600 100,000 100,000 122,496 17,212 34,470 66,676 18 74,163 100,000 100,000 128,508 17,588 37,222 74,587 19 81,053 100,000 100,000 135,184 17,706 39,973 83,201 20 88,288 100,000 100,000 142,598 17,517 42,709 92,575 25 130,267 100,000 100,000 205,487 10,183 56,098 152,212
(1) If premiums are paid more frequently than annually the payments would be $1,259.18 semiannually, $640.59 quarterly, or $215.16 monthly. The death benefits and cash surrender values shown would be affected by the more frequent premium payments. The annual premium on the Premium Change Date assuming current cost of insurance charges will be as follows: $3,039 assuming a 0 pct. rate of return; $3,031 assuming a 6 pct. rate of return; and $2,445 assuming a 12 pct. rate of return. (2) The premiums accumulated at 5% interest in Column 2 are those payable if the gross investment return is 6%. (3) Assumes no Policy loan has been made. It is emphasized that the hypothetical investment rates of return shown above and elsewhere in this prospectus are illustrative only and should not be deemed a representation of past or future investment rates of return. Actual rates of return may be more or less than those shown and will depend on a number of factors, including the separate accounts chosen by an owner. The Death Benefit, Cash Surrender Value and premium on the premium change date for a Policy would be different from those shown if the actual rates of return average 0%, 6%, and 12% over a period of years, but also fluctuated above or below those averages for individual Policy years. No representations can be made by PMLIC that these hypothetical rates of return can be achieved for any one year or sustained over any period of time. 10 11 PROVIDENT MUTUAL -- MODIFIED PREMIUM VARIABLE LIFE INSURANCE POLICY MALE ISSUE AGE 35 $100,000 FACE AMOUNT (GUARANTEED DEATH BENEFIT) $1,143 INITIAL SCHEDULED PREMIUM FOR NON-SMOKERS(1) WITH $10,000 UNSCHEDULED PREMIUM PAID AT POLICY ISSUE USING CURRENT COST OF INSURANCE CHARGES WITH BASIC DEATH BENEFIT
DEATH BENEFIT CASH SURRENDER VALUE PREMIUMS ------------------------------------------- ------------------------------------------- END OF ACCUMULATED ASSUMING HYPOTHETICAL GROSS(3) ASSUMING HYPOTHETICAL GROSS(3) POLICY AT 5 PCT. INT. ANNUAL INVESTMENT RETURN OF ANNUAL INVESTMENT RETURN OF YEAR PER YEAR(2) 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS ------ -------------- ------------ ------------ ------------- ------------ ------------ ------------- 1 11,700 100,723 101,324 101,925 9,098 9,699 10,300 2 13,485 101,007 102,275 103,614 9,719* 10,987* 12,327* 3 15,360 101,187 103,192 105,426 10,322 12,328 14,562 4 17,328 101,321 104,136 107,441 10,907 13,721 17,026 5 19,394 101,407 105,106 109,678 11,471 15,169 19,742 6 21,564 101,445 106,103 112,165 12,228 16,887 22,949 7 23,843 101,430 107,127 114,925 13,021 18,717 26,516 8 26,235 101,363 108,179 117,991 13,791 20,607 30,419 9 28,747 101,241 109,259 121,393 14,538 22,556 34,690 10 31,384 101,063 110,369 125,189 15,261 24,567 39,368 11 34,154 100,824 111,506 136,347 15,744 26,426 44,268 12 37,062 100,524 112,672 147,912 16,201 28,349 49,635 13 40,115 100,160 113,867 160,417 16,630 30,337 55,507 14 43,321 100,000 115,092 173,415 17,032 32,392 61,934 15 46,687 100,000 116,346 186,892 17,401 34,516 68,964 16 50,221 100,000 117,630 200,833 17,737 36,709 76,654 17 53,932 100,000 118,940 216,044 18,035 38,970 85,056 18 57,829 100,000 120,278 231,811 18,289 41,299 94,232 19 61,921 100,000 121,644 249,136 18,496 43,694 104,241 20 66,217 100,000 123,036 267,148 18,648 46,153 115,150 25 91,143 100,000 130,464 372,423 18,484# 59,454 186,211 30 122,956 100,000 138,644 515,430 16,240 74,488 294,531 35 163,558 100,000 147,638 708,943 10,389 91,086 457,382 40 215,378 100,000 157,527 979,596 3,427 109,134 699,711 45 281,514 100,000 168,655 1,361,839 0 128,304 1,055,689
(1) If premiums are paid more frequently than annually the payments would be $588.65 semiannually, $299.47 quarterly, or $100.58 monthly. The death benefits and cash surrender values shown would be affected by the more frequent premium payments. The annual premium on the Premium Change Date assuming current cost of insurance charges will be as follows: $2,239 assuming a 0 pct. rate of return; $1,143 assuming a 6 pct. rate of return; and $1,143 assuming a 12 pct. rate of return. (2) The premiums accumulated at 5% interest in Column 2 are those payable if the gross investment return is 6%. (3) Assumes no Policy loan has been made. # First year shown in which Special Premium Payment Provision ceases to be in effect. It is emphasized that the hypothetical investment rates of return shown above and elsewhere in this prospectus are illustrative only and should not be deemed a representation of past or future investment rates of return. Actual rates of return may be more or less than those shown and will depend on a number of factors, including the separate accounts chosen by an owner. The Death Benefit, Cash Surrender Value and premium on the premium change date for a Policy would be different from those shown if the actual rates of return average 0%, 6%, and 12% over a period of years, but also fluctuated above or below those averages for individual Policy years. No representations can be made by PMLIC that these hypothetical rates of return can be achieved for any one year or sustained over any period of time. 11 12 PROVIDENT MUTUAL -- MODIFIED PREMIUM VARIABLE LIFE INSURANCE POLICY MALE ISSUE AGE 35 $100,000 FACE AMOUNT $1,143 INITIAL SCHEDULED PREMIUM FOR NON-SMOKERS(1) WITH $10,000 UNSCHEDULED PREMIUM PAID AT POLICY ISSUE USING CURRENT COST OF INSURANCE CHARGES WITH INCREASING DEATH BENEFIT
DEATH BENEFIT CASH SURRENDER VALUE PREMIUMS ------------------------------------------- ------------------------------------------- END OF ACCUMULATED ASSUMING HYPOTHETICAL GROSS(3) ASSUMING HYPOTHETICAL GROSS(3) POLICY AT 5 PCT. INT. ANNUAL INVESTMENT RETURN OF ANNUAL INVESTMENT RETURN OF YEAR PER YEAR(2) 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS 0 PCT. GROSS 6 PCT. GROSS 12 PCT. GROSS ------ -------------- ------------ ------------ ------------- ------------ ------------ ------------- 1 11,700 110,000 110,000 110,000 9,082 9,682 10,283 2 13,485 110,000 111,143 111,143 9,687 10,953* 12,292* 3 15,360 110,000 112,286 112,286 10,273 12,272 14,507 4 17,328 110,000 113,429 113,429 10,840 13,642 16,950 5 19,394 110,000 114,572 114,572 11,386 15,063 19,642 6 21,564 110,000 115,715 115,715 12,125 16,751 22,825 7 23,843 110,000 116,858 116,858 12,897 18,548 26,369 8 26,235 110,000 118,001 118,001 13,646 20,400 30,249 9 28,747 110,000 119,144 119,144 14,369 22,306 34,501 10 31,384 110,000 120,287 124,541 15,066 24,271 39,164 11 34,154 110,000 121,430 135,651 15,522 26,078 44,043 12 37,062 110,000 122,573 147,165 15,947 27,942 49,384 13 40,115 110,000 123,716 159,614 16,342 29,867 55,230 14 43,321 110,000 124,859 172,554 16,704 31,852 61,626 15 46,687 110,000 126,002 185,970 17,030 33,897 68,623 16 50,221 110,000 127,145 199,847 17,320 36,005 76,277 17 53,932 110,000 128,288 214,987 17,567 38,173 84,641 18 57,829 110,000 129,431 230,681 17,766 40,398 93,773 19 61,921 110,000 130,574 247,926 17,912 42,679 103,734 20 66,217 110,000 131,717 265,853 17,998 45,012 114,592 25 91,143 110,000 137,432 370,628 17,381 57,483 185,314 30 122,956 110,000 143,147 512,947 14,404 71,265 293,112 35 163,558 110,000 148,862 705,521 7,295 86,025 455,174 40 215,378 110,000 154,577 974,857 0 101,498 696,326 45 281,514 110,000 160,292 1,355,235 0 117,247 1,050,569
(1) If premiums are paid more frequently than annually the payments would be $588.65 semiannually, $299.47 quarterly, or $100.58 monthly. The death benefits and cash surrender values shown would be affected by the more frequent premium payments. The annual premium on the Premium Change Date assuming current cost of insurance charges will be as follows: $2,239 assuming a 0 pct. rate of return; $1,143 assuming a 6 pct. rate of return; and $1,143 assuming a 12 pct. rate of return. (2) The premiums accumulated at 5% interest in Column 2 are those payable if the gross investment return is 6%. (3) Assumes no Policy loan has been made. It is emphasized that the hypothetical investment rates of return shown above and elsewhere in this prospectus are illustrative only and should not be deemed a representation of past or future investment rates of return. Actual rates of return may be more or less than those shown and will depend on a number of factors, including the separate accounts chosen by an owner. The Death Benefit, Cash Surrender Value and premium on the premium change date for a Policy would be different from those shown if the actual rates of return average 0%, 6%, and 12% over a period of years, but also fluctuated above or below those averages for individual Policy years. No representations can be made by PMLIC that these hypothetical rates of return can be achieved for any one year or sustained over any period of time. 12