EX-99.4(P) 3 a51440a1exv99w4xpy.htm EXHIBIT 4(P) EXHIBIT 4(p)
SVER TERM INSURANCE RIDER -TRUST/EXECUTIVE BENEFIT
This Rider (“Rider”) becomes a part of the policy to which it is attached (“the Policy”). All terms of the Policy that do not conflict with this Rider’s terms apply to this Rider.
Rider Benefit Summary – This Rider provides term insurance on the Insured under the Policy as long as the Policy is In Force and this Rider has not terminated. The Face Amount of this Rider contributes to the Total Face Amount, and consequently to the Death Benefit, of the Policy. This rider has no Accumulated Value of its own, but affects the Policy’s Accumulated Value because the charges for the Rider are deducted from the Accumulated Value of the Policy.
If you surrender your Policy, this Rider also increases the Policy’s Net Cash Surrender Value by a Termination Credit as described below, unless either of the following is true:
•   the Policy is being surrendered in connection with the purchase of a replacement life insurance Policy including, but not limited to, a replacement intended to qualify as a tax free exchange under Code section 1035; or
 
•   the Owner of the Policy at the time of surrender is a life insurance company and is different than the original Owner.
Insured – As used in this Rider, the “Insured” means the individual covered under the Policy’s Basic Coverage, as shown in the Policy Specifications.
Rider Coverage Layer – is a layer of insurance coverage under this Rider. There may be one or more Rider Coverage Layers. Any elective increase in Rider Face Amount will comprise a new Rider Coverage Layer. Each Rider Coverage Layer has its own Face Amount, Risk Class, effective date, and set of charges. The Face Amount, Risk Class, effective date, and set of charges for the initial Rider Coverage Layer are shown in the Policy Specifications. The Face Amount, Risk Class, effective date, and set of charges for any Rider Coverage Layer added at a later time will be shown in a Supplemental Schedule of Coverage sent to you at that time.
Rider Face Amount –The Face Amount of this Rider is the sum of the Face Amounts of all Rider Coverage Layers.
Elective Increases in Rider Face Amount – Elective increases in the Face Amount of this Rider are increases that you apply for after the Policy has been issued. You may submit an application to increase the Rider Face Amount. Your application must include Evidence of Insurability satisfactory to us and is subject to our approval. The effective date of the increased Rider Face Amount will be the first Monthly Payment Date on or next following the date all required conditions are met or any other date you request and we approve. We reserve the right to limit increases to one per policy year and to charge a fee, not to exceed $100, to evaluate insurability. Upon approval of any such increase, we will send you a Supplemental Schedule of Coverage, which will include the following information:
•   the increased Rider Face Amount and the effective date of the increase;
 
•   the Risk Class for the increase;
 
•   the Maximum Monthly Cost of Insurance Rates applicable to the increase;
 
•   the Maximum Monthly Coverage Charge for the increase; and
 
•   if the Guideline Premium Test is used, the new Guideline Premiums.
Decrease in Rider Face Amount – You may decrease the Rider Face Amount, subject to the provisions in the Policy. If there are Coverage Layers with the same effective date, they will be decreased or eliminated in the following order:
•   first, the Face Amount of any other Rider that contributes to the Total Face Amount will be decreased or eliminated;
 
•   then, the Face Amount of this Rider will be decreased or eliminated; and
 
•   finally, the Face Amount of Basic Coverage under the Policy will be decreased.

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•   Charge for this Rider – On each Monthly Payment Date prior to the Monthly Deduction End Date, there is a charge for this Rider, which is the sum of the Rider Coverage Charge,
 
•   the Rider Cost of Insurance Charge, and
 
•   the Termination Credit Charge. Such charges may vary by Class, and for the purpose of this Rider, Class includes the Policy form to which this Rider is attached.
Rider Coverage Charge – The Coverage Charge for this Rider is the sum of the Coverage Charge for each Rider Coverage Layer. The Coverage Charge for the initial Rider Coverage Layer will not exceed the Coverage Charge shown in the Policy Specifications. The Coverage Charge for any later Rider Coverage Layer will not exceed the Coverage Charge shown in the Supplemental Schedule of Coverage to be sent to you when the Coverage Layer is added. This charge is based on the Face Amount of the Rider Coverage Layer as of its effective date. The Coverage Charge will not decrease even if the Face Amount of the associated Rider Coverage Layer is decreased.
Rider Cost of Insurance Charge – The Cost of Insurance Charge for this Rider is the sum of the Cost of Insurance Charge for each Rider Coverage Layer. The Cost of Insurance Charge for each Rider Coverage Layer is equal to (1) multiplied by (2), where:
  (1)   is the Maximum Monthly Cost of Insurance Rate for the Coverage Layer divided by 1000; and
 
  (2)   is the Net Amount at Risk allocated to the Coverage Layer.
The Net Amount at Risk is allocated proportionately to each Coverage Layer, including each Coverage Layer of other Riders that contribute to the Total Face Amount and each Coverage Layer of Basic Coverage under the Policy, according to Face Amount.
Termination Credit Charge – The Termination Credit Charge is shown in the Policy Specifications, and continues until the end of the Termination Credit Charge Period shown in the Policy Specifications.
Termination Credit – The Termination Credit equals the sum of Termination Credit Part 1 plus Termination Credit Part 2, unless the Termination Credit Part 1 is zero, in which case the Termination Credit Part 2 will also be zero.
Termination Credit Part 1 equals A x B, where:

A = the Termination Credit Percentage as described below; and

B = the Termination Credit Basis as described below.
Termination Credit Part 2 equals the greater of zero and C x D x [E – (F ÷ G)], where:

C = the Termination Credit Factor shown in the Policy Specifications;

D = the lesser of 60 and the number of whole policy months that have elapsed since the Policy Date;

E = the Maximum Annual Termination Credit Basis, as shown in the Policy Specifications;

F = the sum of premiums paid; and

G = 1 + the number of whole policy years elapsed since the Policy Date.
Termination Credit Percentage – The Termination Credit Percentage is used to calculate the Termination Credit. The initial Termination Credit Percentage schedule is shown in the Policy Specifications. We may reduce the schedule of Termination Credit Percentages, and even reduce such percentages to zero, but not until at least 30 days after we have sent you revised Policy Specifications pages that show the reduced Termination Credit Percentages. Any such reduced schedule of Termination Credit Percentages will apply uniformly to all members of the same Class.
Termination Credit Basis – The Termination Credit Basis is an amount used to calculate the Termination Credit and is the dollar amount to which the percentage previously described is applied. The Termination Credit Basis is the lesser of [(a) minus (c)] or [(b) minus (c)], where:
(a)   is the total amount of premiums actually paid on the Policy;
(b)   is the Maximum Annual Termination Credit Basis, as shown in the Policy Specifications, multiplied by 1 + the number of whole policy years elapsed since the Policy Date; and

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(c)   is the total amount of any withdrawals.
Minimum Death Benefit – While this Rider is in force, the Minimum Death Benefit of the Policy will be as follows: If the Policy’s Death Benefit Qualification Test is the Cash Value Accumulation Test, then the Minimum Death Benefit will be the amount required for this Policy to be deemed a “life insurance” contract according to the Code, but not less than 101% of the sum of the Accumulated Value and the Termination Credit; or if the Policy’s Death Benefit Qualification Test is the Guideline Premium Test, then the Minimum Death Benefit will be the death benefit percentage for the Age of the Insured as described in the Policy multiplied by the sum of the Accumulated Value and the Termination Credit.
Effective Dates – This Rider is effective on the Policy Date. It will terminate on the earliest of:
•   your Written Request; or
 
•   termination of the Policy.
Signed for Pacific Life Insurance Company,
         
-s- Signature   -s- Signature    
Chairman, President and Chief Executive Officer   Secretary    

Page 3 of 3

 

POLICY NUMBER: AAAAAAAAAAA
POLICY SPECIFICATIONS
SUMMARY OF COVERAGES EFFECTIVE ON THE POLICY DATE
SECTIONS FOR OTHER COVERAGES
         
R09SVERT   SVER TERM INSURANCE RIDER — TRUST/EXECUTIVE BENEFIT
 
        
 
  FACE AMOUNT:   $100,000 
 
  INSURED:   LELAND STANFORD
 
  SEX AND AGE:   MALE 35 
 
  RISK CLASS:   STANDARD NONSMOKER
PAGE 3.1

 

 

POLICY NUMBER: AAAAAAAAAAA
POLICY SPECIFICATIONS
TERMINATION CREDIT
         
MONTHLY TERMINATION CREDIT CHARGE:
   $ 8.38  
TERMINATION CREDIT CHARGE PERIOD:
     5 YEARS  
MAXIMUM ANNUAL TERMINATION CREDIT BASIS:
   $ 3,351.06  
             
POLICY YEAR       TERMINATION CREDIT FACTOR
1 – 5
        0.25 %
6+
        0 %
                 
            TERMINATION CREDIT
POLICY YEAR   POLICY MONTH   PERCENTAGE
1
    1       1.50 %
1
    2       2.00 %
1
    3       2.50 %
1
    4       3.00 %
1
    5       3.50 %
1
    6       3.87 %
1
    7       4.23 %
1
    8       4.60 %
1
    9       4.96 %
1
    10       5.32 %
1
    11       5.69 %
1
    12       6.05 %
2
    1 – 12       6.05 %
3
    1 – 12       6.00 %
4
    1 – 12       5.60 %
5
    1 – 12       5.00 %
6
    1 – 12       4.50 %
7
    1 – 12       4.40 %
8
    1 – 12       4.30 %
9
    1 – 12       4.30 %
10
    1 – 12       4.00 %
11
    1 – 12       1.40 %
12
    1 – 12       0.50 %
13+
    1 – 12       0.00 %
Page 3.2

 

 

POLICY NUMBER: AAAAAAAAAAA
POLICY SPECIFICATIONS
TABLE OF COST OF INSURANCE RATES
FOR SVER TERM INSURANCE RIDER-TRUST/EXECUTIVE BENEFIT
INSURED:                LELAND STANFORD
MAXIMUM MONTHLY COST OF INSURANCE RATES PER $1000.00 OF NET AMOUNT AT RISK APPLICABLE TO THIS COVERAGE.
             
POLICY       MONTHLY
YEAR       RATE
1
        0.10090  
2
        0.10670  
3
        0.11170  
4
        0.12010  
5
        0.12840  
6
        0.13760  
7
        0.14930  
8
        0.16350  
9
        0.17930  
10
        0.19940  
11
        0.22110  
12
        0.24200  
13
        0.26460  
14
        0.27790  
15
        0.29380  
16
        0.31390  
17
        0.33900  
18
        0.37330  
19
        0.41180  
20
        0.45950  
21
        0.51560  
22
        0.57510  
23
        0.63890  
24
        0.69180  
25
        0.75230  
26
        0.82540  
27
        0.91630  
28
        1.02660  
29
        1.14970  
30
        1.27900  
31
        1.41510  
32
        1.55240  
33
        1.68980  
34
        1.83930  
35
        1.99170  
36
        2.17330  
37
        2.37670  
38
        2.64820  
39
        2.93180  
40
        3.23010  
41
        3.56140  
42
        3.92360  
43
        4.34570  
44
        4.84010  
Page 4.x

 

 

POLICY NUMBER: AAAAAAAAAAA
POLICY SPECIFICATIONS
TABLE OF COST OF INSURANCE RATES
FOR SVER TERM INSURANCE RIDER-TRUST/EXECUTIVE BENEFIT
CONTINUED
INSURED:                LELAND STANFORD
MAXIMUM MONTHLY COST OF INSURANCE RATES PER $1000.00 OF NET AMOUNT AT RISK APPLICABLE TO THIS COVERAGE.
             
POLICY       MONTHLY
YEAR       RATE
45
        5.41330  
46
        6.04180  
47
        6.76170  
48
        7.51460  
49
        8.33040  
50
        9.24140  
51
        10.27540  
52
        11.43490  
53
        12.71510  
54
        14.10520  
55
        15.59360  
56
        17.17060  
57
        18.67330  
58
        20.26540  
59
        21.97380  
60
        23.81220  
61
        25.79270  
62
        27.64150  
63
        29.65380  
64
        31.85100  
65
        34.25960  
66
        36.90860  
67
        39.06360  
68
        41.41760  
69
        43.99540  
70
        46.82420  
71
        49.93700  
72
        53.37330  
73
        57.18460  
74
        61.42910  
75
        66.18210  
76
        71.53880  
77
        77.62690  
78
        83.33330  
79
        83.33330  
80
        83.33330  
81
        83.33330  
82
        83.33330  
83
        83.33330  
84
        83.33330  
85
        83.33330  
86
        83.33330  
87+
        0  
Page 4.x

 

 

POLICY NUMBER: AAAAAAAAAAA
POLICY SPECIFICATIONS
TABLE OF MAXIMUM MONTHLY COVERAGE CHARGES
FOR SVER TERM INSURANCE RIDER-TRUST/EXECUTIVE BENEFIT
INSURED:                LELAND STANFORD
             
POLICY       COVERAGE
YEAR       CHARGE
1
        0.00  
2
        65.40  
3
        98.10  
4
        98.10  
5
        98.10  
6
        98.10  
7
        98.10  
8
        98.10  
9
        98.10  
10
        98.10  
11
        65.40  
12
        65.40  
13
        65.40  
14
        65.40  
15
        65.40  
16
        65.40  
17
        65.40  
18
        65.40  
19
        65.40  
20
        65.40  
21
        65.40  
22
        65.40  
23
        65.40  
24
        65.40  
25
        65.40  
26
        65.40  
27
        65.40  
28
        65.40  
29
        65.40  
30
        65.40  
31
        65.40  
32
        65.40  
33
        65.40  
34
        65.40  
35
        65.40  
36
        65.40  
37
        65.40  
38
        65.40  
39
        65.40  
40
        65.40  
41
        65.40  
42
        65.40  
43
        65.40  
44
        65.40  
Page 4.x

 

 

POLICY NUMBER: AAAAAAAAAAA
POLICY SPECIFICATIONS
TABLE OF MAXIMUM MONTHLY COVERAGE CHARGES
FOR SVER TERM INSURANCE RIDER-TRUST/EXECUTIVE BENEFIT
CONTINUED
INSURED:                LELAND STANFORD
             
POLICY       COVERAGE
YEAR       CHARGE
45
      $ 65.40  
46
        65.40  
47
        65.40  
48
        65.40  
49
        65.40  
50
        65.40  
51
        65.40  
52
        65.40  
53
        65.40  
54
        65.40  
55
        65.40  
56
        65.40  
57
        65.40  
58
        65.40  
59
        65.40  
60
        65.40  
61
        65.40  
62
        65.40  
63
        65.40  
64
        65.40  
65
        65.40  
66
        65.40  
67
        65.40  
68
        65.40  
69
        65.40  
70
        65.40  
71
        65.40  
72
        65.40  
73
        65.40  
74
        65.40  
75
        65.40  
76
        65.40  
77
        65.40  
78
        65.40  
79
        65.40  
80
        65.40  
81
        65.40  
82
        65.40  
83
        65.40  
84
        65.40  
85
        65.40  
86
        65.40  
87+
        0  
Page 4.x