EX-99.(4)(DD)(1) 3 d942814dex994dd1.htm SPECIFICATIONS PAGES (FORM R15ART SP) Specifications pages (form R15ART SP)

POLICY NUMBER: [VF99999990]

POLICY SPECIFICATIONS

Summary Of Coverages Effective On The Policy Date

 

 

 

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R15ART R15ART SP     Annual Renewable Term Rider [(Guaranteed Issue)]

 

Face Amount:

Insured:

Sex and Age:

Risk Class:

 

    [$100,000]

    [JOHN DOE]

    [MALE 35]

    [STANDARD NONSMOKER]
     

 

[P15PVA SP]

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POLICY NUMBER: [VF99999990]

POLICY SPECIFICATIONS

 

[Annual Renewable Term Rider Value Features

Alternate Rider Cost Of Insurance Charge

[AV Ratio –The AV Ratio as of the Monthly Payment Date is equal to a ÷ b where:

a = the Accumulated Value at the beginning of the Policy month before the Monthly Deduction is charged; and

b = the Death Benefit after any policy changes but before the Monthly Deduction is charged.

In order to determine if the AV Ratio Cost of Insurance Rates can be used, on each Monthly Payment Date, we will calculate the AV Ratio of the Policy and compare it to the current Threshold Percentage. We reserve the right to use Threshold Percentages lower than the Maximum Threshold Percentage shown in the Policy Specifications. Any lesser Threshold Percentage will apply uniformly to all members of the same Class.

AV Ratio Cost of Insurance Rates – Upon the later of the Insured’s age 100 or the 26th Coverage Year, Cost of Insurance Rates may be calculated using the AV Ratio of the policy. These Cost of Insurance Rates may be less than, but will be no greater than the Maximum Cost of Insurance Rates shown in the Policy Specifications. If the AV Ratio is greater than or equal to the Threshold Percentage, then the AV Ratio Cost of Insurance Rates may be used.

If the AV Ratio is less than the Maximum Threshold Percentage, then the AV Ratio Cost of Insurance Rates will not be used and the current Cost of Insurance Rate will be used.

Table of Maximum Threshold Percentages: [ 75]%]]

 

R15ART SP

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POLICY NUMBER: [VF99999990]

POLICY SPECIFICATIONS

 

Table of Cost of Insurance (COI) Rates

for Annual Renewable Term (“ART”) Rider [(Guaranteed Issue)]

    Insured:                                  [JOHN DOE]                            

Maximum Monthly Cost of Insurance Rates Per $1000.00 of Net Amount at Risk Applicable to this Coverage.

 

Policy

Year

COI

Rate

Policy

Year

COI

Rate

Policy

Year

COI

Rate

[1 0.10090 30 1.27900 59 21.97380
2 0.10670 31 1.41510 60 23.81220
3 0.11170 32 1.55240 61 25.79270
4 0.12010 33 1.68980 62 27.64150
5 0.12840 34 1.83930 63 29.65380
6 0.13760 35 1.99170 64 31.85100
7 0.14930 36 2.17330 65 34.25960
8 0.16350 37 2.37670 66 36.90860
9 0.17930 38 2.64820 67 39.06360
10 0.19940 39 2.93180 68 41.41760
11 0.22110 40 3.23010 69 43.99540
12 0.24200 41 3.56140 70 46.82420
13 0.26460 42 3.92360 71 49.93700
14 0.27790 43 4.34570 72 53.37330
15 0.29380 44 4.84010 73 57.18460
16 0.31390 45 5.41330 74 61.42910
17 0.33900 46 6.04180 75 66.18210
18 0.37330 47 6.76170 76 71.53880
19 0.41180 48 7.51460 77 77.62690
20 0.45950 49 8.33040 78 83.33330
21 0.51560 50 9.24140 79 83.33330
22 0.57510 51 10.27540 80 83.33330
23 0.63890 52 11.43490 81 83.33330
24 0.69180 53 12.71510 82 83.33330
25 0.75230 54 14.10520 83 83.33330
26 0.82540 55 15.59360 84 83.33330
27 0.91630 56 17.17060 85 83.33330
28 1.02660 57 18.67330 86 83.33330
29 1.14970 58 20.26540   87+ 0]

 

R15ART SP

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POLICY NUMBER: [VF99999990]

POLICY SPECIFICATIONS

 

Table of Maximum Monthly Coverage Charges for

Annual Renewable Term (“ART”) Rider [(Guaranteed Issue)]

            Insured:                             [JOHN DOE]                            

 

Policy

Year

Coverage

Charge

Policy

Year

Coverage

Charge

Policy

Year

Coverage

Charge

[1 26.80 30 36.35 59 36.35
2 26.80 31 36.35 60 36.35
3 26.80 32 36.35 61 36.35
4 26.80 33 36.35 62 36.35
5 26.80 34 36.35 63 36.35
6 26.80 35 36.35 64 36.35
7 26.80 36 36.35 65 36.35
8 26.80 37 36.35 66 36.35
9 26.80 38 36.35 67 36.35
10 26.80 39 36.35 68 36.35
11 26.80 40 36.35 69 36.35
12 26.80 41 36.35 70 36.35
13 26.80 42 36.35 71 36.35
14 26.80 43 36.35 72 36.35
15 26.80 44 36.35 73 36.35
16 26.80 45 36.35 74 36.35
17 26.80 46 36.35 75 36.35
18 26.80 47 36.35 76 36.35
19 26.80 48 36.35 77 36.35
20 26.80 49 36.35 78 36.35
21 36.35 50 36.35 79 36.35
22 36.35 51 36.35 80 36.35
23 36.35 52 36.35 81 36.35
24 36.35 53 36.35 82 36.35
25 36.35 54 36.35 83 36.35
26 36.35 55 36.35 84 36.35
27 36.35 56 36.35 85 36.35
28 36.35 57 36.35 86 36.35
29 36.35 58 36.35 87+ 0]

 

R15ART SP

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