489-North American Life Master Application For Group Insurance
Nor[h American Life
we, C{ty of Sanford, FL
Full Legal Name of Applicant
apply to North American Life Assurance Company (the Company) for the Group Insurance Benefits checked below in accordance with
the details set out on the attached pages.
GROUP INSURANCE BENEFITS
~Z] Group Life Insurance [] Voluntary Accidental Death and Dismemberment insurance
[] Dependent Life Insurance ~ Weekly Income Insurance
~ Optional Life Insurance [] Long Term Disablility Income Insurance
~3 Accidental Death and Dismemberment Insurance []
EFFECTIVE DATE
We agree to the STANDARD CONDITIONS FOR COMMENCEMENT OF INSURANCE printed on the reverse and subject to these conditions
we request that insurance become effective on:
Date 10/0:~/93
If the MINIMUM ENROLLMENT REOUIREMENTS are not satisfied by such date we request that:
X] Insurance be provided for one month for all eligible Employees.
E:] Insurance be provided for one month for all eligible Employees who were insured under the plan being replaced,
~ Insurance not commence until such requirements are satisfied·
PREMIUM
We hereby tender an initial premium in the amount of $ (Please make cheque payable to North American Life Assurance Company)
The Applicant acknowledges and agrees that:
1. The statements recorded in the Master Application are true and complete to the best of his knowledge and belief and form the basis
of any policy or policies which may be issued by the Company.
2. The Appendix pages which are attached form part of the Master Application.
3. The insurance requested in this Master Application will come into force only if approved by the Company at its Group Division Head Office.
4. Acceptance of any policy or policies of insurance issued as a result of the Master Application will be deemed acceptance of the terms
and conditions of the policy or policies.
5. If more than one policy of insurance is issued to the Applicant as a result of this Master Application or any subsequent application,
the policies bearing the same number will be considered as one contract for the purpose of premium payments.
No change will be made by the Company which affects:
a) the amount and commencement date of insurance;
b) any plan of benefits;
c) the classes of Employees to be insured; or
d ) the classification of risk;
unless the change or changes are agreed to by the Applicant in writing.
at ~A~Z0er~sTa ~h. is 3RD day of JUNE 19 93
· ~ · , CITY MANAGER
I n II 81 ~OF AUTHORSTED OFFICIAL
LICeNBED ReS raquired by lawl ESENTAT~VE
300-US NORTH AMERICAN LIFE ASSURANCE COMPANY 8.88
90NVltRSNI ~O INSINgON31NINO0 HO~ SNOIJ, IONOO OUVONViS
APPENDIX A (LIFE) TO MASTER A aCATION
FOR GROUP INSURANCE
NORTH AMERICAN LIFE
Name of Applicant City of Sanford, FL
SCHEDULE OF BENEFITS FOR EMPLOYEE LIFE INSURANCE
CLASS DESCRIPTION OF CLASS BENEFIT MAXIMUM
(Alphabetically)
A General Employees $5,000 $5,000
B Public Safety Employees 3,000 3,000
C Retirees 3,000 3,000
D Management/Supervisory Employees 1 x annual $100,000
earnings
E Elected Officials $5,000 $5,000
Amounts in schedule based on multiples of earnings are 'rounded' to the higher Preliminary No Evidence Limit
$1,000 unless otherwise indicated. (if applicable)
$ N/A
TOTAL DISABILITY BENEFIT
Premiums will be waived in the event of Total Disability occurring before XZiX Age 60 [] Age 65
Any insurance extended under the Total Disability Benefit will cease at the earlier of the Empioyee's retirement or:
~ age 70;
[] the first day of the Policy Month coinciding with or next following age 70;
[] the Policy Anniversary coinciding with or next following age 70.
REDUCTION AND TERMINATION PROVISIONS
Cover to
(a) Reduce as follows: (describe reduction schedule, then complete (b} or (c) as applicable)
{i~ at Policy Anniversary coinciding with or next following; [] at attained age;
Ag- 65 , 35 %
Age 7Q , ,5 %
Age 75 , 5,5 %
and reduce to $3,000 at retirement maximum.
(b) [i] Terminate on the date of the Employee's retirement.
or
(c} [] Continue for life at reduced amount.
301-US NORTH AMERICAN LIFE ASSURANCE COMPANY 9,88
DEPENDENT LIFE INSURANCE
[] Employee's spouse , Employee's children , each.
Amounts must conform with law. Spouse benefits may not exceed one half Employee' benefit.
insurance terminates at the earlier of the Employee's retirement or cessation of Employee Life Insurance.
OPTIONAL LIFE INSURANCE
~ Employee only [] Employee and spouse
Amount: Units of 10.000 to a maximum of 2 x BASE Barnings or
Other $100,000 whichever is less.
Insurance reduces according to the same reduction schedule as Employee Life and terminates at the earlier of the
Employee's retirement or cessation of Employee Life Insurance.
SUPPLEMENTAL LIFE INSURANCE
Amount: ~:] 1 x [] 2 x, or [] 3 x Annual Earnings Maximum
Insurance reduces according to the same reduction schedule as Employee Life and terminates at the earlier of the Employee's
retirement or cessation of Employee Life Insurance.
OTHER LIFE BENEFITS (Specify)
SPECIAL CONDITIONS
Specify any plan features or special conditions not requested elsewhere. Explain any requests to provide continuity with
any plan to be replaced by this plan.
COST SHARING (Show split by benefit, if applicable.)
Employer ] 0 0 ~ ~ ~
Employee 0 BASIC LIFE 10 SUPPLEHENTAL LIFE
NOTE RE BENEFICIARIES
In the event a death benefit becomes payable in respect to an Employee who is eligible at the Effective Date but has
not completed an enrollment card, such benefits shall be paid as follows:
1) where permitted by law, to the Beneficiary named for any previous plan which is to be replaced
by this Group plan;
2) otherwise, to the estate.
APPENDIX A (ACCIDENTAL DEATH AND DISMEMBERMENT) JJJee~~~e'-
TO MASTER APPLICATION FOR GROUP INSURANCE
Name of Applicant C~ ~-y n~: ~n~l, ;L NodhAme~can Life
SCHEDULE OF BENEFITS FOR ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE
CLASS DESCRIPTION OF CLASS BENEFIT MAXIMUM
(Alphabetically)
A General Employees $5,000 $5,000
B Public Safety Employees 3,000 3,000
C Retirees 3,000 3,000
D Management/Supervisory Employees 1 x annual $100,000
earnings
E Elected Officials $5,000 $5,000
Amounts in schedule based on multiples of earnings are 'rounded' to the higher $1,000 unless otherwise indicated.
24 HOUR
NON OCC.
Cover to reduce according to the same reduction schedule as Employee Life Insurance.
Insurance terminates on the date of the Employee's retirement.
SPECIAL CONDITIONS
Specify any plan features or special conditions not requested elsewhere. Include explanation of arrangements requested
to provide continuity with any plan to be replaced by this plan.
COST SHARING COMMON CARRIER BENEFIT · TABLE OF LOSSES:
Employer 1(~0 % [] YES ~] AD&D (R) - Regular
Employee % ~ NO D AD&D (E) - Enhanced
302-US NORTH AMERICAN LIFE ASSURANCE COMPANY 9.88
APPENDIX B
TO MASTER APPLICATION FOR G..JUp INSURANCE
PLAN DESCRIPTION North American Life
1. A. Full Legal Name of Appllcant City of Sanford, FL
B. Mailing Address of Applicant (Include Zip Code) STREET ADDRESS: 300 N. Park Avenue
P.O. Box 1788 Room 241
Sanford, FL 32772-1788 Sanford, FL 32772-
1788
C. Applicant
[] Corporation [] Sole Proprietorship [] Partnership :El Other (Explain)
(See 9C.) Municipality
2. A. Name and Title of Administrator ~ same for all divisions
[] other
Tim McCauley
B, Administrator
1('1 An Employee of the Applicant [] An Independent Firm (Attach App/icant's Letter of AurhoriW)
C.Mailing Address of Administrator (If nor as above)
same
3, Producer: Mr. Lon Bryan I 4, Policy Year Date
Corporate Name: Cecil W. Powell & Co. 10/01
5, Is any other plan providing insurance? If so, describe benefits and identify carrier.
6, A, State specifically: (i) classes not eligible for benefits under this plan
(ii) minimum no. of hours per week required (if other than 25)
20 Hours
B. Waiting period at the Effective Date C. Waiting period after the Effective Date
None 1st of month following 90 days
D. Retired lives to be covered Did anyone who is to be insured retire early because of
disability?
[] None [] No
[] All present retired lives (State number ) ~ Yes - Give details
[] All future retired lives
~ All present and future retired lives
7. Transfer Business
A. Is anyone absent for any reason at the date of application? [] Yes [] No
If yes, give names, reasons, details and submit all outstanding claims, including for waiver of premium
benefits, to the prior carrier within 30 days of cancellation. If any absent employees are disabled, identify
the nature of the disability and the expected date of return to work.
B, Date of cancellation of previous plan
9/30/93
8. A. Nature of Business - Describe process or services performed, products manufactured, etc. if associated
companies are included and involved in different industries, give full details.
B. SIC Hunic ipal ity
306-US NORTH AMERICAN LIFE ASSURANCE COMPANY 9.88
("THE COMPANY")
9. A. Analysis of Full-time Staff ~ B. Analysis of Eligible Employs, ay Occupation
EE's in EE's Commis- In plant or outside group*/Specify trade or occupation/
Total Waiting Excluded Total Office sion Commis- Super-
Staff Period Under 6A Eligible Group Sales sion visors
(1) (2) (3} (1-2-3) ** Other and
* * Foremen
C. Earnings Definition
*Hourly Paid Earnings - State number of hours on which a work week, or year, is based-- see attached
**Commission Earnings - Describe basis of determining earnings for insurance purposes--
Sales -- Other --
If Partnership - Fiscal Year starts and ends
D. Residence of Eligible Employees (If outs/de USA, spec/fy country)
State No of EE's State . No of EE's State No of EE's
Florida all
10. A. Associated Companies Insured
Full Legal Name Address Relationship
B. Identify any units requiring separate billings
C. Are separate mailings required for 'S'? [] Yes :~3 No
If yes, give mailing address and name of administrator if not as in A above.
11. Method of Administration
E:] Statements and Certificates by Company [] Positive Bill :~3 Statements and Certificates by Insured
(NaI-Billed) [] Exception Bill (Self-Administered)
NOTE: NAL-BILLED GROUPS WITH OVER 100 LIVES AUTOMATICALLY ARE ON EXCEPTION BILL
12. Changes In Cover
Changes under. schedule of benefits to take effect:
[] Immediate E~ Policy Year Date E3 Other: (Specify)
13. Comments and Special Instructions
NORTH AMERICAN LIFE
ASSURANCE COMPANY
(A MUTUAL COMPANY)
Will pay, subject to the provisions of this policy, the Life Insurance Pro-
WHOLE LIFE POLICY ceeds to the beneficiary after receiving proof of the death of the Life In-
sured. Other rights and benefits are provided as stated in this policy.
Face Amount Payable at Death
Eligible for Dividends Signed for the Company at its Home Office in Toronto, Canada on the
Premiums Payable as Shown on Dat..e o
Page 3 .
-DAY RIGHT TO EXAMINE POLICY
The Owner may, ~i i6"'i O day~"~eF~e~i~ifig thiS~'pblid~'; ~etQr6 it t6'ihe
-' ,. "~i~:~:':'~2H6~d'OffiC~ agent of the Co~ f~'6~6'~ellati~TThe polic~iil b~ void
"" ~,, .:~2 .; ': .:Thi~?i~h~>dOeS not apply if this policy w~ issued ~ a resUlt Of a change in, or
conversion of, a prior policy.
,~200US Page I
SECTION 1: GENERAL PROVISIONS
1.1 CONTRACT the Life Insured for two years from the Date of issue.
The contract consists of this policy, the application In issuing this policy, the Company has relied upon
for insurance (a copy of which is attached), and any statements made in connection with the application.
amendment agreed upon in writing (a copy of which
These are representations and not warranties. No
is attached). statement will be used by the Company to void the
Any change in this contract may be made only with' policy or to deny a claim unless that statement is a
material misrepresentation and is part of the applica-
the written consent of the Owner and the Company. lion.
Only the President or Vice-President together with
1.6 SUICIDE
the Secretary or Actuary of the Company have
authority to waive or agree to change any of the Suicide of the Life Insured, while sane or insane,
terms or provisions of this policy. within two years from the Date of Issue, is not
covered by this policy. In that event, the only
1.2 GOVERNING LAW amount payable will be the premiums paid for this
This contract is subject to the laws of the Applicable policy, less any indebtedness.
Jurisdiction. 1.7 SETTLEMENT
1.3 LIFE INSURANCE PROCEEDS The Company will require satisfactory proof of:
(a) the age of the Life Insured; and
The Life insurance ProCeeds will be paid to the (b) the right of the claimant to receive any proceeds
beneficiary upon receipt of proof satisfactory to the payable on surrender, maturity, or death.
Company of the death of the Life Insured. These pro- The Company may also require this policy.
ceeds will include the Face Amount and any other
benefits provided by riders or dividends and payable
because of the death of the Life Insured. All pro- 1.8 MISSTATEMENT OF AGE
ceeds will be paid in accordance with the provisions '
of this policy. Any indebtedness will be deducted If the Issue Age of the Life Insured has been
from the proceeds and an adjustment for the final misstated, the benefits available under this policy
premium may be made. will be those which the premiums paid would have
purchased for the correct age.
1.4 CURRENCY AND PLACE OF PAYMENT
1.9 AGE
All payments made to or by the Company shall be
made in the lawful currency of the Applicable Issue Age is the age on the birthday nearest the
Jurisdiction. Payments to the Company shall be Policy Date.
made at the Home Office or elsewhere as may be
determined by the Company. Payments by the Com- References to Insurance Age mean the policy an-
pany shall be made in the Applicable Jurisdiction, or niversary nearest attainment by the Life Insured of
elsewhere if the Company consents. that specific age.
1.5 INCONTESTABILITY 1.10 POLICY DATE
The Company will not contest the validity of this Policy years, months and anniversaries are measured
policy after it has been in force during the lifetime of from the Policy Date.
400US2 Page 4
SECTION 2: OWNERSHIP AND BENEFICIARY
2.1 OWNER 2.4 BENEFICIARY
All benefits, rights and privileges under this policy a. Designation. The Owner may name one or more
belong to the Owner while the Life insured is living, beneficiaries to receive the Life insurance Pro-
ceeds. If an irrevocable beneficiary is named, no
2.2 CONTINGENT OWNER action under this policy may be taken without his
or her consent except to opt for a paid-up policy
If the Life Insured is not the Owner, the Owner may or to deal with dividends.
name one or more contingent owners to whom this b. Change. The Owner may change any revocable
policy will be transferred on the death of the OWner. beneficiary while the Life Insured is living. A
On the death of the last surviving contingent owner, change of beneficiary appointment will cancel any
the executors or administrators of his or her estate previous appointment.
will be the Owner. Any appointment of a contingent If a change is made, it must be filed in a form
owner may be changed or revoked. satisfactory to the Company at its Home Office.
After being recorded by the Company, the change
2.3 ASSIGNMENT will take effect as of the date the form was
signed. it is subject to any payment made or other
No assignment of this policy will be binding on the action taken by the Company before its recording.
Company unless it is in writing and received by the c. Death of Beneficiary. Unless otherwise provided
Company at its Home Office. The Company will not in the beneficiary appointment:
be responsible for the validity or effect of any assign- ( 1 ) If no beneficiary survives the Life Insured, or
ment. if none has been named, the Life Insurance
Proceeds will be paid to the Owner or the
An absolute assignment will cancel the interest of a Owner's estate; or
revocable beneficiary. A collateral assignment will (2) if a beneficiary dies before the Life Insured,
transfer the interest of the beneficiary to the assignee his or her share will pass to the surviving
to the extent of the assignee's interest. beneficiaries in equal shares.
SECTION 3: PREMIUMS AND REINSTATEMENT
3.1 PREMIUMS premium paid past the policy month in which the
Life Insured dies will be added tothe Life In-
a. Payment. Annual premiums are payable in ad- surance Proceeds.
vance on or before the due date which is the start
of each policy year. Premiums may be paid other 3.2 REINSTATEMENT
than annually with the consent of the Company.
Premiums are payable at the Home Office or This policy may be reinstated within three years after
elsewhere as may be determined by the Corn- the due date of the first unpaid premium unless the
pany. The Owner may request a receipt signed by Surrender Value has been paid.
an officer of the Company for any premium be*
ing paid. To reinstate, the Owner must:
b. Grace Period. Except for the first premium, a a. apply in writing;
grace period of 31 days is allowed for payment b. provide proof satisfactory to the Company that
in full of the premium due. During this time, this the Life Insured is insurable;
policy will stay in force. If the Life Insured dies c. pay overdue premiums with interest; and
during the grace period, any premium due but un- d. pay or reinstate all other indebtedness, with in-
paid will be deducted from the Life Insurance terest.
Proceeds. Overdue premiums and indebtedness will bear interest
If any premium due is not paid by the end of the at the Policy Loan Interest Rate, as provided in Sec-
grace period, this policy will lapse except as pro- tion 6.1 d. Interest will be compounded yearly and
vided in Section 5. must be paid to the date of reinstatement.
c. Premium Adjustment at Death. The part of any
500US5 Page 5
SECTION 4: DIVIDENDS
4.1 ANNUAL DIVIDENDS Company to accumulate at interest. On each
policy anniversary, interest will be credited on
While in force, this policy is eligible to share in the these accumulations at a rate determined annually
divisible surplus, if any, of the Company. This
by the Company and guaranteed to be at least 3
policy's share will be paid as a dividend. The amount 1/2 per cent per year. Dividend accumulations
of any dividend is determined by the Company and may be withdrawn at any time and, if not
credited annually, beginning not later than the end of withdrawn, will be added to the policy proceeds
the second policy year. when the proceeds become payable.
4.2 DIVIDEND OPTIONS Other options may be available with the consent of
the Company.
The Owner may elect one of the following options:
a. Cash. 4.3 ELECTION OF OPTIONS
b. Paid-Up Additions. Dividends will be applied to
The Owner may elect a dividend option:
purchase paid-up additional insurance. Paid-Up
a. in the application for this policy; or
Additions are eligible for dividends and may be
b. by written request in a form satisfactory to the
surrendered for their cash value at any time. Company.
c. Premium Reduction, Dividends will be applied to The option chosen will be effective until another option
pay or reduce any premium then due, provided is elected. A change of option may apply to any
the frequency is other than monthly. if the divi-
dividend payable within 31 days before the election.
· dend is larger than the premium due, the excess
will first be applied toward any policy loan, and If no option has been elected, the dividends will
the balance paid in cash. purchase Paid-Up Additions.
d. Accumulation. Dividends will be left with the
SECTION 5: GUARANTEED VALUES
5.1 CASH VALUE Table of Guaranteed Values. The face amount of
the paid-up policy will be equal to the paid-up
This policy provides a cash value as specified in the
value, increased or decreased in the ratio of the
Table of Guaranteed Values. This cash value is · Surrender Value (excluding the cash value of any
dependent on the Issue Age, and on the number of
Paid-Up Additions) to the cash value. In no event
completed policy years. will the paid-up insurance exceed the Face
Amount.
5.2 USE OF CASH VALUE
The Owner may apply the cash value to one of the 5.3 GENERAL
following options: The cash value for the end of a policy year will be
a, Policy Surrender. This policy may be surrendered available upon request at that time or within the
for its Surrender Value by completion of a form following 31 days. Upon request, the Company will
satisfactory to the Company. The Surrender furnish information about the amount of cash value
Value is equal to the cash value plus the cash
for any period not shown in the Table of Guaranteed
value of any dividend credits, less any Values.
indebtedness. Upon surrender, this policy
terminates. If any premium due is not paid, the Guaranteed
The Company may postpone payment for not Values available on the due date of the premium will
more than six months after receipt of request to be granted, upon request, within the following 60
surrender. days. In the absence of any request, this policy will
b. Paid-Up Insurance. This policy may be continued continue as Paid-Up Insurance (Option b) unless the
as paid-up insurance as of the due date of any un- Automatic Premium Loan provision has been
paid premium, Paid-up values are shown in the elected.
Page6
600US7 (Continued Over)
SECTION 6: LOANS
6.1 POLICY LOAN The loan interest rate will:
The Owner may borrow against this policy. - increase whenever the maximum allowed rate
is at least 1/2 per cent greater than the rate then
a. Loan Value. The Loan Value of this policy is: in use; and
(1) the cash value of this policy; plus - decrease whenever the maximum allowed rate
(2) the cash value of any paid-up additions; is at least 1/2 per cent less than the rate then
in use.
both calculated as of the next policy anniversary
or the next premium due date, whichever is earlier. In no event will the loan interest rate be greater
than allowed by law.
b. Amount of Loan Available. The Amount of Loan
Available will be the Loan Value less: The Company will notify the Owner of the loan in-
terest rate:
(1} any due and unpaid premium;
(2) any existing policy loan; and - when an initial policy loan is made; and
(3) any loan interest to the next policy anniver- - prior to each policy anniversary, while there is
sary. a policy loan.
Any due and unpaid premiums deducted in arriv- e. Loan Interest. Interest is payable at the Policy Loan
ing at the Amount of Loan Available will form part Interest Rate. Unpaid interest will be added to the
of the policy loan and be subject to loan interest. principal yearly and will be subject to interest at
the same rate.
c. Application for Loan, The Owner may obtain all or
part of the Amount of Loan Available by request ' f. Repayment. The outstanding policy loan, together
in a form satisfactory to the Company. The Corn- ' with accrued interest, may be repaid in full or in
pany may postpone payment for not more than six part while this policy is in force.
months after receipt of a request for a policy loan This policy will terminate at the end of the first policy
unless the loan is to pay premiums to the month in which the policy loan and loan interest ex-
Company. ceed the Loan Value. Any existing dividend accumula-
d. Policy Loan Interest Rate. This policy will bear tion will then be paid. In no event will this policy ter-
interest at a variable rate. The rate: rainate until 31 days after notice of termination has
been mailed to the Owner and any assignee. at their
- will be set by the Company, in advance,
addresses on record with the Company.
effective the beginning of each policy year; and
- may change only at the beginning of any policy 6.2 AUTOMATIC PREMIUM LOAN
year.
The Au;comatic Premium Loan provision will apply if
The loan interest rate set each year will not exceed elected in the application or in writing at a later date.
the 9reater of: The election may be cancelled at anytime by written
- the Published Monthly Average for the calendar notice.
month ending two months before the date on This provision provides a policy loan at the end of the
which the rate is set; and grace period to pay an overdue premium. If the un-
- the rate used to compute the cash values of the paid premium exceeds the Amount of Loan Available,
policy plus one per cent.
a part of the premium will be paid. This policy will ter-
"Published Monthly Average" means "The rainate at the end of the first policy month in which
Moody's Corporate Bond Yield Average- Monthly the policy loan and loan interest exceed the Loan
Average Corporates" as published by Moody's Value.
Investors Service, Inc., or a similar average approved An Automatic Premium Loan is subject to the same
by the Department of Insurance of the Applicable provisions as other policy loans.
Jurisdiction.
700US7 Page 7
SECTION 7: POLICY SETTLEMENT
7.1 PAYMENT OF PROCEEDS Payment Option to be payable to:
The Company will pay the policy proceeds in a single (1) the beneficiary upon the death of the Life
sum; or may, upon request, apply the proceeds to
insured; or
one of the Payment Options described in this Sec-
(2) the Owner upon surrender of this policy
tion. Other options may be available with the con-
sent of the Company. as the payee under that option.
The payee under any Payment Option must be a
natural person. At the time of the election, the Owner may also
designate one or more successor payees to
7.2 PAYMENT OPTIONS receive any unpaid amount remaining with the
a. Deposit (Option A}. Proceeds may be left with the Company at the death of a payee. This designa-
tion will automatically terminate any previous
Company with interest payable yearly. The in- designation of a successor payee.
terest rate is determined each year by the Com-
pany and is guaranteed to be at least 3 1/2 per b. At the Time Proceeds are Payable. At the time the
proceeds become payable, the person who is en-
cent per year. Withdrawals may be made in sums
titled to payment in a single sum may elect to
of ~250 or more.
b. Instalments for Fixed Elected Amount (Option B). receive the proceeds as payee under any .Pay-
ment Option.
Insraiment payments will be made until the pro-
ceeds plus interest have been paid. interest will c. Form of Election. Any election or change must be
be added to the proceeds yearly at a rate deter- in writing in a form satisfactory to the Company.
mined by the Company and guaranteed to be at 7.4 MINIMUM AMOUNTS
least 3 1/2 per cent per year. The total annual
amount of the elected payments must be at least
If the proceeds payable to a payee under an option
~ 100 for each ~ 1,000 of proceeds. amount to less than ~2,500, or the instalment under
c. Instalments for Specific Number of Years (Option any option is less than $ 50.00, the Company may
CI. Equal instalments will be made in advance for
cancel the option and pay the proceeds to the payee
the number of years elected, but not more than
30. These payments'Willb~ 'ba~ed'~nth,e interest in one sum.
rate determined by the~:~mpa~i~)lat~'th~!~irne!0f!*l~'~'l:~'i,i-~ ......... ",~' : ' .'
7.5 GENERAL
settlement. Instalments are guaranteed to be not
less than shown in the (Option C) Table.
a. Payee. ~,;payee is a natural person who is to
d. Life :Income (Option D). Equal',~nthly in-
receive the payments.
stalments will be made in advan~during the
lifetime of the payee, In any eve~(;'i~talments b. Death of p~yee. Upon the death of the last surviv-
are guaranteed to be paid for 10 o:r 15~years, as ing paye~,:the Company will pay in one sum to
elected. that payee's executors or administrators:
(1) any balance on deposit under (Option A) or
The amount of payment will be determined by the (Option B); or
Company at the time of se~lement, and will de-
(2) the commuted value of any remaining
pend on the age of the payee. InStalments are
guaranteed instalments under (Option C) or
guaranteed to be not less than shown in the (Op- (Option D) as determined by the Company.
tion D) Table. , The commuted value is always less than the
sum, of any remaining guaranteed in-
The Company may require satisfa~t0r~ proof of stalinants.
the age and continuing survival of:any'payee.
7.3 ELECTION OF OPTIONS :~, .... c. Designation by Payee. A payee may designate a
successor payee to receive any final amount that
a, Before Proceeds are Payable'. While 'the Life In- woul~ otherwise be payable to the estate of that
sured is living and before the proceeds become payee or may change a successor payee
payable, the Owner may le 2hange any. ~rev
800US2 ~'; Page 8
~ (Continued Over)