Common use of ANSWER THE FOLLOWING QUESTIONS Clause in Contracts

ANSWER THE FOLLOWING QUESTIONS. Yes No a. Has any Proposed Insured ever had a heart attack, stroke, cancer, diabetes or disorder of the immune system, or during the last two years been confined in a hospital or other health care facility or been advised to have any diagnostic test (exclude HIV testing) or surgery not yet performed? [_] [_] b. Is any Proposed Insured age 71 or above? [_] [_] STOP If the correct answer to any question above is YES, or any question is answered falsely or left blank, coverage is not available under the Agreement and it is void. This form should not be completed and premium may not be collected. Any collection of premium will not activate coverage under the Agreement. The Company will pay the death benefit amount described below to the beneficiary named in the application if: . The Company receives due proof of death that the Primary Proposed Insured (and the Other Proposed Insured if the application was for a joint life or survivorship policy) died, while the coverage under the Agreement was in effect, except due to suicide; and . All eligibility requirements and conditions for coverage under the Agreement have been met. The total death benefit amount pursuant to the Agreement and any other limited temporary life insurance agreements covering the Primary Proposed Insured (and the Other Proposed Insured if the application was for a joint life or survivorship policy) will be the LESSER of: . The Plan amount applied for to cover the Proposed Insured(s) under the base life policy; or . $500,000 plus the amount of any premium paid for coverage in excess of $500,000. If death is due to suicide, the amount of premium paid will be refunded, and no death benefit will be paid.

ANSWER THE FOLLOWING QUESTIONS. Yes No a. Has any Proposed Insured ever had a heart attack, [ ] [ ] stroke, cancer, diabetes or disorder of the immune system, or during the last two years been confined in a hospital or other health care facility or been advised to have any diagnostic test (exclude HIV testing) or surgery not yet performed? [_] [_]? b. Is any Proposed Insured age 71 or above? [_[ ] [_[ ] -------------------------------------------------------------------------------- STOP If the correct answer to any question above is YES, or any question is answered falsely or left blank, coverage is not available under the Agreement and it is void. This form should not be completed and premium may not be collected. Any collection of premium will not activate coverage under the Agreement. -------------------------------------------------------------------------------- The Company will pay the death benefit amount described below to the beneficiary named in the application if: . The Company receives due proof of death that the Primary Proposed Insured (and the Other Proposed Insured if the application was for a joint life or survivorship policy) died, while the coverage under the Agreement was in effect, except due to suicide; and . All eligibility requirements and conditions for coverage under the Agreement have been met. The total death benefit amount pursuant to the Agreement and any other limited temporary life insurance agreements covering the Primary Proposed Insured (and the Other Proposed Insured if the application was for a joint life or survivorship policy) will be the LESSER of: . The Plan amount applied for to cover the Proposed Insured(s) under the base life policy; or . $500,000 plus the amount of any premium paid for coverage in excess of $500,000. If death is due to suicide, the amount of premium paid will be refunded, and no death benefit will be paid.