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Exhibit 4
LAST SURVIVOR FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE
INSURANCE POLICY
A B
PLEASE READ YOUR POLICY CAREFULLY
This Policy is a legal contract between the Owner (you, your) and Nationwide
Life Insurance Company (we, our, us, the Company).
INSURING AGREEMENT:
We issue this Policy in consideration of your application and the payment of the
Initial Premium. We agree to pay the Death Proceeds to the Beneficiary upon
receiving proof that both Insureds have died while this Policy is in force prior
to the Maturity Date. We agree to pay the Maturity Proceeds to you if either
Insured is living on the Maturity Date.
You and we are bound by the conditions and provisions of this Policy.
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The Cash Surrender Value of this Policy will vary from day to day. It may
increase or decrease depending on the investment experience of the Policy. Refer
to the Nonforfeiture Provisions on page 11 for details. There is no guaranteed
Cash Surrender Value.
The amount or duration of the death benefit will be variable and depend on the
investment experience of the Policy. The death benefit will never be less than
the Specified Amount as long as your Policy is in force. Refer to the Death
Benefit Provisions on page 9 for details.
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RIGHT TO EXAMINE POLICY
You may return this Policy to us within (1) 10 days after you get it, or (2) 45
days after you sign the application, or (3) 10 days after we mail or deliver the
Notice of Withdrawal Right, whichever is latest. The Policy, with a written
request for cancellation, must be mailed or delivered to our Home Office or to
the agent who sold it to you. The returned Policy will be treated as if we never
issued it and we will refund any premiums paid.
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If you have any questions about your Policy or need additional insurance
service, contact your agent or write to our Home Office.
Signed at our Home Office on the Policy Date.
A B C D P Q R S
Adjustable Death Benefit
Flexible premiums payable during either Insured's lifetime
until the Maturity Date
Death Proceeds payable at death of both Insureds
prior to the Maturity Date
Maturity Proceeds payable on the Maturity Date
Non-Participating
Not eligible for dividends
Investment experience reflected in benefits
VLO-0600 Nationwide Life Insurance Company
Home Office: ▇▇▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇ ▇▇▇▇▇▇▇▇, ▇▇▇▇ ▇▇▇▇▇-2220
Nationwide is on your side.
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PROVISION PAGE
Annual Report.................................................................7
Assignment....................................................................8
Beneficiary...................................................................7
Cash Surrender Value..........................................................4
Cash Value...................................................................11
Death Benefit.................................................................9
Definitions...................................................................4
Error in Age or Sex...........................................................6
Fixed Account................................................................16
Grace Period..................................................................8
Incontestability..............................................................6
Insureds......................................................................4
Insuring Agreement............................................................1
Loan.........................................................................13
Monthly Cost of Insurance....................................................12
Nonforfeiture................................................................11
Optional Modes of Settlement.................................................16
Ownership.....................................................................7
Policy Data Page..............................................................3
Premium.......................................................................8
Reinstatement.................................................................9
Suicide.......................................................................6
Surrender....................................................................12
Termination...................................................................7
Transfers....................................................................16
Valuation of Assets..........................................................14
Variable Account.............................................................15
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DEFINITIONS
ATTAINED AGE: For each Insured, Attained Age is the Issue Age of such Insured
plus the number of full years since the Policy Date.
ISSUE AGE: For each Insured, Issue Age is the Insured's age on the last birthday
on or before the Policy Date. It is shown on the Policy Data Page.
BENEFICIARY: The Beneficiary is the person to whom the Death Proceeds are paid.
The Beneficiary is named in the application, unless changed.
CASH SURRENDER VALUE: The Cash Surrender Value of your Policy on any date is
equal to (1) minus (2) minus (3) where:
1. is the Cash Value;
2. is any Indebtedness; and
3. is any Surrender Charge.
CASH VALUE: Your Policy's Cash Value is the sum of the associated values in any
Variable Account, the Fixed Account, and the Policy Loan Account. Refer to the
Nonforfeiture Provision for details.
COMPANY: The Company is the Nationwide Life Insurance Company. "We," "our", and
"us" refer to the Company.
CONTINGENT BENEFICIARY: The Contingent Beneficiary will become the Beneficiary
if the named Beneficiary dies prior to the date Death Proceeds become payable.
The Contingent Beneficiary is named in the application, unless changed.
CONTINGENT OWNER: The Contingent Owner will become the Owner if the named Owner
dies prior to the date Death Proceeds become payable. The Contingent Owner is
named in the application, unless changed.
DEATH PROCEEDS: The Death Proceeds are the amount of money payable to the
Beneficiary if both Insureds die while your Policy is in force prior to the
Maturity Date. Refer to the Death Benefit Provisions for details.
FIXED ACCOUNT: A Fixed Account is an investment option which is funded by the
General Account of the Company.
FUND: A Fund is the underlying mutual fund in which Subaccount assets are
invested. There is a Fund that corresponds to each Subaccount in a Variable
Account. The Funds are listed on the Policy Data Page with the corresponding
Subaccounts.
GENERAL ACCOUNT: The General Account is made up of all of our assets other than
those held in any separate investment account.
HOME OFFICE: The Home Office of the Company is at ▇▇▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇,
▇▇▇▇▇▇▇▇, ▇▇▇▇.
INDEBTEDNESS: Indebtedness is any amount you owe us as a result of a policy
loan. Indebtedness consists of principal amount plus accrued interest.
INITIAL INVESTMENT DATE : The Initial Investment Date is the later of the Policy
Date or the date we receive the Initial Premium at our Home Office.
INSUREDS: The Insureds are the persons whose lives are covered by this insurance
Policy and are named in the application.
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MATURITY DATE : The Maturity Date is the Policy Anniversary on or next following
the younger Insured's 100th birthday.
MATURITY PROCEEDS: Maturity Proceeds are the amount of money payable to you on
the Maturity Date if your Policy is still in force. The Maturity Proceeds will
be equal to the amount of the Cash Value, less any Indebtedness.
MONTHLY ANNIVERSARY DAY: The Monthly Anniversary Day is the same day as the
Policy Date for each succeeding month.
NET PREMIUM: The Net Premium is equal to the actual premium minus the percent of
premium charge. The percent of premium charge is shown on the Policy Data Page.
The Company may at its sole discretion apply a lower percent of premium charge.
OWNER: The Owner has all rights under this Policy and is named in the
application unless later changed and endorsed on this Policy. "You" or "your"
refer to the Owner of this Policy.
POLICY ANNIVERSARY: The Policy Anniversary is the same day and month as the
Policy Date for each succeeding year.
POLICY DATE: The Policy Date is the date the provisions of this Policy take
effect. It is shown on the Policy Data Page. Policy years and policy months are
measured from the Policy Date.
POLICY LOAN ACCOUNT: The Policy Loan Account is that portion of the Cash Value
which results from policy loans.
PROCEEDS: The Proceeds are the amount payable on the Maturity Date, on the
surrender of this Policy prior to the Maturity Date, or on the death of both
Insureds while this Policy is in force.
SEC: SEC is the Securities and Exchange Commission.
SPECIFIED AMOUNT: The Specified Amount is a dollar amount used to determine the
death benefit of your Policy. The Specified Amount is the sum of the Basic
coverage and any Supplemental coverage. It is shown on the Policy Data Page.
SUBACCOUNT: A Subaccount is a part of a Variable Account. The assets in each
Subaccount are invested exclusively in a specified Fund. The Subaccounts are
listed on the Policy Data Page.
SURRENDER CHARGE: If you lapse or surrender this Policy, we deduct a Surrender
Charge from the Cash Value. The surrender charge varies by policy year as shown
in the Table of Surrender Charges on the Policy Data Page.
VALUATION DAY: A Valuation Day is each day that the New York Stock Exchange is
open for trading except for customary holidays observed by us.
VALUATION PERIOD: A Valuation Period is the interval of time between a Valuation
Day and the next Valuation Day.
VARIABLE ACCOUNT: One or more Variable Accounts are named on the Policy Data
Page. Each is a separate investment account of the Company.
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GENERAL POLICY PROVISIONS
ENTIRE CONTRACT: The entire contract consists of this Policy, any attached
riders or endorsements, and the attached copy of any written application,
including any written supplemental applications. No agent, registered
representative, or other person may change this Policy or waive any of its
provisions. Any agreement to alter this Policy must be in writing, signed by our
President or Secretary and attached to or endorsed on your Policy. We will not
be bound by any promise or representations made by any agent or other persons.
APPLICATION: All statements made in an application are considered
representations and not warranties. In issuing this Policy, we have relied on
the statements made in any application to be true and complete. No such
statement will be used to void the Policy or to deny a claim unless that
statement is a material misrepresentation.
INCONTESTABILITY: We will not contest payment of the Death Proceeds based on the
initial Specified Amount after this Policy has been in force during the lifetime
of both Insureds for 2 years from the Policy Date. For any increase in Specified
Amount requiring evidence of insurability, we will not contest payment of the
Death Proceeds based on such an increase after it has been in force during the
lifetime of both Insureds for 2 years from its effective date.
We require notification of the first death within one year even though Death
Proceeds are not payable until the second death. Two years after the Policy Date
and the effective date of any increase in Specified Amount, if we have not
received such notice, we will request confirmation that both Insureds are alive.
SUICIDE: If either Insured commits suicide, while sane or insane, within 2 years
from the Policy Date, we will not pay the Death Proceeds. Instead, we will pay
the Beneficiary an amount equal to all premiums paid, less any Indebtedness, and
less any partial surrenders.
For any increase in Specified Amount requiring evidence of insurability, if
either Insured commits suicide, while sane or insane, within 2 years from the
effective date of any such increase, we will not pay the Death Proceeds
associated with such an increase. Instead, our liability with respect to such an
increase will be limited to its cost.
ERROR IN AGE OR SEX: If the age or sex of either Insured has been misstated, the
affected benefits will be adjusted by the ratio of the last monthly cost of
insurance deducted to the monthly cost of insurance that would have been
deducted based on the true age and sex of each Insured.
PAYMENT OF PROCEEDS: Unless an optional mode of settlement is elected, the Death
Proceeds will be paid in one sum to the Beneficiary. Unless an optional mode of
settlement is elected, any Proceeds payable on maturity date or upon surrender
of this Policy will be paid in one sum to you.
POSTPONEMENT OF PAYMENTS: We will normally pay any amount payable on maturity,
surrender or policy loan within seven days after we receive your written
request. We will normally pay any Death Proceeds within seven days after we
receive proofs of death for both Insureds and any other information we may
reasonably require to pay a claim.
However, such payments may be postponed if:
1. the New York Stock Exchange is closed (except for customary holiday
closings); or
2. the SEC requires trading be restricted or declares an emergency; or
3. the SEC lets us defer payments for the protection of our Policy
Owners; or
4. policy values are being withdrawn from the Fixed Account.
EFFECTIVE DATE OF COVERAGE: The effective date of coverage of any person insured
under your Policy is as follows:
1. the Policy Date is the effective date for all coverage provided in the
original application;
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2. for any increase or addition to coverage, the effective date will be the
Monthly Anniversary Day on or next following the date we approve the
supplemental application; and
3. for any insurance that has been reinstated, the effective date is the
Monthly Anniversary Day on or next following the date we approve the
application for reinstatement.
TERMINATION: All coverage under your Policy will terminate when any one of
the following events occurs:
1. you request in writing that the coverage terminate;
2. both Insureds die;
3. the Policy matures;
4. the Grace Period ends; or
5. you surrender the Policy for its Cash Surrender Value.
ANNUAL REPORT: We will send you a report at least once a year which shows the
current Cash Value, Cash Surrender Value, amount of insurance, premiums paid,
all charges since the last report and outstanding policy Indebtedness. The
report will also include any other information required by laws and regulations,
both federal and state. We will mail this report to you at your last known
address.
ILLUSTRATION OF BENEFITS AND VALUES: We will provide a projection of
illustrative future benefits and values under this Policy at any time. Your
written request and payment of a service fee set by us at the time of the
request will be required.
NONPARTICIPATION: This is a nonparticipating Policy on which no dividends are
payable. Your Policy will not share in our profits or surplus earnings.
CURRENCY: Any money we pay, or that is paid to us, must be in United States
currency.
SIGNATURE GUARANTEE: For your protection, a request for a surrender, policy
loan, or a change in ownership must be signed. The Company may require the
signature to be guaranteed by a member firm of the New York, American, Boston,
Midwest, Philadelphia, or Pacific Stock Exchange, or by a commercial bank (not a
savings bank), which is a member of the Federal Deposit Insurance Corporation.
In some cases, the Company may require additional documentation of a customary
nature.
OWNER, BENEFICIARY AND ASSIGNMENT PROVISIONS
OWNERSHIP: While either Insured is living, all rights in your Policy belong to
you. Your rights in your Policy belong to your estate if you die before both
Insureds die and there is no Contingent Owner.
You may name a Contingent Owner or a new Owner at any time while either Insured
is living. If a new Owner is named, any earlier designation is automatically
revoked. Any change must be in a written form satisfactory to us and recorded at
our Home Office. Once recorded, the change will take effect as of the date you
signed it. It will not affect any payment made or any action taken by us before
it was recorded. We may require that you send us your Policy for endorsement
before making a change.
BENEFICIARY: The Beneficiary and Contingent Beneficiary on the Policy Date are
named in the application. More than one Beneficiary or Contingent Beneficiary
may be named. If more than one Beneficiary is alive when Death Proceeds become
payable, we will pay them in equal shares, unless you have provided otherwise.
If any Beneficiary dies before Death Proceeds become payable, that Beneficiary's
interest will be paid to any surviving Beneficiaries or Contingent Beneficiaries
according to their respective interests, unless you have provided otherwise. If
no Beneficiary is living when the Death Proceeds become payable, we will
consider you or your estate to be the Beneficiary.
While either Insured is living, you may change any Beneficiary or Contingent
Beneficiary. Any change must be in a written form satisfactory to us and
recorded at our Home Office. Once recorded, the change will take effect as of
the date you
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signed it. It will not affect any payment made or action taken by us before it
was recorded. We may require that you send us your Policy for endorsement before
making a change.
ASSIGNMENT: While either Insured is living, you may assign any or all rights
under your Policy. We will not be bound by any assignment unless it is in a
written form acceptable to us and is recorded at our Home Office. An assignment
will not affect any payments made or actions taken by us before we record it. We
will not be responsible for the sufficiency or validity of any assignment.
The assignment will be subject to any Indebtedness owed to us before it was
recorded. The interest of any Beneficiary will be subject to the rights of any
assignee of record at our Home Office.
PREMIUM PROVISIONS
PREMIUM PAYMENTS: The Initial Premium is due on the Policy Date. It will be
credited on the Initial Investment Date. Any due and unpaid monthly deductions
will be subtracted from the Cash Value at this time. Insurance will not be
effective until the Initial Premium is paid. The Initial Premium is shown on the
Policy Data Page.
Premiums other than the Initial Premium may be paid at any time while your
Policy is in force subject to the limits described below. We will send planned
premium payment reminder notices to you. We will send them according to the
premium mode shown on the Policy Data Page. You may pay the Initial Premium to
us at our Home Office or to an authorized agent. All premiums after the first
are payable at our Home Office. Premium receipts will be furnished upon request.
LIMITS: Each premium payment must be at least $50. Additional premium payments
may be made at any time while your Policy is in force. However, we reserve the
right to require satisfactory evidence of insurability for both Insureds before
accepting any additional premium payment which results in any increase in the
net amount at risk. Also, we will refund any portion of any premium payment
which is determined to be in excess of the premium limit established by law to
qualify your Policy as a contract for life insurance. We may also require that
any existing Policy Indebtedness is repaid prior to accepting any additional
premium payments.
GRACE PERIOD PROVISIONS
GRACE PERIOD: If the Cash Surrender Value on a Monthly Anniversary Day is not
sufficient to cover the current monthly deduction, and the premium payments
required to guarantee the death benefits have not been met, a Grace Period will
be allowed for the payment of a premium of the lesser of 3 times the current
monthly deduction or the premium necessary to satisfy the Guaranteed Policy
Continuation Provision. We will send you a notice of your lapse pending status
when you enter the Grace Period, at your address in the application or another
address you specify, stating the amount of premium required. The Grace Period
will end 61 days after the day we mail you the notice. We will send an
additional reminder notice at least 31 days prior to the end of the Grace
Period. If you do not pay the required amount by the end of the Grace Period,
this Policy will terminate without value. If Death Proceeds become payable
during the Grace Period, we will pay the Death Proceeds.
GUARANTEED POLICY CONTINUATION PROVISION: During the Guaranteed Policy
Continuation Period, we will not lapse this policy if on each Monthly
Anniversary Day (1) is greater than or equal to (2) where:
1. is the sum of all premiums paid to date, including the Initial
Premium, minus any Indebtedness, and minus any partial surrender
amounts; and
2. is the sum of the minimum monthly premiums due since the Policy Date
including such premium for the current Monthly Anniversary Day.
If (1) is not greater than or equal to (2) then the Guaranteed Policy
Continuation Provision is not in effect, and the Grace Period Provision will
apply. The minimum monthly premiums and the Guaranteed Policy Continuation
Period are shown on the Policy Data Page. The minimum monthly premiums may vary
by policy duration and may be affected by changes to the Policy.
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REINSTATEMENT: If the Grace Period has ended and you have not paid the required
premium and have not surrendered your Policy for its Cash Surrender Value, you
may reinstate your Policy if you:
1. submit a written request at any time within 3 years after the end of the
Grace Period and prior to the Maturity Date;
2. provide evidence of insurability of both Insureds satisfactory to us;
3. pay sufficient premium to cover all monthly deductions that were due and
unpaid during the Grace Period;
4. pay sufficient premium to keep the Policy in force for 3 months from the
date of reinstatement; and
5. repay any Indebtedness against the policy which existed at the end of
the Grace Period.
The effective date of a reinstated policy will be the Monthly Anniversary Day on
or next following the date the application for reinstatement is approved by us.
If your Policy is reinstated, the Cash Value on the date of reinstatement, but
prior to applying any premiums received, will be set equal to the lesser of:
1. the Cash Value at the end of the Grace period; or
2. the surrender charge for the policy year in which this Policy is
reinstated.
Unless you have provided otherwise, all amounts will be allocated based on the
Fund allocation factors in effect at the start of the Grace Period.
DEATH BENEFIT PROVISIONS
DEATH BENEFIT: If both Insureds die while the Policy is in force, your Policy
will provide a death benefit. The death benefit will be determined in accordance
with one of the following options, whichever is in effect when Death Proceeds
become payable. The current option in effect is shown on the Policy Data Page.
Option 1
The death benefit will be the greater of:
1. the Specified Amount on the date Death Proceeds become payable; or
2. the applicable percentage of the Cash Value on the date Death Proceeds
become payable.
Option 2
The death benefit will be the greater of:
1. the Specified Amount plus the Cash Value on the date Death Proceeds
become payable; or
2. the applicable percentage of the Cash Value on the date Death Proceeds
become payable.
For either Death Benefit option, the applicable percentages of Cash Value are
show on the Policy Data Page.
Option 3
The death benefit will be the Specified Amount plus the Accumulated Premium
Account on the date of death.
The Accumulated Premium Account is all premium payments accumulated to the date
of death less any partial surrenders accumulated to the date of death. The
accumulations will be calculated based on the Option 3 interest rate shown on
the Policy Data Page. In no event will the Accumulated Premium Account be less
than zero or greater than the Option 3 Maximum Increase shown on the Policy Data
Page.
DEATH PROCEEDS: The actual amount of money payable to the Beneficiary if both
Insureds die while your Policy is in force prior to the Maturity Date is called
the Death Proceeds. The Death Proceeds equals:
1. the death benefit provided by your Policy; plus
2. any insurance that may be provided by riders to your Policy; minus
3. any Indebtedness; and minus
4. any due and unpaid monthly deductions accruing during a Grace Period.
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We will pay the Death Proceeds to the Beneficiary after we receive at our Home
Office proofs of death for both Insureds satisfactory to us and such other
information as we may reasonably require. We require notification of the first
death within one year even though Death Proceeds are not payable until the
second death. The Death Proceeds will be adjusted under certain conditions.
Refer to the Incontestability, Suicide, and Error in Age or Sex Provisions.
DEATH BENEFIT OPTION CHANGES: After the first policy year, you may change the
death benefit option under your Policy. If the change is from Option 1 to Option
2, the Specified Amount will be decreased by the amount of the Cash Value. We
will decrease the Basic and Supplemental coverages proportionally. If the change
is from Option 2 to Option 1, the Specified Amount will be increased by the
amount of the Cash Value. We will increase the Basic and Supplemental coverages
proportionally. We reserve the right to require evidence of insurability of both
Insureds for a change from Option 2 to Option 1. The effective date of change
will be the Monthly Anniversary Day on or next following the date we approve the
request for change. We will also allow death benefit option changes from Option
3 to Option 1 or Option 2. We will not allow death benefit option changes from
Option 1 to Option 3 or Option 2 to Option 3.
Only one change of option is permitted in a policy year. We will refuse a death
benefit option change which would reduce the Specified Amount to a level where
the total premiums already paid to date exceed the premium limit established by
law to qualify your Policy as a contract for life insurance. In order for a
death benefit option change to become effective, the Cash Surrender Value, after
the change, must be sufficient to keep the Policy in force for at least 3
months.
SPECIFIED AMOUNT INCREASES: At any time after the first policy year, you may
request an increase in Specified Amount. Your request must be in writing to our
Home Office on our official forms. Any increase shall be subject to the
following conditions:
1. you provide evidence of insurability of both Insureds satisfactory to
us;
2. the increase is for at least $10,000;
3. the Cash Surrender Value is sufficient to keep this Policy in force
for at least 3 months; and
4. age limits are the same as for a new issue.
An approved increase will have an effective date of the Monthly Anniversary Day
on or next following the date we approve the supplemental application. We will
increase the Basic and Supplemental coverages proportionally. We reserve the
right to limit the number of increases in Specified Amount to one each policy
year.
SPECIFIED AMOUNT DECREASES: At any time after the first policy year, you may
request a decrease in the Specified Amount. Any decrease will be effective on
the Monthly Anniversary Day on or next following our receipt of your request. We
will decrease the Basic and Supplemental coverages proportionally. We will
decrease insurance in the following order:
1. insurance provided by the most recent increase;
2. the next most recent increases successively; and
3. insurance provided under the original application.
We reserve the right to limit the number of decreases in the Specified Amount to
one each policy year. We will refuse a request for a decrease which would:
1. reduce the Specified Amount to less than the minimum issue amount,
which is shown on the Policy Data Page; or
2. disqualify this Policy as a contract for life insurance.
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NONFORFEITURE PROVISIONS
CASH VALUE: The Cash Value of your Policy is the sum of the Cash Value in each
Subaccount, the Fixed Account and the Policy Loan Account. The Cash Value in
each Subaccount on the Initial Investment Date is equal to the portion of the
Net Premium allocated to the Subaccount minus a pro-rata monthly deduction for
the month following the Policy Date.
The Cash Value in each Subaccount on each subsequent Valuation Day is equal to
(1) plus (2) plus (3) minus (4) minus (5) minus (6) where:
1. is the Cash Value in the Subaccount on the preceding Valuation Day
multiplied by its net investment factor for the current Valuation Period;
2. is any Net Premiums or other amounts allocated to the Subaccount during
the current Valuation Period;
3. is any amounts transferred to the Subaccount during the current
Valuation Period;
4. is any amounts transferred from the Subaccount during the current
Valuation Period;
5. is the portion of any monthly deductions which are due and charged to
the Subaccount during the current Valuation Period; and
6. is any partial surrender amounts allocated to the Subaccount during the
current Valuation Period.
The Cash Value in the Policy Loan Account is zero, unless you take a policy
loan. If you take a policy loan, then the Cash Value in the Policy Loan Account
on the loan date is equal to the amount of the loan. The loan amount is
transferred from a Variable Account in proportion to the Cash Value in each
Subaccount on the date of the loan. Loan amounts will be transferred from the
Fixed Account only when insufficient amounts are available in the Variable
Subaccounts.
The Cash Value in the Policy Loan Account on each subsequent Valuation Day is
equal to (1) plus (2) plus (3) minus (4) minus (5) where:
1. is the Cash Value in the Policy Loan Account on the preceding Valuation
Day;
2. is any interest credited during the current Valuation Period;
3. is any amounts transferred to the Policy Loan Account because of
additional policy loans and any due and unpaid loan interest during the
current Valuation Period;
4. is the amount of any loan repayments you make during the current
Valuation Period; and
5. is any amount of interest transferred from the Policy Loan Account to a
Variable Account or the Fixed Account during the current Valuation Period.
The Cash Value in the Fixed Account is zero unless some or all of the Cash Value
is allocated to the Fixed Account. At the time of this initial allocation, the
Cash Value in the Fixed Account is equal to the amount of Cash Value allocated
to the Fixed Account. The Cash Value in the Fixed Account on each subsequent
Valuation Day is equal to (1) plus (2) plus (3) minus (4) minus (5) minus (6)
where:
1. is the Cash Value in the Fixed Account on the preceding Valuation Day;
2. is any interest credited during the current Valuation Period;
3. is any Net Premiums or other amounts allocated to the Fixed Account
during the current Valuation Period;
4. is any amounts transferred from the Fixed Account during the current
Valuation Period;
5. is the portion of any monthly deductions which are due and charged to
the Fixed Account during the current Valuation Period; and
6. is any partial surrender amounts allocated to the Fixed Account during
the current Valuation Period.
MONTHLY DEDUCTION: The monthly deduction for each policy month shall be
calculated as:
1. the monthly cost of insurance; plus
2. the monthly cost of any additional benefits provided by Riders; plus
3. the mortality and expense risk charges; plus
4. the monthly expense charges. These charges will not exceed the maximum
monthly policy expense charges shown on the Policy Data Page.
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The monthly deductions, other than the Mortality and Expense Charge, will be
charged proportionately to the Cash Values in each Subaccount and the Fixed
Account.
MORTALITY AND EXPENSE RISK CHARGE: The Mortality and Expense Charge will be
charged proportionately to the Cash Values in each Variable Subaccount.
The Company assumes certain risks for guaranteeing the mortality and expense
charges. To compensate the Company for assuming these risks associated with the
Policies, the Company deducts on a monthly basis from the Cash Value
attributable to the Variable Account, a charge to provide for mortality and
expense risks. This charge is equivalent to an annual effective rate of 0.60% of
the first $25,000.00 of Cash Value attributable to the Variable Account, 0.30%
of the next $225,000.00 of Cash Value attributable to the Variable Account, and
0.10% of the Cash Value attributable to the Variable Account in excess of
$250,000.00. These charges are all guaranteed.
MONTHLY COST OF INSURANCE: A deduction will be made on the Policy Date and each
Monthly Anniversary Day for the cost of insurance. This monthly deduction will
be charged proportionately to the Cash Values in each Subaccount and the Fixed
Account. The monthly cost of insurance for each policy month is determined by
multiplying the monthly cost of insurance rate by the net amount at risk. The
monthly cost of insurance rate is described under the Cost of Insurance Rates
Provision.
If there have been increases in the Specified Amount, then the Cash Value shall
be first considered a part of the initial Specified Amount. If the Cash Value
exceeds the initial Specified Amount, it shall then be considered a part of the
increases in Specified Amounts in the order of the increases.
COST OF INSURANCE RATES: A separate monthly cost of insurance rate is used to
obtain the monthly cost of insurance for the initial Specified Amount and each
increase in Specified Amount. Each rate is based on the age, sex, underwriting
class, and any substandard rating of each Insured at the time the initial
Specified Amount was issued or increase took effect, and on the duration since
that time.
These rates will never be greater than the guaranteed maximum monthly cost of
insurance rates shown on the Policy Data Page. The basis for these guaranteed
maximum cost of insurance rates is shown in the Basis of Computation on the
Policy Data Pages.
INTEREST CREDITING: Any Cash Value allocated to the Policy Loan Account will be
credited interest daily. The guaranteed minimum annual effective rate is 3%.
Interest in excess of the minimum guaranteed rate may be used.
Any Cash Value allocated to the Fixed Account will be credited interest daily.
The guaranteed minimum annual effective rate is 3%. Interest in excess of the
minimum guaranteed rate may be used. The current interest rate in effect at the
time of transfer to the Fixed Account will be guaranteed through the end of the
calendar quarter. Thereafter, any excess interest rates will be guaranteed for
the following three months. Where required, we have filed our method for
determining current interest rates with the Insurance Department of the state in
which this Policy was delivered.
MINIMUM LEGAL VALUES: The cash surrender, loan and other values in your Policy
are at least as large as those set by law in the state where it is delivered.
Where required, we have given the insurance regulator a detailed statement of
how we compute values and benefits.
CONTINUATION OF INSURANCE: If the premium payments are not made, insurance
coverage under this Policy and any benefits provided by Rider will be continued
in force. Such coverage will be continued as provided in the Grace Period
Provision. This provision will not continue the Policy beyond the Maturity Date
nor continue any Rider beyond the date for its termination, as provided in such
Rider.
COMPLETE SURRENDER: Your Policy may be surrendered for its Cash Surrender Value
at any time while it is in force. You must submit a written request on a form
acceptable to us. We may also require the return of your Policy. The date of
surrender will be the date we receive your written request at our Home Office.
The Cash
VLO-0600 12
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Surrender Value will be determined as of the end of the Valuation Period during
which your request is received. All coverage will end on the date of surrender.
PARTIAL SURRENDER: A partial surrender may be made at any time after the first
policy year while this Policy is in force. You must submit a written request. We
may also require that this Policy be sent to us. We reserve the right to limit
the number of partial surrenders in a policy year to one. In addition, a partial
surrender will be allowed only if after the partial surrender, this Policy
continues to qualify as a contract for life insurance. We reserve the right to
deduct a fee from the partial surrender amount. The maximum fee is shown on the
Policy Data Page.
When a partial surrender is made, we will reduce the Cash Value by the partial
surrender amount. We will also reduce the Specified Amount by the amount
necessary to present an increase in the Net Amount at Risk. We will decrease the
Basic and Supplemental coverages proportionally. Any such decrease will reduce
insurance in the following order:
1. against the insurance provided by the most recent increase;
2. against the next most recent increase successively; and
3. against the insurance under the original application.
The amount of any partial surrender is subject to the following conditions:
1. the minimum amount of a partial surrender is $200;
2. during the first ten policy years, the amount of a partial surrender
cannot exceed 10% of Cash Surrender Value as of the beginning of the
Policy year;
3. after the completion of ten Policy years, the maximum amount of a
partial surrender is the Cash Surrender Value less the greater of $500
or 3 monthly deductions; and
4. a partial surrender may not reduce the Specified Amount below the
Minimum Specified Amount.
In addition, the partial surrender will be allowed only if after the surrender
this Policy continues to qualify as a contract for life insurance.
CHANGES IN POLICY COST FACTORS: Changes in cost of insurance rates, credited
interest rates, mortality and expense risk charges, percent of premium charges
or other Policy expense charges will be by class and will be based on changes in
future expectations for factors such as:
1. investment earnings;
2. mortality;
3. persistency;
4. expenses; and
5. taxes
Any changes will be determined in accordance with the procedures on file, if
required, with the insurance regulator in the state in which this Policy was
delivered.
LOAN PROVISIONS
POLICY LOAN: After the first policy year, you may request a loan at any time
while your Policy is in force. The loan must be requested in writing on a form
acceptable to us. The amount of the loan and all existing loans may not be more
than the maximum loan value as of the loan date. The loan date is the date we
process the loan. The minimum loan amount is $1,000. The loan will be made upon
the sole security of the Policy and proper assignment of your Policy to us.
MAXIMUM LOAN VALUE: The maximum loan value is determined by multiplying (1) by
(2) where:
1. is 90%; and
2. is the Cash Value less the Surrender Charge.
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LOAN INTEREST: The loan interest rate is 3.9% per year. Interest is charged
daily and payable at the end of each policy year. Unpaid interest will be added
to the existing Indebtedness as of the due date and will be charged interest at
the same rate as the rest of the loan.
LOAN REPAYMENT: All or part of a loan may be repaid to us at any time while your
Policy is in force during either Insured's lifetime. Any payment intended as a
loan repayment, rather than a premium payment, must be identified as such. Any
Indebtedness that exists at the end of the Grace Period may not be repaid unless
this Policy is reinstated.
EFFECT OF LOAN: When you take a loan, we will transfer an amount equal to the
policy loan from a Variable Subaccount or the Fixed Account to the Policy Loan
Account. Any loan interest that becomes due and is unpaid will also be so
transferred. Amounts transferred to the Policy Loan Account will earn interest
daily from the date of transfer. When you repay part or all of a loan, we will
transfer an amount equal to the amount you repay from the Policy Loan Account to
a Subaccount or the Fixed Account. We reserve the right to require that any loan
repayments resulting from loans transferred from the Fixed Account must be
allocated to the Fixed Account.
Unless otherwise specified, transfers from the Subaccounts to the Policy Loan
Account will be in proportion to the Cash Value in each Subaccount as of the
loan date. Loan amounts will be transferred from the Fixed Account only when
insufficient amounts are available in the Variable Subaccounts. Any loan
interest which becomes due and is unpaid will be transferred to the Policy Loan
Account in proportion to the Cash Values in each Subaccount and the Fixed
Account. Unless specified, loan repayments will be allocated among the
Subaccounts using the Fund allocation factors in effect on the date of the
repayment subject to any other restrictions the Company may impose.
Since the amount you borrow is removed from a Variable Subaccount or the Fixed
Account, a loan will have a permanent effect on any death benefit and Cash
Surrender Value of this Policy. The effect may be favorable or unfavorable. This
is true whether you repay the loan or not. If not repaid, Indebtedness will
reduce the amount of any Death Proceeds or Maturity Proceeds.
If the total Indebtedness ever equals or exceeds the Cash Value less the
Surrender Charge, your Policy will terminate without value, as described in the
Grace Period Provision.
VALUATION OF ASSETS IN A VARIABLE ACCOUNT
DETERMINING INVESTMENT RESULTS: The Cash Value will change with a change in the
investment results of the Subaccounts. An index called an accumulation unit
value measures changes in a Subaccount's investment experience. Each Subaccount
has its own accumulation unit value.
For each Subaccount, the accumulation unit value was initially set at $10.00.
The accumulation unit value for a Subaccount in each subsequent Valuation Period
is equal to (1) multiplied by (2) where:
1. is the Subaccount's accumulation unit value for the preceding
Valuation Period; and
2. is the Subaccount's net investment factor for the subsequent Valuation
Period.
A net investment factor is defined below.
Because the net investment factor may be greater than or less than one, the
accumulation unit value may increase or decrease from one Valuation Period to
the next; however, the accumulation unit value remains constant throughout a
Valuation Period.
NET INVESTMENT FACTOR: The net investment factor for a Subaccount for a
Valuation Period is obtained by dividing (1) by (2) where:
1. is the net of:
(a) the net asset value per share of the Fund held in the Subaccount
at the end of the current Valuation Period; plus
(b) the per share amount of any dividend and capital gains
distributions made by the Fund held in the Subaccount if the "ex-dividend"
date occurs during the current Valuation Period; plus or minus
(c) a per share charge or credit for taxes reserved for, if any, which
is determined by the Company to have resulted from the investment
operations of the Subaccount.
VLO-0600 14
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2. is the net of:
(a) the net asset value per share of the Fund held in the Subaccount
determined as of the end of the immediately preceding Valuation Period;
plus or minus
(b) the per share charge or credit for taxes reserved for in the
immediately preceding Valuation Period.
VARIABLE ACCOUNT PROVISIONS
VARIABLE ACCOUNT: A Variable Account is a separate investment account of the
Company. One or more are named on the Policy Data Page. A Variable Account is
also subject to the laws of Ohio.
We own the assets of any Variable Account; we keep them separate from the assets
of our General Account. We maintain assets which are at least equal to the
reserves and other liabilities of a Variable Account. Such assets will not be
charged with liabilities that arise from any other business we conduct. We may
transfer to our General Account assets which exceed the reserves and other
liabilities of a Variable Account.
We will determine the value of the assets in a Variable Account at the end of
each Valuation Day.
SUBACCOUNTS: A Variable Account may have several Subaccounts. We list them on
the Policy Data Page. You determine, using Fund allocation factors, how Net
Premiums will be allocated among the Subaccounts. You may choose to allocate
nothing to a particular Subaccount. But any allocation you make must be at least
5%; you may not choose a fractional percent. The sum of the Fund allocation
factors must equal 100%.
During the "Right to Examine Policy" period, Net Premiums will be allocated to
the Subaccount that invests in a money market Fund or to the Fixed Account. At
the end of this period, the Cash Value in that Subaccount will be transferred to
the Variable Subaccounts according to your chosen Fund allocation factors. Also,
any subsequent Net Premiums will be allocated according to your chosen factors.
Fund allocation factors during and immediately after the "Right to Examine
Policy" period, are shown on the Policy Data Page. After the "Right to Examine
Policy" period has expired, you may transfer amounts among the Subaccounts.
Transfers will take effect on the date your written request is received at our
Home Office, subject to any restrictions imposed by a Fund.
You may change the allocation for future Net Premiums at any time while your
Policy is in force. To do so, you must notify us in writing in a form that meets
our approval. The change will take effect on the date we receive your written
request at our Home Office.
Income and realized and unrealized gains and losses from assets in each
Subaccount are credited to, or charged against, the Subaccount. This is without
regard to income, gains, or losses in our other Subaccounts, separate investment
accounts, or our General Account.
CHANGES OF FUND: A Fund might, in our judgment, become unsuitable for investment
by a Subaccount. This might happen because of a change in investment policy, a
change in the laws or regulations, the shares are no longer available for
investment, or for some other reason. If that occurs, we have the right to
substitute another Fund. But we would first notify you and seek approval from
the SEC and the Superintendent of Insurance of the State of Ohio. We would also
get any other required approvals.
OTHER CHANGES: To the extent permitted by applicable laws and regulations
(including any order of the SEC), we may make changes as follows:
1. A Variable Account may be operated as a management company under the
Investment Company Act of 1940, or in any other form permitted by law, if
we deem it to be in the best interest of the Policy Owners.
2. A Variable Account may be deregistered under the Investment Company Act
of 1940 in the event registration is no longer required.
3. A Variable Account may be combined with other separate investment
accounts.
4. The provisions of this and other policies may be modified to comply with
any other applicable federal or state laws.
In the event of such changes, we may make appropriate endorsement on this
and other policies having an interest in a Variable Account and take other
actions as may be necessary to effect such a change.
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FIXED ACCOUNT PROVISIONS
FIXED ACCOUNT: The Fixed Account is funded by the General Account of the
Company. The Fixed Account is credited with interest as described under the
Nonforfeiture Provisions. In addition to allocating your Net Premiums to one or
more of the Subaccounts described above, you may direct all or part of your Net
Premiums into the Fixed Account.
RIGHT TO TRANSFER: You may annually transfer a portion of the Cash Value between
the Fixed Account and the Subaccounts without penalty or adjustment. We reserve
the right to limit the amount of Cash Value transferred out of the Fixed Account
each Policy year. Transfers from the Fixed Account must be made within 30 days
following the termination date of the Interest Rate Guaranteed Period.
You may request a transfer of up to 100% of the Cash Value from the Subaccounts
to the Fixed Account. Transfers to the Fixed Account may not be made prior to
the first Policy Anniversary or within 12 months of any prior transfer. The Cash
Value in each Subaccount will be determined as of the date the transfer request
is received in our Home Office in good order. We reserve the right to restrict
transfers to the Fixed Account to 25% of the Cash Value.
RIGHT OF CONVERSION: At any time upon written request within 24 months of the
Policy Date, you may elect to transfer all Subaccount Cash Values to the Fixed
Account. No transfer charge will be assessed.
OPTIONAL MODES OF SETTLEMENT PROVISIONS
Proceeds may be paid in a lump sum. Optional modes of settlement are also
available. After the Proceeds are applied under such optional modes, any amounts
payable are paid from our General Account and will not be affected by the
investment experience of any separate investment account.
One or a combination of settlement options may be chosen. A settlement option
may be chosen only if the total amount placed under the option is at least
$2,000.00 and each payment is at least $20.00.
A settlement option election may be changed at any time by proper written
request to our Home Office. Once recorded, it will become effective on the date
it was requested. We may require proof of the age and sex of any person to be
paid under a settlement option. While this Policy is in force, you may choose or
change settlement options at any time. If no settlement option has been chosen
prior to the date the Death Proceeds become payable, the Beneficiary may choose
one. A change of Beneficiary automatically revokes any option in effect.
When Proceeds become payable under any option, a Settlement Contract is issued
in exchange for this Policy. The new contract's effective date is the date Death
Proceeds become payable or the date this Policy is surrendered.
Settlement option payments are not assignable. To the extent allowed by law,
settlement option payments are not subject to the claims of creditors or to
legal process.
Under Options 2, 3, 4, and 5, payments will be made at the beginning of each 12,
6, 3, or 1 month interval beginning on the effective date of the Settlement
Contract. Under Option 1 and 6, payments will be made at the end of every 12, 6,
3, or 1 month interval from the effective date of the Settlement Contract.
Under Options 1, 2, and 4, withdrawal of any outstanding balance may be made by
written request to our Home Office. No amount left with us under Options 3, 5,
or 6 may be withdrawn.
Options 1, 2, 4, and the guaranteed period of Option 3, provide for payment of
interest at a guaranteed minimum interest rate of 21/2% per year, compounded
annually. Any interest to be paid in excess of this rate will be determined once
a year.
1. INTEREST INCOME: The Proceeds remain with us to earn interest. This interest
may be left to accumulate or be paid periodically as stated above.
2. INCOME FOR A FIXED PERIOD: Proceeds remaining with us will be paid over a
specified number of years (not exceeding 30 years). Each payment consists of a
portion of the Proceeds plus a portion of the interest credited on the
outstanding balance. The amount payable monthly for each $1,000 left with us
will be at least the amount shown in the Option 2 Table.
VLO-0600 16
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3. LIFE INCOME WITH PAYMENTS GUARANTEED: Payments are made for a guaranteed
period of 10, 15, or 20 years, and thereafter for the remainder of a payee's
lifetime. The amount payable monthly for each $1,000 left with us is shown in
the Option 3 Table, according to the payee's sex and age on the effective date
of the option.
4. FIXED INCOME FOR VARYING PERIODS: The Proceeds may be left on deposit with us
at interest with payments of a fixed amount being paid at specified intervals
until principal and interest have been exhausted. The last payment will be for
the balance only. The total amount payable each year may not be less than 5% of
the original proceeds. (i.e., not less than $50 per annum of each $1,000 of
original proceeds.)
5. JOINT AND SURVIVOR LIFE INCOME: Equal payments will be made for the longer of
the lives of two named payees. In other words, when one payee dies, the same
payment continues to be paid for the remainder of the surviving payee's life. We
will furnish values for other age combinations (than those shown in Option 5
Table) upon request.
6. ALTERNATE LIFE INCOME: We will use the Proceeds to purchase an annuity. The
amount payable will be 102% of our current individual immediate annuity purchase
rate on the effective date of the Settlement Contract. We reserve the right to
change our current annuity rates at any time. However, once this option has been
selected and the Settlement Contract issued, any revision in rates will not
affect payment to a payee or payees. Upon request, we will quote the amount
currently payable under this settlement option.
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TABLES FOR SETTLEMENT OPTIONS
Monthly Installments for each $1,000 of Proceeds
OPTION 2 Option 2 - Income for a Fixed Period
Number of Years Specified Amount of Each Installment Number of Years Specified Amount of Each Installment
1 $84.28 16 $6.30
2 42.66 17 6.00
3 28.79 18 5.73
4 21.86 19 5.49
5 17.70 20 5.27
6 14.93 21 5.08
7 12.95 22 4.90
8 11.47 23 4.74
9 10.32 24 4.60
10 9.39 25 4.46
11 8.64 26 4.34
12 8.02 27 4.22
13 7.49 28 4.12
14 7.03 29 4.02
15 6.64 30 3.93
Annual, semi-annual or quarterly payments are 11.865, 5.969 and
2.994 respectively times the monthly installments.
Monthly Installments for each $1,000 of Proceeds
OPTION 3 Option 3 - Life Income with Payments Guaranteed
GUARANTEED PERIOD GUARANTEED PERIOD GUARANTEED PERIOD
AGE OF PAYEE ----------------- AGE OF PAYEE ----------------- AGE OF PAYEE -----------------
LAST BIRTHDAY YEARS LAST BIRTHDAY YEARS LAST BIRTHDAY YEARS
-------------------------------------------------------------------------------------------------------------
MALE FEMALE 10 15 20 MALE FEMALE 10 15 20 MALE FEMALE 10 15 20
-------------------------------------------------------------------------------------------------------------
5 & 10 &
Under Under 2.54 2.54 2.53 30 35 3.11 3.10 3.09 55 60 4.78 4.62 4.39
6 11 2.55 2.55 2.55 31 36 3.15 3.14 3.12 56 61 4.90 4.71 4.45
7 12 2.57 2.56 2.56 32 37 3.18 3.18 3.16 57 62 5.01 4.80 4.52
8 13 2.58 2.58 2.58 33 38 3.23 3.22 3.20 58 63 5.14 4.90 4.59
9 14 2.60 2.59 2.59 34 39 3.27 3.26 3.24 59 64 5.26 5.00 4.65
10 15 2.61 2.61 2.61 35 40 3.31 3.30 3.28 60 65 5.40 5.10 4.71
11 16 2.63 2.63 2.62 36 41 3.36 3.35 3.32 61 66 5.54 5.20 4.77
12 17 2.65 2.64 2.64 37 42 3.41 3.39 3.36 62 67 5.68 5.30 4.83
13 18 2.66 2.66 2.66 38 43 3.46 3.44 3.41 63 68 5.83 5.40 4.89
14 19 2.68 2.68 2.68 39 44 3.51 3.49 3.46 64 69 5.99 5.50 4.94
15 20 2.70 2.70 2.70 40 45 3.57 3.54 3.50 65 70 6.16 5.61 4.99
16 21 2.72 2.72 2.72 41 46 3.63 3.60 3.55 66 71 6.33 5.71 5.03
17 22 2.74 2.74 2.74 42 47 3.69 3.66 3.60 67 72 6.50 5.81 5.07
18 23 2.77 2.76 2.76 43 48 3.76 3.72 3.66 68 73 6.68 5.90 5.11
19 24 2.79 2.79 2.78 44 49 3.82 3.78 3.71 69 74 6.86 5.99 5.14
20 25 2.81 2.81 2.80 45 50 3.89 3.84 3.77 70 75 7.05 6.08 5.17
21 26 2.84 2.83 2.83 46 51 3.97 3.91 3.82 71 76 7.23 6.16 5.19
22 27 2.86 2.86 2.85 47 52 4.04 3.98 3.88 72 77 7.42 6.24 5.21
23 28 2.89 2.88 2.88 48 53 4.12 4.05 3.94 73 78 7.61 6.30 5.23
24 29 2.92 2.91 2.91 49 54 4.21 4.12 4.00 74 79 7.79 6.37 5.24
25 30 2.94 2.94 2.93 50 55 4.29 4.20 4.07 75 80 7.97 6.42 5.25
26 31 2.97 2.97 2.96 51 56 4.38 4.28 4.13 76 81 8.14 6.47 5.26
27 32 3.01 3.00 2.99 52 57 4.48 4.36 4.19 77 82 8.31 6.51 5.26
28 33 3.04 3.03 3.02 53 58 4.57 4.44 4.26 78 83 8.46 6.54 5.27
29 34 3.07 3.07 3.06 54 59 4.68 4.53 4.32 79 84 8.61 6.57 5.27
80 & 85 &
Over Over 8.74 6.59 5.27
If the income payable for a specific guaranteed period is
equal to that for other guarantee periods the longer period
will be deemed to have been elected.
Monthly Installments for each $1,000 of Proceeds
OPTION 5 Option 5 - Joint & Survivor Life Income
Female 50 55 60 65 70
Male
50 3.53 3.71 3.86 4.00 4.11
55 3.62 3.86 4.09 4.30 4.48
60 3.70 4.00 4.30 4.60 4.89
65 3.77 4.11 4.48 4.89 5.30
70 3.83 4.20 4.63 5.13 5.70
NATIONWIDE LIFE INSURANCE COMPANY
ENDORSEMENTS (Endorsements may be made only by the Company at the Home Office)
A B C D
LAST SURVIVOR FLEXIBLE PREMIUM VARIABLE UNIVERSAL
LIFE INSURANCE POLICY
Adjustable Death Benefit
Flexible premiums payable during either Insured's lifetime until
the Maturity Date
Death Proceeds payable at death of both
Insureds prior to the Maturity Date
Maturity Proceeds payable on the Maturity Date
Non-Participating
Not eligible for dividends
Investment experience reflected in benefits
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