Global Security Life Insurance Limited Registered address: Albert House, South Esplanade, St Peter Port, Guernsey, Channel Islands GY1 1AW Registration Number 59972 Postal address: PO Box 68, Albert House, South Esplanade St Peter Port, Guernsey, Channel Islands, GY1 3BY Innovation Life+ is issued by Global Security Life Insurance Limited, which is incorporated in Guernsey under the Companies (Guernsey) Law 2008 as amended and is licensed by the Guernsey Financial Services Commission under Section 7 of the Insurance (Bailiwick of Guernsey) Law, 2002 to carry on lon g term business. In in accordance with a condition of its license, Global Security Life Insurance Limited operates a policyholder protection scheme under which Global Security Life Insurance Limited is required to hold assets representing at least 90% of policyholder liabilities in trust with an approved third party trustee. The Trustee is Kleinwort Benson (Guernsey) Trustees Limited and the custodian is ABN AMRO (Guernsey) Limited. We promise to pay the sums assured, subject to the provisions of this policy, when we receive due proof of the insured’s claim. Payment will be made only if this policy is in force on the date of said claim. The consideration for this policy is the application and the payment in advance of the premiums in accordance with the terms and conditions of this policy. The first premium is payable on or before delivery of this policy; the amount of and the interval between planned premiums are shown in the Policy Schedule. POLICY SCHEDULE POLICY NUMBER: POLICY EFFECTIVE DATE: POLICY EXPIRY DATE: INSURED: AGE: ANNUAL PREMIUM: IMPORTANT NOTICE This policy was issued based on the insured’s response to the questions in the application. A copy of the application is attached. Please read it and determine that the answers are complete, true and correctly recorded. If there is any information that is not correct or has been omitted, we may have the right to deny any claim or rescind the policy subject to the incontestability provision. If the application contains an error or is incomplete, please notify us now, before a claim arises. This policy is a legal contract between you and us. This policy takes effect at 12:01 am local time of the insured on the effective date shown in the policy schedule. THIS POLICY IS NOT AVAILABLE TO UNITED STATES CITIZENS, OR ANY INDIVIDUAL WHO FILES, OR IS REQUIRED TO FILE, A U.S. TAX RETURN. THE POLICYHOLDER ASSUMES ALL INVESTMENT RISK IN THE INVESTMENT PORTFOLIO. The value of the units allocated under your policy, after deducting the applicable charges, will be dependent on the investment performance of the funds as chosen by you. 20 DAY RIGHT TO EXAMINE CONTRACT It is important to us that you are satisfied with this policy. If you are not satisfied you may, within 20 days after this policy is delivered to you, return it to us or to our agent. If you return the policy within this time period we will refund all of the premium you have paid. The policy will then be deemed void from the beginning. GUARANTEED ANNUAL RENEWABLE INSURANCE POLICY Automatically Renewable by Payment of Premiums until Expiry Date Sums assured payable prior to Expiry Date Nonparticipating – Not eligible for dividends 16 June 2015 TABLE OF CONTENTS POLICY DETAILS / SCHEDULE OF BENEFITS INVESTMENT DEFINITIONS INSURANCE COVERAGE PAYMENT OF PROCEEDS Claims Misstatement of Age or Sex Claims against Beneficiaries PREMIUMS AND REINSTATEMENT Payment of Premiums Reinstatement Grace Period GENERAL PROVISIONS Assignment Autopsy Beneficiary Claim Forms Common Disaster Correspondence Currency Entire Contract Exclusions Governing Law Incontestability Legal Actions Nonparticipation Our Consent Owner Place of Payment Policy Date Policy Settlement Proof of Loss Suicide Exclusion Surrender of Policy Tax Considerations Termination 16 June 2015 POLICY DETAILS POLICY NUMBER: POLICY EFFECTIVE DATE: POLICY EXPIRY DATE: OWNER / POLICYHOLDER: MAILING ADDRESS: TELEPHONE NUMBER: MOBILE NUMBER: EMAIL ADDRESS: INSURED: AGE: GENDER: BENEFICIARY: (Subject to change) SCHEDULE OF BENEFITS LIFE INSURANCE [AMOUNT OF COVERAGE] [PREMIUM] CHILDREN’S LIFE RIDER [NONE / $10,000] [PREMIUM] CRITICAL ILLNESS RIDER [NONE / $25,000] [PREMIUM] TOTAL ANNUAL PREMIUM: INVESTMENT [Initial amount] THIS POLICY IS NON-CANCELABLE BY THE COMPANY EXCEPT FOR NON-PAYMENT OF PREMIUM 16 June 2015 DEFINITIONS Accident - A violent, external incident that is sudden, involuntary and unforeseen, causing bodily injuries directly and independently of any other cause. Age – is the age on the last birthday. Beneficiary – the person designated by you to receive the proceeds payable on the death of the insured. Date of Issue – the date on which this policy was issued at our office Effective Date – the date the coverage begins. Expiry Date – the date the coverage ends; this date not to exceed thirty (30) years from the Effective Date Funds / Fund Options – the fund portfolio(s) or individual funds selected by you Lapse – the termination of the insurance policy, without value due to non-payment of renewal premiums Switching – the process of changing the allocation percentage of existing funds Switching Charge – the charge applicable on Switching Units – the identical subset of the funds’ assets and liabilities as the fund is divided into a number of equal units Valuation Date – is the date of calculation of NAV (net asset value per unit) Sums Assured – the amounts payable as shown in the Schedule of Benefits You and Your– the owner(s) of this policy We, Our, and Us – Global Security Life Insurance Limited Written Request – a request, in writing, signed by you, dated, and submitted to our office. The request must be made on a form supplied by us or be of a form and content acceptable to us. 16 June 2015 INSURANCE COVERAGE LIFE INSURANCE This provides payment in the event of loss of life occurring to the insured while the policy is in force. The death benefit is payable to the beneficiary of the policy. Payment will be made after we receive due proo f of the insured’s death. Due proof of the insured’s death will consist minimally of our company claim form completed by the beneficiary and a certified copy of the death certificate of the insured. The owner, or beneficiary if the insured is the owner, must provide a claim form and written statement signed by a physician providing details of the death. We reserve the right to obtain a second medical opinion at our expense, and to rely on such opinion if it differs. Coverage includes death by accident or other causes unless excluded under the policy. Specific excluded events are shown in Exclusions under the General Provisions. COMA (This coverage is automatically provided as part of the life policy) A coma is a state of unconsciousness with no reaction or response to external stimuli or internal needs. This diagnosis must be supported by evidence of all of the following (as confirmed by a neurologist appointed by the Company): no response to external stimuli continuously for at least 96 hours; life-support measures being necessary to sustain life; and brain damage resulting in permanent neurological deficit which must be assessed at least 30 days after the onset of the coma. The Coma Benefit is $25,000. The coma benefit is payable to the policy owner, or beneficiary if the insured is the owner. The policy owner must provide, within 90 days of diagnosis of a Coma, a written statement signed by a physician indicating the diagnosis and stating the medical condition of the insured. Payment of a benefit under this policy will be made only once at which time this coverage under the policy will terminate. Before payment of a benefit, we will require you to provide us with proof satisfactory to us. This proof will include the certification of a licensed physician. We reserve the right to obtain a second medical opinion at our expense and to rely upon such opinion if it differs. No benefit will be provided if a Coma: results from intentionally self-inflicted injuries; is caused directly or indirectly from Infection with Human Immunodeficiency Virus (HIV) or conditions due to any Acquired Immune Deficiency Syndrome (AIDS). results directly or indirectly from alcohol or drug abuse is excluded. Additional excluded events are shown in Exclusions under the General Provisions. TERMINAL ILLNESS (This coverage is automatically provided as part of the life policy) A non-correctable medical condition that with reasonable medical certainty, will result in the death of the insured in 12 months or less from the date of a licensed physician’s certification of such Insured’s life expectancy; and was first diagnosed on or after the effective date of this rider. 16 June 2015 Terminal Illness coverage is only available if the insured has life coverage under this policy. The Terminal Illness coverage provides for acceleration of payment of a portion of the death benefit proceeds upon receipt of satisfactory evidence that the insured is terminally ill with 12 months or less to live. The benefit paid will reduce the death benefit or the amount due upon the death of the insured. The benefit is a one-time acceleration of up to 50% of the death benefit proceeds payable under the policy, not to exceed $250,000. The accelerated amount may never be less than $10,000. The benefit is payable in one lump sum to the insured under the policy. The policy owner must provide a written statement signed by a physician indicating the diagnosis and stating that the medical condition of the insured is expected to result in death; and because of the severity of the medical condition, the insured’s life expectancy is not greater than 12 months. We reserve the right to obtain a second medical opinion at our expense and to rely upon such opinion if it differs. The accelerated amount must be requested while the policy is in force. If the death of the insured occurs before approval of the benefit or before the approved benefit is paid, no benefit will be payable. Payment of an accelerated benefit under this policy will be made only once at which time this coverage will terminate. A one-time processing fee of $250 will be deducted from the benefit payment. After payment of the Terminal Illness Benefit, we will defer any premiums due on the policy. The total of any premiums deferred will be assigned to us and deducted from the death benefit of the base policy. When an accelerated benefit is paid, a lien against future base policy death benefits will be established. The policy will stay in force according to the policy provisions. The lien at the time the accelerated benefit is paid will be equal to the amount of such benefit payment received plus any deferred premiums plus interest at 5% per annum. Once the lien has been established, it can only be repaid through policy surrender, maturity, or as a death claim. No benefit will be provided by this rider if terminal illness results from intentionally self -inflicted injuries. Additional excluded events are shown in Exclusions under the General Provisions. The following insurance riders may be part of this policy. Please refer to the Schedule of Benefits to determine which of these are included in your policy. RIDERS: CHILDREN’S LIFE This provides payment in the event of loss of life occurring to an eligible child of the insured while the policy is in force. The amount of the death benefit is $10,000 for each eligible child. The death benefit is payable to the insured of the policy. Payment will be made after we receive due proof of the eligible child’s death. Due proof of the eligible child’s death will consist minimally of our company claim form completed by the insured and a certified copy of the death certificate of the eligible child. The owner or insured must provide a claim form and written statement signed by a physician providing details of the death. We reserve the right to obtain a second medical opinion at our expense, and to rely on such opinion if it differs. 16 June 2015 Eligible Child - Any child who is at least six (6) months old, and is: A child born to or legally adopted by the Insured, and who has been named as a proposed Insured Child in the application; or A child born to the insured after the date of the application for this policy; or A child legally adopted by the insured after the date of the application for this policy but prior to the child’s twentieth (20th) birthday. Any child born or legally adopted while this policy is in force is automatically covered from the age of 6 months upon written request from the insured advising us of the child’s name and date of birth. Insurance for any insured child under this rider ends on the earliest of the following dates: th a) The child’s twenty-fifth (25 ) birthday; b) The date the insured child dies; c) The effective date of your cancellation, as described in the policy provisions; and d) The date insurance under this policy ends, as described in the policy provisions. Coverage includes death by accident or other causes unless excluded under the policy. Additional excluded events are shown in Exclusions under the General Provisions. CRITICAL ILLNESS The Critical Illness Benefit is $25,000. The benefit is payable to the insured under the policy. The policy owner must provide, within 90 days of diagnosis of a Critical Illness, a written statement signed by a physician indicating the diagnosis and stating the medical condition of the insured. Payment of a Critical Illness benefit under this policy will be made only once at which time this coverage will terminate. The premium rate for this rider is guaranteed for the first ten (10) years that the policy is inforce. This rider may be renewed for additional ten (10) year periods at the prevailing rates. Before payment of a benefit, we will require you to provide us with proof satisfactory to us. This proof will include the certification of a licensed physician. We reserve the right to obtain a second medical opinion at our expense and to rely upon such opinion if it differs. This coverage provides payment of a benefit for the following specified Critical Illnesses: Cancer – excluding less advanced cases. Any malignant tumor positively diagnosed with histological confirmation and characterized by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumor includes leukemia, sarcoma and lymphoma except cutaneous lymphoma (lymphoma confined to the skin). For the above definition of Cancer, the following are not covered: i. All cancers which are histologically classified as any of the following: pre-malignant; non-invasive; cancer in situ; having either borderline malignancy; or having low malignant potential; ii. all tumors of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0; 16 June 2015 iii. iv. chronic lymphocytic leukemia unless histologically classified as having progressed to at least Binet Stage A; any skin cancer (including cutaneous lymphoma) other than malignant melanoma that has been histologically classified as having caused invasion beyond the epidermis (outer layer of skin) unless the skin cancer has been confirmed as malignant and has spread to the lymph nodes or distant organs. Coronary Artery By-Pass Grafts. The undergoing of surgery on the advice of a consultant cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts. For the above definition, the following are not covered: balloon angioplasty, atherectomy, insertion of stents and laser treatment or any other procedure. Heart Attack. Death of heart muscle, due to inadequate blood supply is referred to as a Myocardial Infarc tion. Definite Diagnosis of an acute Myocardial Infarction, which is supported by all relevant medical reports, tests and investigations, as defined by the recognized international standard prevailing at the time of claim. For the above definition, the following are not covered: Other acute coronary syndromes including but not limited to unstable angina. Kidney Failure - requiring dialysis. Chronic and end stage failure of both kidneys to function, as a result of which regular dialysis is necessary. Major Organ Transplant. The undergoing as a recipient of a transplant of bone marrow or a complete heart, kidney, pancreas, whole or part (lobe) of a liver, lung(s), or inclusion on an official waiting list for such a procedure. Multiple Sclerosis – with persisting symptoms. A definite Diagnosis of Multiple Sclerosis by a consultant neurologist. There must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least three months. Stroke – resulting in permanent symptoms. Death of brain tissue due to inadequate blood supply or hemorrhage within the skull resulting in permanent neurological deficit with persisting clinical symptoms. For the above definition, the following is not covered: Transient ischemic attack (TIA) No benefit will be provided if a Critical Illness: results from intentionally self-inflicted injuries; is first diagnosed as one of the specified critical illnesses or the insured undergoes the specified procedure within 90 days of the effective date of the Policy shown in the Policy Details. is caused directly or indirectly from Infection with Human Immunodeficiency Virus (HIV) or conditions due to any Acquired Immune Deficiency Syndrome (AIDS). 16 June 2015 This rider will terminate on the earliest of the following dates: On the date the base policy terminates for any reason; On the date a benefit under this rider is paid; Upon written request from the policy owner that this rider be terminated; Upon the insured’s 65th birthday. Additional excluded events are shown in Exclusions under the General Provisions. PAYMENT OF PROCEEDS CLAIMS Subject to the other provisions of this policy, we will pay the proceeds when we receive, at our office, due proof of the claim while this policy is in force. We may require the return of this policy to us. The proceeds of this policy consist of: 1. the sums assured shown on the Policy Details page; plus 2. that portion of any premium paid beyond the policy month in which the insured’s death occurs; plus 3. the value of any portfolios or funds, if any; minus 4. any premium due for the policy month in which the claim occurs. We will not incur any liability prior to the delivery of this policy. Insurance under this policy does not begin unless and until both this policy is delivered and the premium is paid while the facts concerning the insurability of the insured are the same as described in the application. CLAIMS AGAINST BENEFICIARIES To the extent permitted by law, the payment of proceeds will not be subject to the claims of any creditors. MISSTATEMENT OF AGE If the insured’s date of birth are misstated, the proceeds payable will be the amount which the premiums paid would have purchased for the correct date of birth and sex according to our premiums in effect for the term period in which the insured’s death occurs. The age shown on the Policy Details is the insured’s age at his or her last birthday. PREMIUMS AND REINSTATEMENT PAYMENT OF PREMIUMS All premiums must be paid in advance either at our office or to one of our agents who are authorized to receive such payments for us. A receipt will be furnished upon request. You may pay your insurance premium by credit card, wire transfer, or by any other method deemed acceptable to us. This right is subject to our rates and minimum premium requirement at the date of issue. If this policy is in your possession and you have not paid the premium, it is not in force. It will be considered that you have the policy for inspection only. If any check, draft, or other such instrument that you use to pay premiums is not paid when presented 16 June 2015 for payment in due course of business, the premium will be considered unpaid. Failure to pay the premium will result in cancellation of the insurance policy. REINSTATEMENT If this policy has lapsed, you may reinstate it at any time within one (1) year after the date it lapsed if we receive at our office: 1. a written application for reinstatement; 2. evidence of insurability acceptable to us; and 3. payment of all premiums due with compound interest rate at the rate of 5% per year to the date of reinstatement. The reinstated policy will be in force from the date on which we approve your request for reinstatement. GRACE PERIOD We will keep your policy in force for thirty (30) days beyond the due date of a premium, except for the first premium. However, if you do not pay the premium by the end of this grace period, your policy will lapse; it will no longer be in force. If a claim by death during the grace period becomes payable under this policy, we will deduct the premium for the policy month in which death occurs. GENERAL PROVISIONS ASSIGNMENT An assignment is a transfer of all or some of the policy rights and privileges to someone else. While the insured is living, you can assign this policy or any interest in it. If you assign this policy, your rights, and the rights of anyone who is to receive payment, are subject to the terms of that assignment. If the beneficiary appointment in effect is irrevocable, the written consent of such beneficiary is required. A change of owner is an absolute assignment. An assignee cannot change the beneficiary nor transfer ownership of this policy. The interest of any assignee takes precedence over that of any beneficiary or contingent owner. We are not responsible for the soundness of an assignment. It will be subject to any payment we make or other action we take before we record it. No assignment will bind us unless it is written and acknowledged by us in writing. AUTOPSY We have the right to make an autopsy in case of death where it is not forbidden by law. BENEFICIARY While the insured is living, you may appoint one or more beneficiaries and may revoke an appointment unless you made it irrevocable. If you have reserved the right to change the beneficiary, you may do so by written request. You must revoke any previous appointments and designate the new person or person to be beneficiary (ies). No appointment or change in appointment will take effect unless we receive the request. When received, the request will take effect as of the date it was signed, subject to payment or other action taken by us before it was received. 16 June 2015 The beneficiary (ies) of this policy shall be stated in the application unless later changed. We will pay the amount due at the death of the insured under the beneficiary appointment in effect at the date of death. If more than one beneficiary has been appointed and one or more of them dies, the proceeds will be paid to the surviving beneficiaries equally, unless otherwise designated. If no beneficiary is alive at the death of the Insured, nor if none has been appointed, we will pay the proceeds to you or to your estate. CLAIM FORMS When we receive the notice of claim, we will send you claim forms for filing proof of loss. You will meet the proof of loss requirements by giving us a written statement and the completed claim forms within the time limit stated in the Proof of Loss provision. COMMON DISASTER If any beneficiary who would otherwise receive death proceeds dies with the insured in a common disaster, it must be proved to our satisfaction that the insured died first. Unless provided otherwise, the proceeds are payable as if such beneficiary died before the insured. CORRESPONDENCE Any request, notice or proof shall be filed with our home office. CURRENCY All premiums paid by you, and all amounts payable by us under this policy, shall be paid in the same currency. ENTIRE CONTRACT The entire insurance contract consists of the policy, which includes the Policy Details page(s), the application, any supplementary applications, and any riders or endorsements added to the policy. In the absence of fraud, all statements made in an application shall be deemed representations and not warranties. We assume these statements are true and complete to the best of the knowledge and belief of those who made them. We cannot use any statement to void a policy or to deny a claim unless it is contained in a written application that is made a part of a policy by attachment or endorsement. The approval of two Directors is required to modify a policy or waive any of our rights or requirements; no agent or other person may do this. Any change in a policy must: 1. be made in writing; and 2. bear the signature or a reproduction of the signature of at least one of the above officers. EXCLUSIONS This policy does not cover loss caused by or resulting from any of the following: • Pre-existing medical conditions defined as any medical condition for which the insured person has received treatment, consultations, advice, or medical diagnosis within the five (5) years previous to the effective date of the policy. • This insurance excludes loss, damage, cost or expense of any nature directly or indirectly caused by, resulting from or in connection with the following, regardless of any other cause or event contributing concurrently or in any other sequence to the loss: 1. War or warlike operations (whether war be declared or not), 16 June 2015 2. • • • • • • • • • • Terrorist Activity, including the use of armaments, the detonation of any form of explosive or nuclear devices, the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous chemical agent and/or biological agent, including the poisoning via the air or water supplies or food products and deliberate destruction of buildings and transportation. This exclusion extends to any action taken in controlling, preventing, suppressing or in any way relating to any terrorist activity. Active participation in a war or in warlike operations. Ionizing radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel, or the radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof. Suicide, attempted suicide and intentionally self-inflicted injuries, whether sane or insane, gross negligence and violation of the law. Any loss caused directly, or indirectly, by HIV/AIDS or related conditions. Abuse of drugs, alcohol and medication other than prescribed by a physician. The insured’s deliberate exposure to exceptional danger (except in an attempt to save human life). The insured’s own criminal act. Any loss caused directly or indirectly from extortion, kidnap & ransom or wrongful detention of the Insured or hijacking of any aircraft, motor vehicle, train or waterborne vessel on which the Insured is traveling. Poisoning in any form, or inhalation of gas or fumes, whether voluntary or involuntary; Injuries where there is no visible contusion or wound on the exterior of the body, except in the case of drowning or internal injuries revealed by an autopsy. Benefits will not be paid under this policy if death or bodily injury occurs, either directly or indirectly, voluntarily or involuntarily, from any regularly and / or extensively practiced hazardous sports, including but not limited to; boxing, climbing / mountaineering requiring ropes or guides or free-climbing; flying except as a fare-paying passenger in a scheduled aircraft or in an employer owned or hired jet or helicopter for transportation of employees; all professional sports; hang-gliding, delta-wing-gliding and paragliding; motorized racing of any form; deep sea diving; parachuting; bungee jumping; show jumping, steeple chasing, eventing or flat racing with a horse. GOVERNING LAW This contract is subject to the laws of the Bailiwick of Guernsey. If any provision of the contract does not conform to these laws, the contract will be applied to conform to the law. IMMEDIATE FAMILY A spouse, child, brother, sister, parent of grandparent of the owner or the insured; or of the spouse of the owner or the insured. INCONTESTABILITY We will not contest a policy after it has been in force during the insured’s lifetime for two (2) years from its date of issue, except for: 1. failure to pay premiums; or 2. any benefit provided by a disability waiver of premium rider 16 June 2015 LEGAL ACTIONS You cannot sue us for benefits under this policy sooner than ninety (90) days after we have been provided with written proof of death as required. No such action may be brought after one (1) year from the time written proof of death is required. NON-PARTICIPATION This policy is not eligible for dividends and will not participate in our divisible surplus. OUR CONSENT If our consent is required, it must be given in writing. It must bear the signature or a reproduction of the signature of our two Directors. OWNER / POLICYHOLDER The owner of this policy is as stated in the application unless later changed. If all named owners and contingent owners have died or if there is no owner named, the owner is the insured. While the insured is living, as owner you may exercise all rights and privileges granted by this policy, subject to the terms of any beneficiary appointment or assignment. All rights as owner expire at the death of the insured. These are your principal rights as owner: 1. to appoint or change beneficiaries; 2. to change the owner; 3. to receive amounts payable prior to the death of the insured; 4. to assign this policy. PHYSICIAN An individual who is licensed to practice medicine and treat illness or injury in the country in which treatment is received and who is acting within the scope of that license. Physician does not include: 1. The insured; 2. The owner; 3. A person who lives with the owner or the insured; 4. A person who is a member of the immediate family of the owner or the insured. PLACE OF PAYMENT All amounts payable by us will be payable at our office. POLICY DATE The policy date is shown in the Policy Details. It is the date this policy goes into effect. POLICY LOAN Your policy will not be eligible for any loans. You can write to us for effecting an assignment of your interest in your funds to another party. Such assignment will only be effective from the date of registering the assignment. POLICY SETTLEMENT In any settlement we may require the return of this policy. 16 June 2015 PROOF OF LOSS Written proof of loss must be given within ninety (90) days after the date of loss. SUICIDE EXCLUSION We will not pay the sum assured if the insured commits suicide (while sane or insane) within two (2) years from the date of issue of a policy. Instead, we will be liable only for the amount of the premium paid. SUMS ASSURED The sums assured are shown in the Schedule of Benefits. The owner has the option to reduce the AD&D or Life sum assured. The minimum sum assured is based on the insured’s age. The owner must provide a written request indicating the new sum assured for insurance. This request must be received by the Company ninety (90) days prior to any policy renewal and the new sum assured would be effective at the time the policy is renewed. Insured’s Age 18 to 59 60 to 69 Minimum Amount of Accidental Death & Dismemberment Insurance or Life Insurance $250,000 $100,000 SURRENDER OF POLICY The owner may, by written request, surrender this policy at any time before the end of the policy year while the insured is alive. If the owner surrenders this policy, the portion of any premium paid for the period beyond the policy month of cancellation will not be refunded. TAX CONSIDERATIONS You are encouraged to consult a qualified tax advisor. Neither we nor our agents are authorized to give tax or legal advice. TERMINATION This policy will end on the earliest of the following: 1. We receive your written request, at our office, to end the policy. 2. The date of the insured’s death. 3. The date the grace period ends if sufficient premium has not been paid. 4. The policy expiry date. 5. The policy anniversary date following the insured’s 70th birthday. 16 June 2015 INVESTMENT (All investments must be made via wire transfer) THIS POLICY IS NOT AVAILABLE TO UNITED STATES CITIZENS, OR ANY INDIVIDUAL WHO FILES, OR IS REQUIRED TO FILE, A U.S. TAX RETURN. FUND PORTFOLIO - reflects the chosen portfolios, and the amount initially invested in each portfolio, as indicated in your application. Investment Approach Safe Harbor Portfolio Asset Protection Portfolio Balanced Growth Portfolio Wealth Generator Portfolio Asset Allocation Model (approx.) Annual Management Fee Global Money Market Fund ($) 100% .80% Global Bonds Index Global Equity Index Global Money Market Fund ($) U.S. Property Index Fund Global Equity Index Global Bonds Index Global Money Market Fund ($) U.S. Property Index Fund Global Equity Index U.S. Property Index Fund Global Bonds Index Global Money Market Fund ($) 35% 30% 25% 10% 46% 25% 15% 14% 63% 17% 15% 5% 1.50% 1.90% .80% 1.90% 1.90% 1.50% .80% 1.90% 1.90% 1.90% 1.50% .80% Participating Funds Amount Invested PORTFOLIO CHARGES A Premium Allocation Charge of 2.0% will be deducted before your premium is allocated to the portfolio The Annual Management Fee will be deducted quarterly as a percentage of the portfolio value A nominal Switching Charge of .05% will be deducted for each switch to another portfolio The Company reserves the right to vary the contract fees as set out above by giving notice of no less than 30 days to the policyholder. The fund manager reserves the right to vary the fund management fees as set out above by giving notice of no less than 30 days to the policyholder. The Global Money Market funds may have a negative return if the annual management fee exceeds the fund investment returns. 16 June 2015 INDIVIDUAL FUND INVESTMENT (Minimum aggregate investment of $1,000,000) – reflects the chosen funds, and the amount initially invested in each fund, as indicated in your application. Fund Global Equity Index Fund ($) Emerging Markets Index Fund ($) Consumer Staples Index Fund ($) Global Bond Index Fund ($) U.S. Equity Index Fund ($) U.S. Property Index Fund ($) Global Money Market Fund ($) Real Estate Equity Index Fund (€) European Equity Index Fund (€) European Government Bond Index Fund (€) Global Money Market Fund (€) Global Money Market Fund (£) Annual Management Fee 1.90% 1.90% 1.90% 1.50% 1.90% 1.90% .80% 1.90% 1.90% 1.50% .80% .80% Amount Invested (minimum $50,000 per Fund) INDIVIDUAL FUND CHARGES A Premium Allocation Charge of 2.0% will be deducted before your premium is allocated to the fund The Annual Management Fee will be deducted quarterly as a percentage of the Fund Value A nominal Switching Charge of .05% will be deducted for each switch to another fund. Any changes to the Charges or Fees will be communicated to the Insured thirty (30) days in advance of the effective date of any change. The fund manager reserves the right to vary the fund management fees as set out above by giving notice of no less than 30 days to the policyholder. The Global Money Market funds may have a negative return if the annual management fee exceeds the fund investment returns. 16 June 2015