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SAMPLE SETTLEMENT AGREEMENT

ABC-XYZ Life Insurance Company

How Benefits Are Paid

You can have insurance benefits and the net cash surrender value paid immediately in one sum, or you can choose another form of payment for all or part of them. If you do not arrange for a specific choice before the Insured dies, the beneficiary will have this right when the Insured dies. If you do make an arrangement, however, the Beneficiary cannot change it after the Insured dies.

The options are as follows:

A. Deposit: The sum will be left on deposit for a period mutually agreed upon. We will pay interest at the end of every month, every 3 months, every 6 months, or every 12 months, as chosen.

B. Installment Payments: There are two ways that we pay installments:

1. Fixed Period. We will pay the sum in equal installments for a specified number of years (but not more than 30). The installments will be at least those shown in the Table of Guaranteed Payments.

2. Fixed Amount. We will pay the sum in installments as mutually agreed upon until the original sum, together with interest on the unpaid balance, is used up.

C. Monthly Life Income: We will pay the sum as a monthly income for life. The amount of the monthly payment will be at least that shown in the Table of Guaranteed Payments. You may choose any one of three ways to receive the monthly life income. We will guarantee payments for at least 10 years (called 10-Year Certain), at least 20 years (called 20-year Certain), or until the payments we make equal the original sum (called Refund Certain). If at the payee�s age the benefit would be the same for more than one period certain, we will deem that the longest period has been chosen.

D. Other: We will apply the sum under any other option requested that we make available at the time of the Insured�s death or net cash surrender value withdrawal.

We guarantee interest under the Deposit option at the rate of 3 percent a year and under either Installment option at 3.5 percent a year. We may raise these guaranteed rates. We may also allow interest under the Deposit option and under either Installment option at a rate above the guaranteed rate. The payee may name and change a successor payee for any amount we would otherwise pay to the payee�s estate.

SAMPLE SETTLEMENT AGREEMENT (Continued)

ABC-XYZ Life Insurance Company

 

The Deposit, Installment, and Monthly Life Income options do not participate in dividends.

Any arrangements involving more than one of the options or a payee who is not a natural person (for example, a corporation) or who is a fiduciary must have our approval. Details of all arrangements will be subject to our rules at the time the arrangement takes effect. These include rules on the minimum amount we will apply under an option and minimum amounts for installment payments, withdrawal or commutation rights, naming payees and successor payees, and proving age and survival.

Payment choices (or any later changes) will be made and will take effect in the same way as a change of Beneficiary. Amounts applied under these options will not be subject to the claims of creditors or to legal process, to the extent permitted by law.

SAMPLE SETTLEMENT AGREEMENT (Continued)

ABC-XYZ Life Insurance Company

 

TABLE OF GUARANTEED SETTLEMENT PAYMENTS

(Minimum Amount for Each $1,000 of Policy Proceeds Applied)

Option B1

Fixed-period Installments

     

Number of Years'

Installments

Monthly

Installment

Annual

Installment

     

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

$84.70

43.08

29.21

22.28

18.12

15.36

13.38

11.91

10.76

9.84

9.09

8.47

7.94

7.49

7.11

6.77

6.47

6.20

5.97

5.76

5.57

5.40

5.24

5.10

4.97

4.84

4.73

4.63

4.54

4.45

$1,000.00

508.60

344.86

263.04

213.99

181.32

158.01

140.56

127.00

116.18

107.34

99.98

93.78

88.47

83.89

79.89

76.37

73.25

70.47

67.98

65.74

63.70

61.85

60.17

58.62

57.20

55.90

54.69

53.57

52.53

 

 

SAMPLE SETTLEMENT AGREEMENT (Continued)

ABC-XYZ Life Insurance Company

 

TABLE OF GUARANTEED SETTLEMENT PAYMENTS

(Minimum Amount for Each $1,000 of Policy Proceeds Applied)

 

Option C

Male Monthly Life Income per $1,000

       

 

Age

10-Year

Certain

20-Year

Certain

Refund

Certain

       

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79

80

81

82

83

84

85 and over

$4.50

4.58

4.67

4.75

4.85

4.94

5.04

5.15

5.26

5.37

5.49

5.62

5.75

5.88

6.03

6.17

6.32

6.48

6.64

6.80

6.97

7.15

7.32

7.50

7.67

7.85

8.02

8.19

8.36

8.52

8.67

8.81

8.94

9.06

9.16

9.26

$4.27

4.32

4.38

4.44

4.50

4.56

4.62

4.68

4.74

4.81

4.86

4.92

4.98

5.04

5.09

5.14

5.19

5.24

5.28

5.32

5.35

5.38

5.41

5.43

5.45

5.47

5.48

5.49

5.50

5.50

5.51

5.51

5.51

5.51

5.51

5.51

$4.28

4.35

4.42

4.50

4.58

4.66

4.74

4.83

4.93

5.03

5.13

5.24

5.35

5.48

5.60

5.74

5.88

6.03

6.18

6.35

6.53

6.71

6.91

7.12

7.34

7.58

7.82

8.09

8.38

8.67

9.00

9.34

9.70

10.10

10.52

10.96

 

 

 

 

SAMPLE SETTLEMENT AGREEMENT (Continued)

ABC-XYZ Life Insurance Company

 

TABLE OF GUARANTEED SETTLEMENT PAYMENTS

(Minimum Amount for Each $1,000 of Policy Proceeds Applied)

Option C

Female Monthly Life Income per $1,000

       

 

Age

10-Year

Certain

20-Year

Certain

Refund

Certain

       

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79

80

81

82

83

84

85 and over

$3.96

4.02

4.09

4.16

4.24

4.32

4.40

4.49

4.58

4.68

4.78

4.89

5.00

5.12

5.25

5.39

5.53

5.68

5.83

6.00

6.17

6.34

6.53

6.72

6.92

7.12

7.32

7.53

7.75

7.96

8.16

8.36

8.55

8.73

8.90

9.05

$3.89

3.94

4.00

4.06

4.12

4.18

4.24

4.31

4.38

4.45

4.52

4.59

4.66

4.73

4.80

4.88

4.95

5.01

5.08

5.14

5.20

5.26

5.30

5.35

5.38

5.42

5.44

5.46

5.48

5.49

5.50

5.51

5.51

5.51

5.51

5.51

$3.87

3.93

3.99

4.05

4.11

4.18

4.25

4.33

4.41

4.49

4.58

5.67

4.77

4.88

4.99

5.10

5.22

5.35

5.49

5.64

5.79

5.96

6.13

6.32

6.52

6.73

6.96

7.21

7.47

7.75

8.05

8.39

8.73

9.12

9.53

9.97

 

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