CLAIMS PROVISIONS FILING A CLAIM: Written notice of a claim must be given to us within thirty (30) days after the date your disability begins, or as soon thereafter as reasonably possible. Notice means providing us with enough information so that we are able to identify you as an insured under a long term disability policy issued by Reliance Standard Life Insurance Company. Written proof of your claim must be sent to us within ninety (90) days after the end of the Elimination Period. If written proof is not given in that time, the claim will not be invalidated nor reduced if it is shown that written proof was given as soon as reasonably possible. In any event, proof must be given within one (1) year after the date that proof of claim is otherwise required, unless you are legally incapable of doing so. The notice and proof of claim should be sent to us by mail to Reliance Standard Claims, P.O. Box 8330, Philadelphia, PA 19101-8330, by email to ClaimsIntake@rsli.com, by fax to (267)256- 4262, or electronically to https://rslclaims.com/. Notice or proof of claim sent to another location will not constitute valid notice or proof of claim. Claim forms and other information needed to provide proof of your claim should be filed promptly. You can access claim forms through our online website at https://customercare.rsli.com/Forms/ or you can call the customer care center at 1- 800-351-7500 to request a claim form from us. Our standard claim form includes a section to complete for you, the Policyholder, and the Physician providing you Regular Care for the Sickness or Injury causing your Total Disability. You are responsible for giving the Policyholder and your Physician the appropriate section of the claim form for their completion. The completed form must be sent to us within the timeframes stated above for providing proof of claim. If you request a claim form from us and do not receive the claim form or electronic access to the claim form within 15 days after your request, then proof of claim will be met by giving us a written statement of your claim, including the occurrence, character and extent of the Total Disability for which the claim is made, within the time period required for providing proof of claim. This written statement of your claim must include enough information for us to begin processing the claim, including your name, address, telephone number, Policy number, your employer’s name and address, and the Policyholder's name and address (if different from the employer). WRITTEN PROOF OF LOSS: We will evaluate your written proof of claim to determine if you have provided satisfactory proof of loss and to determine the amount of any benefits that may be payable. Your proof of loss must include the following items, provided at your expense: (1) That you are under the Regular Care of a Physician; (2) The date your Total Disability began; (3) The cause of your Total Disability as determined by objective medical evidence, diagnostic studies, and examinations acceptable to the medical community; (4) The extent of your Total Disability, including all restrictions and/or limitations; (5) The name and address of all pharmacies, Hospital(s) or Institution(s) where you received Treatment, including all Physicians who prescribed medications or provided Regular Care; (6) Documentation of your Covered Monthly Earnings and all income received while Totally Disabled, including all earnings, income or benefits of any kind that you may be receiving or eligible to receive while also claiming disability benefits under the Policy; (7) Documentation that you have applied for all Other Income Benefits that you may be eligible for during the period of Total Disability for which you are claiming disability benefits under the Policy; (8) Written authorization for you to release and for us to obtain medical, employment, and financial, information and any other information we may reasonably require to determine your eligibility to receive benefits under the Policy and the amount of benefits payable under the Policy. This includes your receipt of or eligibility for Other Income Benefits and signing a reimbursement agreement upon our request; and (9) Tax returns, including all associated schedules and worksheets, business records, accountant’s statements, and any other information we deem necessary to determine eligibility for benefits and the amount of benefits payable under the Policy. You are required to send proof of your continuing eligibility to receive disability benefits under the Policy and the amount of those benefits. This may include sending proof that you are under the Regular Care of a Physician and/or any other information required above for proof of loss. We have the right to make this request as often as it is reasonably required during any ongoing review of benefit eligibility and while a claim is pending, including during any appeal from an adverse LRS-6570-4-0719-IN Page 5.0