SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT SECTION12A-SEATBELTBENEFIT This Section applies to Basic Accidental Death Insurance. SEATBELTBENEFIT AULwillpayanAdditionalAccidentalDeathBenefitif You die as a result of a non-occupational Automobile accident while You are properly wearing a Seat Belt at the time of the accident. The following rules apply: 1) TheSeatBeltBenefitequalsthe lesser of: a) 10%ofYourAD&DPrincipalSumshownintheScheduleofBenefits;or b) $25,000. 2) AULmustreceivesatisfactorywritten proof that Your death resulted from an Automobile accident and that You wereproperly wearing a Seat Belt at the time of the accident. A copy of all police reports must be submitted with the claim, and must show conclusively the Seat Belt was properly worn. 3) This benefit will not be paid if You, while operating the Automobile, were legally intoxicated as defined by applicable laws, violating traffic laws other than an infraction, racing, stunt-driving, or engaging in other similar activity during the accident. In no event will the total of all Additional Accidental Death Benefits payable exceed 100% of Your AD&D Principal Sum. In addition to the above limitations, this benefit is subject to the further limitations and provisions of this Section 12. GC2510.15 SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT SECTION12A-SEATBELTBENEFIT

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