POLICYHOLDER PROVISIONS APPLICATION FOR GROUP INSURANCE You must submit to us an executed Application for Group Insurance form electing to participate in this Group Whole Life Insurance Policy. POLICYHOLDER DUTIES Your duties include, but are not limited to, the following: 1. Provide to us any and all information we determine is necessary for the enrollment and determination of eligibility of your employees or members and their eligible dependents. You must also provide us with all information necessary to underwrite the coverage, to calculate premiums, to maintain necessary administrative records, and to manage claims. 2. Maintain records pertaining to the insurance provided under this policy, for which we may reasonably require information while this policy is in force and for 2 years after this policy terminates. You must also allow us to examine these records at any reasonable time during normal business hours. 3. Upon our request, you will deliver any required notices regarding this insurance to certificate holders. ENTIRE POLICY The entire policy consists of this group contract; any attached rider(s), amendment(s), or endorsement(s); any schedule(s); and the Application for Group Insurance form. For all purposes related to the coverage issued under this policy, you act as an agent of the certificate holder. Therefore, you do not act as our agent for any purposes related to coverage provided under this policy. POLICY INCONTESTABILITY Any statement made by you will be considered a representation and not a warranty. We rely on the statements made in the Application for Group Insurance form for this policy. We will not use any statement you make to void this policy after it has been in force for 2 years from the date of issue. CLERICAL ERROR If any clerical error is made by us or you, the premiums and/or benefits will be adjusted according to the correct data. An error will not end insurance validly in force, nor will it continue insurance validly terminated. Complete proof must be supplied by you documenting any clerical errors. TIME PERIODS All periods affecting this policy begin and end at 12:01 a.m. at your address of record. All periods affecting a certificate holder’s coverage begin and end at 12:01 a.m. at his or her address of record. CHANGE(S) IN THIS POLICY The terms of this policy may not be changed unless one of our executive officers approves it in writing. Any approved change will be added to this policy in writing. This policy will automatically comply with any state or federal law or regulation, including tax law, as of the effective date of such law or regulation, even if we have not notified you of the change or this policy has not been amended. EFFECTIVE DATE OF CHANGES Unless we agree otherwise in writing, the effective date of any change in benefits offered under this policy will be the first day of the month that immediately follows the date we send notice of the change in benefits and corresponding change in premium rates. GWLPIN Page 7