GTL-C600-0608M-IN 1 MADISON NATIONAL LIFE INSURANCE COMPANY, INC. Mailing: PO Box 5008, Madison, WI 53705 • Phone: 1-800-356-9601 Home Office: 1241 John Q. Hammons Drive, Madison, WI 53717 GROUP TERM LIFE INSURANCE CERTIFICATE OF INSURANCE PLEASE READ THIS CERTIFICATE CAREFULLY This Certificate of Insurance (hereinafter referred to as “Certificate”) is evidence of insurance provided under the Group Policy issued to the Group Policyholder (hereinafter referred to as “Policyholder”). This Certificate describes the essential features of such insurance. Madison National Life Insurance Company, Inc., in performing its obligations under the Group Policy, is acting only as a life insurer with respect to the Group Policy and is not in any way acting as a plan administrator, a plan sponsor or a plan trustee for the purposes of the Employee Retirement Income Security Act of 1974 (ERISA), as amended, or any other federal or state laws. No coverage under the Group Policy is in effect until approved in writing by Us and issued and delivered to the Policyholder. All terms, conditions and other provisions of the Group Policy are governed by the laws of the state in which the Policyholder is located. All provisions on this and the following pages are part of this Certificate. The Group Policy is on file and available for review at the main office of the Policyholder. The President and Secretary of Madison National Life Insurance Company, Inc witness this Certificate: Marita Zuraitis Donald M. Carley President Corporate Secretary WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.