Features Three Easy Steps to Get Covered SAMPLE NON- TOBACCO Select a Whole Life Plan MONTHLY PREMIUM RATES 4 1 Add riders to enhance your coverage. FOR BASE WHOLE LIFE PLAN $10K+ $50K+ $100K $150K $300K 2 Answer Three Health Questions 25 $11.10 $39.00 $75.00 $105.00 $207.00 2 Don’t worry about participating in any invasive medical exams. 35 $14.50 $56.50 $110.00 $157.50 $312.00 Get Death Benefit Coverage 45 $19.90 $83.50 $164.00 $237.00 $471.00 3 Immediately3 55 $29.10 $123.00 $243.00 n/a n/a Your death benefit coverage starts when you sign the application. + Shaded amounts available for spouse base policy purchases. Premium and amount of benefits vary dependent upon level selected at time of application. 5 5 EMPLOYEE ISSUE AGE AND MAXIMUM SPOUSE ISSUE AGE AND MAXIMUM Ages 17*-49: $300,000 Ages 17**-49: $50,000 Ages 50-65: $100,000 Ages 50-60: Ages 66-70: $10,000 $25,000 5 CHILD/GRANDCHILD ISSUE AGE AND MAXIMUM ACCELERATED BENEFIT FOR TERMINAL CONDITION Ages 1 month - 26: (14 in MA, WA; 17 in MI, PA) You can receive a portion of the chosen death benefit if you are $50,000 ($15,000 in WA) diagnosed with a Terminal Condition, as defined in the policy. RATES BASED ON ISSUE AGE AND TOBACCO STATUS LEVEL PREMIUM AND DEATH BENEFIT6 Your premiums will be based on your age on the date your Premiums and the death benefit are guaranteed to remain level policy becomes effective. You may be eligible for reduced rates for the life of the policy to age 121. Death benefits are generally 7 if you are a non-tobacco user. paid tax free . 2Issuance of the policy may depend on the answer to these questions. 3Interim coverage for death will be in force from the date your application is signed if, on such date, the proposed insured is insurable per our underwriting guidelines for the requested coverage per the terms of the policy. This interim coverage for death will remain in force until the earlier of 1) the date a policy becomes effective, 2) the date we decline the application, or 3) the date we notify the proposed insured that they are ineligible for interim coverage. The employee and/or spouse must remain actively at work during the interim coverage period. If the death of the proposed insured occurs during the interim coverage period, the first month’s premium will be subtracted from the policy proceeds. Interim coverage is only for death benefits under the base policy and Children’s Term Rider. No interim coverage benefits are available under any Waiver of Premium Rider, Accidental Death and Dismemberment Rider, Accelerated Benefit 4 Rider for Long Term Illness or Accelerated Benefit for Critical Illness Rider. Example is based on monthly non-tobacco rates for a WL14 base plan only. Contact your American Fidelity account manager for specific ages, rates or face amounts. 5Face amounts vary based on issue age. Issuance of coverage may be subject to responses received to a few medical questions. 6Provided no partial surrenders or accelerated benefits are taken. 7Please consult your tax advisor for your specific situation. *In the states of AK, AR, CO, IA, KS, MN, MO, NH, OR, PA, RI, SC, TN and WI, the minimum issue age for younger employees is 18. **In the states of MO and PA, the minimum issue age for younger spouses is 18.