Allstate Whole Life Advantage SM

Transcription

1 A WHOLE LIFE INSURANCE ILLUSTRATION Allstate Whole Life Advantage SM A Company You Can Count On For more than 25 years, Allstate Life Insurance Company of New York has been in the business of helping protect what s important to you. With Allstate, you can feel better prepared and more in control of your future than ever before. We pride ourselves on strength, stability and integrity as well as our ability to provide financial solutions and professional assistance to help families achieve their lifelong dreams. To learn more, call or visit your Allstate agency today. Illustration Prepared for: Male 40 Prepared by: Jane W. Life Life Agency 1234 Main Street Suite 200 Any Town, IL (800) What's Inside: Policy Highlights... S.1 Policy Overview... 1 Key Terms...6 Policy Summary (Signatures)... 8 Policy Details... 9 Disclosures The Next Steps... A.1 Prepared on: June 12, 2014 To be presented in the state of New York Administrative Office: 2940 South 84th Street, Lincoln, NE 68506

2 Policy Highlights Prepared by Jane W. Life for No Surprises. Solid Protection & Growth. That s Allstate Whole Life Advantage. When it comes to protecting your life, your family and your financial assets Surprise isn t a word you want to hear. With Allstate Whole Life Advantage, you get a strategy for solid, dependable, protection and growth. No surprises. Whole Life Advantage provides lifetime coverage, plus level premiums and guaranteed cash values. On day one, you ll know the minimum cash value you ll have in your policy each year for the life of the policy regardless of the market. In the future, you can choose a reduced paid-up benefit, resulting in a lower death benefit while maintaining your cash value and never paying another premium again. Whole Life Advantage A Solid Strategy: Level s set and will not increase Death certain to be there and will not decrease Increasing safe, secure cash for the future regardless of market conditions Why let any surprises catch you off guard? Solid, secure, dependable protection and growth you can count on. That s Whole Life Advantage. Plus, earn more with Excess Credits Like dividends, when Excess Credits are paid, they can add value to your policy or cash back to you. Choose how to receive the excess credits: increase death benefit and cash values with paid-up additions reduce your premium due take excess credits in cash repay policy debt or accumulate excess credits with interest Your illustration includes Excess Credit Option Purchase Additions, as you selected. And Choose Optional Features Whole Life Advantage also offers optional features or riders which you can use to add protection or increase your coverage. Learn more about the riders you selected in the Policy Overview section of this illustration. Page S.1 of S.1 This supplemental illustration is not valid without an accompanying product illustration. Refer to the basic life insurance illustration for guaranteed elements and complete policy detail information. FIN2487A

3 Policy Overview $250,000 Initial Death Policy Overview A LIFE INSURANCE ILLUSTRATION Prepared By Jane W. Life Life Agency 1234 Main Street Suite 200 Any Town, IL (800) To be presented in the state of New York Important Notices This is an illustration only and not a contract. If there are any discrepancies between this illustration and your contract, the contract language will prevail. About Allstate Whole Life Advantage Allstate Whole Life Advantage is a whole life insurance policy issued by Allstate Life Insurance Company of New York and is available using Form NYLU796. This policy provides you with guaranteed premiums and guaranteed cash values along with lifetime coverage. It also has an excess credits feature that can mean added insurance benefits or cash back. Excess credits are based on factors that include our future expectations of mortality, investments and expenses, and may be paid throughout the life of the policy. They may be used to purchase paid-up additions, taken in cash, accumulated with interest, applied to future premiums or used for the payment of policy debt. These excess credits are not guaranteed and subject to change by Allstate Life Insurance Company of New York. Underwriting Class Preferred Elite Your underwriting class is based on factors such as overall health history, driving record, occupation and activities that involve risk. This illustration assumes you are classified as Preferred Elite. Your actual payments will depend on the outcome of an underwriting process. Initial Net Death $250,000 This is the death benefit at the time your policy is issued. Refer to the Policy Details section for future death benefit variations. Page 1 of 15

4 Policy Overview $250,000 Initial Death Initial Contract s $3, paid Annually Illustrated Coverage Face Amount Annual (s) Years Payable Whole Life Base Policy $250,000 $3, The premium(s) shown above are based on annual premiums, and does not necessarily reflect the premium mode selected. Other Payment Schedules Your premium quote was for an annual payment. This section shows other payment schedules that are available. Frequency Initial Contract Initial Annualized Contract Annual $3, $3, Semi-Annual $1, $3, Semi-Annual Automatic $1, $3, Quarterly $ $3, Quarterly Automatic $ $3, Monthly Automatic $ $3, The excess credit option to reduce premium is only available for direct annual billing mode. Seven-Pay $9, The seven-pay limit is defined by federal tax law as the maximum amount you can pay annually, in addition to any 1035 exchange amount, during the first seven policy years. In addition, a change in benefits may also trigger a new seven-pay period. If you exceed the seven-pay limit, your policy becomes a Modified Endowment Contract (MEC) and you may be subject to additional taxes and penalties on any distributions from your policy that are taken while you are still living. Based upon the scheduled premium payments in the illustration your policy is not a MEC. Excess Credit Option Purchase Additions Excess credits may be applied to your policy at the end of each policy year and will purchase additional life insurance coverage, referred to as paid-up additions. Excess credits are shown on the Policy Details page of this illustration. Paid-up additions are reflected in any non-guaranteed values shown in this illustration. Page 2 of 15

5 Policy Overview $250,000 Initial Death Accessing Your Your policy allows you to: Take loans against the policy s cash surrender value. Take withdrawals from the cash surrender value of the paid-up additions. Take withdrawals from the cash surrender value of the Insurance Rider. Take excess credits in cash. Take withdrawals of excess credits accumulated with interest. Loans, if not repaid, and partial withdrawals will reduce your death benefit and cash surrender value. An interest charge will apply to loaned amounts. How withdrawals are taxed: Withdrawals from a life insurance policy are generally taxed as income to the extent the withdrawal exceeds the investment in the policy. In some situations, withdrawals during the first 15 policy years may result in taxable income prior to recovery of the investment in the policy. If a policy is a MEC, withdrawals are treated as a taxable distribution to the extent of policy gain. Withdrawals are treated first as distributions of the policy gain subject to ordinary income taxation, and may be subject to an additional 10% federal tax penalty if made prior to age 59½. How loans are taxed: Loans from a life insurance policy are generally not taxable if taken from a life insurance policy that is not a MEC. However; when a policy is surrendered and cash surrender values are used to repay a loan, the transaction is treated like a withdrawal and will be taxed accordingly. If a policy is a MEC, loans are treated as a taxable distribution to the extent of the policy gain. Loans are treated first as distributions of the policy gain subject to ordinary income taxation, and may be subject to an additional 10% federal tax penalty if made prior to age 59½. How excess credits paid in cash or accumulated with interest are taxed: Excess credits paid in cash or accumulated with interest are generally taxed when the excess credit is paid to the extent the amount exceeds the investment in the policy. If a policy is a MEC, the excess credits are treated as a taxable distribution to the point of the policy gain. The excess credits are treated first as distributions of the policy gain subject to ordinary income taxation, and may be subject to an additional 10% federal tax penalty if made prior to age 59½. Please consult your tax advisor for the possible tax implications in your situation. Page 3 of 15

6 Policy Overview $250,000 Initial Death Reduced Option A reduced paid-up benefit can be elected at any time, provided that sufficient cash surrender value is available. The cash surrender value, less policy debt, will be used as a net single payment to purchase a reduced life insurance benefit. payments stop at this point. The reduced paid-up option will have increasing cash values and is eligible for excess credits. A reduced paid-up benefit will be automatically set up if the grace period expires with no available automatic premium loans or all available automatic premium loans have been paid. Annual for the Paid- Up Insurance Rider This rider allows you to contribute an annual premium to the policy to purchase paid-up life insurance until attained age 80, assuming your policy is still in force. The minimum annual premium required each year is equal to $100, except in the first policy year in which there is no minimum annual premium requirement. The maximum annual premium allowed is equal to the annual base policy premium. Failure to contribute the minimum premium will not cause the rider to terminate, however, no additional premiums will be allowed. This rider is eligible for excess credits. Additional Rider This policy offers a rider that you have chosen not to purchase at the time your policy is issued. The Child Term Rider may be added to your policy in the future. It offers you an affordable way to purchase life insurance for your children who are ages 0 to 17. This rider may be added through age 64. You must submit a written request to have this rider added to your policy. The addition of this rider is subject to future availability and may require additional underwriting. Age 121 If the policy is still in force after the anniversary following your 121st birthday, the following will apply: s are no longer required. The cash value continues to earn interest. Any policy debt will continue to accrue interest. Policy Transactions We will not automatically process any loans, withdrawals, or policy changes. If your illustration includes any of these transactions, you will need to send your written request at the time you would like the transaction to be processed. Page 4 of 15

7 Policy Overview $250,000 Initial Death Cost and Net Payment Indexes The Life Insurance Payment Cost Index and the Life Insurance Net Payment Cost Index are measures that are useful only for comparing the relative costs of two or more similar plans of insurance. A low index number represents a plan with a lower cost than one with a higher index number. These indexes assume a 5% time value of money. Guaranteed s Non-Guaranteed Current Assumptions 10 Years 20 Years 10 Years 20 Years Cost Index Net Payment Index Page 5 of 15

8 Key Terms Allstate Whole Life Advantage SM Key Terms $250,000 Initial Death The following terms and definitions will help you as you review the policy values in the illustration. Age The insured s age at the end of the policy year. The amount that is available for surrender or loan. This includes end of year values, which have been adjusted for policy debt, under the base policy and any illustrated riders. Contract The total amount of premiums you are required to pay each policy year. This illustration assumes the first premium is received on 06/12/2014. Cumulative Outlay This is the anticipated sum of the yearly Outlays from the issue date of the policy to the policy year shown. Current Assumptions These values reflect excess credits being declared each year and used according to the excess credit option selected. The interest rate used in the calculation of excess credits for this illustration is 4.35%. These values are not guaranteed. Death The amount that we will pay to the beneficiary at your death as long as the policy is still in force. This includes the amounts on the base policy and any illustrated riders on the life of the insured, less any outstanding loan balance. Excess Credit A non-guaranteed amount paid at the end of the policy year. Excess credits are based on factors that include future expectations of mortality, investments and expenses. Guaranteed s These values are guaranteed provided all premiums are paid when due. Page 6 of 15

9 Key Terms $250,000 Initial Death Mid-Point Assumptions These values reflect values between the Guaranteed s and the Current Assumptions. These values are not guaranteed. Net Distributions The total of all loans, withdrawals, and loan repayments made each policy year. This number shows the amount of net distributions coming out of the policy. Distributions are assumed to occur at the beginning of the policy year. Non-Guaranteed Elements of the Policy These values illustrate the use of excess credits on the policy. Depending on the option you selected, excess credits may be used to purchase additional death benefits, reduce premium, receive a cash withdrawal, accumulate with interest or make a repayment of policy debt. The values shown are hypothetical and excess credits cannot be predicted with certainty. The illustration assumes that excess credits will continue unchanged for all years shown. This is not likely to occur, and actual results may be more or less favorable than those shown. Additions This is the cumulative amount of paid-up life insurance purchased with excess credits. The paid-up additions are included in the Non-Guaranteed Death. Additions This amount is the cash value from the paid-up additions purchased with excess credits. It is available for withdrawal and is included in the Non-Guaranteed. Policy Year This is the twelve month period that begins on the day your policy is issued. Subsequent policy years begin on the policy s anniversary date. Outlay The amount of premium assumed to be paid out-of-pocket. This consists of the premium; less surrendered cash value; less excess credits paid in cash or used to reduce premium; less any policy loans received; plus any loan interest paid; plus any loan principal paid. Reduced The amount of paid-up insurance benefit which can be purchased by using the cash surrender value available on a single premium basis. The reduced paid-up benefit is eligible for excess credits and has loan value. Page 7 of 15

10 Policy Summary (Signatures) Owner Signature Agent Signature Owner Date Agent Date Allstate Whole Life Advantage SM Policy Summary $250,000 Initial Death Guaranteed s Non-Guaranteed Mid-Point Assumptions Non-Guaranteed Current Assumptions Policy Year Age Cumulative Outlay Death Cumulative Outlay Death Cumulative Outlay Death ,825 9, ,000 17,825 9, ,269 17,825 9, , ,650 26, ,000 35,650 27, ,104 35,650 28, , ,300 68, ,000 71,300 73, ,526 71,300 78, , , , , , , , , , , , , , , , , , , ,559 The table above is designed to help you understand how changes in non-guaranteed factors may affect policy values. The Guaranteed s are based on policy guarantees and assume timely payment of Contract s each year. The Non-Guaranteed Current Assumptions assume 100% of excess credits are paid. The Non-Guaranteed Mid-Point assumptions assume 50% of excess credits are paid. I understand that this illustration is for illustrative purposes only and nothing herein is a contractual obligation. If there are any discrepancies between this illustration and my contract, the language in my contract will prevail. I have received a copy of this illustration and understand that any non-guaranteed elements illustrated are subject to change and could be either higher or lower. The agent has told me they are not guaranteed. Signature of Proposed Owner Date I certify that this illustration has been presented to the applicant and that I have explained that any non-guaranteed elements illustrated are subject to change. I have made no statements that are inconsistent with the illustrations. Signature of Agent Date Page 8 of 15

11 Policy Details Allstate Whole Life Advantage SM Policy Details $250,000 Initial Death Guaranteed s Non-Guaranteed Assumptions Policy Year Age Contract Death Reduced Outlay Death Reduced , , , , , , , , ,565 2, ,000 9,731 3,565 2, ,074 9, ,565 5, ,000 20,748 3,565 5, ,231 20, ,565 9, ,000 31,301 3,565 9, ,538 31, ,565 12, ,000 41,427 3,565 12, ,993 42, ,565 15, ,000 51,149 3,565 16, ,592 52, ,565 19, ,000 60,512 3,565 20, ,330 62, ,565 22, ,000 69,575 3,565 23, ,203 72, ,565 26, ,000 78,319 3,565 28, ,207 82, ,565 30, ,000 86,741 3,565 32, ,342 92, ,565 34, ,000 94,827 3,565 36, , , ,565 38, , ,583 3,565 41, , , ,565 42, , ,008 3,565 46, , , ,565 46, , ,097 3,565 51, , , ,565 51, , ,854 3,565 56, , , ,565 55, , ,304 3,565 61, , , ,565 59, , ,492 3,565 67, , , ,565 64, , ,437 3,565 72, , , ,565 68, , ,136 3,565 78, , , ,565 73, , ,585 3,565 84, , , ,565 78, , ,777 3,565 90, , , ,565 82, , ,707 3,565 97, , , ,565 87, , ,383 3, , , , ,565 92, , ,836 3, , , , ,565 97, , ,084 3, , , , , , , ,150 3, , , , , , , ,059 3, , , , , , , ,813 3, , , , , , , ,417 3, , , ,452 Excess credits are included in the Non-Guaranteed Assumptions. View the Excess Credit Option Summary table for further information. Non-guaranteed benefits and values are based on assumptions subject to change by the company and are not guaranteed. Actual results may be more or less favorable than those illustrated. Please refer to the Policy Overview, Key Terms and Policy pages for guaranteed values and other policy information. Page 9 of 15

12 Policy Details $250,000 Initial Death Guaranteed s Non-Guaranteed Assumptions Policy Year Age Contract Death Reduced Outlay Death Reduced , , , ,873 3, , , , , , , ,160 3, , , , , , , ,277 3, , , , , , , ,233 3, , , , , , , ,051 3, , , , , , , ,733 3, , , , , , , ,287 3, , , , , , , ,704 3, , , , , , , ,975 3, , , , , , , ,096 3, , , , , , , ,080 3, , , , , , , ,934 3, , , , , , , ,672 3, , , , , , , ,293 3, , , , , , , ,802 3, , , , , , , ,201 3, , , , , , , ,484 3, , , , , , , ,657 3, , , , , , , ,713 3, , , , , , , ,676 3, , , , , , , ,549 3, , , , , , , ,359 3, , , , , , , ,110 3, , , , , , , ,801 3, , , , , , , ,430 3, , , , , , , ,018 3, , , , , , , ,566 3, , , , , , , ,080 3, , , , , , , ,546 3, , , , , , , ,969 3, , , ,902 Excess credits are included in the Non-Guaranteed Assumptions. View the Excess Credit Option Summary table for further information. Non-guaranteed benefits and values are based on assumptions subject to change by the company and are not guaranteed. Actual results may be more or less favorable than those illustrated. Please refer to the Policy Overview, Key Terms and Policy pages for guaranteed values and other policy information. Page 10 of 15

13 Policy Details $250,000 Initial Death Guaranteed s Non-Guaranteed Assumptions Policy Year Age Contract Death Reduced Outlay Death Reduced , , , ,345 3, , , , , , , ,718 3, , , , , , , ,076 3, , , , , , , ,418 3, , , , , , , ,744 3, , , , , , , ,068 3, , , , , , , ,374 3, , , , , , , ,676 3, , , , , , , ,967 3, , , , , , , ,238 3, , , , , , , ,508 3, , , , , , , ,767 3, , , , , , , ,007 3, , , , , , , ,248 3, , , , , , , ,472 3, , , , , , , ,685 3, , , , , , , ,895 3, , , , , , , ,096 3, , , , , , , ,279 3, , , , , , , ,445 3, , , , , , , ,000 3, , , ,559 Excess credits are included in the Non-Guaranteed Assumptions. View the Excess Credit Option Summary table for further information. Non-guaranteed benefits and values are based on assumptions subject to change by the company and are not guaranteed. Actual results may be more or less favorable than those illustrated. Please refer to the Policy Overview, Key Terms and Policy pages for guaranteed values and other policy information. Page 11 of 15

14 Excess Credit Option Summary Allstate Whole Life Advantage SM Policy Details $250,000 Initial Death Excess Credit Option Summary Non-Guaranteed Assumptions Policy Year Age Contract Excess Credit Net Distr Additions Additions Outlay , , , , , ,565 2, , ,565 5, , ,565 9, , ,565 12, , , ,565 16, , , ,565 20, , ,203 1,055 3,565 23, , ,207 1,433 3,565 28, , ,342 1,880 3,565 32, , ,605 2,401 3,565 36, , ,994 3,002 3,565 41, , ,507 3,686 3,565 46, , ,143 4,458 3,565 51, , ,897 5,322 3,565 56, , ,767 6,283 3,565 61, , ,752 7,345 3,565 67, , ,847 8,515 3,565 72, ,565 1, ,053 9,796 3,565 78, ,565 1, ,368 11,193 3,565 84, ,565 1, ,793 12,711 3,565 90, ,565 1, ,328 14,354 3,565 97, ,565 1, ,971 16,124 3, , ,565 1, ,722 18,028 3, , ,565 1, ,584 20,072 3, , ,565 1, ,548 22,259 3, , ,565 1, ,612 24,594 3, , ,565 1, ,775 27,081 3, , ,565 1, ,035 29,726 3, ,373 Non-guaranteed benefits and values are based on assumptions subject to change by the company and are not guaranteed. Actual results may be more or less favorable than those illustrated. Please refer to the Policy Overview, Key Terms and Policy pages for guaranteed values and other policy information. Page 12 of 15

15 Policy Details $250,000 Initial Death Excess Credit Option Summary Non-Guaranteed Assumptions Policy Year Age Contract Excess Credit Net Distr Additions Additions Outlay ,565 2, ,394 32,530 3, , ,565 2, ,852 35,495 3, , ,565 2, ,417 38,622 3, , ,565 2, ,082 41,914 3, , ,565 2, ,852 45,377 3, , ,565 2, ,725 49,014 3, , ,565 2, ,697 52,821 3, , ,565 2, ,770 56,795 3, , ,565 3, ,951 60,934 3, , ,565 3, ,236 65,231 3, , ,565 3, ,626 69,680 3, , ,565 3, ,128 74,285 3, , ,565 3, ,733 79,038 3, , ,565 3, ,449 83,946 3, , ,565 3, ,269 88,991 3, , ,565 4, ,196 94,166 3, , ,565 4, ,239 99,465 3, , ,565 4, , ,872 3, , ,565 4, , ,388 3, , ,565 4, , ,996 3, , ,565 4, , ,704 3, , ,565 4, , ,540 3, , ,565 4, , ,481 3, , ,565 5, , ,523 3, , ,565 5, , ,654 3, , ,565 5, , ,884 3, , ,565 5, , ,227 3, , ,565 5, , ,677 3, , ,565 5, , ,217 3, , ,565 5, , ,827 3, ,532 Non-guaranteed benefits and values are based on assumptions subject to change by the company and are not guaranteed. Actual results may be more or less favorable than those illustrated. Please refer to the Policy Overview, Key Terms and Policy pages for guaranteed values and other policy information. Page 13 of 15

16 Policy Details $250,000 Initial Death Excess Credit Option Summary Non-Guaranteed Assumptions Policy Year Age Contract Excess Credit Net Distr Additions Additions Outlay ,565 5, , ,518 3, , ,565 6, , ,342 3, , ,565 6, , ,300 3, , ,565 6, , ,389 3, , ,565 6, , ,614 3, , ,565 6, , ,972 3, , ,565 6, , ,464 3, , ,565 6, , ,097 3, , ,565 7, , ,862 3, , ,565 7, , ,764 3, , ,565 7, , ,805 3, , ,565 7, , ,981 3, , ,565 7, , ,294 3, , ,565 7, , ,746 3, , ,565 7, , ,336 3, , ,565 8, , ,066 3, , ,565 8, , ,936 3, , ,565 8, , ,949 3, , ,565 8, , ,097 3, , ,565 8, , ,314 3, , ,565 7, , ,559 3, ,559 Non-guaranteed benefits and values are based on assumptions subject to change by the company and are not guaranteed. Actual results may be more or less favorable than those illustrated. Please refer to the Policy Overview, Key Terms and Policy pages for guaranteed values and other policy information. Page 14 of 15

17 Disclosures Allstate Whole Life Advantage SM Disclosures $250,000 Initial Death All guarantees are based on the claims-paying ability of Allstate Life Insurance Company of New York. This illustration is based on our understanding of the current income tax laws. We make no guarantees regarding the tax treatment of your policy or transactions involving your policy. We recommend that you consult with your tax advisor on all tax related matters. Loans, withdrawals or changes to the death benefit can alter your guaranteed life insurance protection. Loans or withdrawals can reduce the policy s cash surrender value and death benefit, increase the possibility of policy lapse and may result in a tax liability. Consult a tax advisor for additional information on the tax treatment of loans or withdrawals from a life insurance policy. Allstate Whole Life Advantage SM is a whole life insurance policy issued by Allstate Life Insurance Company of New York, Home Office: Hauppauge, NY, a wholly-owned subsidiary of Allstate Life Insurance Company, Home Office: Northbrook, IL. Allstate Whole Life Advantage is available with series NYLU796. It may be accompanied by the following riders: Additional Insured Term Insurance Rider (NYLU799), Insurance Rider (NYLU797), Primary Insured Term Insurance Rider (NYLU801), Guaranteed Insurability Rider (NYLU800), Children's Level Term Insurance Rider (NYLU697) and Waiver of Rider (NYLU699). Allstate Life Insurance Company is not responsible, as parent, for the contractual or financial obligations of Allstate Life Insurance Company of New York. Administrative Office: 2940 South 84th Street, Lincoln, NE Page 15 of 15

18 The Next Steps Once you ve customized a life insurance plan for your personal needs, here s what to expect: 1. Applying for Insurance Your agent will help you fill out an application along with any other required forms. The application will ask for personal and medical information which will be used to determine your underwriting class. It will also help determine the amount of insurance you are eligible to receive. It is possible to receive temporary insurance coverage during the application and underwriting process. Please talk to your agent to see if you are eligible. 2. Completing the Underwriting Process After you fill out the application, the next step is to complete the underwriting requirements. For a 40-year old applying for $250,000 of coverage, the following requirements are typical: A blood draw and a urine specimen Your build, blood pressure and pulse Allstate Life Insurance Company of New York will request all medical records and exams, as well as cover all of the expenses for the exams. Typically all of this will happen within a few days of the application being received. If your policy is not approved, or you are approved at an underwriting class that is different than you applied for, your agent will discuss your options with you. 3. Reviewing Your Policy Once your policy is approved and issued, your policy will be delivered to you. You will typically receive your policy within 4-8 weeks of completing your application. Your policy contains a free-look provision. If you decide that you don t want your policy during the free-look period, notify either your agent or Allstate Life Insurance Company of New York and you will receive a refund of all premium payments you have made less any outstanding loans or withdrawals. Refer to your contract for details. 4. Reassessing Your Coverage Life changes, and your life insurance needs to keep up. After all, it s one of the most important ways you can protect your family. We recommend contacting Jane W. Life at (800) to review your life insurance needs annually. Page A.1 of A.1 FIN1906A, Version: 1.05

19 INPUT SUMMARY - ALLSTATE WHOLE LIFE ADVANTAGE INSURED TAB Name Male 40 Class Sex Male Owner Same as Insured Yes Date of Birth 6/1974 Table Rating 0 Age 40 Flat Extra $0.00 Flat Extra Years All Back Dating None CONCEPT TAB Concept Policy Highlights PLAN INFO TAB Solve For Face Amount $250,000 Mode Annual Planned $0.00 Payment Option To Age 121 Excess Credit Option Purchase Additions Non-1035 Lump Sum $ Amount $0.00 Amount of Basis $ Loan Amount $0.00 APUR Match Amount None APUR Annual Amount $0.00 APUR Rider Years 0 Adjust for MEC No Fund with SPIA No Single $0.00 RIDERS TAB CTR Units/Coverage 0 - $0 CTR Years Max GIR Amount $0 PTR Amount $0 PTR Level Period 10-Year WOP No WOP Years Max DISTRIBUTIONS TAB Solve for Level Distribution Type None Withdrawals None Loans None Repayments None For Home Office Use. The Input Report displays values resulting from any searches and solves that have been performed. Please return this sheet to the Home Office along with the illustration and the application. Page 1 of 2

20 INPUT SUMMARY - ALLSTATE WHOLE LIFE ADVANTAGE AGENT TAB Name Jane W. Life Agency Life Agency Address Main Street Phone Number (800) Address 2 Suite 200 City Any Town State IL Zip Application Signed in NY REPORT OPTIONS TAB Years of Detail All Revised Illustration No Print NAIC Illustration Yes 5-Year Summaries Yes Print Ledger Only No Cost Indexes Yes Agent Notices Yes Print Next Steps Appendix Yes Text Size Small Run Date 06/12/2014 Input Summary Yes For Home Office Use. The Input Report displays values resulting from any searches and solves that have been performed. Please return this sheet to the Home Office along with the illustration and the application. Page 2 of 2