ACCORDIA LIFE AND ANNUITY COMPANY. Home Office: Des Moines, Iowa

Transcription

1 ACCORDIA LIFE AD AUITY COMPAY Home Office: Des Moines, Iowa Administrative Office: PO Box 3527 ashville, T Fax A Life Insurance Policy Illustration Flexible Premium Adjustable Life Insurance with Extended Guarantee and Optional Indexed Feature Designed for d Barry Wirt, Jr. Premier Life Strategies 11 S. Jefferson Street Suite 62 Roanoke, VA barrywirtjr@premierlifestrateg Global Atlantic Financial Group (Global Atlantic) is the marketing name for Global Atlantic Financial Group Limited and its subsidiaries, including and Forethought Life Insurance Company. Each subsidiary is responsible for its own financial and contractual obligations. is issued by Accordia Life and Annuity Company, Des Moines, Iowa THIS IS A ILLUSTRATIO OLY. A ILLUSTRATIO IS OT ITEDED TO PREDICT ACTUAL PERFORMACE. ITERES T RATES, DIVIDEDS AD VALUES SET FORTH I THE ILLUSTRATIO ARE OT GUARATEED, EXCEPT FOR THOSEITEMS CLEARLY LABELED AS GUARATEED. THIS ILLUSTRATIO IS OT BIDIG. This is page 1 of 21 pages

2 Designed for: d Assumed Issue Date April 26, 217 Coverage Summary Description Initial Amount From Age To Age Primary Insureds Initial Base Plan $ 45 - Life of Insured Additional s Illustrated Premium o Lapse Guarantee Basic o Lapse Guarantee Extended Guarantee Minimum Premium Test $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level ILLUSTRATIO EXPLAATIO Accelerated Death Rider (Terminal Illness) Accelerated Access Rider (Chronic and Critical Illness) Overloan Protection Rider Initial Annual Premium: $.. This is the initial premium you are planning to pay which may not be sufficient to continue the p olicy in-force. See Ledgers for illustrated premiums in all durations. You may vary the amount and timing of premium payments as long as they are sufficient to keep the policy in-force and do not violate the maximum limitations imposed by federal tax law. The illustration assumes that any premium payment made is at the beginning of the month of the premium mode selected. If actual p remium payments are different from the scheduled premium pay ments, or the actual payment dates are not consistent with the assumptions in theillustration, then the policy values will be different from those in this illustration. If premium payments are suspended, monthly charges will continue to be applied against the policy values. Additional premiums may be required to keep the policy in-force. This policy provides for two levels of o Lapse Guarantee: 1) a Basic o Lapse Guarantee (Basic LG); and 2) an Extended Guarantee. If the Cash is less than or equal to zero and the Minimum Premium Test is met, both levels of o Lapse Guarantee will be automatically activated. Under the Basic LG, this policy will not end under the Grace Period and Lapse provisions for 25 years if you meet the M inimum Premium Test. The Basic LG provides a guarantee of the current Base Face Amount of your policy and the amount of the Primary Insured Life Insurance Rider, if any. The Extended Guarantee begins at the end of the Basic LG period and will remain in effect for the lifetime of your policy as long as the M inimum Premium Test is met. Under this provision, the current Base Face Amount and the face amount of the Primary Insured Life Insurance Rider, if any, will be reduced by 5%. The face amount of certain other riders will also be reduced. You must pass the M inimum Premium Test that is based on a Minimum M onthly Premium of $532.5 to age 121 to retain the o Lapse Guarantee as described above. either level of o Lapse Guarantee will p revent your policy from lap sing if Policy Loans exceed the Cash. Both levels of o Lapse Guarantee will terminate if the Terminal Illness Accelerated Death Rider or the Chronic Illness Accelerated Death Rider is exercised. This is page 2 of 21 pages

3 Designed for: d Assumed Premium Direction Underwriting Class Universal Life Insurance Death Death Option Basic Interest Strategy: $4, Annually 1 Yr Fixed Term Strategy: % remaining premium Indexed Strategies: 1 Yr PtP Increased Participation: 1% remaining premium $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level on-guar. Assumed % 3.65% 5.% Other Premium Strategies may be available. Consult your agent, or your contract, for a full listing. The premium options and monthly charges calculated for this illustration assume a policy is issued with the underwriting class listed above. The actual underwriting class will depend on the outcome of the underwriting process, and may vary from what is shown on this illustration. If so, you will receive a revised illustration with your insurance contract. Changes to the underwriting class can affect the cost of your insurance coverage. Any illustrated increases to specified face amount, death benefit option change from level to increasing, addition of riders, increases to riders, underwriting class changes and removal of ratings are subject to underwriting approval. Any illustrated changes that are not contractual, do not occur automatically, but must be requested in writing by the contract owner. is a flexible premium adjustable life insurance policy (sometimes referred to as universal life). This life insurance provides for an adjustable death benefit and flexible premium payments. This illustration shows values and benefits based upon assumptions specified herein, and reflects both guaranteed and non-guaranteed values. Illustrated values will not represent actual policy performance. The Cash is based upon a number of factors, including premium pay ments, monthly charges, surrender charges, partial withdrawals, loans, and interest credited to the policy. The cost of insurance, which is part of the monthly charges, is based on the difference between the death benefit and the Account. Interest rates and charges are subject to change. The guaranteed annual effective interest rate is 2.% for the Basic Interest Strategy and each Fixed Term Strategy. For each Indexed Strategy, a minimum interest rate of 2% is guaranteed on the earlier of policy termination or end of Indexed Strategy term. The charges are guaranteed not to exceed the maximums listed in the contract. See the policy for more information. This is a life insurance product and does not represent an investment in the stock market. This life insurance product is offered through and is not FDIC insured. The death benefit assumed at issue is shown above. The actual amount payable at death may be decreased by loans, withdrawals, and/or accelerated death benefit payments, including applicable interest and fees. The insurance contract will specify how to determine the benefit. The policy, as illustrated, provides for a level death benefit. The death benefit option may be changed at any time after the first policy year, subject to evidence of insurability as required by the policy. See the policy for more information. This is page 3 of 21 pages

4 Designed for: d Guaranteed Elements $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level The guaranteed Cash is the lowest amount available to the contract owner upon surrender of the policy based upon the accompanying Guaranteed Ledger and is contingent upon premium payments, timing of premium payments, and other changes available in the contract. This value is based upon a guaranteed annual effective interest rate of 2.% and maximum policy charges. The guaranteed net death benefit is the minimum amount available upon death of the insured. Account Surrender Charges Penalty Free Withdrawal Cash Cash on-guaranteed Elements The sum of the value of the Basic Interest Strategy, the value of all Fixed Term Strategies, the value of all Indexed Strategies, and the outstanding balance of any Annually Declared (fixed) policy loans. The Account s are subject to a surrender charge in the first fifteen years from issue or after a face increase. Each policy year, an amount up to 2% of the net cash value as of the date of the withdrawal (but not more than the maximum amount available as defined in your contract), less any prior penalty free withdrawals taken in that policy year will be available without incurring a surrender charge. However, the withdrawal fee will still apply. If less than 2% is withdrawn in any policy year, the remaining amount does not roll over to future policy years. The Account less any surrender charges that apply. The Cash less any outstanding policy loans and loan interest due, if any. This is the amount available to the contract owner upon surrender. When there is a zero in the Cash column and a zero in the Death column in the same year on the Ledgers, indicate the policy will lapse in that year, as illustrated. Many aspects of your life insurance contract will be guaranteed including your minimum interest rate and maximum charges. However, other aspects of the policy cannot be predicted. For example, the interest rate credited may exceed the guaranteed rate and monthly charges may be less than the maximum guaranteed charges. This illustration assumes a non-guaranteed annual account value enhancement, beginning at the end of year 21. This enhancement is.6% of the average monthly account value. The non-guaranteed elements can improve the value of your life insurance by increasing y our contract's cash value and/or death benefit. Variations in these factors could affect: death benefits, net cash value, or available loans and withdrawals. The on-guaranteed Alternate Scale is credited with a rate equal to that of the 1 Year Fixed Term Strategy. All other elements are equal to those shown under the on-guaranteed Assumptions. The minimum average annual rate and maximum average annual rate listed below reflect the lowest and highest average annual credited rates of the 1 Year Point to Point strategy over the lookback period required by regulation. Minimum Average Annual Rate 4.16% Maximum Average Annual Rate 8.3% This is page 4 of 21 pages

5 Designed for: d 7 Pay Premiums (MEC Calculations) IRC 772 Life Insurance Test Cost Disclosure Payment and Cost Indexes The non-guaranteed pages provide snapshots of your projected policy values assuming higher interest and lower charges than those that are guaranteed. Since these elements cannot be predicted, ranges of results are illustrated. The actual policy values will be less or more favorable than these illustrated results. The illustration also assumes all premium outlays are paid as shown. Unless otherwise stated, all values shown are determined as of the end of the contract year. All values are based on the actual Modal Premium Payment selected. The non-guaranteed benefits and values are based on assumptions that are subject to change by the company. In order to receive favorable tax treatment of distributions (including loans) under the Internal Revenue Code (IRC), a life insurance contract must satisfy a 7-Pay Premium limitation during the first 7 years and during 7 years after certain contract changes. Exceeding this limitation makes the contract a M odified Endowment Contract (M EC) and causes distributions, including loans and withdrawals, to be taxable to the extent that there is a gain in the contract. In addition, there is a penalty of 1% of taxable income for distributions from such contracts before age 59½ with certain exceptions. Initial 7-Pay Annual Premium: $46, Certain changes to the contract's benefits (whether illustrated or not) will alter the premium limitations and could cause a non-mec contract to become a MEC. Please consult your tax advisor for more information. This test is used to determine if a policy will qualify as life insurance under applicable tax laws. This illustration uses the Cash Accumulation Test. The non-guaranteed elements illustrated are based on fully allocated expenses. Interest Adjusted Indexes are based on a 5% rate for the basic contract. Guaranteed on-guaranteed Year Surrender Cost Payment Surrender Cost Payment $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level Surrender Cost Index is a standard industry index which reflects the cost of surrendering this policy at the end of the year noted based upon Guaranteed and on-guaranteed values. Payment Index is a standard industry index which reflects the cost of receiving death benefits at the end of the year noted based upon Guaranteed and on-guaranteed values. Cost Indexes are useful only for comparison of the related costs of two or more similar contracts. A low index number represents a lower cost than a higher index number. Gross Premium DEFIITIOS OF KEY TERMS O LEDGERS This is the amount of premium you plan to pay for this policy. This is page 5 of 21 pages

6 Designed for: d $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level This is the amount of Gross Premium the contract owner plans to pay minus withdrawals minus loans plus loan interest paid out of pocket. This is page 6 of 21 pages

7 Designed for: d Summary Indexed Strategies $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level IDEXED STRATEGIES DIS CLOSURE 's Indexed Strategy is a premium direction option available with this life insurance policy. It is not a substitute for an equity indexed mutual fund or any other type of equity investment. Premium directed to any Indexed Strategy does not directly participate in any stock or investments. STRATEGY AME Glossary of Terms Current Participation Rate Guaranteed Minimum Participation Rate * Current Cap Minimum Cap * Interest Crediting Period Indexed Segment Term Interest Crediting Dates 1 Yr PtP Increased Participation 2% 2% 9% Annually 1% Annually 12 Months 5 Years 12, 24, 36, 48 & 6 Months Index Used S&P 5 * Guaranteed while the policy remains in-force Terms used in calculating Interest Credits on an Indexed Strategy: Index Used - the relevant Index(es) used for determining the Interest Credits are identified with each strategy in the chart displayed above. Index umber - as of any date is the value of the Index as of the close of business on the day before such date. We determine the Index umber using the value as reported by a third party source at a consistent time each day. Any change in the reported value of the Index after our determination of the Index umber will not be included in the calculation of the Index Growth for that day, if applicable. If the value of the Index is not reported on any day for which an Index umber is needed, the first preceding reported value of the Index will be used. Index Growth - the percentage increase in the Index umber from one Interest Crediting Date to the next Interest Crediting Date. The starting Index umber is reset each time the growth is measured. This is page 7 of 21 pages

8 Designed for: d $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level Participation Rate - the percentage of the Index Growth you are eligible to earn. The Participation Rate is guaranteed to be no less than 1% for the life of the the contract, and may be higher based on your Indexed Strategy selection. Cap - a limit on the Index Growth that can be credited to a segment. This cap may be reset for each segment on the schedule displayed on the chart above, subject to certain minimums. Interest Credits - interest credited to the segment based on Index Growth. Interest Credits are credited to each segment on an Interest Crediting Date. 1 Yr PtP Increased Participation - Interest Credits are calculated by multiplying the Participation Rate by the percentage increase in the Index, if any, from one Interest Crediting Date to the next Interest Crediting Date. The resulting interest crediting rate is subject to a Cap, which can change on every Interest Crediting Date, within specified limits. The interest crediting rate in any year can never be less than zero. Indexed Strategy Operation Each time a portion of your Account is directed to an Indexed Strategy, a new segment is created. Each segment has its own Participation Rate and Cap. The values and Interest Credits for each segment are calculated independently of other segments. For each segment created, no Interest Credits are credited between Interest Crediting Dates. Interest Credits will not be credited should the policy cease prior to the Interest Crediting Date. Likewise, if amounts are withdrawn from a segment between Interest Crediting Dates, no Interest Credits are credited on the withdrawn funds. At the end of the term of each segment, the values in that segment will automatically be directed into the Basic Interest Strategy. At that point, part of the values may be directed into the strategies you have elected. This is page 8 of 21 pages

9 Designed for: d Historical Index Returns $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level HISTORIC AL I DEX CHAGES AD HYPOTHETICAL I TEREST CRED ITIG RATES The following table shows hypothetical interest rates using current index parameters for the most recently completed 2 year period. End of Year S&P 5 Index 1 Yr Point-to- Point (1 Yr PtP) Strategies Linked to S&P 5 Index 1 Yr PtP Increased Participation 1 Yr PtP Elevated Cap 1 Yr Monthly Cap 2 Yr Point-to- Point (2 Yr PtP) Hang Seng Index 1 Yr PtP International Index % 11.% 9.% 14.5% 13.21% 2.29%.% % 11.% 9.% 14.5% 8.82% 27.% 6.29%.% % 11.% 9.% 14.5% 1.51% 68.8% 13.% %.%.%.%.% 7.41% 11.%.% %.%.%.%.% 24.5%.% %.%.%.%.%.% 18.21%.% % 11.% 9.% 14.5% 14.44% 34.92% 13.% % 8.99% 9.% 5.99% 8.52% 27.% 13.15% 13.% 25 3.% 3.% 6.%.% 3.12% 4.54% 4.54% % 11.% 9.% 1.62% 12.99% 17.3% 34.2% 13.% % 3.53% 7.6%.53% 3.% 39.31% 13.% %.%.%.%.%.% 48.27%.% % 11.% 9.% 14.5% 4.62% 52.2% 13.% % 11.% 9.% 9.78%.% 27.% 5.32% 5.32% 211.%.%.%.%.% 19.97%.% % 11.% 9.% 1.41% 1.8% 13.4% 22.91% 13.% % 11.% 9.% 14.5% 22.5% 2.87% 2.87% % 11.% 9.% 8.39% 1.6% 27.% 1.28% 1.28% %.%.%.%.% 7.16%.% % 9.54% 9.% 6.54% 7.27% 8.74%.39%.39% This is page 9 of 21 pages

10 Designed for: d $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level The "S&P 5 Index" is a product of S&P Dow Jones Indices LLC("SPDJI"), and has been licensed for use by. St andard & Poor's, S&P and S&P 5 are registered trademarks of St andard & Poor's Financial Services LLC ("S&P"); Dow Jones is a registered trademark of Dow Jones Trademark Holdings LLC ("Dow Jones") and these trademarks have been licensed for use by SP DJI and sublicensed for certain purposes by. 's products are not sponsored, endorsed, sold or promoted by SP DJI, Dow Jones, S&P, any of their respective affiliates (collectively, "S&P Dow Jones Indices"). S&P Dow Jones Indices makes no representation or warranty, express or implied, to the owners of the 's products or any member of the public regarding t he advisability of investing in securities generally or in the Accordia Life and Annuity Company's products particularly or the ability of the S&P 5 Index to track general market performance. S&P Dow Jones Indices' only relationship to with respect to the S&P 5 Index is the licensing of the Index and certain trademarks, service marks and/or trade names of S&P Dow Jones Indices and/or its licensors.the S&P 5 Index is determined, composed and calculated by S&P Dow Jones Indices without regard to or 's products. S&P Dow Jones Indices has no obligation to take the needs of or the owners of 's products into consideration in determining, composing or calculating the S&P 5 Index. S&P Dow Jones Indices is not responsible for and has not participated in the determination of the prices, and amount of 's products or the timing of the issuance or sale of 's products or in the determination or calculation of the equation by which 's products is to be converted into cash, surrendered or redeemed, as the case may be. S&P Dow Jones Indices has no obligation or liability in connection with the administration, marketing or trading of 's products. There is no assurance that investment products based on the S&P 5 Index will accurately track index performance or provide positive investment returns. S&P Dow Jones Indices LLC is not an investment advisor. Inclusion of a security within an index is not a recommendation by S&P Dow Jones Indices to buy, sell, or hold such security, nor is it considered to be investment advice. otwithstanding the foregoing, CME Group Inc. and its affiliates may independently issue and/or sponsor financial products unrelated to 's products currently being issued by, but which may be similar to and competitive with Accordia Life and Annuity Company's products. In addition, CME Group Inc. and its affiliates may trade financial products which are linked to the performance of the S&P 5 Index. S&P DOW JOES IDICES DOES OT GUARATEE THE ADEQUACY, ACCURACY, TIMELIESS AD/OR THE COMPLETEESS OF THE S&P 5 IDEX OR AY DATA RELATED THERETO OR AY COMMUICATIO, ICLUDIG BUT OT LIMITED TO, ORAL OR WRITTE COMMUICATIO (ICLUDIG ELECTROIC COMMUICATIOS) WITH RESPECT THERETO. S&P DOW JOES IDICES SHALL OT BE SUBJECT TO AY DAMAGES OR LIABILIT Y FOR AY ERRORS, OMISSIOS, OR DELAYS THEREI. S&P DOW JOES IDICES MAKE O EXPRESS OR IMPLIED WARRATIES, AD EXPRESSLY DISCLAIMS ALL WARRATIES, OF MERCHATABILITY OR FITESS FOR A PARTICULAR PURPOSE OR USE OR AS TO RESULTS T O BE OBTAIED BY ACCORDIA LIFE AD AUITY COMPAY, OWERS OF ACCORDIA LIFE AD AUITY COMPAY'S PRODUCTS, OR AY OTHER PERSO OR ETITY FROM THE USE OF THE S&P 5 IDEX OR WITH RESPECT TO AY DATA RELATED THERETO. WITHOUT LIMITIG AY OF THE FOREGOIG, I O EVET WHATSOEVER SHALL S&P DOW JOES IDICES BE LIABLE FOR AY IDIRECT, SP ECIAL, ICIDETAL, PUITIVE, OR COSEQUETIAL DAMAGES ICLUDIG BUT OT LIMITED TO, LOSS OF PROFITS, T RADIG LOSSES, LOST TIME OR GOODWILL, EVE IF THEY HAVE BEE ADVISED OF THE POSSIBLITY OF SUCH DAMAGES, WHETHER I COTRACT, TORT, STRICT LIABILITY, OR OTHERWISE. THERE ARE O THIRD PART Y BEEFICIARIES OF AY AGREEMETS OR ARRAGEMETSBETWEE S&P DOW JOES IDICES AD ACCORDIA LIFE AD AUITY COMPAY OTHER THA THE LICESORS OF S&P DOW JOES IDICES. This is page 1 of 21 pages

11 Designed for: d Terminal Illness Accelerated Death Rider (ICC13- LTABR-E14) Chronic and Critical Illness Accelerated Death Rider (ICC16-LCCABR2- I16) Overloan Protection Rider (ICC13- ILOPR-E14) $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level DESCRIPTIO OF ADDITIOAL BEEFITS Riders provide additional benefits that are not available through the base plan. ote that riders that have a monthly charge will reduce the surrender value otherwise available to the contract owner without the rider. In the event of a requested term conversion, electing riders may require additional underwriting. Additional s This rider is automatically included. It provides an acceleration of death benefits if the insured becomes terminally ill. There may be an administrative fee charged for exercising this benefit. If the insured is diagnosed with a terminal illness, a benefit of up to one half of the policy face amount (up to $25,) is available. The total eligible amount will be based on the current death benefit less any outstanding loans and liens at the time of claim. Receipt of the accelerated death benefits may be taxable and may affect eligibility for public assistance programs. This rider provides an acceleration of death benefits if the Insured is certified as being Chronically Ill or Critically Ill, all ap plicable eligibility requirements are met, and applicable elimination periods are met. There may be a Claims Processing Fee charged for exercising this benefit. Any benefits paid under this rider along with interest on those benefits will reduce the death proceeds payable to the beneficiary. Although payments made for a Chronic Illness under this rider generally are intended to qualify for favorable tax treatment under section 11(g) of the Internal Revenue Code and payments made for a Critical Illness under this rider generally are intended to qualify in whole or in part for favorable tax treatment under section 14(a)(3) of the Internal Revenue Code, payments under this rider may be taxable. The owner should consult a professional tax advisor to determine the current tax consequences before requesting any accelerated death benefits. This rider is not intended to be a: Qualified long term care insurance contract under section 772B(b) of the Internal Revenue Code on-qualified long term care insurance contract This rider prevents a contract from lapsing due to loan indebtedness when certain conditions are met by automatically converting it to a paid up coverage. Conditions include a minimum attained age, minimum percent of indebtedness, minimum number of years the contract must be in-force, and a loan balance that exceeds the current base face amount. There is a maximum fee of 13.5% of the Account when the rider benefit is triggered. This is page 11 of 21 pages

12 Designed for: d POLICY YEAR shows the age of the policy in years. EOY (End of Year) AGE shows the insured's age at the end of the policy year. GUARATEED is the guaranteed amount available to the contract owner upon surrender/death. 2% interest rate for the Basic Interest and each Fixed Term Strategy, 2% minimum interest rate for each Indexed Strategy guaranteed on earlier of policy termination or end of Indexed Strategy Term. O-GUARATEED MIDPOIT shows hypothetical net cash value/death benefit based on non-guaranteed elements approximately midway between the guaranteed values and the current values. O-GUARATEED ASSUMED shows the value/death benefit is not guaranteed and is subject to change. See Assumed Premium Direction paragraph on page 3. This illustration assumes the non-guaranteed elements will continue as assumed for all years shown. This is not likely to occur, and actual results may be more or less favorable. Policy Year $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level UMERIC SUMMARY EOY Age Guaranteed Cash Death on-guaranteed Midpoint Cash Death on-guaranteed Assumed Cash Death ,71 32, ,66 149, , ,12 The coverage under each of the scenarios illustrated above will terminate at: Guaranteed: Life of Insured. Midpoint: Life of Insured. Assumed: Life of Insured. 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. I have received a copy of the Indexed Strategies Disclosure (which is part of this illustration) for the policy applied for. I understand that any values shown, other than guaranteed minimum values, are not guarantees, promises or warranties. Signature of Applicant (Policy/Contract 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 illustration. I certify that the Indexed Strategies Disclosure (which is part of this illustration) has been presentedto the Applicant. A copy was provided to the Applicant. I have not made statements which differ in any significant manner from this material. I have not made any promises or guarantees about the future value of any non-guaranteedelements. Signature of Agent Agent Code Date 1b938t THIS ILLUSTRATIO IS OT A POLICY COTRACT This is page 12 of 21 pages

13 Designed for: d GUARATEED LEDGER $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level Policy Year Gross Premium Guaranteed at 2% Cash Death EOY Age Key Account 1 46 A 1, A 3, A 4, A 5, A 6, A 7, A 7, A 7, A 7, A 6,588 86,79 86, A 5, A 3, A A 15 6 A A A A A 2 65 A 173,58 173, A A A A 25 7 A A 5, A 5, A 5, A 5, 3 75 A 5, 26,37 26,37 This is page 13 of 21 pages

14 Designed for: d Policy Year Gross Premium $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level Guaranteed at 2% Cash Death EOY Age Key Account A 5, A 5, A 5, A 5, 35 8 A 5, A 5, A 5, A 5, A 5, 4 85 A 5, 347,16 347, A 5, A 5, A 5, A 5, 45 9 A 5, A 5, A 5, A 5, A 5, 5 95 A 5, 433,95 433, A 5, A 5, A 5, A 5, 55 1 A 5, A 5, A 5, A 5, A 5, 6 15 A 5, 52,74 52,74 This is page 14 of 21 pages

15 Designed for: d Policy Year Gross Premium $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level Guaranteed at 2% Cash Death EOY Age Key Account A 5, A 5, A 5, A 5, A 5, A 5, A 5, A 5, A 5, A 5, 67,53 67, A 5, A 5, A 5, A 5, A 5, A 5, 659,64 659,64 Key: A = Annual Prems S = Semi-Annual Prems Q = Quarterly Prems M = Monthly/PAC Prems L = Loan R = Loan Repayment W = Withdrawal I = Interest Paid Out of Pocket F = Force Out P = Exercise of OP Rider This is page 15 of 21 pages

16 Designed for: d Assumed Premium Direction Policy Year Gross Premium O-GUARATEED LEDGER Basic Interest Strategy: $4, Annually 1 Yr Fixed Term Strategy: % remaining premium Indexed Strategies: 1 Yr PtP Increased Participation: 1% remaining premium on-guaranteedalternate Scale at 3.65% Cash Death on-guaranteed Assumed Cash Death EOY Age Key Account Account 1 46 A 3,76 3, A 7,567 7, A 11,423 11, A 15,333 15, A 19,292 2, A 23,313 4,88 24,45 6, A 27,389 1,799 28,939 12, A 31,528 16,781 33,566 18, A 35,733 22,83 38,34 25, A 4,18 28,958 43,278 32,218 86,79 86, A 48,324 39,17 52,381 43, A 56,756 49,383 61,761 54, A 65,362 59,832 71,476 65, A 74,147 7,461 81,543 77, A 83,129 81,285 91,991 9, A 92,239 92,239 12,764 12, A 11,474 11, , , A 11,796 11, , , A 12,236 12, ,65 137, A 129, , , , ,58 173,58 See the GUARATEED LEDGER on page 13 for guaranteed elements. $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level on-guar. Assumed % 3.65% 5.% This is page 16 of 21 pages

17 Designed for: d Policy Year Gross Premium on-guaranteedalternate Scale at 3.65% Cash Death on-guaranteed Assumed Cash Death EOY Age Key Account Account A 14,129 14, , , A 15,77 15,77 176, , A 161, ,478 19,813 19, A 172, ,365 25,721 25, A 183, , ,12 221, A 194, , , , A 25,212 25, , , A 216, ,199 27,32 27, A 227,15 227,15 287, , A 238,55 238,55 35,294 35,294 26,37 26, A 248, , , , A 259, , , , A 269, , , , A 279, , ,86 381, A 288, ,316 41,934 41, A 296, , , , A 33,789 33, ,44 443, A 39,968 39, ,8 464, A 314, , , , A 318, ,417 57,253 57, ,16 347, A 32,98 32,98 529, , A 319, , , , A 316, , , , A 31,615 31, , , A 31,1 31,1 621, , A 287, , , , A 269, ,214 67,654 67, A 245, , , , A 214, , ,68 724, A 176,53 176,53 754,63 754,63 433,95 433,95 See the GUARATEED LEDGER on page 13 for guaranteed elements. $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level This is page 17 of 21 pages

18 Designed for: d Policy Year Gross Premium on-guaranteedalternate Scale at 3.65% Cash Death on-guaranteed Assumed Cash Death EOY Age Key Account Account A 192,77 192,77 84,483 84, A 28,313 28, , , A 225,24 225,24 913, , A 242, , , , A 261, ,283 1,36,4 1,36,4 1,56, A 28,462 28,462 1,12,259 1,12,259 1,124, A 3,456 3,456 1,172,187 1,172,187 1,195, A 321,3 321,3 1,246,33 1,246,33 1,27, A 343,31 343,31 1,324,16 1,324,16 1,35, A 365, ,686 1,46,368 1,46,368 1,434,495 52,74 52, A 389,34 389,34 1,493,334 1,493,334 1,523, A 413, ,926 1,585,172 1,585,172 1,616, A 439, ,595 1,682,155 1,682,155 1,715, A 466, ,355 1,784,572 1,784,572 1,82, A 494, ,253 1,892,727 1,892,727 1,93, A 523, ,337 2,6,941 2,6,941 2,47, A 553, ,658 2,127,554 2,127,554 2,17, A 585, ,269 2,254,924 2,254,924 2,3, A 618, ,223 2,389,43 2,389,43 2,437, A 652, ,578 2,531,472 2,531,472 2,582,11 67,53 67, A 688, ,394 2,681,472 2,681,472 2,735, A 725, ,733 2,839,875 2,839,875 2,896, A 764, ,659 3,7,153 3,7,153 3,67, A 85,241 85,241 3,183,83 3,183,83 3,247, A 847, ,548 3,37,35 3,37,35 3,437, A 891, ,654 3,567,348 3,567,348 3,638, ,64 659,64 See the GUARATEED LEDGER on page 13 for guaranteed elements. $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level Key: A = Annual Prems S = Semi-Annual Prems Q = Quarterly Prems M = Monthly/PAC Prems L = Loan R = Loan Repayment W = Withdrawal I = Interest Paid Out of Pocket F = Force Out P = Exercise of OP Rider This is page 18 of 21 pages

19 Designed for: d Premium payments can be increased up to the maximum limits in order to extend and increase benefits and values. Policy Year $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level POLICY OUTLAY EOY Age Policy on-guaranteed Assumed Gross Withdrawal on-guaranteed Assumed Loan Balance 7-Pay Premiums Annual 7-Pay Cumulative 7-Pay ,63 46, ,63 93, ,63 139, ,63 186, ,63 233, ,63 279, ,63 326, , , ,37 This is page 19 of 21 pages

20 Designed for: d Premium payments can be increased up to the maximum limits in order to extend and increase benefits and values. Policy Year EOY Age Policy on-guaranteed Assumed Gross Withdrawal $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level on-guaranteed Assumed Loan Balance 7-Pay Premiums Annual 7-Pay Cumulative 7-Pay , , ,74 This is page 2 of 21 pages

21 Designed for: d Premium payments can be increased up to the maximum limits in order to extend and increase benefits and values. Policy Year EOY Age Policy on-guaranteed Assumed Gross Withdrawal $ Selected Face Amount Initial Annual Premium: $. Initial Death Option: Level on-guaranteed Assumed Loan Balance 7-Pay Premiums Annual 7-Pay Cumulative 7-Pay , ,64 This is page 21 of 21 pages

22 Living benefits available from your Life Insurance Policy. Life insurance can help provide financial security and continuity during one of life s most difficult times: the death of a loved one. What you may not know is that life insurance can also help during another one of life s most difficult times: a chronic, critical or terminal illness. This help comes in the form of optional riders called Accelerated Death Riders, often referred to as Living s, w hich can be added at no additional cost. The policy may also offer cash value that may be used for supplemental income or for unexpected emergencies. In addition, w aivers are available to assist in maintaining the funding of your life insurance policy in the event of disability. Insured: d Product: Initial Face Amount: $ Provided See Page 2 for more details Impairment Qualification Projected on-guaranteed Chronic Illness Rider that provides an acceleration of death benefits if the insured is certified as Chronically Ill. This rider can help reduce the financial burden by helping to pay for medical expenses and other costs related to Chronic Illness w hen the insured meets certain qualifications. Unable to perform without substantial assistance at least 2 of the 6 Activities of Daily Living (ADLs) One condition is expected to be permanent Maximum Annual Age Amount 65 $117,6 75 $163,2 85 $18, Critical Illness Designed to help fill the financial gaps not covered by traditional health, disability, life and accident insurance. If a life-threatening illness occurs, our Critical Illness rider provides a benefit to help protect quality of life. The insured becomes Critically Ill w ith one of the 1 covered conditions Age 5 $5, 55 $5, 65 $5, Terminal Illness We automatically provide this valuable feature at no charge. Terminal illness can cause a lot of hardship, emotionally and financially. This rider helps with the latter by providing some of the death benefit up front to assist with health costs and other expenses. The life expectancy of the insured is 12 months or less At Issue $25, The values and benef its are not guaranteed and are subject to change unless the inf ormation is marked guaranteed. The v alues and representations in the table abov e are based on current policy expenses and interest rates, and are not guaranteed. This supplemental illustration must be accompanied by a Basic illustration f or required disclosure, including inf ormation on guaranteed elements and v alues. Products are issued by Accordia Lif e and Annuity Company, 215 1th Street, Des Moines, Iowa. Accordia Lif e is a subsidiary of Global Atlantic Financial Group Limited. This is page 1 of 3 pages

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27 Initial Death $ ame: d Male Age : 45-Preferred on-tobacco Date: 4/26/217 Initial Payment $ on-guaranteed Interest Rate (1st Yr) 4.27% Tax Bracket 35% Year Age Annual Cumulative Annual Cash Incr / Decr Surrender Death , , , ,395 T@ 5 43,395 43, ,74 6,17 6, ,753 6,333 12, ,432 6,47 18, ,111 6,617 25, ,79 6,781 32,218 T@ 55 86,79 86,79 32,218 32, ,469 1,945 43, ,148 11,224 54, ,827 11,558 65, ,56 11,911 77, ,185 12,291 9,147 T@ 6 13,185 13,185 9,147 9, ,864 12,617 12, ,543 11,19 113, ,222 11, , ,91 11, , ,58 12,83 149,149 T@ ,58 173,58 149, , ,259 13, , ,938 13, , ,617 14,416 19, ,296 14,98 25, ,975 15, ,12 T@ 7 216, , ,12 221,12 V2.51. C This is a supplemental illustration. It must be accompanied by a Accordia Life Provider proposal from Accordia Life and Annuity Company which contains guaranteed elements and other important information. Any non-guaranteed elements illustrated are subject to change and can be either higher or lower. Presented by: Barry Wirt, Jr. Page 27.1 of 27.5

28 Initial Death $ ame: d Male Age : 45-Preferred on-tobacco Date: 4/26/217 Initial Payment $ on-guaranteed Interest Rate (1st Yr) 4.27% Tax Bracket 35% Year Age Annual Cumulative Annual Cash Incr / Decr Surrender Death ,654 15, , ,333 16, , ,12 16,835 27, ,691 17, , ,37 17,98 35,294 T@ 75 26,37 26,37 35,294 35, ,49 18, , ,728 18, , ,47 19,43 362, ,86 19, , ,765 2,74 41,934 T@ 8 33,765 33,765 41,934 41, ,444 2,47 422, ,123 2,72 443, ,82 21,36 464, ,481 21,48 485, ,16 21,764 57,253 T@ ,16 347,16 57,253 57, ,839 22,76 529, ,518 22, , ,197 22, , ,876 23, , ,555 23, ,224 T@ 9 39,555 39, , , ,234 24, , ,913 25,166 67, ,592 26, , ,271 27, , ,95 29, ,63 T@ ,95 433,95 754,63 754,63 V2.51. C This is a supplemental illustration. It must be accompanied by a Accordia Life Provider proposal from Accordia Life and Annuity Company which contains guaranteed elements and other important information. Any non-guaranteed elements illustrated are subject to change and can be either higher or lower. Presented by: Barry Wirt, Jr. Page 27.2 of 27.5

29 Initial Death $ ame: d Male Age : 45-Preferred on-tobacco Date: 4/26/217 Initial Payment $ on-guaranteed Interest Rate (1st Yr) 4.27% Tax Bracket 35% Year Age Annual Cumulative Annual Cash Incr / Decr Surrender Death ,629 5,42 84, ,38 53, , ,987 56, , ,666 59, , ,345 62,75 1,36,4 1,56,761 T@ 1 477, ,345 1,36,4 1,36,4 1,56, ,24 66,218 1,12,259 1,124, ,73 69,928 1,172,187 1,195, ,382 73,846 1,246,33 1,27, ,61 77,983 1,324,16 1,35, ,74 82,352 1,46,368 1,434,495 T@ 15 52,74 52,74 1,46,368 1,46,368 1,434, ,419 86,966 1,493,334 1,523, ,98 91,838 1,585,172 1,616, ,777 96,983 1,682,155 1,715, ,456 12,417 1,784,572 1,82, ,135 18,155 1,892,727 1,93,581 T@ , ,135 1,892,727 1,892,727 1,93, , ,214 2,6,941 2,47, ,493 12,613 2,127,554 2,17, , ,37 2,254,924 2,3, , ,56 2,389,43 2,437, ,53 142,42 2,531,472 2,582,11 T@ ,53 67,53 2,531,472 2,531,472 2,582, ,29 15, 2,681,472 2,735, , ,44 2,839,875 2,896, , ,278 3,7,153 3,67, , ,65 3,183,83 3,247, , ,547 3,37,35 3,437,757 T@ 12 65,925 65,925 3,37,35 3,37,35 3,437, ,64 196,998 3,567,348 3,638,695 T@ ,64 659,64 3,567,348 3,567,348 3,638,695 V2.51. C This is a supplemental illustration. It must be accompanied by a Accordia Life Provider proposal from Accordia Life and Annuity Company which contains guaranteed elements and other important information. Any non-guaranteed elements illustrated are subject to change and can be either higher or lower. Presented by: Barry Wirt, Jr. Page 27.3 of 27.5

30 Column Description Page April 26, 217 Annual Annual outlay net of taxes (Tax on Withdrawal and MEC Loan). Cumulative Sum of net annual outlay. Annual Cash Incr / Decr Annual increase in cash value. Surrender Gross Cash net of Loans and Withdrawals. Death Gross Death net of Loans and Withdrawals. Page 27.4 of 27.5

31 Illustration Concept: Concept Information Page April 26, 217 The Ledger concept illustrates non-guaranteed values and other nonguaranteed elements. The net annual premium outlay column includes total illustrated annual premium for the base policy and any riders less any loans, dividends and/or surrenders of other policy values, plus any tax consequences that might result from situations such as a Modified Endowment Contract. Please refer to the Basic Ledger and Supplemental Ledger for a complete description of non-guaranteed values including definitions of cash value and death benefit columns. Page 27.5 of 27.5

32 Client Input Summary Company:, a Global Atlantic C Product: April 26, 217 Insured Insured ame d Sex Male Age 45 Class Preferred on-tobacco Flat Extra 1 to 5 -. State of Issue Alabama Application Sign Date 4/26/217 Solve For Solve For o Solve Total Face Amount 1 to 76 - Modal Premium 1 to 76 - Primary Insured Rider Amount 1 to 54 - Commission Target Disbursements Disbursements Policy Options 1 Year Fixed % 1 Year Point to Point % 1 Year Point to Point Increased Participation% 1 1 Year Point to Point International Index% 1 Year Point to Point Elevated Cap% 1 Year Monthly Cap % 2 Year Point to Point % Total Allocation % MUST EQUAL 1% 1 Basic Interest % Year Fixed % Year Point to Point % Year Point to Point Increased Participation% 5 1 Year Point to Point International Index% Year Point to Point Elevated Cap% Year Monthly Cap % Year Point to Point % 2.5 Death Option 1 to Level Premium Mode Annual Insurance Test Cash Accum Prevent MEC Y Lump Sum 1 to Exchange Amount Revised Illustration Years to Print Max Page 1 of 2

33 Client Input Summary Company:, a Global Atlantic C Product: April 26, 217 Policy Riders Policy Riders Waiver of Spec Premium Accidental Death Guaranteed Purchase Option Children's Insurance Accelerated Death [Terminal Illness] Overloan Protection Wellness for Life Chronic and Critical Illness Rider Y Y Y Y Other Insured Additional Insureds Supplemental Reports Supplemental Reports Agent Only Illustration Internal Rate of Return Policy Expenses Policy s Cost Loan Guaranteed Interest Supp Report Policy vs. 4 Funds Policy vs. Qualified Plan Living s Supplemental Report Global Atlantic Thinking Ahead Financials Supplemental Report Y Y Y Agent Info Agent ame Barry Wirt, Jr. Agent Company Premier Life Strategies Agent Address1 11 S. Jefferson Street Agent Address2 Suite 62 Agent City Roanoke Agent State Virginia Agent Zip Code 2411 Agent Phone Agent barrywirtjr@premierlifestrateg Agent License # Bank Sale Concept Concept Ledger Tax Bracket 1 to Page 2 of 2