LifeScape Single Premium Whole Life Insurance Illustration

LifeScape Single Whole Life Insurance Illustration Prepared for: Sample Client M NS Age 55 Presented by: Dennis Begley Associated Insurance Agents, Inc. 2800 Freeway Blvd. Brooklyn Center, Minnesota 55430 Phone Number: (763) 549-2260 www.assurity.com

Prepared for: Sample Client M NS Age 55 Issue Age: 55 NARRATIVE SUMMARY Policy Description LifeScape Single Whole Life is a level-benefit, single premium, participating whole life insurance policy with maturity at age 121. Payment of the premium, assuming no loans are made, guarantees that the policy will remain in force until age 121. Any dividends declared on this policy due to its participating status will be paid according to the dividend option selected. Underwriting Class: Male, Select Non- Tobacco Initial Base : $198,776 Contract : $99,999.70 Initial Dividend Option Selected: Paid-Up Additions This policy is a modified endowment contract (MEC) at issue. Money distributed from a modified endowment contract by cash distributions, withdrawals, loans or assignments will be considered taxable income until all gain, if any, has been distributed. The taxable income amounts will also be subject to a 10% penalty tax unless the owner is at least 59 1/2, becomes disabled or annuitizes the entire cash value. benefits of modified endowment contracts paid to the beneficiary continue to be treated as life insurance proceeds and therefore are not subject to income tax. The premium required for the insurance coverage 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 policy. The initial base death benefit is $198,776. The contract premium is $99,999.70. Policy dividends are used to purchase additional paid-up insurance. The amount of additional insurance purchased is that which the dividend, applied as net single premium, can buy at the insured's attained age. This dividend option is selected from age 55 to 121. NUMERIC SUMMARY AND POLICY VALUES DEFINITIONS Guaranteed Columns Illustrate the policy values that are guaranteed and established at issue. These policy values assume no dividends are paid. Available cash values and death benefits will never be less than the values shown here assuming timely payment of the contract premium. Non-Guaranteed Columns Illustrated Scale Columns Illustrate the policy values that are not guaranteed because the assumptions on which they are based are subject to change. These underlying assumptions will change as Assurity's future experience with respect to mortality, interest, expenses, taxes and other factors unfolds. The outlays, values and benefits shown in these columns are neither guarantees nor estimates of future Assurity performance. Actual outlays, values and benefits may be more or less favorable than those illustrated. The expense basis used in this illustration is the current NAIC-approved Generally Recognized Expense Table. Illustrate the policy values that are based on the current dividend scale. The values shown in these columns assume that dividends are payable according to the current scale for the life of the policy. This is very unlikely to occur. Actual results may be more or less favorable. THIS IS ONLY A LIFE INSURANCE ILLUSTRATION, NOT A CONTRACT. AMOUNTS, BENEFITS, TERMS AND CONDITIONS ARE GOVERNED ONLY BY THE ACTUAL CONTRACT, NOT BY THIS ILLUSTRATION. Version 2.95.084 Page 1 of 9

Prepared for: Sample Client M NS Age 55 Issue Age: 55 NARRATIVE SUMMARY (continued) Midpoint Scale Columns Illustrate the policy values that are based on dividends payable at one-half of the current scale for the life of the policy. Contract Illustrated at the beginning of the year and represents the total premium payments required to maintain the base policy and rider benefits shown in this illustration. Guaranteed Cash Guaranteed Illustrated at the end of the year and represents the cash value guaranteed to be available upon policy surrender assuming timely payment of the guaranteed contract premium(s) by the owner/payor. Policy loans, withdrawals and partial surrenders will reduce the otherwise available death benefits and cash values. Illustrated at the end of the year and represents the death benefit guaranteed to be paid upon the death of the insured assuming timely payment of the guaranteed contract premium(s) by the owner/payor. Policy loans, withdrawals and partial surrenders will reduce the otherwise available death benefits and cash values. Shows the contract premium less any dividends paid in cash or used to reduce premium, any surrenders of paid-up additions, and/or any new policy loans or loan repayments in the year. These values are meant to represent the owner/payor's out-of-pocket cost for the given year. These premium outlay amounts are not guaranteed to maintain the policy and rider benefits illustrated since these outlays assume that portions or all of the contract premium will be paid from nonguaranteed elements. Annual Dividend Illustrated at the end of year and includes dividends earned on the base policy and any paid-up additions. These values are not guaranteed. The dividends illustrated are based on 100% of Assurity's current scale and are neither guaranteed nor estimates for the future. Surrender Illustrated at the end of year and includes the guaranteed cash value, terminal dividends and any paid-up additions cash value. Policy loans, withdrawals and partial surrenders will reduce the otherwise available death benefits and cash values. These values are not guaranteed. Illustrated at the end of year and includes the death benefits provided by the base policy, any riders, terminal dividends and any paid-up insurance purchased by the annual dividend on the policy or riders. Policy loans, withdrawals and partial surrenders will reduce any death benefit and cash values. These values are not guaranteed. Accelerated s Rider (AB) Single Insurance Rider (SPI) RIDER DESCRIPTIONS In some states, this policy may include coverage under the Accelerated s Rider at no additional cost. The Accelerated s Rider provides the option to accelerate a portion of policy proceeds if the insured is terminally ill or, if age 65 and over, requiring continuous confinement in a long-term care facility or under a written plan of home care expected to last until death. Allows flexible additional payments to be applied to the policy. Each payment, less a premium load is applied as paid-up additions. Evidence of insurability may be required. Each payment must be at least $500.00. Version 2.95.084 Page 2 of 9

Prepared for: Sample Client M NS Age 55 Issue Age: 55 NARRATIVE SUMMARY (continued) DISCLOSURE Incontestability and Suicide Provisions Suicide, incorrect age and incontestability provisions apply. Please review the policy or ask your representative for more information. Version 2.95.084 Page 3 of 9

Prepared for: Sample Client M NS Age 55 Initial : $198,776 NUMERIC SUMMARY Yr Age ---------------Guaranteed--------------- Contract s Cash --------------------------------------Non-Guaranteed-------------------------------------- ---------------Mid-Point--------------- Surrender ---------------Illustrated Scale--------------- Surrender 5 60 0 102,652 198,776 0 106,459 206,148 0 110,453 213,881 10 65 0 116,129 198,776 0 125,345 214,551 0 135,638 232,169 15 70 0 129,852 198,776 0 146,486 224,238 0 166,342 254,634 20 75 0 143,564 198,776 0 169,728 235,003 0 203,184 281,325 66 121 0 198,776 198,776 0 397,341 397,341 0 902,007 902,007 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. Policy 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. Authorized Representative: Date: Dennis Begley Associated Insurance Agents, Inc. 2800 Freeway Blvd. Brooklyn Center, Minnesota 55430 Phone Number: (763) 549-2260 Version 2.95.084 Page 4 of 9

Prepared for: Sample Client M NS Age 55 Initial : $198,776 POLICY VALUES Yr Age ---------------Guaranteed--------------- Contract Cash -------------------------------Non-Guaranteed------------------------------- Annual Dividend Surrender 1 56 100,000 92,278 198,776 100,000 1,308 93,586 201,593 2 57 0 94,812 198,776 0 1,396 97,552 204,521 3 58 0 97,384 198,776 0 1,482 101,681 207,545 4 59 0 99,998 198,776 0 1,569 105,979 210,664 5 60 0 102,652 198,776 0 1,662 110,453 213,881 6 61 0 105,331 198,776 0 1,767 115,102 217,215 7 62 0 108,027 198,776 0 1,888 119,936 220,689 8 63 0 110,724 198,776 0 2,028 124,959 224,330 9 64 0 113,426 198,776 0 2,183 130,190 228,155 10 65 0 116,129 198,776 0 2,345 135,638 232,169 11 66 0 118,840 198,776 0 2,510 141,314 236,367 12 67 0 121,565 198,776 0 2,668 147,223 240,729 13 68 0 124,309 198,776 0 2,818 153,362 245,234 14 69 0 127,074 198,776 0 2,962 159,736 249,868 15 70 0 129,852 198,776 0 3,113 166,342 254,634 16 71 0 132,639 198,776 0 3,279 173,191 259,548 17 72 0 135,412 198,776 0 3,475 180,286 264,648 18 73 0 138,153 198,776 0 3,700 187,636 269,972 19 74 0 140,871 198,776 0 3,937 195,264 275,528 20 75 0 143,564 198,776 0 4,187 203,184 281,325 21 76 0 146,234 198,776 0 4,450 211,413 287,374 22 77 0 148,873 198,776 0 4,730 219,959 293,689 23 78 0 151,463 198,776 0 5,039 228,825 300,303 24 79 0 153,988 198,776 0 5,387 238,026 307,257 25 80 0 156,433 198,776 0 5,762 247,567 314,579 26 81 0 158,792 198,776 0 6,158 257,459 322,287 27 82 0 161,064 198,776 0 6,550 267,693 330,371 28 83 0 163,255 198,776 0 6,944 278,278 338,826 29 84 0 165,362 198,776 0 7,368 289,237 347,683 30 85 0 167,377 198,776 0 7,813 300,576 356,961 31 86 0 169,286 198,776 0 8,254 312,256 366,653 32 87 0 171,081 198,776 0 8,650 324,217 376,703 33 88 0 172,752 198,776 0 8,967 336,353 387,021 34 89 0 174,299 198,776 0 9,202 348,566 397,516 35 90 0 175,722 198,776 0 9,387 360,799 408,134 Version 2.95.084 Page 5 of 9

Prepared for: Sample Client M NS Age 55 Initial : $198,776 POLICY VALUES (continued) Yr Age ---------------Guaranteed--------------- Contract Cash -------------------------------Non-Guaranteed------------------------------- Annual Dividend Surrender 36 91 0 177,040 198,776 0 9,537 373,042 418,843 37 92 0 178,282 198,776 0 9,689 385,348 429,645 38 93 0 179,449 198,776 0 9,898 397,769 440,609 39 94 0 180,538 198,776 0 10,156 410,340 451,792 40 95 0 181,542 198,776 0 10,450 423,071 463,234 41 96 0 182,478 198,776 0 10,767 436,020 474,962 42 97 0 183,371 198,776 0 11,092 449,244 486,986 43 98 0 184,216 198,776 0 11,424 462,739 499,313 44 99 0 185,001 198,776 0 11,821 476,531 512,014 45 100 0 185,703 198,776 0 12,318 490,657 525,199 46 101 0 186,341 198,776 0 12,761 505,103 538,811 47 102 0 186,963 198,776 0 13,146 519,936 552,788 48 103 0 187,571 198,776 0 13,541 535,169 567,138 49 104 0 188,161 198,776 0 13,947 550,800 581,872 50 105 0 188,736 198,776 0 14,364 566,846 597,000 51 106 0 189,294 198,776 0 14,792 583,316 612,533 52 107 0 189,837 198,776 0 15,231 600,219 628,482 53 108 0 190,364 198,776 0 15,683 617,567 644,858 54 109 0 190,875 198,776 0 16,146 635,371 661,672 55 110 0 191,370 198,776 0 16,622 653,640 678,937 56 111 0 191,847 198,776 0 17,110 672,379 696,665 57 112 0 192,310 198,776 0 17,612 691,614 714,869 58 113 0 192,753 198,776 0 18,127 711,335 733,562 59 114 0 193,182 198,776 0 18,655 731,575 752,757 60 115 0 193,594 198,776 0 19,198 752,331 772,470 61 116 0 193,989 198,776 0 19,756 773,625 792,713 62 117 0 194,371 198,776 0 20,329 795,475 813,503 63 118 0 194,735 198,776 0 20,917 817,881 834,854 64 119 0 195,121 198,776 0 21,521 841,021 856,778 65 120 0 196,015 198,776 0 22,141 867,018 879,231 66 121 0 198,776 198,776 0 22,776 902,007 902,007 Version 2.95.084 Page 6 of 9

Prepared for: Sample Client M NS Age 55 Initial : $198,776 MODIFIED ENDOWMENT CONTRACT DISCLOSURE STATEMENT The Technical and Miscellaneous Revenue Act of 1988 created a new class of life insurance contracts known as Modified Endowment Contracts. The principal purpose of this law was to restrict the use of life insurance as an investment. The law limits the amount of premium that is allowed to be paid into a life insurance contract. The allowable amount of premium is dependent on the death benefit. If the calculated premium limits (defined in IRS code section 7702A) for the life insurance contract are exceeded, the life insurance contract becomes a Modified Endowment Contract. The plan of insurance exceeds the calculated allowable premium limits and would therefore be considered a Modified Endowment Contract. A policy that is a Modified Endowment Contract has the following implications: 1)Money distributed from a Modified Endowment Contract by cash distributions, withdrawals, loans, or assignments, will be considered taxable income until all gain, if any, has been distributed. 2)The taxable income amounts will also be subject to a 10% penalty tax unless the Owner is at least 59 1/2, becomes disabled, or annuitizes the entire cash value. (If the Owner is a corporation, such proceeds are subject to the 10% penalty tax at any time). benefits of Modified Endowment Contracts paid to the beneficiary continue to be treated as life insurance proceeds and therefore are not subject to income tax. I acknowledge that I have read this disclosure statement and understand that the plan of insurance illustrated is a Modified Endowment Contract and therefore subject to special tax treatment as outlined above. / / Date (MM/DD/YYYY) Signature of Owner/Proposed Owner Printed Name Printed Insured/Proposed Insured s Name (First, Middle, Last) Policy Number (if applicable) Version 2.95.084 Page 7 of 9

Prepared for: Sample Client M NS Age 55 Initial : $198,776 INDICES AND PREMIUM Life Insurance Indices at 5.00% 10 Year 20 Year Surrender Cost 10.43 9.02 Net Payment Cost 54.66 29.82 Equivalent Level Annual Dividend 7.39 8.63 s Included Base policy $99,999.70 Version 2.95.084 Page 8 of 9

Prepared for: Sample Client M NS Age 55 Initial : $198,776 HOME OFFICE INFORMATION New Business-ID Units LS SPWL 198.776 ACCDB121 R I1109 State: MN Version 2.95.084 Page 9 of 9

End of Year LifeScape Single Whole Life Supplemental Illustration Internal Rate of Return Prepared for: Sample Client M NS Age 55 Initial : $198,776 Tax Bracket: 28% Riders Included: None Surr. Cash Net IRR Surr. Non-Guaranteed Current Pre-tax Equiv Return at Surr. Net IRR at Pre-tax Equiv Return at Age Annual Accum. 1 56 100,000 100,000 93,586 6.41% 6.41% 201,593 101.59% 141.10% 2 57 0 100,000 97,552 1.23% 1.23% 204,521 43.01% 59.74% 3 58 0 100,000 101,681 0.56% 0.78% 207,545 27.56% 38.28% 4 59 0 100,000 105,979 1.46% 2.03% 210,664 20.48% 28.44% 5 60 0 100,000 110,453 2.01% 2.79% 213,881 16.42% 22.81% 6 61 0 100,000 115,102 2.37% 3.29% 217,215 13.80% 19.17% 7 62 0 100,000 119,936 2.63% 3.65% 220,689 11.97% 16.63% 8 63 0 100,000 124,959 2.82% 3.92% 224,330 10.63% 14.76% 9 64 0 100,000 130,190 2.97% 4.13% 228,155 9.60% 13.33% 10 65 0 100,000 135,638 3.10% 4.31% 232,169 8.79% 12.21% 11 66 0 100,000 141,314 3.19% 4.43% 236,367 8.13% 11.29% 12 67 0 100,000 147,223 3.28% 4.56% 240,729 7.60% 10.56% 13 68 0 100,000 153,362 3.34% 4.64% 245,234 7.14% 9.92% 14 69 0 100,000 159,736 3.40% 4.72% 249,868 6.76% 9.39% 15 70 0 100,000 166,342 3.45% 4.79% 254,634 6.43% 8.93% 16 71 0 100,000 173,191 3.49% 4.85% 259,548 6.14% 8.53% 17 72 0 100,000 180,286 3.53% 4.90% 264,648 5.89% 8.18% 18 73 0 100,000 187,636 3.56% 4.94% 269,972 5.67% 7.88% 19 74 0 100,000 195,264 3.58% 4.97% 275,528 5.48% 7.61% 20 75 0 100,000 203,184 3.61% 5.01% 281,325 5.31% 7.38% 21 76 0 100,000 211,413 3.63% 5.04% 287,374 5.16% 7.17% 22 77 0 100,000 219,959 3.65% 5.07% 293,689 5.02% 6.97% 23 78 0 100,000 228,825 3.66% 5.08% 300,303 4.90% 6.81% 24 79 0 100,000 238,026 3.68% 5.11% 307,257 4.79% 6.65% 25 80 0 100,000 247,567 3.69% 5.13% 314,579 4.69% 6.51% 26 81 0 100,000 257,459 3.70% 5.14% 322,287 4.60% 6.39% 27 82 0 100,000 267,693 3.71% 5.15% 330,371 4.53% 6.29% 28 83 0 100,000 278,278 3.72% 5.17% 338,826 4.45% 6.18% 29 84 0 100,000 289,237 3.73% 5.18% 347,683 4.39% 6.10% 30 85 0 100,000 300,576 3.74% 5.19% 356,961 4.33% 6.01% The values and benefits are not guaranteed and are subject to change unless the column is marked guaranteed. This supplemental illustration must be accompanied by a basic illustration for required disclosure. Refer to the basic illustration for guaranteed elements and other important information. Version 2.95.084 Page 1 of 3

End of Year LifeScape Single Whole Life Supplemental Illustration Internal Rate of Return Prepared for: Sample Client M NS Age 55 Initial : $198,776 Tax Bracket: 28% Riders Included: None Surr. Cash Net IRR Surr. Non-Guaranteed Current Pre-tax Equiv Return at Surr. Net IRR at Pre-tax Equiv Return at Age Annual Accum. 31 86 0 100,000 312,256 3.74% 5.19% 366,653 4.28% 5.94% 32 87 0 100,000 324,217 3.74% 5.19% 376,703 4.23% 5.88% 33 88 0 100,000 336,353 3.74% 5.19% 387,021 4.19% 5.82% 34 89 0 100,000 348,566 3.74% 5.19% 397,516 4.14% 5.75% 35 90 0 100,000 360,799 3.73% 5.18% 408,134 4.10% 5.69% 36 91 0 100,000 373,042 3.72% 5.17% 418,843 4.06% 5.64% 37 92 0 100,000 385,348 3.71% 5.15% 429,645 4.02% 5.58% 38 93 0 100,000 397,769 3.70% 5.14% 440,609 3.98% 5.53% 39 94 0 100,000 410,340 3.69% 5.13% 451,792 3.94% 5.47% 40 95 0 100,000 423,071 3.67% 5.10% 463,234 3.91% 5.43% 41 96 0 100,000 436,020 3.66% 5.08% 474,962 3.87% 5.38% 42 97 0 100,000 449,244 3.64% 5.06% 486,986 3.84% 5.33% 43 98 0 100,000 462,739 3.63% 5.04% 499,313 3.81% 5.29% 44 99 0 100,000 476,531 3.61% 5.01% 512,014 3.78% 5.25% 45 100 0 100,000 490,657 3.60% 5.00% 525,199 3.75% 5.21% 46 101 0 100,000 505,103 3.58% 4.97% 538,811 3.73% 5.18% 47 102 0 100,000 519,936 3.57% 4.96% 552,788 3.70% 5.14% 48 103 0 100,000 535,169 3.56% 4.94% 567,138 3.68% 5.11% 49 104 0 100,000 550,800 3.54% 4.92% 581,872 3.66% 5.08% 50 105 0 100,000 566,846 3.53% 4.90% 597,000 3.64% 5.06% 51 106 0 100,000 583,316 3.52% 4.89% 612,533 3.62% 5.03% 52 107 0 100,000 600,219 3.51% 4.88% 628,482 3.60% 5.00% 53 108 0 100,000 617,567 3.49% 4.85% 644,858 3.58% 4.97% 54 109 0 100,000 635,371 3.48% 4.83% 661,672 3.56% 4.94% 55 110 0 100,000 653,640 3.47% 4.82% 678,937 3.54% 4.92% 56 111 0 100,000 672,379 3.46% 4.81% 696,665 3.53% 4.90% 57 112 0 100,000 691,614 3.45% 4.79% 714,869 3.51% 4.88% 58 113 0 100,000 711,335 3.44% 4.78% 733,562 3.50% 4.86% 59 114 0 100,000 731,575 3.43% 4.76% 752,757 3.48% 4.83% 60 115 0 100,000 752,331 3.42% 4.75% 772,470 3.47% 4.82% The values and benefits are not guaranteed and are subject to change unless the column is marked guaranteed. This supplemental illustration must be accompanied by a basic illustration for required disclosure. Refer to the basic illustration for guaranteed elements and other important information. Version 2.95.084 Page 2 of 3