LifeScape® Whole Life Insurance - AssureLINK

LifeScape? Whole Life Insurance

Annual Premium per $1,000 Benefit

Issue Ages 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

Non-Tob 5.04 5.36 5.68 6.04 6.44 6.59 6.77 6.93 7.08 7.24 7.44 7.68 7.95 8.24 8.54 8.85 9.18 9.53 9.89 10.23 10.53 10.79 11.01 11.22 11.44 11.71 12.02 12.34 12.69 13.07 13.48 13.92 14.40 14.90 15.42 15.94 16.46 16.99 17.53 18.11 18.74 19.41 20.12

For all states except the following: MT

Band 1: Benefit Amounts $10,000-$74,999

Male

Tobacco Waiver

Issue Ages Non-Tob

43

20.87

44

21.66

45

22.51

46

23.38

47

24.27

48

25.23

49

26.29

50

27.50

51

28.90

52

30.46

53

32.13

54

33.83

55

35.52

56

37.21

57

38.82

10.01

0.20

58

40.44

10.99

0.21

59

42.17

11.56

0.23

60

44.09

11.87

0.23

61

46.15

12.10

0.24

62

48.29

12.48

0.26

63

50.59

12.85

0.27

64

53.15

13.16

0.28

65

56.05

13.45

0.28

66

59.34

13.75

0.29

67

62.97

14.11

0.32

68

66.86

14.51

0.33

69

70.94

14.93

0.34

70

75.13

15.39

0.35

71

79.05

15.88

0.38

72

82.73

16.41

0.40

73

86.78

16.98

0.43

74

91.78

17.57

0.45

75

98.31

18.21

0.48

76

106.23

18.92

0.52

77

115.16

19.70

0.55

78

125.29

20.57

0.60

79

136.86

21.53

0.64

80

150.08

22.54

0.70

81

164.69

23.60

0.77

82

180.56

24.69

0.82

83

198.06

25.84

0.91

84

217.55

26.98

0.99

85

239.43

Tobacco 28.15 29.37 30.67 32.05 33.49 34.99 36.56 38.22 39.95 41.74 43.61 45.58 47.65 49.77 51.93 54.22 56.73 59.55 62.74 66.24 69.96 73.80 77.67 81.37 84.98 88.77 93.02 98.01 103.69 109.86 116.62 124.06 132.27 140.38 148.33 157.42 168.97 184.28 203.17 224.76 249.34 277.17 308.54

Waiver 1.07 1.18 1.30 1.42 1.57 1.74 1.94 2.15 2.40 2.69 3.02 3.39 3.80

To calculate the modal premium, multiply the number of units (benefit amount divided by 1,000) by the unit rate listed above, add the policy fee of $65, multiply by the mode factor (annual, 1.00; semi-annual, 0.51; quarterly, 0.264; and monthly 0.087) and round to the nearest $.01.

For agent use only. Not for use with consumers. Policy form I L0880 (R01-13). Product availability, features and rates may vary by state. The policy may contain reductions of benefits, limitations and exclusions. For complete details of coverage, please contact Assurity Life Insurance Company or ask to review the policy for more information. 16-175-01101 (Rev. 09/13)

LifeScape? Whole Life Insurance

Annual Premium per $1,000 Benefit

Issue Ages 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

Non-Tob 3.66 3.92 4.20 4.51 4.84 5.18 5.54 5.91 6.27 6.45 6.64 6.86 7.08 7.30 7.53 7.78 8.06 8.36 8.67 8.97 9.25 9.50 9.73 9.95 10.19 10.45 10.74 11.06 11.39 11.74 12.10 12.48 12.88 13.30 13.73 14.16 14.59 15.03 15.48 15.95 16.46 17.00 17.57

For all states except the following: MT

Band 1: Benefit Amounts $10,000-$74,999

Female

Tobacco Waiver

Issue Ages Non-Tob

43

18.16

44

18.79

45

19.46

46

20.15

47

20.85

48

21.60

49

22.43

50

23.37

51

24.47

52

25.69

53

26.99

54

28.30

55

29.58

56

30.77

57

31.85

8.98

0.19

58

32.95

9.87

0.20

59

34.21

10.39

0.22

60

35.77

10.68

0.23

61

37.63

10.90

0.23

62

39.70

11.28

0.25

63

41.98

11.62

0.26

64

44.47

11.91

0.27

65

47.15

12.19

0.27

66

50.02

12.48

0.28

67

53.07

12.82

0.29

68

56.33

13.22

0.31

69

59.83

13.66

0.33

70

63.60

14.12

0.35

71

67.62

14.61

0.36

72

71.86

15.12

0.39

73

76.37

15.66

0.41

74

81.17

16.23

0.44

75

86.28

16.82

0.47

76

91.32

17.42

0.49

77

96.25

18.04

0.52

78

101.69

18.66

0.56

79

108.22

19.28

0.60

80

116.44

19.92

0.65

81

126.46

20.60

0.68

82

137.89

21.33

0.75

83

150.55

22.12

0.80

84

164.28

22.94

0.86

85

178.91

Tobacco 23.82 24.74 25.72 26.75 27.82 28.95 30.14 31.40 32.73 34.12 35.57 37.08 38.65 40.24 41.86 43.55 45.36 47.34 49.43 51.61 53.95 56.51 59.38 62.54 65.96 69.62 73.55 77.74 82.16 86.74 91.59 96.83 102.60 108.12 113.32 119.34 127.32 138.42 153.03 170.39 189.90 210.96 232.98

Waiver 0.94 1.03 1.12 1.22 1.35 1.48 1.65 1.83 2.02 2.27 2.52 2.83 3.15

To calculate the modal premium, multiply the number of units (benefit amount divided by 1,000) by the unit rate listed above, add the policy fee of $65, multiply by the mode factor (annual, 1.00; semi-annual, 0.51; quarterly, 0.264; and monthly 0.087) and round to the nearest $.01.

For agent use only. Not for use with consumers. Policy form I L0880 (R01-13). Product availability, features and rates may vary by state. The policy may contain reductions of benefits, limitations and exclusions. For complete details of coverage, please contact Assurity Life Insurance Company or ask to review the policy for more information. 16-175-01101 (Rev. 09/13)

LifeScape? Whole Life Insurance

Annual Premium per $1,000 Benefit

Issue Ages Preferred +

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

7.59

16

7.85

17

8.10

18

8.36

19

8.63

20

8.89

21

9.15

22

9.41

23

9.67

24

9.94

25

10.24

26

10.56

27

10.89

28

11.24

29

11.61

30

12.01

31

12.44

32

12.90

33

13.38

34

13.86

35

14.35

36

14.82

37

15.28

38

15.76

39

16.27

40

16.84

41

17.47

42

18.14

Preferred

7.59 7.91 8.22 8.53 8.83 9.12 9.39 9.65 9.90 10.16 10.46 10.78 11.12 11.48 11.87 12.29 12.75 13.24 13.75 14.28 14.81 15.32 15.83 16.35 16.91 17.53 18.21 18.93

For all states except the following: MT

Band 2: Benefit Amounts $75,000-$149,999

Male

Non-Tobacco

Select 4.21 4.30

Waiver

Issue Ages Preferred +

43

18.85

44

19.60

4.40

45

20.40

4.51

46

21.23

4.64

47

22.10

4.79

48

23.01

4.94

49

23.97

5.10

50

24.99

5.28

51

26.07

5.49

52

27.21

5.74

53

28.40

6.06

54

29.62

6.42

55

30.86

6.82

56

32.07

7.22

57

33.27

7.59

0.18

7.94

0.18

8.29

0.20

58

34.51

59

35.86

60

37.39

8.63

0.20

8.96

0.22

61

39.07

62

40.84

9.27

0.24

63

42.77

9.55

0.25

9.79

0.26

64

44.89

65

47.24

10.03

0.26

10.28

0.27

10.57

0.29

66

49.80

67

52.53

68

55.48

10.89

0.31

11.22

0.32

69

58.69

70

62.22

11.58

0.33

71

65.86

11.97

0.35

12.39

0.38

72

69.58

73

73.68

12.85

0.40

74

78.45

13.36

0.43

13.88

0.46

75

84.19

76

90.35

14.43

0.49

14.97

0.53

77

96.74

78

104.18

15.50

0.57

79

113.47

16.02

0.61

16.56

0.65

80

125.45

81

140.10

17.14

0.72

82

156.87

17.78

0.77

18.48

0.84

83

175.78

84

196.84

19.22

0.92

85

220.07

Preferred 19.71 20.52 21.38 22.28 23.22 24.20 25.25 26.35 27.53 28.77 30.07 31.40 32.76 34.10 35.43 36.81 38.32 40.01 41.86 43.82 45.94 48.26 50.82 53.59 56.55 59.74 63.21 67.00 70.92 74.93 79.33 84.44 90.56 97.11 103.90 111.78 121.61 134.24 149.59 167.08 186.86 209.04 233.78

Select 20.01 20.85 21.76 22.72 23.73 24.81 25.95 27.16 28.45 29.82 31.25 32.75 34.31 35.93 37.62 39.37 41.19 43.08 44.95 46.81 48.78 50.98 53.54 56.45 59.62 63.07 66.81 70.85 74.97 79.17 83.77 89.09 95.45 102.24 109.26 117.40 127.57 140.68 156.66 174.91 195.53 218.61 244.25

Waiver 1.00 1.10 1.22 1.34 1.48 1.65 1.85 2.06 2.32 2.61 2.95 3.33 3.75

To calculate the modal premium, multiply the number of units (benefit amount divided by 1,000) by the unit rate listed above, add the policy fee of $65, multiply by the mode factor (annual, 1.00; semi-annual, 0.51; quarterly, 0.264; and monthly 0.087) and round to the nearest $.01.

For agent use only. Not for use with consumers. Policy form I L0880 (R01-13). Product availability, features and rates may vary by state. The policy may contain reductions of benefits, limitations and exclusions. For complete details of coverage, please contact Assurity Life Insurance Company or ask to review the policy for more information. 16-175-01101 (Rev. 09/13)

LifeScape? Whole Life Insurance

Annual Premium per $1,000 Benefit

Issue Ages 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

Preferred

8.88 9.36 9.83 10.27 10.70 11.11 11.48 11.82 12.15 12.49 12.88 13.30 13.74 14.20 14.70 15.25 15.85 16.50 17.19 17.90 18.62 19.33 20.04 20.78 21.57 22.44 23.39 24.40

For all states except the following: MT

Band 2: Benefit Amounts $75,000-$149,999

Male

Tobacco

Standard Waiver

Issue Ages Preferred

43

25.48

44

26.63

45

27.86

46

29.16

47

30.52

48

31.96

49

33.50

50

35.14

51

36.91

52

38.78

53

40.75

54

42.79

55

44.88

56

46.94

57

48.99

8.88

0.18

58

51.14

9.43

0.18

59

53.50

9.96

0.20

60

56.19

10.45

0.20

61

59.21

10.92

0.22

62

62.48

11.35

0.24

63

66.00

11.73

0.25

64

69.76

12.06

0.26

65

73.75

12.37

0.26

66

77.94

12.70

0.27

67

82.34

13.07

0.29

68

86.99

13.49

0.31

69

91.92

13.92

0.32

70

97.17

14.39

0.33

71

102.45

14.90

0.35

72

107.72

15.45

0.38

73

113.44

16.06

0.40

74

120.05

16.71

0.43

75

128.00

17.41

0.46

76

136.48

18.13

0.49

77

145.21

18.88

0.53

78

155.37

19.63

0.57

79

168.16

20.40

0.61

80

184.78

21.20

0.65

81

205.20

22.07

0.72

82

228.62

23.01

0.77

83

255.09

24.03

0.84

84

284.62

25.12

0.92

85

317.26

Standard 26.27 27.50 28.82 30.21 31.68 33.23 34.87 36.63 38.51 40.51 42.60 44.77 46.99 49.22 51.47 53.81 56.33 59.09 62.07 65.21 68.56 72.17 76.09 80.31 84.79 89.56 94.61 99.96 105.31 110.65 116.44 123.11 131.13 139.68 148.46 158.69 171.58 188.35 208.99 232.68 259.44 289.29 322.23

Waiver 1.00 1.10 1.22 1.34 1.48 1.65 1.85 2.06 2.32 2.61 2.95 3.33 3.75

To calculate the modal premium, multiply the number of units (benefit amount divided by 1,000) by the unit rate listed above, add the policy fee of $65, multiply by the mode factor (annual, 1.00; semi-annual, 0.51; quarterly, 0.264; and monthly 0.087) and round to the nearest $.01.

For agent use only. Not for use with consumers. Policy form I L0880 (R01-13). Product availability, features and rates may vary by state. The policy may contain reductions of benefits, limitations and exclusions. For complete details of coverage, please contact Assurity Life Insurance Company or ask to review the policy for more information. 16-175-01101 (Rev. 09/13)

LifeScape? Whole Life Insurance

Annual Premium per $1,000 Benefit

For all states except the following: MT

Issue Ages Preferred +

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

6.45

16

6.69

17

6.94

18

7.18

19

7.43

20

7.68

21

7.93

22

8.17

23

8.42

24

8.68

25

8.96

26

9.26

27

9.58

28

9.92

29

10.27

30

10.63

31

11.01

32

11.42

33

11.84

34

12.26

35

12.68

36

13.09

37

13.49

38

13.90

39

14.33

40

14.81

41

15.33

42

15.88

Preferred

6.45 6.72 6.98 7.25 7.51 7.77 8.02 8.27 8.51 8.77 9.06 9.37 9.70 10.05 10.41 10.79 11.19 11.62 12.07 12.51 12.96 13.39 13.81 14.24 14.70 15.20 15.75 16.32

Band 2: Benefit Amounts $75,000-$149,999

Female

Non-Tobacco

Select

Waiver

Issue Ages Preferred +

3.61

43

16.46

3.69

44

17.07

3.78

45

17.72

3.88

46

18.39

3.98

47

19.09

4.10

48

19.82

4.21

49

20.60

4.33

50

21.42

4.46

51

22.30

4.61

52

23.23

4.82

53

24.20

5.09

54

25.19

5.42

55

26.20

5.77

56

27.18

6.12

57

28.14

6.45

0.16

58

29.15

6.75

0.17

59

30.24

7.05

0.19

60

31.49

7.33

0.20

61

32.87

7.62

0.20

62

34.35

7.89

0.22

63

35.94

8.15

0.23

64

37.68

8.39

0.25

65

39.59

8.63

0.25

66

41.62

8.89

0.25

67

43.75

9.17

0.27

68

46.05

9.48

0.28

69

48.60

9.81

0.31

70

51.46

10.17

0.32

71

54.54

10.53

0.33

72

57.79

10.92

0.36

73

61.35

11.33

0.39

74

65.36

11.76

0.41

75

69.95

12.21

0.44

76

74.76

12.67

0.47

77

79.69

13.12

0.49

78

85.30

13.56

0.53

79

92.15

14.00

0.57

80

100.79

14.45

0.62

81

111.45

14.92

0.65

82

123.76

15.44

0.72

83

137.38

16.00

0.77

84

151.97

16.60

0.84

85

167.19

Preferred 16.94 17.58 18.26 18.97 19.70 20.48 21.29 22.16 23.09 24.07 25.10 26.15 27.23 28.29 29.33 30.43 31.62 32.98 34.48 36.09 37.83 39.72 41.78 43.96 46.26 48.73 51.45 54.48 57.73 61.15 64.89 69.07 73.85 78.83 83.93 89.72 96.77 105.65 116.65 129.39 143.44 158.36 173.71

Select 17.23 17.90 18.60 19.33 20.09 20.90 21.75 22.66 23.64 24.68 25.77 26.90 28.06 29.22 30.40 31.62 32.93 34.37 35.90 37.50 39.22 41.09 43.18 45.44 47.84 50.43 53.28 56.43 59.80 63.35 67.21 71.52 76.41 81.50 86.70 92.59 99.74 108.73 119.88 132.81 147.04 162.07 177.43

Waiver 0.92 1.01 1.10 1.21 1.34 1.47 1.64 1.83 2.03 2.28 2.55 2.87 3.20

To calculate the modal premium, multiply the number of units (benefit amount divided by 1,000) by the unit rate listed above, add the policy fee of $65, multiply by the mode factor (annual, 1.00; semi-annual, 0.51; quarterly, 0.264; and monthly 0.087) and round to the nearest $.01.

For agent use only. Not for use with consumers. Policy form I L0880 (R01-13). Product availability, features and rates may vary by state. The policy may contain reductions of benefits, limitations and exclusions. For complete details of coverage, please contact Assurity Life Insurance Company or ask to review the policy for more information.

16-175-01101 (Rev. 09/13)

LifeScape? Whole Life Insurance

Annual Premium per $1,000 Benefit

Issue Ages 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

Preferred

7.79 8.23 8.65 9.06 9.45 9.82 10.16 10.47 10.77 11.09 11.45 11.86 12.30 12.76 13.25 13.77 14.32 14.89 15.49 16.10 16.72 17.32 17.92 18.53 19.19 19.91 20.70 21.55

For all states except the following: MT

Band 2: Benefit Amounts $75,000-$149,999

Female

Tobacco

Standard Waiver

Issue Ages Preferred

43

22.44

44

23.39

45

24.38

46

25.41

47

26.49

48

27.61

49

28.80

50

30.07

51

31.42

52

32.85

53

34.34

54

35.88

55

37.48

56

39.08

57

40.70

7.79

0.16

58

42.40

8.29

0.17

59

44.22

8.76

0.19

60

46.24

9.21

0.20

61

48.44

9.63

0.20

62

50.79

10.03

0.22

63

53.29

10.38

0.23

64

55.96

10.69

0.25

65

58.80

10.98

0.25

66

61.79

11.29

0.25

67

64.93

11.65

0.27

68

68.25

12.07

0.28

69

71.77

12.51

0.31

70

75.52

12.99

0.32

71

79.32

13.50

0.33

72

83.15

14.03

0.36

73

87.29

14.60

0.39

74

92.02

15.20

0.41

75

97.61

15.83

0.44

76

103.51

16.47

0.47

77

109.53

17.12

0.49

78

116.51

17.75

0.53

79

125.28

18.37

0.57

80

136.68

19.01

0.62

81

151.37

19.70

0.65

82

168.79

20.47

0.72

83

187.95

21.32

0.77

84

207.86

22.22

0.84

85

227.53

Standard 23.19 24.20 25.27 26.38 27.54 28.75 30.03 31.39 32.83 34.35 35.93 37.58 39.28 41.03 42.82 44.68 46.63 48.69 50.82 53.00 55.30 57.79 60.52 63.50 66.69 70.08 73.68 77.49 81.32 85.17 89.32 94.06 99.66 105.57 111.59 118.57 127.36 138.81 153.60 171.16 190.48 210.50 230.22

Waiver 0.92 1.01 1.10 1.21 1.34 1.47 1.64 1.83 2.03 2.28 2.55 2.87 3.20

To calculate the modal premium, multiply the number of units (benefit amount divided by 1,000) by the unit rate listed above, add the policy fee of $65, multiply by the mode factor (annual, 1.00; semi-annual, 0.51; quarterly, 0.264; and monthly 0.087) and round to the nearest $.01.

For agent use only. Not for use with consumers. Policy form I L0880 (R01-13). Product availability, features and rates may vary by state. The policy may contain reductions of benefits, limitations and exclusions. For complete details of coverage, please contact Assurity Life Insurance Company or ask to review the policy for more information. 16-175-01101 (Rev. 09/13)

LifeScape? Whole Life Insurance

Annual Premium per $1,000 Benefit

For all states except the following: MT

Issue Ages Preferred +

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

6.41

16

6.58

17

6.77

18

6.98

19

7.19

20

7.43

21

7.68

22

7.94

23

8.23

24

8.52

25

8.84

26

9.18

27

9.53

28

9.91

29

10.29

30

10.69

31

11.09

32

11.49

33

11.91

34

12.36

35

12.84

36

13.36

37

13.91

38

14.50

39

15.11

40

15.75

41

16.41

42

17.10

Preferred

6.41 6.66 6.91 7.16 7.43 7.69 7.95 8.21 8.48 8.76 9.08 9.43 9.80 10.20 10.61 11.03 11.46 11.89 12.34 12.83 13.36 13.94 14.55 15.20 15.88 16.59 17.32 18.08

Band 3: Benefit Amounts $150,000+

Male

Non-Tobacco

Select

Waiver

Issue Ages Preferred +

3.58

43

17.81

3.68

44

18.57

3.79

45

19.39

3.91

46

20.26

4.04

47

21.18

4.19

48

22.15

4.35

49

23.16

4.51

50

24.23

4.69

51

25.37

4.89

52

26.57

5.10

53

27.82

5.33

54

29.08

5.59

55

30.33

5.86

56

31.51

6.13

57

32.64

6.41

0.15

58

33.80

6.69

0.16

59

35.09

6.98

0.17

60

36.58

7.27

0.18

61

38.25

7.57

0.19

62

40.05

7.85

0.21

63

42.01

8.12

0.22

64

44.18

8.37

0.23

65

46.60

8.62

0.23

66

49.24

8.89

0.24

67

52.08

9.20

0.27

68

55.15

9.54

0.28

69

58.52

9.91

0.29

70

62.24

10.30

0.30

71

66.09

10.71

0.33

72

70.03

11.14

0.35

73

74.39

11.57

0.38

74

79.49

12.02

0.40

75

85.67

12.48

0.42

76

92.36

12.98

0.46

77

99.34

13.53

0.50

78

107.45

14.12

0.53

79

117.54

14.75

0.57

80

130.46

15.42

0.62

81

146.16

16.13

0.68

82

164.08

16.86

0.74

83

184.28

17.62

0.81

84

206.82

18.40

0.89

85

231.76

Preferred 18.87 19.71 20.61 21.57 22.57 23.62 24.74 25.91 27.16 28.49 29.87 31.27 32.65 33.96 35.21 36.50 37.94 39.60 41.47 43.49 45.70 48.11 50.79 53.68 56.76 60.10 63.74 67.75 71.91 76.16 80.87 86.35 92.95 100.08 107.51 116.13 126.83 140.48 156.94 175.62 196.74 220.54 247.22

Select 19.22 20.10 21.03 22.02 23.07 24.16 25.33 26.56 27.88 29.29 30.75 32.24 33.73 35.16 36.54 37.97 39.56 41.39 43.45 45.68 48.10 50.75 53.65 56.77 60.08 63.65 67.52 71.76 76.12 80.57 85.47 91.16 98.01 105.39 113.06 121.97 133.03 147.19 164.31 183.75 205.75 230.49 258.20

Waiver 0.96 1.07 1.18 1.30 1.45 1.62 1.82 2.03 2.29 2.59 2.93 3.31 3.74

To calculate the modal premium, multiply the number of units (benefit amount divided by 1,000) by the unit rate listed above, add the policy fee of $65, multiply by the mode factor (annual, 1.00; semi-annual, 0.51; quarterly, 0.264; and monthly 0.087) and round to the nearest $.01.

For agent use only. Not for use with consumers. Policy form I L0880 (R01-13). Product availability, features and rates may vary by state. The policy may contain reductions of benefits, limitations and exclusions. For complete details of coverage, please contact Assurity Life Insurance Company or ask to review the policy for more information.

16-175-01101 (Rev. 09/13)

LifeScape? Whole Life Insurance

Annual Premium per $1,000 Benefit

Issue Ages 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

Preferred

7.76 8.18 8.59 8.99 9.39 9.78 10.15 10.50 10.84 11.21 11.62 12.07 12.55 13.05 13.58 14.14 14.71 15.30 15.92 16.58 17.31 18.10 18.95 19.85 20.80 21.79 22.82 23.88

For all states except the following: MT

Band 3: Benefit Amounts $150,000+

Male

Tobacco

Standard Waiver

Issue Ages 43 44 45

Preferred 25.00 26.19 27.48

46

28.85

47

30.30

48

31.83

49

33.47

50

35.21

51

37.10

52

39.12

53

41.23

54

43.38

55

45.52

56

47.55

7.76

0.15

57

49.49

58

51.52

8.25

0.16

8.73

0.17

9.18

0.18

59

53.79

60

56.48

61

59.60

9.61

0.19

10.03

0.21

62

63.04

63

66.77

10.41

0.22

64

70.77

10.75

0.23

11.07

0.23

65

75.00

66

79.43

11.42

0.24

11.82

0.27

12.27

0.28

67

84.07

68

88.98

69

94.23

12.75

0.29

13.25

0.30

70

99.86

71

105.56

13.79

0.33

72

111.28

14.35

0.35

14.93

0.38

73

117.51

74

124.74

15.53

0.40

16.16

0.42

16.84

0.46

75

133.44

76

142.79

77

152.47

17.58

0.50

18.39

0.53

78

163.72

79

177.78

19.25

0.57

80

195.88

20.16

0.62

21.12

0.68

81

217.95

82

243.15

22.14

0.74

23.19

0.81

24.29

0.89

83

271.62

84

303.48

85

338.85

Standard 25.44 26.67 28.00 29.43 30.93 32.53 34.23 36.05 38.02 40.14 42.35 44.61 46.86 49.00 51.05 53.19 55.57 58.37 61.60 65.16 69.00 73.11 77.45 81.98 86.72 91.73 97.06 102.78 108.55 114.35 120.65 127.95 136.73 146.16 155.90 167.23 181.39 199.66 221.96 247.44 276.22 308.41 344.13

Waiver 0.96 1.07 1.18 1.30 1.45 1.62 1.82 2.03 2.29 2.59 2.93 3.31 3.74

To calculate the modal premium, multiply the number of units (benefit amount divided by 1,000) by the unit rate listed above, add the policy fee of $65, multiply by the mode factor (annual, 1.00; semi-annual, 0.51; quarterly, 0.264; and monthly 0.087) and round to the nearest $.01.

For agent use only. Not for use with consumers. Policy form I L0880 (R01-13). Product availability, features and rates may vary by state. The policy may contain reductions of benefits, limitations and exclusions. For complete details of coverage, please contact Assurity Life Insurance Company or ask to review the policy for more information. 16-175-01101 (Rev. 09/13)

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