New York State Incorporations Regulations by eru16792

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									                   NEW YORK INSURANCE DEPARTMENT
         GROUP UNIVERSAL LIFE INSURANCE CHECKLIST (09/09/02)

          COMPANY:                                                             Form No:
Company Contact:                                                      Phone Number:
     E-Mail Address:                                                      Fax Number:

Instructions:
A. All items must be answered. Failure to complete all applicable items will result in this filing
   being returned without further review.
B. Check the “YES” box if the item applies without qualification.
C. Check the “N/A” box if the item is not applicable to the policy form.
D. Check the “ * ” box for the items for which an explanation is necessary. Attach the
   explanation(s) referencing the relevant item number(s). Also use this box if you are unsure of
   the appropriate box to check.
E. Where required enter the page and paragraph reference of the policy form. The policy form is
   identified by form number at the top of page one of this checklist.
F. The signature of the company representatives completing this checklist and the date it was
   completed must be furnished on the attached pages.
G. For the purposes of this checklist, items applicable to policies apply equally to certificates,
   unless the context clearly indicates otherwise.
______________________________________________________________________________________
     I.    Filing Process

       A. Type of Filing (select only one)

1.     For Prior Approval Section 3201(b)(1) – CL 1997-14
       In accordance with CL 1999-8, the caption or “Re” of the submission letter identifies the form number with a
       generic product description from Appendix A and a generic form description from Appendix B for each form.
       Includes “FILING FOR APPROVAL” or “FILING FOR INFORMATIONAL PURPOSES” in bold print.

       For Expedited Approval Section 3201(b)(6) – CL 1998-2, CL 1997-14
       (i) In accordance with CL 1999-8, the caption or “Re” of the submission letter identifies the form number with
       a generic product description from Appendix A and a generic form description from Appendix B for each form.
       Includes “SECTION 3201(b)(6) DEEMER FILING” in bold print.

       (ii) A certification signed by an officer of the Company is included with the filing. The certification identifies all
       the New York (or Federal) laws and regulations that specifically apply or are unique to the policy forms (and
       rates as required) submitted or certifies compliance with all the applicable New York (or Federal) laws and
       regulations in the appropriately identified product outline(s).

       For Approval with Certification Section 3201(b)(6) – CL 2000-27, CL 1997-14
       (i) In accordance with CL 1999-8, the caption or “Re” of the submission letter identifies the form number with a
       generic product description from Appendix A and a generic form description from Appendix B for each form.
       Include “PRIOR APPROVAL WITH CERTIFICATION” in bold print.

       (ii) A certification signed by an officer of the Company and the required Checklist(s) are included with the filing.
       The certification follows the format of Exhibit I attached to CL 27-2000 and certifies compliance with the
       appropriately identified product outline(s).

       B. Submission Package Requirements:

                                                                1
2.    Forms and transmittal letters are submitted in duplicate.                                 YES   N/A   *

3.    Form identification numbers are in the left-hand corner at the bottom of the page of      YES   N/A   *
      all policy forms being submitted for approval or informational purposes.

4.    All blank spaces for the policy forms are completed with hypothetical data.               YES   N/A   *

5.    Forms are to be illustrated and the required Regulation 74 certifications are             YES   N/A   *
      attached. A copy of the draft or final illustration is available upon request.
6.    All incorporations by reference are attached to the forms and submitted for approval      YES   N/A   *
      or if previously approved, accompany the submission. See Section 3204 and 3201
      and Circular Letter 1963-4 Guidelines for Examination of Group Life Forms § I. B.12.

7.    The application (or enrollment form) has been submitted. If previously approved,          YES   N/A   *
      the form or submission letter indicates the Department file number, form number
      and approval date. § I.E.4.

8.    The forms are designed to replace forms previously approved by the Department,            YES   N/A   *
      and a highlighted copy showing the differences or changes made to the submitted
      form is attached. In addition, a description of the differences or changes is included
      in the submission letter.

9.    If a form replaces a recently approved form that has not been issued and uses the         YES   N/A   *
      same form number, the original approved form is returned to the Department and
      the submission letter states that the form has not been issued.

10.   Flesch score certification with a minimum score of 45 is attached, where required.        YES   N/A   *

11.   The submission package complies with all the requirements of Circular Letter No. 6        YES   N/A   *
      (1963), Section I.A. through I.G.

12.   The submission is being made on behalf of the insurer and a letter of authorization       YES   N/A   *
      from the insurer is attached.

13.   This is a combination group life and group accident and health submission and any         YES   N/A   *
      accident and health forms, including accidental death and dismemberment forms,
      have been submitted to the Health Bureau for approval.

14.   For a market value adjustment policy, an actuarial opinion and memorandum (AOM)           YES   N/A   *
      is provided as required by §3201(c)(10) and §43.7 of Regulation No. 136.

15.   Forms are subject to Regulation 123, forms comply with Regulation 123                     YES   N/A   *
      requirements and the submission material includes filing memorandum required to
      comply with Sections 59.5 and 59.7 of Regulation 123.

16.   A detailed statement of the method of computation of the cash surrender values            YES   N/A   *
      and paid-up nonforfeiture benefits is provided if the policy states that such
      statement has been file with the Department. Such statement includes sample
      projections (including beginning and ending account values, cash surrender values,
      and all policy cost factors) so that the account value mechanics can be fully
      understood.

17.   A certification of compliance is attached in the format provided in Circular Letter No.   YES   N/A   *
      27 (2000). The checklist is completed and attached.

                                                             2
18.   For §3201(b)(6) deemer submissions, a certification of compliance is provided.              YES     N/A         *

19.   List of material included in the submission (in duplicate).    Form Type:      Policy      Rider
      Endorsement           Amendment           Application          Certificate       Insert Page       Submission
      Letter
      Statement of Variability       Other      (Specify:        )

      C. Transmittal Letter Requirements:

20.   States whether the form replaces a previously submitted form. If yes, the letter     YES            N/A         *
      states whether the previously submitted form is currently pending review or has been
      disposed (approved, filed, disapproved, withdrawn, rejected, etc).
      Unless provided herein, the letter identifies the form number       , control number
            , disposal date      , if applicable, and describes the changes and reasons for
      changes               .


21.   Describes how variable items are noted on the policy forms submitted for review (i.e., YES          N/A         *
      bracketed, underlined, set forth in red ink, etc.).


22.   The caption or “Re" of the submission letter identifies all forms submitted, provides a     YES     N/A         *
      generic product description and form description in accordance with Circular Letter
      No. 8 (1999) and, if applicable identifies the filing as a Section 3201(b)(6) Deemer
      submission or a Circular letter No. 27 (2000) filing.
23.   States that the application and enrollment forms to be used with the policy are             YES     N/A         *
      approved.


24.   States this policy is sex-distinct.                                                         YES     N/A         *

      States the policy is on a sex-distinct basis and will “not” be issued in any employer-      YES     N/A         *
      employee situation subject to the Norris decision and/or Title VII of the Civil Rights
      Act or 1964.

      States the policy is sex-distinct but unisex endorsements or pages for use only in
                                                                                                  YES     N/A         *
      the Title VII or Norris decision and/or Title VII of the Civil Rights Act of 1964 will be
      utilized.

      States the policy is unisex.
                                                                                                  YES     N/A         *

25.   States whether risk has been assumed prior to form approval and whether a                   YES     N/A         *
      Circular Letter 64-1 filing was made to the Department.

26.   Identifies the submitting insurer, lists all policy forms and other materials and           YES     N/A         *
      documents submitted with the filing.

27.   For policy forms submitted with insert pages, the insurer identifies the mandatory          YES     N/A         *
      pages that are always included in the policy form, and a list of all optional pages, if
      any, including application forms, together with an explanation of how the form will
      be used. Previously approved forms are identified by form number and approval
      date. See § I.G.8. See also Circular Letter 1963-4 Guidelines for Examination of
      Group Life Forms § I.A.2.

28.   Describes the benefits and coverage provided and explains the purpose and use of            YES     N/A         *
                                                               3
      each form submitted if such purpose and use is not indicated on the policy form.
      Circular Letter 1963-6 § I.G.2 and 7 and § I.E.1.

29.   Specifies the type of group under §4216(b) that best describes the prospective            YES   N/A   *
      policyholder.

30.   States the classes covered, as defined in §4216, if not all persons are eligible.         YES   N/A   *

31.   States whether the contract is noncontributory, contributory or funded solely by          YES   N/A   *
      employee or member contributions.

32.   Describes the type of employee benefit plan or other program funded by the policy.        YES   N/A   *

33.   The policy will be used in the Section 3205 (d) market and has been reviewed for          YES   N/A   *
      compliance with the COLI product outline available on the Department website.

34.   States whether the group policy will be delivered in New York or out-of-state and         YES   N/A   *
      whether the certificates will be delivered or deemed to be delivered in New York.

35.   States that the terms of the certificate control in the event of a conflict between the   YES   N/A   *
      contract and certificate.

36.   States the form numbers of individual policy forms available for use with                 YES   N/A   *
      conversions under §3220(a)(6).

37.   States whether rate material and/or compensation schedules are included.                  YES   N/A   *

38.   Indicate whether the policy is in whole or in part on a plan of insurance other than      YES   N/A   *
      the term plan as anticipated by Section 3220(a)(11) and, if so. Includes an actuarial
      certification that no nonforfeiture values would be required if Section 4221 and
      Regulation 149 were applied. This certification will often obviate the need for
      actuarial review for all, except Regulation 123 forms.

39.   Indicates whether nonforfeiture values are less than the minimum nonforfeiture            YES   N/A   *
      values permitted for individual universal life insurance in New York.

40.   Advises as to whether the policy will be illustrated pursuant to §53-3.1(b) of            YES   N/A   *
      Regulation 74. And provides certification required by § 53-3.7(d) of Regulation 74.
      A copy of the draft or final illustration is available upon request.

41.   Includes an explanation of how the rates for the continued or ported lives are            YES   N/A   *
      calculated, comments on how said rates are sustainable and describes the relative
      cost of the conversion benefit versus the portability/continuation benefit.

42.   Describes any innovative and/or unique features and any special markets intended.         YES   N/A   *
      (See C.L. 27 (2000) for definition of innovative or unique).

43.   The policy does not comply with a specific product outline provision and the              YES   N/A
      submission letter identifies the provision and provides a complete explanation of the
      Company’s position on the issue.

44.   The submission letter advises as to whether or not the policy provides for a              YES   N/A
      secondary guarantee feature and if so advises as to whether or not it is a no-lapse
      guarantee or other than a no-lapse guarantee.



                                                              4
45.   Check Applicable Boxes:
      Usage: In-State        Out-of-State          Both          General Submission            One Case Submission

      D.    Explanation of Variables

46.   A statement of variability indicating the nature and scope of variations is provided.        YES      N/A      *
      The explanation of variables is drafted in sufficient detail to determine the scope of
      variation of each variable item.

47.   Variable material indicated by Red Ink        Underlining       Bracketing      Other        YES      N/A      *
      (Specify:      )

48.   The explanation of variables does not state only that variations "will conform to law"       YES      N/A      *
      or "as requested by the contractholder" or other similar language.

49.   The explanation indicates the limits of range of variable items (i.e., minimum or            YES      N/A      *
      maximum amounts).

50.   The explanation indicates that any one of several alternative provisions may be used         YES      N/A      *
      or that a provision may be either included as submitted or omitted.

51.   The explanation includes two copies of all alternative language (if not included in the      YES      N/A      *
      form).

52.   Blank spaces filled in with hypothetical data to show the purpose and use of the             YES      N/A      *
      form.

      II. Policy/Certificate Provisions

      A. General Policy Provision Requirements:

           Cover Page

53.   The licensed New York company’s name appears on the            YES       N/A        *
      front or back cover. No other insurer or entity other than
      insurer is identified on the cover page with greater
      prominence than the New York licensed insurer issuing
      the contract.

54.   The full street address of the company’s Home Office           YES       N/A        *
      appears on front or back cover.

55.   At least one signature of a company officer is provided.       YES       N/A        *

56.   A corporate or company logo or trademark or affiliation        YES       N/A        *
      appears on the front or back cover and complies with
      §219.4(p) of Regulation 34-A.

57.   No unlicensed insurer name appears anywhere on the             YES       N/A        *
      form.

58.   The policy is not labeled in a manner that would have a        YES       N/A        *
      tendency to mislead or deceive as to the true identity of
      the insurer, or create the impression that someone other
      than the insurer would have any responsibility for the

                                                             5
      financial obligations under the policy. See §219.4(a), (l)
      and (p) of Regulation No. 34-A.

59.   A free look period of not less than 10 nor more than 30        YES   N/A   *
      days from policy deliver, whereby policyholder may
      receive a refund in compliance with Section 3203(a)(11).

60.   The policy is for mail order and a 30 day Free Look is         YES   N/A   *
      provided in compliance with Section 3203(a)(11).

61.   Generic name of the product is indicated on cover page.        YES   N/A   *
      (i.e. Group Universal Life Insurance).

62.   The brief description complies with Section I (A) of           YES   N/A   *
      Circular Letter No. 4 (1963). The brief description of a
      universal life policy addresses the flexibility of premiums,
      benefits or period of coverage.

63.   The cover page states whether the policy is participating      YES   N/A   *
      or nonparticipating. Circular Letter No. 4 (1963), Section
      II.F.1.

64.   A form identification number is printed on the lower left-     YES   N/A   *
      hand corner of the form in accordance with Circular Letter
      1963-6 § I.D.

65.   For market value adjustment accounts, the cover page           YES   N/A   *
      contains prominent statement that the contract contains a
      market value adjustment formula and that the operation
      of the formula may result in both upward and downward
      adjustments in cash surrender benefits. Points in time
      when cash surrender benefits are available without the
      application of the market value adjustment formula are
      also described on the cover page. § 43.8 of Regulation
      136.

66.   The disclosure of the war or travel exclusion as required      YES   N/A   *
      by Section 3201(c)(4) is set forth on the form’s face page.

           Specifications Page

67.   Guaranteed factors of mortality, expense and interest          YES   N/A   *
      that may be deducted from premiums paid or from the
      account value are set forth. Section 3203(a)(12).

68.   Complies with Section 3203(a)(17), regarding minimum           YES   N/A   *
      guaranteed interest rate. The guaranteed minimum
      interest rate shown is      %.

69.   This is a participating policy and provides the language       YES   N/A   *
      required by Section 3203(a)(15) (i.e., that dividends are
      not guaranteed and the insurer has the right to change
      the amount of dividends to be credited to the policy
      which may result in lower dividend cash values than were
      illustrated or require more premiums to be paid than
      were illustrated).
                                                               6
70.   The policy provides the language required by Section          YES   N/A   *
      3203(a)(16) (i.e., that additional amounts are not
      guaranteed and that the insurer has the right to change
      the amount of interest credited to the policy and the cost
      of insurance or other expense charges which may require
      more premium to be paid or result in less cash values
      than was illustrated).

71.   Limitations on the crediting of additional interest on a      YES   N/A   *
      portion of the policy value or cash surrender value are set
      forth. Sections 3203(a)(4) and 3204(a)(1).

72.   Surrender charges and partial withdrawal fees are set         YES   N/A   *
      forth, Sections 4221 (n-1)(1)(A) and 3203(a)(12).

73.   If non-guaranteed factors are shown, then the non-            YES   N/A   *
      guaranteed and guaranteed factors, such as interest,
      mortality and expense factors, are given equal
      prominence, Section 3201(c)(1).

74.   Disclosure is provided that the policy might not mature       YES   N/A   *
      even if the planned premiums are paid due to changes in
      the current interest rate credited, current expense loads
      or cost of insurance charges, loans, partial withdrawal
      activity and changes in death benefit options. The
      planned premium is disclosed.

75.   This is a universal life policy and “planned premiums”        YES   N/A   *
      are disclosed and defined in the policy.

76.   This policy contains a no lapse guarantee period. The         YES   N/A   *
      no-lapse premium and period payable are disclosed.

77.   The policy contains a secondary guarantee other than a        YES   N/A   *
      no lapse guarantee period. The premium payable (if any)
      and period (if any) for the secondary guarantee are
      disclosed.

78.   The policy allows for a negative account balance to be        YES   N/A   *
      accumulated during the no-lapse guarantee period and
      the language required by Section II.E.1.(b) of the product
      outline is prominently set forth.

79.   The specifications page is completed with hypothetical        YES   N/A   *
      data.

           Table of Contents

80.   The policy has more than 3000 words or 3 pages and a          YES   N/A   *
      table of contents is included.

           Incontestability

81.   The policy provides for an incontestability provision and     YES   N/A   *
      the policy language complies with §3220(a)(1).
                                                               7
82.   A two-year or less contestable period –in compliance with      YES   N/A   *
      §3220(a)(1) is provided.

83.   Contests are based on material misrepresentations only         YES   N/A   *
      and the provision includes this language or is not
      contrary to §3105.

84.   Policy indicates that any increase in the policy death         YES   N/A   *
      benefit after issue, if requested by the owner and subject
      to evidence of insurability, shall be contestable for two
      years from the date of increase.

85.   The contestable period for a policy issued as a conversion     YES   N/A   *
      or portability is measured from the original policy’s issue
      date.

           Entire Contract

86.   The policy provides for an entire contract provision and       YES   N/A   *
      the policy language complies with §§3220(a)(2) and
      3204.

87.   All statements made by or by the authority of, the             YES   N/A   *
      applicant for the issuance, reinstatement, or renewal of
      the policy shall be deemed representations and not
      warranties.

88.   The phrase “In absence of fraud” is not used in the entire     YES   N/A   *
      contract provision – Section II.H.7 of Circular Letter No. 4
      (1963).

89.   Nothing is incorporated by reference, unless a copy is         YES   N/A   *
      endorsed upon or attached to the policy.

90.   The policy cannot be modified, nor can any rights or           YES   N/A   *
      requirements be waived, except in writing by a person
      specified by the insurer in such policy.

           Misstatement of Age or Sex

91.   The policy provides for a Misstatement of Age or Sex           YES   N/A   *
      provision and complies with §3220(a)(3) and § II.H.8 of
      Circular Letter No. 4 (1963).

92.   The policy provides only for a Misstatement of Age             YES   N/A   *
      provision because it is a unisex policy.

           Certificate Issuance and Validity

93.   The policy provides for the issuance of a certificate for      YES   N/A   *
      delivery to each person covered under the policy.
      §3220(a)(4). Se also § 4216(b)(1), (2), (6), (7), (10),
      (11), (12) and (13).



                                                               8
94.   The certificate states the insurance protection to which      YES   N/A   *
      the insured is entitled including any changes in such
      protection depending on the age of the person whose life
      is insured and the statutory conversion rights.
      §3220(a)(4). The certificate includes in substance all
      provisions of the policy that have any relevance to the
      insured.

95.   The entire contract provision in the policy includes          YES   N/A   *
      reference to the certificate.

96.   The terms of the policy do not conflict with the terms of     YES   N/A   *
      the certificate. In the event of a conflict, the group
      policy does not state that the terms of the policy control
      over the terms of the certificate.

97.   States that nothing in the group policy invalidates or        YES   N/A   *
      impairs any rights granted to the certificate holder in the
      certificate.

           Grace Period

98.   The policy provides a grace period provision of at least 31   YES   N/A   *
      days or one month and is in compliance with Section
      3203(a)(1) and (2). If the policy is a flexible premium
      policy the grace period is provided when the account
      value or cash surrender value is no longer adequate to
      prevent default as defined in the policy.

99.   The policy provides that a notice will be sent to the         YES   N/A   *
      policyholder at least 15 and not more than 45 days prior
      to when failure to receive a payment would cause the
      policy to lapse, Section 3211(a). The notice is in
      compliance with Section 3211(b).

           Beneficiary and Facility of Payment

100. States that the benefits payable under the policy shall be     YES   N/A   *
     payable to the beneficiary or beneficiaries designated by
     the insured, except where the policy contains conditions
     pertaining to family status and the beneficiary is a
     specified family member.

101. If there is no designated or specified beneficiary as to all   YES   N/A   *
     or part of the insurance payable at the death of the
     insured, then the policy provides that the amount of
     insurance is payable to the estate of the insured or to
     one or more of the following surviving relatives: wife,
     husband, mother, father, child or children, brothers or
     sisters.




                                                              9
102. The policy permits the insurer to deduct from the death       YES   N/A   *
     benefit an amount not to exceed $500 to be paid to any
     person or persons appearing to the insurer to be equitably
     entitled to such payment by reason of having incurred
     expenses on behalf of the insured or for his or her burial.

103. The policy and certificate describes how primary and          YES   N/A   *
     secondary beneficiary designations operate and how
     multiple beneficiary designations are handled.

104. The policy provides that any change in the beneficiary        YES   N/A   *
     designation will take effect on the date the notice of
     change is signed, subject to action taken by the insurer
     prior to receipt of this notice.

105. The policy provides for payment of all benefits               YES   N/A   *
     thereunder to the person insured or to some beneficiary
     or beneficiaries other than the employer/policyholder,
     except as provided in Section 4231(b) for dividends and
     Section 3220(a)(5) for burial or other expenses.

106. If irrevocable beneficiaries are permitted, the beneficiary   YES   N/A   *
     provision clearly explains that such beneficiaries cannot
     be changed without the written consent of the
     irrevocable beneficiaries.

           Reinstatement

107. The policy provides for a reinstatement provision and the     YES   N/A   *
     policy language is in compliance with Section
     3203(a)(10).

108. This is a flexible premium policy and provides for a          YES   N/A   *
     reinstatement provision.

109. A minimum reinstatement period of three years is              YES   N/A   *
     provided – Section 3203(a)(10).

110. With respect to any reinstated policy, the contestable        YES   N/A   *
     period is based only on statements in the
     reinstatement application. – Section 3210.

111. This is a flexible premium policy and it does not             YES   N/A   *
     require payment of past premiums.

112. This is a flexible premium policy and it requires the         YES   N/A   *
     payment of an amount sufficient to keep the policy in
     force for no more than three months.

113. The policy explains how the account value and                 YES   N/A   *
     surrender charge will be determined upon
     reinstatement.




                                                              10
114. The account value and surrender charges are                    YES   N/A   *
     determined so that no part of the surrender charge is
     assessed more than once.

115. If policy is reinstated, the suicide exclusion does not        YES   N/A   *
     begin anew.

            Assignment

116. The policy is freely assignable and the policyholder can       YES   N/A   *
     assign all or any of the incidents of ownership, including
     any right to designate beneficiaries and any right to
     convert to an individual policy. §3220(c).

117. The policy is not freely assignable and expressly prohibits    YES   N/A   *
     or restricts the right of assignment. §3220(c).

118. The policy permits assignment of a covered person’s            YES   N/A   *
     rights but does not restrict the covered person from
     making assignments other than by gift, §7809.

119. The policy describes the procedures for making any             YES   N/A   *
     assignment and the assignment is effective as of the date
     signed, subject to any action taken by the company prior
     to receipt of the notice of assignment.

           Termination of Coverage

120. The policy specifies all reasons for termination of            YES   N/A   *
     coverage.

           Policy Loans

121. This policy provides for a policy loan provision               YES   N/A   *
     pursuant to Section 3203(a)(8)(A).

122. The policy loan provision language provided complies           YES   N/A   *
     with Sections 3203(a)(8) and 4222.

123. The policy loan value complies with §4222.                     YES   N/A   *

124. The policy provides for a fixed (payable in arrears)           YES   N/A   *
     loan rate not to exceed 8%. The loan interest rate is
           .

125. The policy provides for an adjustable loan rate not to         YES   N/A   *
     exceed 8%. The maximum loan rate is            .

126. An adjustable loan rate is used and the policy complies        YES   N/A   *
     with Section 3206.

127. The policy provides for an adjustable loan rate and            YES   N/A   *
     provides that the loan rate is adjusted at least once
     every 12 months, but not more frequently than once
     in any three month period. Section 3203(a)(8)(F).

                                                               11
128. The loaned portion of the account value is credited              YES   N/A   *
     with an interest rate that is up to 2% less than the
     applicable loan rate but in no event less than the
     guaranteed rate. Section 3203(a)(8)(H).

129. The loan provision provides for an adjustable loan rate          YES   N/A   *
     and indicates that the policy cannot lapse as a result
     of a change in the policy loan interest rate. Section
     3206(e).

130. Policy states that the insurer reserves the right to             YES   N/A   *
     defer any such loan, except when made to pay
     premiums, for six months after receipt of the loan
     application. Section 4222.

131. Where a future reduction in the loan spread is                   YES   N/A   *
     illustrated or disclosed, it is guaranteed in the policy.
     § 53-3.2(d) of Regulation 74.

132. If a loan is outstanding, the policy states how a payment        YES   N/A   *
     not designated as a premium or loan repayment is
     treated.

133. The company will comply with Section 3227 with                   YES   N/A   *
     respect to deferral of loans. Any policy language on
     such deferral complies with Section 3227.

134. The policy provides that any indebtedness shall be               YES   N/A   *
     deducted from proceeds payable on death. Section
     3203(a)(8)(B).

135. The policy provides any indebtedness will be deducted            YES   N/A   *
     from the cash surrender value. Section 3203(a)(8)(B).

           Settlement Option

136. The policy provides that the death benefit may, in addition      YES   N/A   *
     to the lump sum, be paid in installments.

137. The policy provides that the death benefit is payable only       YES   N/A   *
     in a lump sum.

138. The policy provides that the death benefit is payable            YES   N/A   *
     only in installments.

139. The policy provides for installment or annuity payments          YES   N/A   *
     and a table is provided in the policy. The guaranteed
     interest rate is      and the annuity table used is
           .




                                                                 12
140. If any life income settlement option with a period certain     YES   N/A   *
     provides for installment payments of the same amount at
     same ages for different periods certain, the policy states
     that the insurer will deem an election to have been made
     for the longest period certain which could have been
     elected for such age and amount.

           Conversion Right

141. The policy and certificate have conversion rights that         YES   N/A   *
     comply with §3220(b)(6). The following conditions apply:
      - No evidence of insurability is required.
                                                                    YES   N/A   *
      - The insured applies for conversion within 31 days after
      such termination or reduction of insurance or within any      YES   N/A   *
      extended conversion notice period, whichever is later.
      - Premium payment is based upon the class of risk to
      which the insured belongs, and the form and amount of         YES
                                                                          N/A   *
      the policy at his/her then attained age;
      - For conversions not due to total and permanent
      disability, the conversion policy (other than the required    YES
      preliminary term insurance) is in any one of the life               N/A   *
      insurance forms customarily issued by such insurer,
      except term insurance.
      - The amount of protection equals the amount of life
      insurance protection (i.e. including any supplemental life    YES
      coverage) under the group policy at the time of such                N/A   *
      termination or reduction, less any amount of life insurance
      remaining in force, except in the case of a reduction
      (other than for an employer or union program), in an
      amount equal to 80% of the insured’s coverage under
      such group policy immediately prior to such coverage.


142. The conversion coverage is provided by an affiliated           YES   N/A   *
     insurer.

143. The conversion coverage is provided by an unaffiliated         YES   N/A   *
     insurer.

144. The policy provides that the amount of life insurance          YES   N/A   *
     converted can be reduced by any group life insurance
     that replaces or reinstates the prior coverage within 45
     days.




                                                             13
145. Conversion rights are provided when coverage is reduced      YES   N/A   *
     in compliance with §3220(b)(6).
      - In the case of a policy covering an employee or union
      member under a plan arranged by the insured person’s        YES   N/A   *
      employer or union, on or after the employee’s or union
      member’s attainment of age sixty (60) in any increment or
      series of increments aggregating 20% or more of the
      amount of coverage in force before the first reduction on
      account of such age;
      - In the case of a policy covering any member other than
      described above, at the time of the first reduction of      YES   N/A   *
      insurance;
      - Due to change in class; or
                                                                  YES   N/A   *
      - Due to an amendment of the policy to take effect
      immediately or at any subsequent date.
                                                                  YES   N/A   *

146. Conversion rights are provided on termination of             YES   N/A   *
     employment or membership in the class or classes eligible
     for coverage or termination of the policy.

147. Conversion is provided for an insured covered under a        YES   N/A   *
     Section 4216(b)(12), (13) or (14) group policy, within 31
     days after notice from the insurer that to continue
     coverage, the insured must contribute more than 133% of
     the net premiums computed according to the
     Commissioners 1960 Standard Group Mortality Table at
     3.0% interest.

148. The conversion policy can be preceded by term insurance      YES   N/A   *
     for one year with the premium payable in any mode
     customarily offered by the insurer.

149. For termination due to total and permanent disability, all   YES   N/A   *
     term life insurance forms are available for conversion.

150. The policy provides that the death benefit (equal to full    YES   N/A   *
     amount of death benefit payable under original policy) is
     payable if death occurs within 31-day period that the
     employee or member was entitled to make application to
     convert coverage to an individual policy. Such period is
     extended by 45 days from the date of notice if notice of
     conversion right is not provided more than 15 days, but
     less than 90 days after the triggering event, subject to a
     maximum of 90 days if no notice is provided.

151. Dependent coverage includes conversion provisions in         YES   N/A   *
     compliance with §3220(a)(7). Conversion privilege is
     available to dependents upon termination or reduction of
     insurance as described in Section 3220(a)(6); upon death
     of employee/member, to the surviving spouse/children
     insured under group policy; upon a child’s attaining the
     limit age and upon divorce or annulment of marriage of
     employee and spouse.


                                                           14
152. Notice of conversion privilege is provided in accordance       YES   N/A   *
     with §§ 3220(a)(8) and 4216(d).

           Continuation and Portability

153. The policy contains a continuation or portability provision.   YES   N/A   *
     Such option is in addition to the conversion option.

154. The coverage is continued under the existing group life        YES   N/A   *
     policy and the insured can exercise the conversion right at
     any time.

155. The coverage is ported to a group life portability trust       YES   N/A   *
     policy that qualifies as a discretionary group under
     §4216(b)(14). The incontestability period and suicide
     exclusion periods relate back to the initial group life
     coverage.

156. Evidence of insurability is not required and there is no       YES   N/A   *
     provision restricting continuation or portability bases on
     factors relating to health status.

157. The notice periods for continuation and portability are the    YES   N/A   *
     same as for conversion.

            Specified Country Exclusion

158. The policy excludes or restricts liability in the event of     YES   N/A   *
     death occurring while the insured is resident in a specified
     foreign country or countries.
           Suicide

159. The policy excludes payment of the death benefit if the        YES   N/A   *
     insured commits suicide within the first two years.
     §3201(b)(1)(B).

160. The policy provides exclusion for suicide within two years     YES   N/A   *
     of the effective date of any increase in death benefits
     which results from an application of the owner subsequent
     to the policy issue date. §3201(b)(1)(B).

161. There is a refund of premiums paid (less dividends paid in     YES   N/A   *
     cash and any indebtedness) in the event of death by
     suicide during the two-year period. §3203(b)(3).

162. The phrase “while sane or insane” is not used, except with     YES   N/A   *
     respect to additional accidental death benefits. Section
     II(I)(1) of Circular Letter No. 4 (1963).

163. The suicide period for a policy issued as a conversion is      YES   N/A   *
     measured from the original policy’s issue date.

            War and Armed Forces Exclusion




                                                            15
164. The policy excludes or restricts liability in the event of     YES   N/A   *
     death as a result of war or act of war or special hazard as
     provided in §3203(c).

165. The exclusion does not exclude deaths due to diseases or       YES   N/A   *
     accidents that are common to the civilian population and
     are not attributable to special hazards to which persons
     serving in the armed forces or attached civilian units are
     exposed in the line of duty.

166. The policy provides that the war exclusion terminates six      YES   N/A   *
     months after the end of the war in which the insured was
     engaged or was likely to engage in at the time of
     application, after the discharge, release or separation of
     the insured from active military service, after the
     demobilization of the insured, or after the insured
     permanently leaves the war area, whichever occurs first.

167. The disclosure of the war exclusion as required by Section     YES   N/A   *
     3201(c)(4) is set forth on the form’s face page.

168. The insurer has notified the Superintendent prior to           YES   N/A   *
     commencing the issuance of life insurance policies with
     war risk exclusions. Section 336.

             Other Exclusions

169. The policy does not provide for exclusions from paying         YES   N/A   *
     the death benefit due to medical conditions.

170. The policy does not provide for exclusions from paying         YES   N/A   *
     the death benefit due to terrorism.
171. The policy specifies the conditions for aviation exclusion.    YES   N/A   *
     §3203(b)(1).

172. The policy provides for a hazardous occupation exclusion       YES   N/A   *
     in which death must occur within two years from the date
     of issue. §3203(b)(1).

173. If a death subject to an exclusion or restriction occurs       YES   N/A   *
     pursuant § 3203(b) or (c), the policy provides for the
     payment of the reserve on the face amount of the policy,
     computed according to the mortality table and interest
     rate specified in the policy, together with the reserve for
     any paid-up additions thereto, and any dividends standing
     to the credit of the policy, less any indebtedness to the
     insurer on the policy, including interest due or accrued. If
     the policy has been in force for not more than two years,
     the policy provides for payment of the amount of the
     gross premiums charged on the policy less dividends paid
     in cash or used in the payment of premiums thereon and
     less any indebtedness to the insurer on the policy,
     including interest due or accrued.




                                                            16
           Dividends and Rate Reductions


174. In the case of a participating group life insurance policy,    YES   N/A   *
     the dividends are payable in cash or applied to the
     payment of any premium under the policy, at the option of
     the policyholder. Section 4231(b)(7).

175. The policy is labeled as participating and states that the     YES   N/A   *
     insurer shall annually ascertain and apportion divisible
     surplus accruing on the policy.

176. The participating policy states that no dividends or only      YES   N/A   *
     minimal amounts are expected to be paid.

177. Additional supplemental benefits attached to a                 YES   N/A   *
     participating policy are not labeled or described as non-
     participating.

178. The policy provides for the following dividend options:        YES   N/A   *
     cash, purchase of paid-up additions and accumulation at
     interest. The automatic dividend option is paid-up
     addition.

179. The cash payment dividend option is not available to the       YES   N/A   *
     extent that such payment would prevent qualification for
     special tax treatment under IRC §403(b).

180. Any dividend apportioned in a participating group life         YES   N/A   *
     policy or any rate reduction on any nonparticipating group
     policy is applied to reduce the policyholder’s part of the
     cost of such policy and the excess, if any, of employee’s or
     members aggregate contributions under the policy over
     the net cost of insurance is applied (I) by the policyholder
     for the sole benefit of such employees or member
     pursuant to Sections 4231(b)(7), 4216(b)(7), (10); or (II)
     by the insurer for groups described in §4216(b)(12), (13),
     or (14) as a cash payment to the insured or to reduce the
     insured’s premium, unless such payment is assigned to
     the policyholder.

181. The policy provides for the readjustment of the rate of        YES   N/A   *
     premium based on the experience thereunder. The
     experience rating of such group premium has been
     addressed in the actuarial memorandum filed with the
     Department.

182. For experience rated multiple employer trust groups, the       YES   N/A   *
     premium charged a participating employer is not based
     solely on the experience of the employees of such
     employer.

            Interest Crediting




                                                            17
183. The policy describes the method of crediting interest.          YES   N/A   *
     Such method complies with §4232(b).

184. The minimum guaranteed interest rate is            %.           YES   N/A   *

185. Interest crediting is based on a bond/interest rate             YES   N/A   *
     index.

186. Interest crediting is based on an equity index or               YES   N/A   *
     another type of index other than a bond/interest rate
     index.

187. Policy values may be subject to a market value                  YES   N/A   *
     adjustment and the requirements of Regulation 136 are
     met.

188. The policy states that that the insurer shall credit any        YES   N/A   *
     additional amount no less frequently than annually during
     any period for which additional amounts may be credited.
     Section 3203(a)(14).

189. The policy states that additional amounts are                   YES   N/A   *
     nonforfeiture after crediting, except indirectly due to
     surrender charges made pursuant to §4221(n-1) or
     market value adjustments made pursuant to §4221(n-2).
     Section 3203(a)(13).

190. Additional interest is not used in illustrations or otherwise   YES   N/A   *
     disclosed, unless it is guaranteed in the policy. Section
     53-3.2(d) of Regulation 74.

           Guaranteed Factors

191. Policy states the guaranteed factors of mortality, expense      YES   N/A   *
     and interest. Sections 3203(a)(7)(A) and 3203(a)(12).

192. The table of mortality charges (cost of insurance rates)        YES   N/A   *
     and the basis of such table is specified in the policy.

193. For substandard policies, the mortality table underlying        YES   N/A   *
     the guaranteed mortality charges is identified.

194. If the guaranteed mortality charges approved exceed             YES   N/A   *
     those for standard policies, the policy indicates that extra
     risk mortality charges apply.

195. If the guaranteed mortality charges do not exceed those         YES   N/A   *
     for standard policies, but if extra premiums are charged
     for a substandard mortality risk, the policy shall indicate
     that extra risk premiums apply.

           Policy Value Calculation Method




                                                              18
196. The policy provides a statement of the method used by         YES   N/A   *
     the insurer in calculating actual policy values. Section
     3203(a)(12).

197. The order of application of charges and credits is            YES   N/A   *
     described in the policy. All terms related to the account
     value are fully defined in the policy. Section 3203(a)(12).

198. If there is a possibility that two or more different rate     YES   N/A   *
     classes could apply at the same time (e.g., due to a
     change in class prior to a face amount increase), the
     policy [or the submission materials (e.g., nonforfeiture
     statement)] describes how the net amount at risk for COI
     calculation purposes is allocated. Similarly, if there are
     two or more rate classes applicable to the face amount,
     the policy (or the submission materials) describes how a
     decrease in face amount would be allocated to those
     classes.

           Prospective Readjustment of Policy Cost
           Factors

199. The policy states that adjustments in policy cost factors     YES   N/A   *
     [interest, mortality deductions (i.e., cost of insurance
     charges), expense charges and loads] are subject to
     adjustment. Sections 3203(a)(7)(A) and 3203(a)(12).

200. The policy states the frequency in which adjustments to       YES   N/A   *
     policy cost factors may be made.

201. The prospective readjustment of such policy cost factors      YES   N/A   *
     complies with the requirements of §4231(g)(1)(D).

202. If future reductions in current expenses, mortality or risk   YES   N/A   *
     charges and/or future additional credits are being
     illustrated, such reductions and credits are guaranteed in
     the policy. Section 53-3.2(d) or Regulation 74.

            Nonforfeiture Provisions

203. The policy, in whole or in part, provides a plan of           YES   N/A   *
     insurance other than a term plan, contains nonforfeiture
     provisions that are equitable to the insured persons and to
     the policyholder.

204. Policy specifies the mortality table, interest rate and       YES   N/A   *
     method used in calculating cash surrender values and
     any paid-up nonforfeiture benefits available under the
     policy. Section 3203(a)(7)(A).




                                                            19
205. The policy provides a detailed statement of the method        YES   N/A   *
     of computation of the cash surrender values and paid-up
     nonforfeiture benefits shown in the policy. (For any
     values and benefits shown in the policy, a Yes response
     is required by Section 3201(c)(5) and 4221(a)(6) on
     either this item or the next)

206. The policy provides that a detailed statement of the          YES   N/A   *
     method of computation of the cash surrender values and
     paid-up nonforfeiture benefits shown in the policy has
     been filed with the insurance supervisory official of the
     state in which the policy is delivered. Section 4221(a)(6).

207. The policy contains a statement of the method to be           YES   N/A   *
     used in calculating the cash surrender value and paid-up
     nonforfeiture benefit available under the policy on any
     policy anniversary beyond the last anniversary for which
     such values and benefits are consecutively shown in the
     policy. Sections 3201(c)(5) and 4221(a)(6).

208. The policy provides a table or statement of any surrender     YES   N/A   *
     charges. Section 4221(a)(5-a), 4221(n-1)(3)(A)(ii) and
     4221(n-1)(3)(B)(ii).

209. The policy explains how nonforfeiture benefits are            YES   N/A   *
     affected by loans. Section 4221(a)(6).

210. The policy states that the insurer reserves the right to      YES   N/A   *
     defer payment of cash surrender values for six months
     from the date of request pursuant to the paragraph
     following Section 4221(a)(8) and to defer any loan,
     except when made to pay premium, for six months after
     receipt of the loan application.

211. The policy states that the cash surrender values and the      YES   N/A   *
     paid-up nonforfeiture benefits available under the policy
     are not less than the minimum values and benefits
     required by any statue of the state in which the policy is
     delivered. Section 4221(a)(6).

212. The policy’s surrender charges comply with Section            YES   N/A   *
     4221(n-1)(3)(B) and the policy provides the option to
     surrender for a paid-up benefit required under Section
     4221(n-1)(3)(B)(iii). The policy indicates that no expense
     charges will be applied thereafter, specifies the purchase
     basis, and how subsequent cash surrender values are
     determined.

           Cash Surrender Value and Surrender Charges




                                                            20
213. The policy provides sufficient detail to allow the          YES   N/A   *
     policyowner to determine the surrender charge applicable
     upon a partial withdrawal or face amount decrease and
     to determine how the remaining surrender charge
     schedule is impacted by a partial withdrawal or face
     amount decrease. Section 4221(a)(5-a) and (6).

214. The policy provides for a cash surrender value when the     YES   N/A   *
     policy becomes paid-up. Section 4221(a)(4).

215. The cash surrender value of any policy continued under      YES   N/A   *
     any paid-up nonforfeiture benefit is not less than the
     present value of the future guaranteed benefits provided
     by the policy, including any existing paid-up additions,
     decreased by any indebtedness to the insurer on the
     policy, including interest due or accrued. Section 4221
     (c)(4).

216. The policy provide that a statement of the cash surrender   YES   N/A   *
     value of the policy will be furnished to the policyholder
     within twenty business days from the date of written
     request. Section 4221(c)(5).

217. The present value of any paid up nonforfeiture benefit is   YES   N/A   *
     greater than or equal to the cash surrender value, or
     what the cash surrender value would have been if it were
     available. Section 4221(d).

218. The maximum amortization period for the surrender           YES   N/A   *
     charge is twenty years. Section 4221(n-1)(3)(C).

          Annual Report

219. The policy states that the insurer will mail to the         YES   N/A   *
     policyholder at least once each policy year or within 60
     days after the end of the policy year, a statement as to
     the death benefit, cash surrender value, and loan value
     under the policy/certificate and other information
     required by the Superintendent. Section 4221(a)(7) and
     §A.7 of Circular Letter No. 4 (1983).

220. The annual report complies with sec 53-3.6 of Regulation    YES   N/A   *
     74.

221. The policy contains a no-lapse guarantee and the annual     YES   N/A   *
     report states whether the no-lapse guarantee is in effect
     as of the date of the annual report.

          Dependent Coverage

222. The policy provides for payment of life insurance benefit   YES   N/A   *
     upon the death of the spouse of the insured employee or
     member.




                                                          21
223. The insurance upon the life of the spouse does exceed         YES   N/A   *
     the amount of insurance for which the employee or
     member is insured at the time application is made for
     spouse coverage.

224.   No coverage is provided for a domestic partner.             YES   N/A   *

225. The policy provides for payment of life insurance benefit     YES   N/A   *
     upon the death of the insured employee’s or member’s
     child dependent upon him or her for support and
     maintenance and the amount of insurance upon the life of
     each dependent child does not exceed $4000.

226. If stepchildren are covered, the signature of the spouse of   YES   N/A   *
     the employee or member (i.e., the natural parent) is
     included in the enrollment/application form.

227. Dependent child coverage includes adopted children, but       YES   N/A   *
     not foster children or children for whom the insured
     employee or member serves as guardian.

           Eligibility Requirements

228. All new employees of an employer or members of the            YES   N/A   *
     labor union or other association or eligible group or
     classes eligible for such insurance are added to such
     groups or classes for which they are eligible.

229. Classes are determined by conditions pertaining to            YES   N/A   *
     employment, membership in a union or association, or a
     combination of such conditions.

230. For single employer groups, classes are determined by         YES   N/A   *
     conditions pertaining to employment and conditions
     pertaining to family status.

231. Eligibility is subject to evidence of insurability.           YES   N/A   *

232. The policy includes an active work requirement with a         YES   N/A   *
     minimum number of hours worked per week for
     employees or members.

233. Dependent eligibility is deferred due to a hospital           YES   N/A   *
     confinement or similar disability.

           Limitations on the Amount of Insurance

234. The policy precludes individual selection by employee,        YES   N/A   *
     policyholders, employers or union in the amount of
     insurance. The maximum coverage for an individual
     employee, or limited number of employees, under a group
     contract is related to the total amount of insurance on the
     group and to the average amount of insurance on each
     member of the group.



                                                           22
235. A limited number of selections by employees or member is        YES   N/A   *
     permitted and the selections offered utilize a consistent
     pattern of grading the amounts of insurance for individual
     group members so that the resulting pattern of coverage
     is reasonable.

236. The policy is fully underwritten and offers an unlimited        YES   N/A   *
     number of selections.

           Age-Based Reductions

237. The policy provides for a reduction in benefits for active      YES   N/A   *
     employees who reach a certain age due to the high cost of
     providing benefits for older employees. The reduction in
     the amount of life insurance complies with the Age
     Discrimination in Employment Act.

            Arbitration

238. The policy language does not provide for binding                YES   N/A   *
     mandatory arbitration.

             Waiver of Surrender Charges or
             Reductions in Fees

239. The policy provides for a waiver of surrender charges or        YES   N/A   *
     reduction in fees based on total and permanent disability
     in accordance with the provisions of Section 3215 of the
     Insurance Law.

240. The policy provides for a waiver of surrender charges or        YES   N/A   *
     reduction in fees based on disability as defined in a
     manner the insurer feels is more favorable than the
     provisions of Section 3215.

241. The policy provides for a waiver of surrender charges or        YES   N/A   *
     reduction in fees based upon terminal illness, nursing
     home confinement or the provision of long term care
     either at home or in a nursing home.

242. The policy with the waiver of surrender charges or              YES   N/A   *
     reduction in fees will not be marketed, advertised or sold as
     long term care coverage or as an alternative to long term
     care insurance.

            Interest on Deferral of Death Proceeds,
            Surrenders and Loans

243. If the policy provides for the payment of interest on           YES   N/A   *
     death claims, the policy language complies with
     §3214.




                                                             23
244. If the policy provides for a deferral period on payment of      YES   N/A   *
     surrenders or policy loans, the language complies with
     Section 3227 including the “ten-day” period and the
     applicable interest rate that is the current rate payable on
     the interest only settlement option.

            Proof of Loss

245. Policy indicates that due proof of death must be                YES   N/A   *
     provided to insurer.

            Claims of Creditors

246. Policy provisions relating to claims of creditors are in        YES   N/A   *
     compliance with §3212.

            Secondary Guarantees


247. Policy contains a no lapse guarantee. The guarantee             YES   N/A   *
     period is        (please identify).

248. The policy language indicates that a negative account           YES   N/A   *
     value (or unpaid charges) will be accumulated during the
     no-lapse guarantee period and advises as to whether or
     not the accumulated deficit needs to be repaid by the
     policyowner at the end of the no-lapse period.

249. The policy language indicates that a negative account           YES   N/A   *
     value will be accumulated during the no-lapse guarantee
     period and fully explains the effect, if any, on the
     calculation of cost of insurance charges and death
     benefits.

250. A negative account value (or unpaid charges) will be            YES   N/A   *
     accumulated during the no-lapse guarantee period and
     rates for the cost of insurance can be applied to a base in
     excess of the death benefit.

251. A negative account value (or unpaid charges) will be            YES   N/A   *
     accumulated during the no-lapse guarantee period and
     the death benefit can be reduced to reflect the negative
     account value (or unpaid charges).

252. The policy language indicates that a negative account           YES   N/A   *
     value will be accumulated during the no-lapse guarantee
     period and the specification page contains a prominent
     statement that based on payment of the no-lapse
     premium, an additional lump sum payment may be
     required to keep the policy in force at the end of the no-
     lapse period and that the policyowner may contact the
     company for additional information.

253. The policy and the annual report describe in a prominent        YES   N/A   *
     place any policy or certificate holder action (e.g. partial
     withdrawal or loan) that will nullify the secondary

                                                                24
      guarantee.


254. The secondary guarantee is provided by rider.                  YES   N/A   *

255. The policy language indicates whether or not the               YES   N/A   *
     secondary guarantee feature can be reinstated and the
     conditions for reinstatement.

256. The policy language advises how and when the insurer           YES   N/A   *
     will verify that the secondary guarantee conditions
     continue to be met.

257. The policy language states that the policy or certificate      YES   N/A   *
     holder will be notified when an additional premium
     payment or any other action is required to maintain the
     secondary guarantee.

258. The policy language indicates that the secondary               YES   N/A   *
     guarantee can terminate even though the policy remains
     in force.

259. Policy contains a secondary guarantee that is other than       YES   N/A   *
     no lapse. If so, it is described in the submission letter
     and in the policy.

            Partial Withdrawals


260. This policy provides for partial withdrawals.                  YES   N/A   *

261. This policy contains a provision describing how partial        YES   N/A   *
     withdrawals operate and the order in which partial
     withdrawals will be made.

262. This policy provides that the net amount of risk cannot        YES   N/A   *
     be increased by making a partial withdrawal.

263. This is a policy with no explicit COI charges or with COI      YES   N/A   *
     charges as a percent of the account value.
      There is a disclosure statement in the partial withdrawal
      provision and the death benefit provision of the contract     YES   N/A
      regarding adjustment to the death benefit following
      partial withdrawals.
      The policy provisions regarding partial withdrawal and
      death benefit options include information about
      adjustments to the death benefit following partial            YES   N/A
      withdrawals.
      The partial withdrawal provision provides for a pro rata
      reduction in the death benefit following a partial
      withdrawal.
                                                                    YES   N/A
      The partial withdrawal provision does not provide for a
      pro rata reduction in the death benefit following a partial
      withdrawal and justification is provided in the submission.
                                                                    YES   N/A

                                                               25
            Maturity Date

264. Policy contains a Maturity Date beyond age 100 or              YES   N/A   *
     permits the policy to continue beyond age 100.

265. A maturity date extension is provided by rider.                YES   N/A   *

266. There is a net amount at risk beyond age 100.                  YES   N/A   *


267. There is no net amount at risk beyond Age 100.                 YES   N/A   *

268. Policy contains provision indicating whether policy loans      YES   N/A   *
     and partial withdrawals are permitted after age 100.

269. The policy provision indicates that there will be no cost of   YES   N/A   *
     insurance charges or other charges except for service
     charges, administrative charge and charges made as a
     reduction in investment return as provided for in 4221(n-
     1)(2)(c), 4221(n-1)(3)(A)(i)(VIII), and 4221(n-1)(2)(A).
     Please identify the type and amount charges that will
     continue to be made here          .

270. The policy provision indicates no further premium              YES   N/A   *
     payments, except as needed to keep the policy from
     lapsing, will be accepted after age 100.

271. The policy provision indicates that loan repayments are        YES   N/A   *
     permissible after age 100.

272. Prominent disclosure statement, indicating that the policy     YES   N/A   *
     may not qualify as life insurance after age 100, may be
     subject to adverse tax consequences and a tax advisor
     should be consulted before choosing to continue the
     policy after age 100, is in the policy.

273. Policy contains provisions explaining the relationship         YES   N/A   *
     between payment of a planned premium and coverage to
     age 100.

            Death Benefit Option and Face Amount
            Increases

274. The policy permits the Company to require evidence of          YES   N/A   *
     insurability if, at the time of a death benefit option
     change, the net amount at risk is increased. Otherwise,
     a change in death benefit option is not subject to
     evidence of insurability.

275. Policy provides that any automatic increases in face           YES   N/A   *
     amount, (i.e., increases that are not requested by the
     policyholder), are not subject to evidence of insurability.

                                                             26
276. Policy states that changes made by holder, including              YES   N/A   *
     payment of additional premium and increases in planned
     premiums that result in an increase in the net amount at
     risk, may require evidence of insurability and/ or the
     premium may be refused.

277. Policy provides that any excess premium payments over             YES   N/A   *
     the maximum amount that can be paid under Section
     7702 of the Internal Revenue Code will be refunded.

278. Policy sets forth any limitations on policy changes such as       YES   N/A   *
     the minimum and maximum amount and number of face
     amount increases or decreases allowed.

              Policies for the Section 403(b) Market


279. The policy will be used in the Section 403(b) market.             YES   N/A   *

280. The policy complies with Circular Letter No. 16 (1993)            YES   N/A   *
      and Sections 3203(a)(8)(J), 4221(q).

281. The policy has a loan provision that complies with Section        YES   N/A   *
      72(p) of the IRC.

282. Policy is on a unisex basis or a unisex endorsement is            YES   N/A   *
      used.

283. The disclosure form required by §3209(j) is attached.             YES   N/A   *


            Additional Benefits

284. The policy provides for accelerated death benefits under          YES   N/A   *
     §§ 1113(a)(1), 3201(c)(12) and 3230 and Regulation
     143. If so, the applicable checklist is attached hereto.

285. The policy provides a disability benefit in the form of a         YES   N/A   *
     waiver of premium, extended death benefit, or maturity
     value that complies with § 3215.

286. The policy does not provide for exclusions from paying the        YES   N/A   *
     disability benefits due to terrorism.
287. The waiver of premium rider does not operate to                   YES   N/A   *
     guarantee that the policy will not lapse and a disclosure
     form to be signed by the applicant to that effect is
     attached as part of the submission. In addition, the
     submission letter advises that the insurer will notify the
     policyholder by letter or notice at time of disability that the
     rider does not guarantee the policy will not lapse.

288. A waiver of premium rider which does not guarantee the            YES   N/A   *
     policy will not lapse will only be sold in conjunction with
                                                              27
        the waiver of monthly deduction rider (therefore the
        disclosure above is not required).

 289. The policy provides an accidental death and                     YES   N/A     *
      dismemberment and the insurer has submitted such policy
      form to the Health Bureau.

 290. The policy does not provide for exclusions from paying the      YES   N/A     *
      accidental death and dismemberment benefit due to
      terrorism.
 291. The policy provides an accidental death benefit as an           YES   N/A     *
      additional benefit under the life insurance policy.

 292. The policy does not provide for exclusions from paying          YES   N/A     *
      the accidental death benefit due to terrorism.
 293. Submission contains term life riders on the insured             YES   N/A     *
      covered under the base policy and the group term life
      checklist is included.

 294. The term rider develops no separate policy values.              YES   N/A     *

 295. The term rider complies with Regulation 149.                    YES   N/A     *

 296. Term rider costs are shown separately on the policy             YES   N/A     *
      specification pages.

         II. Other

 297. Any substantive provisions or features provided by the          YES   N/A     *
      terms or operation of this policy which have not been
      addressed by this checklist, are set forth in an attachment
      to this checklist or identified in the submission letter.



Print Name:                                                         Date:

Print Title:


Signature:________________________________________




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                                                               28
                 IV. Actuarial Section

299.           I am a member of the Society of Actuaries or the American Academy of Actuaries          Yes   N/A   *
               and I meet the “Qualification Standards for Prescribed Statements of Actuarial
               Opinion” as adopted by the American Academy of Actuaries at the time of
               completion of this checklist. (Note: the Department considers this checklist to be a
               Prescribed Statement of Actuarial Opinion.)

300.           I have read the forms and supporting material submitted with the filing.                Yes   N/A   *

                                           Nonforfeiture Certification

301.           Each policy form is in compliance with the nonforfeiture requirements of the New        Yes   N/A   *
               York Insurance Law and New York Insurance Regulations applicable to individual
               universal life insurance. Forms reviewed for compliance were (list policy form
               numbers):



302.           The nonforfeiture values may be less than required by New York law and regulations      Yes   N/A   *
               for individual universal life insurance policies. An actuarial memorandum is included
               on nonforfeiture values addressing the appropriateness of nonforfeiture values that
               may be less than required by New York law and regulations for individual universal
               life insurance policies.


                                          Nonforfeiture Memorandum

303.           The policy provides that a detailed statement of the method of computation of           Yes   N/A   *
               the cash surrender values and paid-up nonforfeiture benefits shown in the
               policy has been filed with the insurance supervisory official of the state in which
               the policy is delivered and such statement is provided and includes sample
               projections (including beginning and ending account value and cash surrender
               value and all policy cost factors) so that the account value mechanics can be
               fully understood.



The signature below applies to the Actuarial Section only.



Print Name:                                                           Date:

Print Title:


Signature:________________________________________




                                                                 29

								
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