State Farm Life Insurance Company DISCLOSURE
State Farm Life Insurance Company DISCLOSURE
State Farm Life Insurance Company DISCLOSURE
DISCLOSURE
The total first year premium outlay illustrated is $6,987.12. The initial premium is $582.26 each month. Please review
this illustration for additional changes in illustrated premiums and coverages in years 2 and later.
Description of Coverage
Plan Universal Life (Form Number 08030 - 05) is a flexible premium adjustable life insurance
policy. A death benefit is payable when the Insured dies. Flexible premiums are
payable to the Insured's age 121.
How This Plan Works You start with a planned premium and death benefit. You may change either in the future
subject to policy provisions. When you pay premiums, we deduct a 5% premium charge.
The remaining premium is added to the account value. From this account value we deduct
each month: (A) the current cost of insurance including the charges for any riders, and
(B) a current monthly expense charge of $8.00. During each of the first 24 months
following issue or an increase, an issue charge will be deducted from the account value.
The issue charge is $0.10 per $1000 of the initial Basic Amount and each increase, each
subject to a maximum of $50.00 per month. The account value earns interest at the
current interest rate, but a different rate may be credited to any account value which
you have borrowed. The current interest rate is increased by 0.50% on the unloaned
account value that exceeds 10% of the Basic Amount. Surrender charges apply.
The current monthly cost of insurance rates and monthly expense charge may be changed by
the company at any time, but will never be more than the maximums given in the policy.
The maximum monthly expense charge is $8.00 in policy years one through five, and $10.00
thereafter. The current interest rate can be changed by the company on a monthly basis,
but will never be less than the guaranteed rate of 4%. This policy is participating, but
no dividends are anticipated.
Important Tax Information This policy complies with the definition of life insurance in Internal Revenue Code
Section 7702. This means that the premium illustrated does not exceed the greater
of the Guideline Single Premium or the cumulative Guideline Annual Premium. Payment
of the guideline annual premium will not provide coverage to age 121 under the contract,
on the guaranteed basis. This illustration should not be relied on for tax advice. The tax
status of this policy should be reviewed with the policyowner's legal and tax advisors.
Description of Coverage
If at any time during the first 7 years, the total premiums paid exceed the MEC Reference
Premium shown below times the number of years the policy has been in force, the policy
will be considered a Modified Endowment Contract. This means distributions, which include
cash withdrawals, policy loans, and assignments may be subject to Federal Income Tax to the
extent there is a gain in the contract. An additional 10% penalty tax may also apply prior to the
policyowner's age 59 1/2.
Increases in coverages will require a new premium test with a new 7 year test period.
Reductions in coverages during a 7 year test period will generally result in a lower MEC
Reference Premium retroactive to the beginning of the 7 year test period.
Planned premiums after the 1st year shown on this illustration have not been checked
to determine if the MEC Reference Premium limit has been exceeded.
Waiver of Monthly This rider (Form Number 08206 - 05) provides for the waiver of all monthly deductions so
Deduction for Disability long as the Insured is totally disabled as defined in the policy.
Definitions
Juvenile Available for ages 0 through 19. Insurance costs used in this illustration assume that the
Insured qualifies for Non-Tobacco rates beginning with the first renewal date on or after
age 20. To receive these Non-Tobacco rates, the owner must apply and the Insured be
approved for the Non-Tobacco classification.
Basic Amount The Initial Basic Amount plus any increases less any decreases.
Monthly Deductions The sum of the monthly cost of insurance charges, the monthly expense charge, the issue
charge, and charges for any riders.
Guaranteed Values These values are calculated using the illustrated premiums, 5% premium expense charge,
guaranteed interest rate of 4% and the maximum monthly deductions.
Non-Guaranteed Intermediate Values These values are calculated using the illustrated premiums, 5% premium expense charge,
average of the illustrated and guaranteed interest rates, and the average of the current
and maximum monthly deductions. The intermediate values are not guaranteed. They
demonstrate the impact of changes in company experience.
Non-Guaranteed Illustrated Values These values are calculated using the illustrated premiums, 5% premium expense charge,
illustrated interest rates, and current monthly deductions. The illustrated interest rate has
been increased by 0.50% on the unloaned account value that exceeds 10% of the Basic
Amount. These values are not guaranteed.
Total Annualized Premium Outlay The sum of each year's annualized premium outlay.
Definitions
Account Value This is the accumulation of premiums shown less a 5% expense charge and monthly
deductions.
Cash Surrender Value This value is the account value less the applicable surrender charge. Surrender charges
apply for 15 policy years following issue or an increase in the Basic Amount of insurance.
Death Benefit This is the amount payable at the death of the Insured. Any increase or decrease must be
approved by the Company, subject to policy provisions. Future increases are illustrated
using the premium class of the base policy, subject to the minimum amount requirements
as of the date of the illustration.
Option 1 Under Option 1, the death benefit is the Basic Amount of insurance. The death benefit
may be increased due to Internal Revenue Code provisions. Changes in the Death Benefit
Option can result in the Basic Amount being lowered below the Policy's Minimum Basic
Amount. In these cases, the Minimum Basic Amount stated in the policy will be amended
to reflect a reduced Minimum Basic Amount.
This illustration assumes that the currently illustrated non-guaranteed elements will continue unchanged for all years shown.
This is not likely to occur, and actual results may be more or less favorable than those shown. The assumptions on which
they are based are subject to change by the Company. Cash values and death benefits shown are end of year values.
Premiums are assumed to be paid when due. This illustration contains a general description of coverage. A complete statement
of coverage is found in the policy.
Guaranteed Illustrated
10 Year 20 Year 10 Year 20 Year
These indices are computed by the formulas prescribed by the National Association of
Insurance Commissioners and reflect the time value of money at 5%. These indices
do not include the cost of additional benefits.
Guaranteed Interest Rate: 4.00% Interest Rate: 4.50% Interest Rate: 5.00%
**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis.
I have received a copy of this illustration and understand that any non-guaranteed elements illustrated are subject to change and
could be either higher or lower. The agent has told me they are not guaranteed.
Applicant Date
I certify that this illustration has been presented to the applicant and that I have explained that any non-guaranteed elements
illustrated are subject to change. I have made no statements that are inconsistent with the illustration.
Agent Date
**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis.
These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.
**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis.
These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.
**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis.
These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.
**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis.
These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.
disclosures below. I have been encouraged to ask any questions that I have concerning these disclosures.
I have applied to purchase from one of the State Farm Life insurance companies the following
product: Universal Life . I understand that the life companies are affiliated
with State Farm Bank, but that the product offered is not being offered by the Bank.
If anyone asserts that this product is federally insured or guaranteed, or is as safe as an insured deposit, I should
* IS NOT A DEPOSIT OR OTHER OBLIGATION OF ANY BANK AND IS NOT GUARANTEED BY THE BANK OR
BY THE FEDERAL GOVERNMENT;
* INVOLVES INVESTMENT RISKS, INCLUDING POSSIBLE LOSS OF PRINCIPAL INVESTED.
Dated