A Life Insurance Illustration: Narrative Summary
A Life Insurance Illustration: Narrative Summary
A Life Insurance Illustration: Narrative Summary
NARRATIVE SUMMARY
What follows is a brief description of the illustrated life insurance policy. For additional information please
request a specimen policy from your agent or broker.
About the Customizer WL is a participating whole life individual insurance policy providing a level guaranteed death
Customizer WL benefit. Premiums are payable for the life of the insured, but not beyond age 120. Premium payments cannot
Policy be skipped or reduced; however, if sufficient, you can borrow against the policy's surrender value to pay the
required premiums.
This is only an illustration. Security Mutual Life Insurance Company of New York (i.e., "the Company") will
determine your eligibility for coverage. The Company will determine the premiums to be paid based upon your
issue age and the actual risk classification for your policy as determined by the Company. If we issue the policy
other than as you applied for it, we will send you with the policy, a revised illustration conforming to the policy
as issued.
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.
Contract premiums and/or premium outlays are assumed to be paid at the beginning of each year, and the values
and benefits shown are as of the end of each year. Premiums are assumed to be paid annually.
Any benefit changes, partial surrenders, loans or loan repayments are assumed to be made at the beginning of
the policy year in which they are illustrated. Policy values and benefit amounts are stated as of the end of the
policy year in which they are illustrated.
Death Benefit The total initial death benefit is $210,268. The base policy face amount is $191,097. The Paid-Up Additions
Rider initial death benefit is $19,171.
Dividends It is assumed that dividends purchase Paid-Up Additional (PUA) insurance in all illustrated years.
Underwriting Class The premium outlay for this coverage has been calculated assuming Lino Talley is in the Standard Nonsmoker
underwriting class.
Taxation In order to receive favorable tax treatment of distributions (including loans) under the Internal Revenue Code, a
life insurance policy must satisfy a 7-Pay Premium limitation during the first 7 years and during 7 years after
certain policy changes. Failure to satisfy this limitation would cause distributions to be taxable to the extent
there is a gain in the contract.
In addition, there is a penalty of 10% of taxable income for distributions from such policies before age 59½
with certain exceptions. In any case, a gain in the contract is taxable upon full surrender of the policy.
Non-MEC As illustrated this policy is not a Modified Endowment Contract (MEC) under the Internal Revenue Code. If
there is a material change such as an increase in the death benefit under the policy or any increase in or addition
of a qualified additional benefit this policy may be reclassified as a MEC. If reclassified, distributions,
including loans, from a MEC may be taxable as income and may be subject to a penalty tax.
This illustration is not valid without all pages. This is not a policy or an offer to contract and the descriptions of the policy are in summary form.
Prepared by: Tomas P McFie Ill Adv. 2087 A Life Insurance Policy Illustration
Business: 503-363-5433 Ext: 302 FAX: 503-363-5443 Page 1 of 11 Prepared on: 07/26/2010
State: Hawaii; Version: 16.05.2010 WL-3652, CP-3652
A Life Insurance Illustration
Designed for: Whole Life Insurance
Lino Talley - Male Age 45 Standard Nonsmoker
Policy Form 2087
Riders Consult the actual rider policy form for more information on the illustrated riders.
Paid Up Additions Each PUAR premium payment is used to purchase an additional amount of guaranteed paid up life insurance.
Rider (PUAR) The Paid-Up Additions Rider in this illustration is paid for 4 years.
Accidental Death The Company will pay an additional amount of $250,000 if the insured dies as the result of an accident (as
Benefit (ADB) defined in the rider form) prior to attained age 70.
Waiver of Premium If the insured becomes totally disabled (as defined in the rider benefit form) prior to age 60, for a continuous
(Waiver / WP) period of at least 6 months, the Company will waive the payment of the base plan premium and any benefit
and/or rider premiums.
Living Benefits Rider This rider permits the policyowner to access a portion of the life insurance death proceeds during the insured's
(LBR) lifetime should the insured be diagnosed as terminally ill (life expectancy of 12 months or less).
Column ATT. Age: (Attained Age) The attained age of the insured at the end of the policy year.
Descriptions
Yr (Year): The number of years the policy is assumed to have been inforce.
Contract Premium: The premium required to be paid under the policy, including the premium for all riders or
benefits shown.
PUA Rider Surrender Value: Surrender Value attributable to paid up additional insurance purchased by rider
premiums.
Total Surrender Value: This amount is available to the policyowner upon surrender of the policy provided that
the required contract premiums have been paid when due and there is no outstanding loan on the policy.
PUA Rider Death Benefit: The portion of the Total Death Benefit attributable to paid up additional insurance
purchased by rider premiums.
Total Death Benefit: This amount is payable upon the death of the insured, provided that the required contract
premiums have been paid when due and there is no outstanding loan on the policy.
Non-Guaranteed Annual Dividend: The illustrated dividend is based on the Company's 2010 dividend scale, which is not
Values guaranteed. Actual dividends payable under the policy may be higher or lower than those shown depending on
the Company's actual future experience as it relates to interest, mortality, and expenses. The end of year 1
dividend is contingent upon payment of the second year's contract premium.
PUA Surrender Value is the portion of the Total Surrender Value attributable to paid up additional insurance
purchased by rider premiums or dividends.
Total Surrender Value is the amount that would be available upon surrender of the policy, given the
illustration assumptions. This amount includes the base policy surrender value plus the surrender value of any
paid-up additional insurance or accumulated dividends, less any surrenders and/or any outstanding loan balance.
Total Death Benefit: The amount that would be payable upon the death of the insured, given the illustration
assumptions. This amount includes the base policy death benefit plus any paid-up additional insurance or
accumulated dividends, less any surrenders and/or any outstanding loan balance.
This illustration is not valid without all pages. This is not a policy or an offer to contract and the descriptions of the policy are in summary form.
Prepared by: Tomas P McFie Ill Adv. 2087 A Life Insurance Policy Illustration
Business: 503-363-5433 Ext: 302 FAX: 503-363-5443 Page 2 of 11 Prepared on: 07/26/2010
State: Hawaii; Version: 16.05.2010 WL-3652, CP-3652
A Life Insurance Illustration
Designed for: Whole Life Insurance
Lino Talley - Male Age 45 Standard Nonsmoker
Policy Form 2087
Non-Guaranteed PUA Death Benefit is the portion of the Total Death Benefit attributable to paid up additional insurance
Values purchased by rider premiums or dividends.
(continued)
Premium Outlay: The amount of premium assumed to be paid by the policyowner in cash. If value noted is
negative, a cash distribution, such as policy loan or PUA surrender, has occurred.
PUA Surrendered is the Surrender Value of paid up additional insurance assumed to have been surrendered for
cash or to make a premium payment or possibly for a combination of both.
Numeric Summary The GUARANTEED columns show values and benefits based on the guaranteed provisions of this policy.
and Signature Page
Definitions NON-GUARANTEED VALUES -These benefits and values are not guaranteed. The assumptions on which
they are based are subject to change by the Company. Actual results may be more or less favorable than those
shown.
The MIDPOINT columns show values assuming dividends are reduced by 50% and any policy charges are an
average of the current and guaranteed charges.
The CURRENT columns are based on the Company's current premium rates and dividends, which are not
guaranteed and may be either higher or lower than those shown.
These values are based on a continuous premium payment pattern and do not reflect any loan activity or PUA
surrenders.
Important NON-GUARANTEED VALUES: These values are not guaranteed. The assumption on which they are based
Additional are subject to change by the Company. Actual results may be more or less favorable than those shown. SEE
Information FIRST PAGE OF TABULAR DETAIL FOR GUARANTEED VALUES.
Dividends are NOT GUARANTEED and are subject to significant fluctuation. A dividend scale change may
result in an increase or decrease in the required number of cash premium payments. Also, while dividends and
paid up additions may at one time be sufficient to pay premiums, a decrease in the dividend scale may result in
the need to resume cash premium payments at a later date.
This illustration is not valid without all pages. This is not a policy or an offer to contract and the descriptions of the policy are in summary form.
Prepared by: Tomas P McFie Ill Adv. 2087 A Life Insurance Policy Illustration
Business: 503-363-5433 Ext: 302 FAX: 503-363-5443 Page 3 of 11 Prepared on: 07/26/2010
State: Hawaii; Version: 16.05.2010 WL-3652, CP-3652
A Life Insurance Illustration
Designed for: Whole Life Insurance
Lino Talley - Male Age 45 Standard Nonsmoker
Policy Form 2087
Cost Indexes An explanation of the intended use of these indexes is provided in the Life Insurance Buyer's Guide.
Surrender Cost This index is useful if you consider the level of the cash values to be of primary importance to you. It helps you
Index compare costs if at some future point in time, such as 10 or 20 years, you were to surrender the policy for its
surrender value.
Net Payment This index is useful if your main concern is the benefits that are to be paid at your death and if the level of
Cost Index surrender values is of secondary importance to you. It helps you compare costs if at some future point in time,
such as 10 or 20 years, if you continue paying premiums on your policy and do not take its surrender value.
Equivalent Level This information is helpful in demonstrating the role of dividends, a non-guaranteed policy element, in
Annual Dividend determining the cost of a participating policy.
The interest adjusted cost comparison indexes provide two means of comparing the relative costs of similar
policies. All things being equal, a lower index represents a better value than a higher one. The cost indexes
apply a 5.00% interest factor to the basic cost elements: policy premiums, dividends, and for the surrender cost
index, the 10 and 20 year cash values.
Cost indexes do not take into consideration the quality of service derived from a company or an agent or broker,
differences in policy provisions, or the strength of the Company and its actual performance.
Premium Modes Available initial premium modes and modal premiums are provided below. Note these premiums exclude
Paid-Up Additions Rider premium and any Conversion Credit, if applicable. The Policyowner incurs an
additional cost when paying premiums on a mode other than the Annual mode that varies based on the premium
mode chosen. Some states have encouraged the use of an equivalent “Annual Percentage Rate” (APR). The
APR equivalents for this policy are Semi-Annual 16.67% Quarterly 16.11%, List Bill Monthly 6.94%, EFT
Monthly 6.94%. The policyowner has the right to change payment modes subject to the terms of the policy and
established Company procedures.
This illustration is not valid without all pages. This is not a policy or an offer to contract and the descriptions of the policy are in summary form.
Prepared by: Tomas P McFie Ill Adv. 2087 A Life Insurance Policy Illustration
Business: 503-363-5433 Ext: 302 FAX: 503-363-5443 Page 4 of 11 Prepared on: 07/26/2010
State: Hawaii; Version: 16.05.2010 WL-3652, CP-3652
A Life Insurance Illustration
Designed for: Whole Life Insurance
Lino Talley - Male Age 45 Standard Nonsmoker
Policy Form 2087
This illustration is not valid without all pages. This is not a policy or an offer to contract and the descriptions of the policy are in summary form.
Prepared by: Tomas P McFie Ill Adv. 2087 A Life Insurance Policy Illustration
Business: 503-363-5433 Ext: 302 FAX: 503-363-5443 Page 5 of 11 Prepared on: 07/26/2010
State: Hawaii; Version: 16.05.2010 WL-3652, CP-3652
A Life Insurance Illustration
Designed for: Whole Life Insurance
Lino Talley - Male Age 45 Standard Nonsmoker
Policy Form 2087
Client
I have received a copy of this illustration and understand that any non-guaranteed elements are subject to change and could be either
higher or lower. The agent or broker has told me that they are not guaranteed.
Applicant/Policyowner Date
NON-GUARANTEED VALUES- These benefits and values are not guaranteed. The assumptions on which they are based
are subject to change by the Company. Actual results may be more or less favorable than those shown.
This illustration is not valid without all pages. This is not a policy or an offer to contract and the descriptions of the policy are in summary form.
Prepared by: Tomas P McFie Ill Adv. 2087 A Life Insurance Policy Illustration
Business: 503-363-5433 Ext: 302 FAX: 503-363-5443 Page 7 of 11 Prepared on: 07/26/2010
State: Hawaii; Version: 16.05.2010 WL-3652, CP-3652
A Life Insurance Illustration
Designed for: Whole Life Insurance
Lino Talley - Male Age 45 Standard Nonsmoker
Policy Form 2087
86 41 3,652 62,420 75,308 207,038 266,405 14,827 62,420 75,308 476,061 587,913
87 42 3,652 63,198 75,308 210,534 266,405 15,693 63,198 75,308 498,602 606,668
88 43 3,652 63,926 75,308 213,807 266,405 16,520 63,926 75,308 521,716 626,196
89 44 3,652 64,603 75,308 216,850 266,405 17,315 64,603 75,308 545,335 646,452
90 45 3,652 65,228 75,308 219,659 266,405 18,099 65,228 75,308 569,422 667,421
91 46 3,652 65,801 75,308 222,234 266,405 18,859 65,801 75,308 593,925 689,078
92 47 3,652 66,341 75,308 224,663 266,405 19,565 66,341 75,308 618,974 711,368
93 48 3,652 66,850 75,308 226,951 266,405 20,235 66,850 75,308 644,523 734,247
94 49 3,652 67,328 75,308 229,097 266,405 20,870 67,328 75,308 670,520 757,677
95 50 3,652 67,771 75,308 231,090 266,405 21,516 67,771 75,308 696,931 781,666
96 51 3,652 68,176 75,308 232,911 266,405 22,255 68,176 75,308 723,792 806,313
97 52 3,652 68,565 75,308 234,659 266,405 23,096 68,565 75,308 751,439 831,737
98 53 3,652 68,935 75,308 236,322 266,405 24,011 68,935 75,308 779,901 858,020
99 54 3,652 69,282 75,308 237,883 266,405 24,510 69,282 75,308 808,709 884,749
100 55 3,652 69,600 75,308 239,313 266,405 25,273 69,600 75,308 838,030 912,154
101 56 3,652 69,875 75,308 240,547 266,405 26,069 69,875 75,308 867,697 940,296
102 57 3,652 70,144 75,308 241,756 266,405 26,811 70,144 75,308 898,130 969,133
103 58 3,652 70,407 75,308 242,941 266,405 27,568 70,407 75,308 929,349 998,675
104 59 3,652 70,664 75,308 244,094 266,405 28,340 70,664 75,308 961,344 1,028,933
105 60 3,652 70,912 75,308 245,212 266,405 29,127 70,912 75,308 994,112 1,059,922
106 61 3,652 71,155 75,308 246,303 266,405 29,941 71,155 75,308 1,027,705 1,091,669
107 62 3,652 71,391 75,308 247,367 266,405 30,759 71,391 75,308 1,062,125 1,124,176
108 63 3,652 71,622 75,308 248,400 266,405 31,604 71,622 75,308 1,097,391 1,157,467
109 64 3,652 71,845 75,308 249,404 266,405 32,454 71,845 75,308 1,133,493 1,191,548
110 65 3,652 72,062 75,308 250,378 266,405 33,329 72,062 75,308 1,170,465 1,226,442
111 66 3,652 72,272 75,308 251,322 266,405 34,218 72,272 75,308 1,208,309 1,262,161
112 67 3,652 72,474 75,308 252,234 266,405 35,114 72,474 75,308 1,247,017 1,298,713
113 68 3,652 72,671 75,308 253,116 266,405 36,035 72,671 75,308 1,286,633 1,336,121
114 69 3,652 72,860 75,308 253,966 266,405 36,970 72,860 75,308 1,327,141 1,374,399
115 70 3,652 73,042 75,308 254,787 266,405 37,921 73,042 75,308 1,368,567 1,413,562
116 71 3,652 73,218 75,308 255,578 266,405 38,886 73,218 75,308 1,410,932 1,453,626
117 72 3,652 73,388 75,308 256,338 266,405 39,869 73,388 75,308 1,454,235 1,494,605
118 73 3,652 73,550 75,308 257,070 266,405 40,860 73,550 75,308 1,498,483 1,536,509
119 74 3,652 73,706 75,308 257,771 266,405 41,883 73,706 75,308 1,543,697 1,579,367
120 75 3,652 73,850 75,308 258,419 266,405 42,903 73,850 75,308 1,589,758 1,623,180
NON-GUARANTEED VALUES- These benefits and values are not guaranteed. The assumptions on which they are based
are subject to change by the Company. Actual results may be more or less favorable than those shown.
This illustration is not valid without all pages. This is not a policy or an offer to contract and the descriptions of the policy are in summary form.
Prepared by: Tomas P McFie Ill Adv. 2087 A Life Insurance Policy Illustration
Business: 503-363-5433 Ext: 302 FAX: 503-363-5443 Page 8 of 11 Prepared on: 07/26/2010
State: Hawaii; Version: 16.05.2010 WL-3652, CP-3652
A Life Insurance Illustration
Designed for: Whole Life Insurance
Lino Talley - Male Age 45 Standard Nonsmoker
Policy Form 2087
NON-GUARANTEED
PUA Total PUA Total
Att. Contract PUA Premium Annual Surrender Surrender Death Death
Age Yr Premium Surrendered Outlay Dividend Value Value Benefit Benefit
NON-GUARANTEED VALUES- These benefits and values are not guaranteed. The assumptions on which they are based
are subject to change by the Company. Actual results may be more or less favorable than those shown.
* Premium Offset - See Narrative Summary for Important Additional Information.
This illustration is not valid without all pages. This is not a policy or an offer to contract and the descriptions of the policy are in summary form.
Prepared by: Tomas P McFie Ill Adv. 2087 A Life Insurance Policy Illustration
Business: 503-363-5433 Ext: 302 FAX: 503-363-5443 Page 9 of 11 Prepared on: 07/26/2010
State: Hawaii; Version: 16.05.2010 WL-3652, CP-3652
A Life Insurance Illustration
Designed for: Whole Life Insurance
Lino Talley - Male Age 45 Standard Nonsmoker
Policy Form 2087
NON-GUARANTEED
PUA Total PUA Total
Att. Contract PUA Premium Annual Surrender Surrender Death Death
Age Yr Premium Surrendered Outlay Dividend Value Value Benefit Benefit
NON-GUARANTEED VALUES- These benefits and values are not guaranteed. The assumptions on which they are based
are subject to change by the Company. Actual results may be more or less favorable than those shown.
* Premium Offset - See Narrative Summary for Important Additional Information.
This illustration is not valid without all pages. This is not a policy or an offer to contract and the descriptions of the policy are in summary form.
Prepared by: Tomas P McFie Ill Adv. 2087 A Life Insurance Policy Illustration
Business: 503-363-5433 Ext: 302 FAX: 503-363-5443 Page 10 of 11 Prepared on: 07/26/2010
State: Hawaii; Version: 16.05.2010 WL-3652, CP-3652
A Life Insurance Illustration
Designed for: Whole Life Insurance
Lino Talley - Male Age 45 Standard Nonsmoker
Policy Form 2087
NON-GUARANTEED
PUA Total PUA Total
Att. Contract PUA Premium Annual Surrender Surrender Death Death
Age Yr Premium Surrendered Outlay Dividend Value Value Benefit Benefit
NON-GUARANTEED VALUES- These benefits and values are not guaranteed. The assumptions on which they are based
are subject to change by the Company. Actual results may be more or less favorable than those shown.
* Premium Offset - See Narrative Summary for Important Additional Information.
This illustration is not valid without all pages. This is not a policy or an offer to contract and the descriptions of the policy are in summary form.
Prepared by: Tomas P McFie Ill Adv. 2087 A Life Insurance Policy Illustration
Business: 503-363-5433 Ext: 302 FAX: 503-363-5443 Page 11 of 11 Prepared on: 07/26/2010
State: Hawaii; Version: 16.05.2010 WL-3652, CP-3652