United of Omaha Life Insurance Company

(Page 1

P. O. Box 2476
of

LIFE BROKERAGE SERVICES

Omaha, Nebraska 68103
63)

PKG_ID: BU4219211 WDJ

TE30R
IP2A_P230713868702000061

WDJ
SUM ZAM
6036 FAIRHAVEN DR
CHARLOTTE NC 28213

0485100A00
IP2A_P230713868702000061 0133000000101000011000840
(Page 2 of 63)

JULY 21, 2023

SUM ZAM
6036 FAIRHAVEN DR
CHARLOTTE NC 28213

Dear SUM ZAM:

Congratulations on the purchase of your new life insurance policy from United of Omaha Life Insurance Company.
You have made the right decision to protect the people who are important to you. Thanks to you, their future and
your dreams are now secure.

We are privileged that you have chosen United of Omaha for your life insurance needs. We appreciate the
confidence and trust that you have placed in our company, and we are dedicated to providing you with superior
service. You can be certain that you have made the right choice.

Since 1926, United of Omaha Life insurance Company, a wholly owned subsidiary of Mutual of Omaha Insurance
Company, has been the choice for solid, secure protection. Our strong financial strength and stability demonstrate
that we will be there for you when you need us.

If you have questions about your coverage, please do not hesitate to contact customer service at 800-365-1416
(Monday-Thursday 7:00 a.m. to 5:30 p.m. (CT), Friday 7:00 a.m. to 5:00 p.m.). In addition, we are available
anytime at www.mutualofomaha.com.

Please keep this letter and your policy in a safe place for future reference.

Again, congratulations on your new policy and thank you for choosing United of Omaha. We look forward to
serving you for years to come.

Sincerely,

LL4592

0486000A00 .

IP2A_P230713868702000061 0233000000101000000000850
(Page 3 of 63)

MUTUAL OF OMAHA

PRIVACY NOTICE - PERSONAL INFORMATION

This is the Privacy Notice of Mutual of Omaha or you can contact us at:
Insurance Company and certain of its affiliates listed
Mutual of Omaha
as follows (collectively, "Mutual of Omaha", "us", "our",
Attn: Privacy Office
or "we"):
3300 Mutual of Omaha Plaza
- Companion Life Insurance Company Omaha, NE 68175-1029
- Medicare Advantage Insurance Company of
Information We Collect
Omaha
- Mutual of Omaha Investor Services, Inc. We may collect Personal Information about you
- Mutual of Omaha Marketing Corporation from:
- Mutual of Omaha Medicare Advantage - Applications or other forms we receive from you
Company - Your transactions with us, such as your
- Mutual of Omaha Structured Settlement payment history
Company - Your transactions with other companies
- Omaha Health Insurance Company - Other sources (such as motor vehicle reports,
- Omaha Insurance Company government agencies and medical information
bureaus)
- Omaha Supplemental Insurance Company
- Consumer-reporting agencies
- United of Omaha Life Insurance Company
How We Protect Your Information
- United World Life Insurance Company
This Notice applies to our current as well as former We restrict access to your Personal Information.
customers. It is given only to employees of Mutual of Omaha
companies and others who need to know the
Why You Are Receiving This Notice information to provide our insurance or financial
This Notice describes the Personal Information services to you. We maintain physical, technical
we collect, and how we use and protect it. and administrative safeguards to protect your
Personal Information means information such as Personal Information in compliance with federal
name, address, Social Security number, income, and state law.
employment and similar information. Sharing Within Mutual of Omaha

If you have a policy that is covered by the HIPAA Your Personal Information
Privacy regulations, you received a privacy notice We may share your Personal Information among
that relates to the privacy of your protected health Mutual of Omaha and with our banking and other
information. To obtain an additional copy of the affiliates. We may also share information about
privacy notice related to your protected health your transactions, such as your payment history.
information you can go to our website:
We do not share your medical information, except
https://www.mutualofomaha.com/legal-services/ to the extent required or permitted under federal
privacy-notices-and-forms and state law.

(Continued on reverse side) 456658_0619

0487000A00
IP2A_P230713868702000061 0333000000101000000000860
(Page 4 of 63)

Your Creditworthiness Information Important Privacy Choices

We may also share certain information about
your creditworthiness among Mutual of You may tell us:
Omaha and with our banking and other 1. To not share your Personal Information with
affiliates. It also lets us better match our third parties outside the Mutual of Omaha
products and services with your needs. companies except as required or permitted by
Creditworthiness includes: law, and
- Your marital status 2. To not share information about your
- Your income creditworthiness among Mutual of Omaha or
- Your employment history with our banking or other affiliates.
- Your credit history
Just call us toll free at:
Sharing With Third Parties
1-800-522-6912
We may share your Personal Information with
third parties outside Mutual of Omaha. For When you call, please be prepared to provide
example: your policy or account number.

- With our agents and brokers Your request will apply to all the products you
- To respond to a judicial process or have with Mutual of Omaha. If there is more
government regulatory authority than one owner of any insurance product or
- To process an insurance transaction that service, any one of you may request that we not
you request share Personal Information as described in this
- To service your policy or account, such as Privacy Notice on behalf of yourself and the
paying a claim other owners.
- To allow third parties to perform insurance We will honor your request for as long as you
or other functions on our behalf are our customer and for as long as we keep
- To other financial institutions with whom we information about you.
have joint marketing agreements
If you have already told us to not share your
We do not share your medical information, information, it is not necessary to tell us again
except to the extent required or permitted each time you receive a Privacy Notice. Your
under federal and state law. request will remain on file with us until you ask
for a change.
(Page 5 of 63)

MUTUAL OF OMAHA

AFFILIATE MARKETING OPT-OUT NOTICE

This is the Notice of Mutual of Omaha Insurance other Mutual of Omaha companies. This
Company and certain of its affiliates listed as information may include your income, your
follows (collectively, "Mutual of Omaha", "us", account history, and your credit history.
"our", or "we"):
Your choice to limit marketing offers from the
- Companion Life Insurance Company Mutual of Omaha companies will apply to all
- Medicare Advantage Insurance Company of offers we make after October 1, 2008 until you
Omaha tell us to change your choice.
- Mutual of Omaha Investor Services, Inc.
If there is more than one owner of any insurance
- Mutual of Omaha Marketing Corporation
product or service, any one owner may request
- Mutual of Omaha Medicare Advantage
that we not share information on behalf of the
Company
one owner and the other owners.
- Mutual of Omaha Structured Settlement
Company Your choice to limit marketing offers from the
- Omaha Health Insurance Company Mutual of Omaha companies will apply for at
- Omaha Insurance Company least 5 years from when you tell us your choice.
- Omaha Supplemental Insurance Company Once that period expires, you will receive a
- United of Omaha Life Insurance Company renewal notice that will allow you to continue to
- United World Life Insurance Company limit marketing offers from the Mutual of Omaha
companies for at least another 5 years.
Why You Are Receiving This Notice
If you have already made a choice to limit
Federal law gives you the right to limit some but
marketing offers from the Mutual of Omaha
not all marketing from the Mutual of Omaha
companies, you do not need to act again until
companies. Federal law also requires us to give
you receive the renewal notice.
you this notice to tell you about your choice to limit
marketing from the Mutual of Omaha companies. To limit marketing offers, just check the box

on the Affiliate Marketing Choice Form,

Your Choice to Limit Marketing
complete it and return it to:
You may limit Mutual of Omaha affiliated
Mutual of Omaha
companies, such as our banking affiliate or the
Attn: Privacy Office
Mutual of Omaha companies listed above, from
3300 Mutual of Omaha Plaza
marketing their products or services to you based
Omaha, NE 68175-1029
on personal information that they receive from
456656_0619

$ Detach here - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

MUTUAL OF OMAHA

Affiliate Marketing Choice Form

Do not permit your affiliated companies to use my personal information to market their products and
services to me.

Print your name and address clearly

________________________________________________________________________________________________
First Name Middle Initial Last Name

________________________________________________________________________________________________
Address (line 1)

________________________________________________________________________________________________
Address (line 2)

___________________________________________________________________________________________________________
City State and Zip Code

BU4219211 456656_0619

0488000A00
IP2A_P230713868702000061 0433000000101000000000870
(Page 6 of 63)

Page 1 of 4

STATEMENT OF POLICY COST AND BENEFIT INFORMATION

Policy Number: BU4219211

Prepared Especially For: Sum Zam

Age: 31 Male

Issued By: United of Omaha Life Insurance Company

P. O. Box 2476
LIFE BROKERAGE SERVICES
Omaha, Nebraska 68103

Your Licensed Agent Is: CIAU LAM NUAM

3532 INDIAN CREEK WAY APT F
CLARKSTON GA 30021-2061

Date: July 21, 2023

0389301A00
IP2A_P230713868702000061 0533000000101000010010880
(Page 7 of 63)

This page intentionally left blank

(Page 8 of 63)

Page 2 of 4 Policy BU4219211

This term life insurance policy provides a level death benefit. It is annually renewable to the policy anniversary following
the insured's 100th birthday.

Base plan premiums are level for 30 policy years, increase annually after the 30th year, and guaranteed for all years.

This policy provides a partial return of premium benefit if it is surrendered and the policy is not in force under the Reduced
Paid-Up Life Insurance provision. The benefit depends on the time elapsed since the policy issue date. We will pay you the
Partial Return of Premium Benefit after the 30th policy anniversary date if the benefit is not exercising during the first 30
Policy Years, the insured is then living and the policy is in force.

The policy premiums and benefits shown below are based on annual mode and do not include rider premiums and benefits.

BASE PLAN GUARANTEED PREMIUMS AND BENEFITS

Base Plan
End of Year Base Plan
Beginning Guaranteed Partial Return of Percentage of
Policy of Year Death Maximum Annual Premium Premiums
Year Benefit Premium* Benefit** Returned
1 $50,000 $331.11 $0.00 0.00%
2 50,000 331.11 0.00 0.00%
3 50,000 331.11 0.00 0.00%
4 50,000 331.11 157.87 11.92%
5 50,000 331.11 375.80 22.70%
6 50,000 331.11 602.15 30.31%
7 50,000 331.11 837.17 36.12%
8 50,000 331.11 1,081.53 40.83%
9 50,000 331.11 1,335.63 44.82%
10 50,000 331.11 1,599.59 48.31%
11 50,000 331.11 1,873.91 51.45%
12 50,000 331.11 2,159.49 54.35%
13 50,000 331.11 2,456.53 57.07%
14 50,000 331.11 2,765.09 59.65%
15 50,000 331.11 3,086.27 62.14%
16 50,000 331.11 3,420.23 64.56%
17 50,000 331.11 3,767.40 66.93%
18 50,000 331.11 4,129.07 69.28%
19 50,000 331.11 4,505.04 71.61%
20 50,000 331.11 4,897.11 73.95%
21 50,000 331.11 5,306.07 76.31%
22 50,000 331.11 5,732.11 78.69%
23 50,000 331.11 6,176.95 81.11%
24 50,000 331.11 6,642.59 83.59%
25 50,000 331.11 7,127.97 86.11%
26 50,000 331.11 7,635.19 88.69%
27 50,000 331.11 8,165.76 91.34%
28 50,000 331.11 8,720.37 94.06%
29 50,000 331.11 9,301.64 96.87%
30 50,000 331.11 9,933.30 100.00%
31 50,000 1,481.50 0.00 0.00%
32 50,000 1,655.50 0.00 0.00%
33 50,000 1,846.00 0.00 0.00%
34 50,000 2,044.50 0.00 0.00%
35 50,000 2,251.00 0.00 0.00%
35-AGE 65 50,000 2,251.00 0.00 0.00%
69-AGE100*** 50,000 47,190.00 0.00 0.00%

* The guaranteed maximum annual premiums are the largest premiums that can be charged.

** The partial return of premium benefit values assume no changes are made to the coverage as issued.

*** The expiration date for this policy is shown on the policy Data Pages. If this policy is in force and the insured is still
living, coverage under this policy ends at midnight on the expiration date and the death benefit and guaranteed maximum
annual premiums will be zero.

0390001A00
IP2A_P230713868702000061 0633000000101000000010890
(Page 9 of 63)

Page 3 of 4 Policy BU4219211

RIDERS GUARANTEED PREMIUMS AND BENEFITS

Years Initial Annual Years

Coverage Mode Premium
Provided Premium Payable

Accelerated Death Benefit for Terminal 69 See Rider

Illness Rider

Accelerated Death Benefit for Chronic 69 See Rider

Illness Rider

Accelerated Death Benefit for Critical 69 See Rider

Illness Rider

Waiver of Premium for Unemployment No Charge

Residential Damage Waiver of Premium Rider 69 No Cost

Disability Waiver of Premium Rider*** 29 $23.88 29

Accidental Death Benefit Rider
Benefit $10,000 30 $10.00 30
*** Disability Waiver of Premium Rider premium shown above is for the first policy year. Premiums may change in future
policy years.
(Page 10 of 63)

Page 4 of 4 Policy BU4219211

COST COMPARISON INDEXES

An explanation of the intended use of these indexes is provided in the Life Insurance Buyers Guide. The indexes are useful
only for comparison of relative costs of two or more similar policies. The base plan indexes do not include costs for any
riders.

BASE PLAN DATA

Policy Surrender Cost Net Payment Cost

Year Comparison Index Comparison Index

10 $3.77 $6.62
20 $3.30 $6.62

0391001A00
IP2A_P230713868702000061 0733000000101000000010900
(Page 11 of 63)

This page intentionally left blank

(Page 12 of 63)

Insured Sum Zam

Owner(s) Sum Zam

Face Amount $50,000

Issue Date July 21, 2023
Policy Number BU4219211

TERM LIFE INSURANCE POLICY

Read this policy carefully! This policy is a legal contract between you, the owner, and us, United of Omaha Life Insurance
Company. The consideration for this policy is the application and the premium you paid.

Subject to the terms of this policy, we will pay the death benefit as soon as possible after we receive satisfactory proof at our
home office that the insured died while this policy was in force.

RIGHT TO RETURN THIS POLICY

If you are not satisfied with this policy, you can return it to us or our representative within 30 days from the date you receive
it. You can deliver or mail it to our home office or to any of our agency offices. If you return this policy within the specified
time, we will promptly refund the premium you paid, including any fees or charges, and cancel this policy as of the issue
date.

THIS IS A RENEWABLE TERM LIFE INSURANCE POLICY WITH AN INTERMEDIATE ENDOWMENT BENEFIT

PAYABLE AFTER THE INITIAL PREMIUM GUARANTEED PERIOD SHOWN ON THE DATA PAGES.

THIS POLICY CAN BE CONVERTED TO PERMANENT LIFE INSURANCE ANY TIME AFTER THE EARLIEST

CONVERSION DATE AND BEFORE THE LATEST CONVERSION DATE SHOWN ON THE DATA PAGES.

PREMIUMS ARE LEVEL AND GUARANTEED FOR THE INITIAL PREMIUM GUARANTEE PERIOD SHOWN

ON THE DATA PAGES AND WILL INCREASE THEREAFTER. THE DEATH BENEFIT IS LEVEL FOR ALL

POLICY YEARS.

COVERAGE ENDS ON THE EXPIRATION DATE SHOWN ON THE DATA PAGES.

THIS IS NOT A PARTICIPATING POLICY. NO DIVIDENDS WILL BE PAID.

1-800-775-7894.
For customer service or questions about your coverage, please call

To contact your state insurance department, please call 1-855-408-1212 .

ICC13L117P

2692302A00
PKG_ID: BU4219211 WDJ TE30R IP2A_P230713868702000061 0833000000101000010001910
(Page 13 of 63)

This page intentionally left blank

(Page 14 of 63)

POLICY DATA

Insured Sum Zam

Owner(s) Sum Zam

Sex Male Policy Number BU4219211

Issue Age 31 Issue Date July 21, 2023
Face Amount $50,000 Contestability Date July 13, 2023
Premium Payment Mode BSP Earliest Conversion Date July 21, 2025
Initial Modal Premium $364.99 Latest Conversion Date July 20, 2053
Expiration Date July 21, 2092
Risk Class Standard Non-Tobacco
Rate Class Standard

SCHEDULE OF BENEFITS

Initial Initial Benefit

Form Benefit Premium Annual Years
Guarantee Premium
Period Years
ICC13L117P Term Life Insurance Policy 30 $331.11 69
ICC17L163DP Term Life Insurance Data Pages
A735LNA06R Residential Damage Waiver of Premium Rider No Cost 69
2145L-0989 Accidental Death Benefit Rider $10.00 30
$10,000 Benefit
Rider Expiration Date: July 21, 2053
The premium shown is for all benefit years.
ICC20L204R Accelerated Death Benefit for Terminal See Rider 69
Illness Rider
ICC20L200R Accelerated Death Benefit for Chronic See Rider 69
Illness Rider
ICC20L199R Accelerated Death Benefit for Critical See Rider 69
Illness Rider
D185LNA10R Waiver of Premium for Unemployment Rider No Charge
2697L-1203 Disability Waiver of Premium Rider $23.88 29
Rider Expiration Date: July 21, 2052
The premium shown is for the first policy year only.
Premiums for subsequent policy years may change.
TOTAL INITIAL ANNUAL MODE
PREMIUM
$364.99

Premiums for subsequent policy years are shown on the following data pages .

ICC17L163DP Data Pages 2693002A00

IP2A_P230713868702000061 0933000000101000000001920
(Page 15 of 63)

SCHEDULE OF BENEFITS

Premiums for premium payment modes other than annual:

Modal Annualized Annual Difference*

Premium
Semiannual: $189.79 $379.58 $14.59
Quarterly: $100.37 $401.48 $36.49
Monthly (BSP): $32.48 $389.76 $24.77
*This is the additional amount you will pay in the first policy year if you choose to pay your premiums more often than once
a year. Similar differences for premium payment modes other than annual will occur every year this policy is in force.

The premium for the payment mode you selected includes a modal policy fee of $5.34 . The premium is due on the issue
date and the same day each MONTH thereafter until the expiration date .

ICC17L163DP Data Pages

(Page 16 of 63)

PARTIAL RETURN OF PREMIUM BENEFIT SCHEDULE

Please refer to the Partial Return of Premium Benefit provision for more information.

Please refer to the LOANS section for information regarding the Maximum Loan Amount.

End of Partial Return of Percentage of

Premium Benefit Premiums
Policy Year Returned
Amount
1 $0.00 0.00%
2 $0.00 0.00%
3 $0.00 0.00%
4 $185.83 11.92%
5 $442.37 22.70%
6 $708.81 30.31%
7 $985.46 36.12%
8 $1,273.11 40.83%
9 $1,572.21 44.82%
10 $1,882.93 48.31%
11 $2,205.84 51.45%
12 $2,542.01 54.35%
13 $2,891.66 57.07%
14 $3,254.88 59.65%
15 $3,632.95 62.14%
16 $4,026.06 64.56%
17 $4,434.72 66.93%
18 $4,860.46 69.28%
19 $5,303.03 71.61%
20 $5,764.55 73.95%
21 $6,245.94 76.31%
22 $6,747.44 78.69%
23 $7,271.08 81.11%
24 $7,819.20 83.59%
25 $8,390.55 86.11%
26 $8,987.63 88.69%
27 $9,612.18 91.34%
28 $10,265.03 94.06%
29 $10,949.25 96.87%
30 $11,667.36 100.00%

We will pay you the Partial Return of Premium Benefit after the 30th policy anniversary date if the benefit is not
exercised during the first 30 Policy Years, the insured is then living and the policy is in force. Beginning in policy year
31, the amount of the Partial Return of Premium Benefit will equal 0.00%.
The Partial Return of Premium Benefit Amount shown in the table above equals the initial modal premiums paid into the
contract, accumulated at an effective annual interest rate of 3.75% , less charges to cover mortality, expenses and profit
which include an administrative charge of $5.00 per policy year.

ICC17L163DP Data Pages 2694002A00

IP2A_P230713868702000061 1033000000101000000001930
(Page 17 of 63)

TERM LIFE INSURANCE PREMIUMS BY PAYMENT MODE

Premiums for any Riders are not included.

Beginning as of Bank
Mo Day Year Annual Semiannual Quarterly Service Plan

7 - 21 - 2023 $331.11 $172.18 $91.06 $29.47

7 - 21 - 2024 331.11 172.18 91.06 29.47
7 - 21 - 2025 331.11 172.18 91.06 29.47
7 - 21 - 2026 331.11 172.18 91.06 29.47
7 - 21 - 2027 331.11 172.18 91.06 29.47
7 - 21 - 2028 331.11 172.18 91.06 29.47
7 - 21 - 2029 331.11 172.18 91.06 29.47
7 - 21 - 2030 331.11 172.18 91.06 29.47
7 - 21 - 2031 331.11 172.18 91.06 29.47
7 - 21 - 2032 331.11 172.18 91.06 29.47
7 - 21 - 2033 331.11 172.18 91.06 29.47
7 - 21 - 2034 331.11 172.18 91.06 29.47
7 - 21 - 2035 331.11 172.18 91.06 29.47
7 - 21 - 2036 331.11 172.18 91.06 29.47
7 - 21 - 2037 331.11 172.18 91.06 29.47
7 - 21 - 2038 331.11 172.18 91.06 29.47
7 - 21 - 2039 331.11 172.18 91.06 29.47
7 - 21 - 2040 331.11 172.18 91.06 29.47
7 - 21 - 2041 331.11 172.18 91.06 29.47
7 - 21 - 2042 331.11 172.18 91.06 29.47
7 - 21 - 2043 331.11 172.18 91.06 29.47
7 - 21 - 2044 331.11 172.18 91.06 29.47
7 - 21 - 2045 331.11 172.18 91.06 29.47
7 - 21 - 2046 331.11 172.18 91.06 29.47
7 - 21 - 2047 331.11 172.18 91.06 29.47
7 - 21 - 2048 331.11 172.18 91.06 29.47
7 - 21 - 2049 331.11 172.18 91.06 29.47
7 - 21 - 2050 331.11 172.18 91.06 29.47
7 - 21 - 2051 331.11 172.18 91.06 29.47
7 - 21 - 2052 331.11 172.18 91.06 29.47
7 - 21 - 2053 1,481.50 770.38 407.41 131.85
7 - 21 - 2054 1,655.50 860.86 455.26 147.34
7 - 21 - 2055 1,846.00 959.92 507.65 164.29
7 - 21 - 2056 2,044.50 1,063.14 562.24 181.96
7 - 21 - 2057 2,251.00 1,170.52 619.03 200.34
7 - 21 - 2058 2,460.50 1,279.46 676.64 218.98
7 - 21 - 2059 2,679.00 1,393.08 736.73 238.43
7 - 21 - 2060 2,910.00 1,513.20 800.25 258.99
7 - 21 - 2061 3,169.00 1,647.88 871.48 282.04
7 - 21 - 2062 3,471.50 1,805.18 954.66 308.96
7 - 21 - 2063 3,838.50 1,996.02 1,055.59 341.63
7 - 21 - 2064 4,268.00 2,219.36 1,173.70 379.85
7 - 21 - 2065 4,720.00 2,454.40 1,298.00 420.08
7 - 21 - 2066 5,206.00 2,707.12 1,431.65 463.33
7 - 21 - 2067 5,735.50 2,982.46 1,577.26 510.46
7 - 21 - 2068 6,332.00 3,292.64 1,741.30 563.55
7 - 21 - 2069 7,026.00 3,653.52 1,932.15 625.31
7 - 21 - 2070 7,832.00 4,072.64 2,153.80 697.05
7 - 21 - 2071 8,735.00 4,542.20 2,402.13 777.42
7 - 21 - 2072 9,742.00 5,065.84 2,679.05 867.04
7 - 21 - 2073 10,837.00 5,635.24 2,980.18 964.49
7 - 21 - 2074 11,996.50 6,238.18 3,299.04 1,067.69
7 - 21 - 2075 13,263.00 6,896.76 3,647.33 1,180.41
7 - 21 - 2076 14,671.00 7,628.92 4,034.53 1,305.72
7 - 21 - 2077 16,237.00 8,443.24 4,465.18 1,445.09
7 - 21 - 2078 17,959.50 9,338.94 4,938.86 1,598.40
7 - 21 - 2079 19,821.50 10,307.18 5,450.91 1,764.11
7 - 21 - 2080 21,800.50 11,336.26 5,995.14 1,940.24
7 - 21 - 2081 23,876.50 12,415.78 6,566.04 2,125.01
7 - 21 - 2082 25,945.00 13,491.40 7,134.88 2,309.11
7 - 21 - 2083 27,980.50 14,549.86 7,694.64 2,490.26

ICC17L163DP Data Pages

(Page 18 of 63)

TERM LIFE INSURANCE PREMIUMS BY PAYMENT MODE

Premiums for any Riders are not included.

Beginning as of Bank
Mo Day Year Annual Semiannual Quarterly Service Plan

7 - 21 - 2084 30,113.50 15,659.02 8,281.21 2,680.10

7 - 21 - 2085 32,363.00 16,828.76 8,899.83 2,880.31
7 - 21 - 2086 34,732.00 18,060.64 9,551.30 3,091.15
7 - 21 - 2087 37,078.50 19,280.82 10,196.59 3,299.99
7 - 21 - 2088 39,369.50 20,472.14 10,826.61 3,503.89
7 - 21 - 2089 41,810.00 21,741.20 11,497.75 3,721.09
7 - 21 - 2090 44,413.00 23,094.76 12,213.58 3,952.76
7 - 21 - 2091 47,190.00 24,538.80 12,499.75 4,166.58

ICC17L163DP Data Pages 2695002A00

IP2A_P230713868702000061 1133000000101000000001940
(Page 19 of 63)

TABLE OF REDUCED PAID-UP LIFE INSURANCE FACTORS

● The factors shown are based on the interest rate and mortality table below.

● Please refer to the Reduced Paid-Up Life Insurance provision for more information about how these factors are
applied.

Reduced
End of Insured's Paid-Up Term
Policy Attained Life Insurance
Year Age Factor

1 32 0.17392
2 33 0.17993
3 34 0.18613
4 35 0.19247
5 36 0.19895
6 37 0.20557
7 38 0.21233
8 39 0.21927
9 40 0.22642
10 41 0.23379
11 42 0.24138
12 43 0.24920
13 44 0.25724
14 45 0.26556
15 46 0.27416
16 47 0.28305
17 48 0.29224
18 49 0.30173
19 50 0.31154
20 51 0.32164
21 52 0.33202
22 53 0.34265
23 54 0.35356
24 55 0.36474
25 56 0.37622
26 57 0.38803
27 58 0.40019
28 59 0.41270
29 60 0.42555
30 61 0.43872
34 65 0.49394
39 70 0.56832
44 75 0.64622
49 80 0.72301
54 85 0.79428
59 90 0.85018
64 95 0.88587

Interest Rate 3.75%

Mortality Table Commissioner's 2017 Standard Ordinary Mortality Table, Male or Female, Smoker or
Nonsmoker, Age Last Birthday

ICC17L163DP Data Pages

(Page 20 of 63)

TABLE OF CONTENTS PAGE

DEFINITIONS ....................................................................................................................................................................... 1
DEATH BENEFIT................................................................................................................................................................. 1
Common Carrier Death Benefit ...................................................................................................................................... 2
TAX MATTERS .................................................................................................................................................................... 2
Interest on the Death Benefit .......................................................................................................................................... 3
PREMIUM PAYMENTS...................................................................................................................................................... 3
Grace Period ..................................................................................................................................................................... 3
REINSTATEMENT .............................................................................................................................................................. 3
NONFORFEITURE BENEFITS......................................................................................................................................... 3
Partial Return of Premium Benefit.................................................................................................................................. 3
Reduced Paid-Up Term Life Insurance .......................................................................................................................... 4
Minimum Required Values ............................................................................................................................................. 4
LOANS .................................................................................................................................................................................... 4
CONVERSION ...................................................................................................................................................................... 5
SUICIDE EXCLUSION ....................................................................................................................................................... 5
OWNER AND BENEFICIARY .......................................................................................................................................... 6
Owner................................................................................................................................................................................ 6
Assignment ....................................................................................................................................................................... 6
Beneficiary........................................................................................................................................................................ 6
GENERAL PROVISIONS ................................................................................................................................................... 6
Entire Contract.................................................................................................................................................................. 6
Incontestability ................................................................................................................................................................. 6
Misstatement of Age or Sex ............................................................................................................................................ 7
Conformity with Standards.............................................................................................................................................. 7

ICC13L117P

2696002A00
IP2A_P230713868702000061 1233000000101000000001950
(Page 21 of 63)

DEFINITIONS

This section provides an alphabetical list of certain terms and their meanings as used in this policy. The meanings apply to
both the singular and plural versions of the defined terms. As you read through this policy, any word you see in italics is a
defined term.
Attained age means the insured's age on the most recent policy anniversary.
Beneficiary means the person(s) or legal entity(ies) you designate to receive this policy's death benefit.

Code means the Internal Revenue Code of 1986, as amended.

Common carrier means an entity that is licensed to transport passengers for hire in any public land, air or water
conveyance.
Contestability date means the date that starts the two-year contestability period. After this period, we may no longer
contest the validity of this policy. This date is shown on the data pages .
Data pages means the pages of this policy that contain information specific to you, the insured, and the benefits provided
under this policy. The data pages are identified as such at the bottom of each page.
Death benefit means the benefit we will pay to the beneficiary when the insured dies while this policy is in force.
Executive officer means the chief executive officer, the president, any vice president, the corporate secretary, or any
assistant corporate secretary of United of Omaha Life Insurance Company.
Expiration date means the date on which coverage ends. This date is shown on the data pages .
Home offic e means, at the time of the delivery of this policy, our offices located at the address shown on the face page of
this policy. If our home office moves, home office will mean the offices located at the new address.
Loan means, as of any date of determination, the outstanding principal amount of sums you have borrowed from this policy,
plus the amount of any interest due but unpaid on that principal amount.
Minimum death benefit means an amount, provided by the code , below which the death benefit may not fall.
Policy year means each 12-month period starting on the issue date and each anniversary of the issue date thereafter.
Scheduled airline means a company furnishing air transportation on fixed schedules to ticketed passengers. The aircraft
flown must be:
(a) operated by a scheduled air carrier pursuant to economic authority issued by the Civil Aeronautics Board; or
(b) operated by an intrastate scheduled airline of United States registry licensed by a duly constituted authority
having jurisdiction over civil aviation in the state in which said airline operates.
Spouse means the person to whom you are legally married, or your domestic partner, civil union partner, or equivalent, as
recognized and allowed by any applicable federal or state law.
Written request means a request, in writing, signed by you, dated, and submitted to our home office . The request must be
on a form we supply or be in a form and content acceptable to us.

DEATH BENEFIT

If the insured dies while this policy is in force, we will pay the death benefit , in one lump sum, subject to the terms of this
policy. The death benefit will equal the greater of:

(a) the face amount of this policy; or

(b) the minimum death benefit on the date of the insured's death.
We will adjust the death benefit by:

(a) adding any additional payments due under the Common Carrier Death Benefit provision below;
(b) adding any death benefit provided by a rider;
(c) adding any refund for a premium paid beyond the policy month in which the insured dies;
(d) subtracting any policy loan outstanding; and
(e) subtracting any unpaid premium due.

ICC13L117P Page 1
(Page 22 of 63)

COMMON CARRIER DEATH BENEFIT

In addition to the policy's face amount, we will pay the beneficiary 100% of the policy's face amount or $250,000,
whichever is less, if the insured dies as a result of accidental bodily injury sustained in a common carrier accident. We will
pay this benefit in one lump sum.
Accidental bodily injury must:

(a) occur while this policy is in force; and

(b) be sustained while riding as a fare-paying passenger, and not as an operator, pilot or crew member, in any
public land, air or water conveyance provided by a common carrier or scheduled airline.

The common carrier or scheduled airline must be licensed primarily for passenger service.
Death resulting from accidental bodily injury must:

(a) occur while this policy is in force;

(b) be independent of sickness and all other causes; and
(c) occur within 180 days of the date of the accident.

TAX MATTERS

This policy has been designed to qualify as life insurance under Section 7702 of the code . Among other things, the code
provides a minimum death benefit.
This policy provides a partial return of premium benefit, as described in the Partial Return of Premium Benefit provision.
In some circumstances the value of this benefit can cause the amount of the death benefit to be increased so that the policy
will continue to qualify as life insurance under the code. The increase is calculated using the minimum death benefit
specified in the code .
The minimum death benefit at any time equals the partial return of premium benefit amount, as described in the Partial
Return of Premium Benefit provision, multiplied by the death benefit percentage as shown in the table below.
TABLE OF DEATH BENEFIT PERCENTAGES

Attained Age Death Benefit Attained Age Death Benefit Attained Age Death Benefit
Percentage Percentage Percentage

0-40 250% 61 128% 82 105%

41 243% 62 126% 83 105%
42 236% 63 124% 84 105%
43 229% 64 122% 85 105%
44 222% 65 120% 86 105%
45 215% 66 119% 87 105%
46 209% 67 118% 88 105%
47 203% 68 117% 89 105%
48 197% 69 116% 90 105%
49 191% 70 115% 91 104%
50 185% 71 113% 92 103%
51 178% 72 111% 93 102%
52 171% 73 109% 94 101%
53 164% 74 107% 95 101%
54 157% 75 105% 96 101%
55 150% 76 105% 97 101%
56 146% 77 105% 98 101%
57 142% 78 105% 99 101%
58 138% 79 105% 100+ 100%
59 134% 80 105%
60 130% 81 105%

ICC13L117P Page 2

2697002A00
IP2A_P230713868702000061 1333000000101000000001960
(Page 23 of 63)

INTEREST ON THE DEATH BENEFIT

We will pay interest on the death benefit from the insured's date of death to the date of payment. The interest rate will be
the rate in effect for funds left on deposit with us on the date of the insured's death.
We will pay additional interest on the death benefit at the rate of 10% annually if we do not pay the death benefit within 31
days from the latest of the date:

(a) we receive due proof of the insured's death;

(b) we receive sufficient information to determine the extent of our liability under this policy;
(c) we have determined and or
(d) evidence that any legal impediments to payment of the death benefit that were dependent upon parties other
than us have been removed.

PREMIUM PAYMENTS

Premiums are payable in advance at our home office or to an authorized representative on or before the premium due date.
At your request, we will send you a receipt signed by an executive officer.
You may pay premiums annually, semiannually, quarterly, or at other intervals we may offer. The premium payment mode
you selected is shown on the data pages . After the first policy anniversary, you may change your premium payment mode
by contacting us.

GRACE PERIOD

This policy has a 31-day grace period. This means that this policy will not lapse if you pay the appropriate premium on or
before the date it is due or during the following 31 days. This policy will remain in force during the grace period.
If any premium is not paid by the end of the grace period, this policy will lapse as of the premium due date, unless you
have chosen to continue this policy as reduced paid-up life insurance.

REINSTATEMENT

If the policy lapses before the expiration date and you have not collected any benefits under the Partial Return of
Premium Benefit provision, you may reinstate it within three years after the date of lapse. To reinstate this policy, you
must:

(a) submit a written request, signed by you and the insured, if you are not the insured;
(b) provide evidence of insurability acceptable to us, if required; and
(c) pay the sum of:
(1) the amount of premium you owe for the period of nonpayment plus interest on that amount at the
annual interest rate of 6%; plus
(2) the amount of premium from the beginning of the policy month in which reinstatement occurs to the
next premium due date.

If this policy ends because the loan balance equaled or exceeded the policy's partial return of premium benefit, you may
not reinstate this policy.

NONFORFEITURE BENEFITS

PARTIAL RETURN OF PREMIUM BENEFIT

As described in the paragraphs below, a partial return of premium benefit is available after the Initial Premium Guarantee
Period Years shown on the data pages or upon surrender of the policy.
We will pay the partial return of premium benefit amount after the Initial Guarantee Period Years as described on the
PARTIAL RETURN OF PREMIUM BENEFIT SCHEDULE data page in one lump sum within 30 days. This policy will
continue as long as premium payments are made in accordance with TERM LIFE INSURANCE PREMIUMS BY
PAYMENT MODE table shown on the data pages .

ICC13L117P Page 3
(Page 24 of 63)

Unless the policy is in force under the Reduced Paid-Up Term Life Insurance provision, we will pay the partial return of
premium benefit amount upon surrender of the policy, according to the PARTIAL RETURN OF PREMIUM BENEFIT
SCHEDULE shown on the data pages . We will calculate the amount of any available benefit as of the date we receive your
written request to surrender the policy.

If you surrender the policy between policy anniversaries, the percentage applied under (b) below will be a pro rata
percentage based on the number of months elapsed since the last policy anniversary. If you surrender the policy within 31
days after the due date of an unpaid premium, the percentage applied under (b) below will be the applicable percentage as
of the premium due date. We will refund 100% of any premium paid for the period beyond the policy month of surrender.
The partial return of premium benefit amount equals:

(a) the sum of premiums paid or waived, as described in any waiver of premium riders attached to this policy, for
the years shown on the PARTIAL RETURN OF PREMIUM BENEFIT SCHEDULE; multiplied by
(b) the applicable percentage shown on the PARTIAL RETURN OF PREMIUM BENEFIT SCHEDULE; minus
(c) any policy loan outstanding.
While this policy is in force, if you request a change to your policy that alters the premium payment amounts shown on the
data pages (including a change in premium payment mode), then the partial return of premium benefit amount will change.
We will send you a new PARTIAL RETURN OF PREMIUM BENEFIT SCHEDULE if changes made to your policy alter
the premium payment amounts shown on the data pages , unless changes in premium payment amounts result from changes
in premium payment mode.
Part of the partial return of premium benefit may be taxable to you. Please consult a tax advisor.
We may defer the payment for six months if you surrender the policy.

REDUCED PAID-UP TERM LIFE INSURANCE

If, by the end of the grace period:

(a) you have not paid the premium due; and

(b) the partial return of premium benefit has not been exercised;
we will continue the policy as reduced paid-up term life insurance until the policy's expiration date . Any riders attached
will end as of the effective date of the reduced paid-up term life insurance. Both the Common Carrier Death Benefit and
Partial Return of Premium Benefit provisions will also end as of the effective date of the reduced paid-up term life
insurance.
Under this option you will not need to pay any more premiums. The reduced paid-up term life insurance will begin on the
premium due date of the unpaid premium. We will use the partial return of premium benefit amount, minus any policy loan
outstanding, divided by the applicable reduced paid-up term life insurance factor to determine the amount of death benefit.
The factors for certain policy years are shown on the data pages .
While the policy is in force as reduced paid-up term life insurance, you may surrender it for cash. The cash value will be
the present value of the death benefit as of the effective date of surrender using the interest rate and mortality table shown
on the TABLE OF REDUCED PAID-UP TERM LIFE INSURANCE FACTORS section of the data pages .

MINIMUM REQUIRED VALUES

The cash value and paid-up nonforfeiture benefits available under this policy are not less than the minimum values and
benefits required by or pursuant to the NAIC Standard Nonforfeiture Law for Life Insurance, Model #808 and Actuarial
Guideline XLV. The cash value and paid-up nonforfeiture benefits that are revised due to changes to the premiums will not
be less than the minimum values required by or pursuant to the NAIC Standard Nonforfeiture Law for Life Insurance,
model #808 and Actuarial Guideline XLV.
Values and benefits are based on the mortality table and the interest rate shown on the data pages . Deaths are assumed to
occur at the end of the policy year .

LOANS

If the partial return of premium benefit has not been exercised, you may borrow part of the policy's partial return of
premium benefit amount by written request. You must assign the policy to us as sole security for the loan. We may defer
making a loan for six months unless the loan is to pay premiums to us. If we defer the loan for more than 10 business days,

ICC13L117P Page 4

2698002A00
IP2A_P230713868702000061 1433000000101000000001970
(Page 25 of 63)

we will pay interest on the loan amount at the current rate for funds held on deposit. The interest will be calculated from the
date we receive all necessary documentation to the date of payment.
The maximum loan amount available equals:

(a) the partial return of premium benefit amount, as described in the Partial Return of Premium Benefit
provision ; minus
(b) the interest that will accrue on the loan to the end of the policy year in which the loan is made; minus
(c) any premium due.
We will charge 5.66% interest in advance (6.0% effective annual interest rate). Interest is due on the loan on each policy
anniversary. Interest not paid when due will be added to the loan and bear interest at the same interest rate payable on the
loan .

You may repay all or part of a loan at any time while the policy is in force on a premium-paying basis. You must identify
any payment intended as a loan repayment or it will be considered a premium payment. If you do not repay a loan, the
policy will end when the loan balance equals or exceeds the policy's Partial Return of Premium Benefit. We will send a
notice to your last known address and to any assignee of record at least 30 days before the policy ends.
The death benefit will be reduced by the amount of any loan not repaid on the date the insured dies.

CONVERSION

While this policy is in force, you may convert this policy to a new permanent policy on the life of the insured at any time
after the earliest conversion date and before the latest conversion date shown on the data pages . If any partial return of
premium benefit amount is available at conversion, we will pay this amount in accordance with the Partial Return of
Premium Benefit provision. We will not require evidence of insurability.
To convert this policy, you must:

(a) surrender this policy;

(b) submit an application for conversion signed by you and the insured, if you are not the insured; and
(c) pay the required premium for the new policy.
The new policy will be a form of permanent insurance designated by us as eligible for conversion at the time of conversion.
All of the following rules will apply:

(a) The minimum required premium for the new policy must be greater than the premium for this policy at the
time of conversion.
(b) The face amount of the new policy may not be greater than the face amount of this policy.
(c) The new policy will be based on the insured's age at the time of conversion.
(d) The premium rates for the new policy will be for a risk class and rate class that we determine to be most similar
to the insured's risk class and rate class under this policy at the time of conversion.
(e) If this policy has any rider benefits, they may be included in the new policy only at our option.
(f) We will not waive premiums for the new policy because of an existing disability.
We will return any premiums paid for this policy beyond the policy month in which this policy is converted.
The contestability period and suicide exclusion period of the new policy will be measured from the contestability date of
this policy.
Upon conversion, this policy will end.

SUICIDE EXCLUSION

We will not pay the death benefit if the insured commits suicide, while sane or insane, within two years from the
contestability date . Instead, we will return all premiums paid.

If this policy is reinstated, we will not pay the death benefit if the insured commits suicide, while sane or insane, within two
years from the date of reinstatement. Instead, we will return all premiums paid.

ICC13L117P Page 5
(Page 26 of 63)

OWNER AND BENEFICIARY

OWNER

While the insured is alive, only you, the owner, may exercise the rights under this policy.
You can change the owner of this policy during the insured's lifetime by submitting a written request .
Unless you specify otherwise in the written request, the ownership change will be effective on the date you sign the written
request . If the beneficiary designation in effect is irrevocable, the beneficiary must also sign the written request . We are

not liable for any actions we take before we receive the written request.

ASSIGNMENT

You can assign some or all of your policy rights during the insured's lifetime by submitting a written request .
Unless you specify otherwise in the written request , the assignment will be effective on the date you sign the written
request . If the beneficiary designation in effect is irrevocable, the beneficiary must also sign the written request . We are
not liable for any actions we take before we receive the written request.
We are not responsible for the validity of any assignment of this policy.

BENEFICIARY

The death benefit will be paid to the beneficiary . If you named more than one beneficiary , they will share the death benefit
equally or as you may otherwise specify in the application or by written request. If there is no named beneficiary living
when the insured dies, the death benefit will be paid to:
(a) the insured's spouse ; if no living spouse , then
(b) equally to all living children of the insured; if not, then
(c) equally to the insured's parents; if none, then
(d) equally to the insured's siblings; if none, then
(e) the insured's estate.
You can change the beneficiary during the insured's lifetime by submitting a written request. Unless you specify otherwise
in the written request, the change will be effective on the date you sign the written request. If the beneficiary designation in
effect is irrevocable, the beneficiary must also sign the written request . We are not liable for any actions we take before we
receive the written request.

GENERAL PROVISIONS

ENTIRE CONTRACT

This policy is a contract between you and us. The entire contract is:

(a) this policy;

(b) the attached application;
(c) any supplemental applications made part of this policy;
(d) any riders; and
(e) any endorsements or amendments.
All statements made in an application will, in the absence of fraud, be considered representations and not warranties.
Any change to this policy requires an executive officer's written consent. No other representative has the authority to
change this policy or waive any of its terms.

INCONTESTABILITY

Except for nonpayment of premium or fraud in the procurement of the policy when permitted by applicable state law, this
policy will be incontestable after it has been in force during the insured's lifetime for two years from the contestability date.
If this policy is reinstated, a new contestable period will start on the date of reinstatement.

ICC13L117P Page 6

2699002A00
IP2A_P230713868702000061 1533000000101000000001980
(Page 27 of 63)

MISSTATEMENT OF AGE OR SEX

If the age or sex of the insured has been misstated, we will adjust the amount payable to that which would have been
purchased by the most recent premium paid at the correct age and sex.

CONFORMITY WITH STANDARDS

This policy was approved under the authority of the Interstate Insurance Product Regulation Commission and issued under
its standards. Any provision of this policy that on the issue date is in conflict with Interstate Insurance Product Regulation
Commission standards for this product type is amended as of the issue date to conform to such standards.

ICC13L117P Page 7
(Page 28 of 63)

UNITED OF OMAHA LIFE INSURANCE COMPANY

3300 MUTUAL OF OMAHA PLAZA, OMAHA, NE 68175

ACCELERATED DEATH BENEFIT

FOR TERMINAL ILLNESS RIDER

This rider is part of the policy to which it is attached. It is subject to all of the policy provisions which are not inconsistent
with the provisions of this rider.

When a terminal illness benefit is paid under the terms of this rider, the policy to which this rider is attached will
terminate.

Benefit payments for a terminal illness benefit, as described in this rider, may only be made if the payment is subject
to favorable tax treatment by the federal government.

A terminal illness benefit may be taxable. Receipt of this benefit may adversely affect your eligibility for Medicaid or
other government benefits or entitlements. Accelerated benefits do not and are not intended to qualify as long-term
care insurance. You should consult your personal tax advisor regarding the tax treatment of accelerated benefits.
You should contact a qualified advisor or the applicable government agency (such as the local State Medicaid office)
for advice regarding eligibility for Medicaid or other government benefits or entitlements before requesting this
benefit.

EFFECTIVE DATE

The effective date of this rider is the issue date of the policy.

DEFINITIONS

This section provides an alphabetical list of certain terms and their meanings as used in this rider or the policy. The
meanings apply to both the singular and plural versions of the defined terms.

means the amount of the requested acceleration that will be paid to you as defined in the
Terminal illness benefit

TERMINAL ILLNESS BENEFIT section of this rider. The terminal illness benefit is paid to you in a lump sum.

Terminally illmeans a medical condition that, with a reasonable degree of certainty, will result in your death within 24
months or less from the date a physician signs the statement of proof of terminal illness.

Family member means anyone who is related to you or the insured in any of the following ways: spouse , parent,
grandparent, child or grandchild, brother or sister, aunt or uncle, first cousin, nephew or niece (including adopted, in-law and
step-relatives).

Physician means a Doctor of Medicine or osteopathy as defined in Section 1861(r)(1) of the Social Security Act, other than
you, the insured, or a family member, duly licensed and legally qualified to diagnose and treat sickness and injury. He or she
must be providing services within the scope of his or her license.

means the amount of the death benefit that you request be paid prior to the insured's death under the
Requested acceleration

REQUESTING AN ACCELERATION section of this rider.

REQUESTING AN ACCELERATION

While this rider is in force, you may request to receive a one-time terminal illness benefit. The accelerated death benefit
equals 92% of the death benefit payable under the policy.

ICC20L204R

2600002A00
IP2A_P230713868702000061 1633000000101000000001990
(Page 29 of 63)

The amount payable as a lump sum shall be at least equal to the acceleration percentage multiplied by the difference between
the current policy cash value and any outstanding policy loans.

We may apply a portion of the accelerated death benefit to repay an outstanding policy loan.

We will pay a terminal illness benefit to you or your estate, unless you have otherwise designated or assigned this benefit, in
a lump sum immediately after we receive your acceleration request and satisfactory proof that the insured is terminally ill.

If the insured dies after you elect to receive a terminal illness benefit, but before you have received such benefit, we will
cancel your election and pay the death benefit in accordance with the terms of the policy.

Proof that the insured is terminally ill will include a completed claim form and a written statement from a physician . We will
send you the claim form within 15 days of your acceleration request. If we do not send you the claim form within 15 days,
you can meet the proof of loss requirement by giving us a written statement of your claim. In all events, we must receive
certification from a physician certifying that the insured is terminally ill. We reserve the right to request additional medical
information from the physician submitting the certification. If there is a disagreement between your physician and the
physician designated by us, a third medical opinion may be obtained, at our expense, by a mutually acceptable physician .

Such third medical opinion will be binding on both parties.

We will require the signature of the beneficiary, if the beneficiary designation then in effect is irrevocable, or any assignee
before we pay a benefit under this rider.

Upon payment of the accelerated benefit, we will give you and any irrevocable beneficiary a statement demonstrating the
effect of the payment on your policy.

If you elect to receive a terminal illness benefit payment, this rider and the policy to which it is attached, will terminate upon
payment.

REINSTATEMENT

This rider will be reinstated if:

a) the policy to which this rider is attached lapses and is subsequently reinstated according to the policy's reinstatement
provision; and
b) this rider has not terminated as described in the TERMINATION section.

TERMINATION

This rider will terminate on the earliest of the following:

a) the date a benefit is paid under any Accelerated Death Benefit Rider attached to your policy;
b) the date the policy lapses;
c) the policy's expiration date;
d) if applicable to your policy, the date the policy becomes a reduced paid-up, as described in your policy;
e) the date we receive your written request to cancel coverage under this rider; or
f) the date the insured dies.

If the accelerated death benefit ends, this shall not prejudice the payment of benefits for any qualifying event that occurred
while the form was in force.

United of Omaha Life Insurance Company

ICC20L204R
(Page 30 of 63)

UNITED OF OMAHA LIFE INSURANCE COMPANY

3300 MUTUAL OF OMAHA PLAZA, OMAHA, NE 68175

ACCELERATED DEATH BENEFIT

FOR CHRONIC ILLNESS RIDER

This rider is part of the policy to which it is attached. It is subject to all of the policy provisions which are not inconsistent
with the provisions of this rider.

When a chronic illness benefit is paid under the terms of this rider, the policy to which this rider is attached will
terminate.

Benefit payments for a chronic illness benefit , as described in this rider, may only be made if the payment is subject
to favorable tax treatment by the federal government.

A chronic illness benefit may be taxable. Receipt of this benefit may adversely affect your eligibility for Medicaid or
other government benefits or entitlements. Accelerated benefits do not and are not intended to qualify as long-term
care insurance. You should consult your personal tax advisor regarding the tax treatment of accelerated benefits.
You should contact a qualified advisor or the applicable government agency (such as the local State Medicaid office)
for advice regarding eligibility for Medicaid or other government benefits or entitlements before requesting this
benefit.

EFFECTIVE DATE

The effective date of this rider is the issue date of the policy.

DEFINITIONS

This section provides an alphabetical list of certain terms and their meanings as used in this rider or the policy. The
meanings apply to both the singular and plural versions of the defined terms.

Activities of daily living means six basic activities required for the insured to remain independent. They are:

a) Eating: means feeding oneself by getting food into the body from a receptacle (such as a plate, cup, or table) or by
a feeding tube or intravenously. Eating does not include preparing meals.
b) Toileting: means getting to and from the toilet, getting on and off the toilet, and performing associated personal
hygiene. Toileting does not include other activities that take place in the bathroom or lavatory.
c) Transferring: means moving into or out of a bed, chair, or wheelchair. Transferring does not include mobility
outside of the home or facility, including but not limited to transportation.
d) Bathing: means washing oneself by sponge bath; or in either a tub or shower, including the task of getting into or
out of the tub or shower.
e) Dressing: means putting on and taking off all items of clothing and any necessary braces, fasteners, or artificial
limbs.
f) Continence: means the ability to maintain control of bowel and bladder function; or, when unable to maintain
control of bowel or bladder function, the ability to perform associated personal hygiene (including caring for
catheter or colostomy bag).

means the amount of the requested acceleration that will be paid to you as defined in the CHRONIC
Chronic illness benefit

ILLNESS BENEFIT section of this rider. The chronic illness benefit is paid to you in a lump sum.

ICC20L200R

2601002A00
IP2A_P230713868702000061 1733000000101000000001000
(Page 31 of 63)

Chronic illness or chronically ill means that within the last 12 months a physician has certified that for a continuous period
of at least 90 days the insured:

a) is unable to perform (without substantial assistance from another person) at least two activities of daily living due to
loss of functional capacity; or
b) requires substantial supervision to protect himself or herself from threats to health and safety due to severe
cognitive impairment.

Family member means anyone who is related to you or the insured in any of the following ways: spouse , parent,
grandparent, child or grandchild, brother or sister, aunt or uncle, first cousin, nephew or niece (including adopted, in-law and
step-relatives).

Hands-on assistance means the physical assistance of another person without which the insured would be unable to perform
.
activities of daily living

Physician means a Doctor of Medicine or osteopathy as defined in Section 1861(r)(1) of the Social Security Act, other than
you, the insured, or a family member, duly licensed and legally qualified to diagnose and treat sickness and injury. He or she
must be providing services within the scope of his or her license.

Requested acceleration means the amount of the death benefit that you request be paid prior to the insured's death under the
REQUESTING AN ACCELERATION section of this rider. The requested acceleration amount must be 100% of the
policy's death benefit. The death benefit amount available for a requested acceleration will equal the greater of:

a) the face amount of this policy; or

b) if applicable to your policy, the minimum death benefit, as described in the policy , on the date of the acceleration
request.

We will adjust the death benefit amount available for a requested acceleration by:

a) adding any refund for a premium paid beyond the policy month in which a requested acceleration is paid; minus
b) if your policy offers loans, any policy loan outstanding; minus
c) any unpaid premium due.

The amount payable as a lump sum shall be at least equal to the acceleration percentage multiplied by the difference between
the current policy cash value and any outstanding policy loans.

Severe cognitive impairment means a loss or deterioration in intellectual capacity that is comparable to (and includes)
Alzheimer's disease and similar forms of irreversible dementia. A severe cognitive impairment is measured by clinical
evidence and standardized tests that reliably measure impairment in the insured's:

a) short-term or long-term memory;

b) orientation to people, places, or time;
c) deductive or abstract reasoning; and
d) judgment as it relates to safety awareness.

Spouse means the person with whom you or the insured has entered into marriage, domestic partnership, civil union
partnership, or the equivalent as recognized and allowed by any applicable federal or state law.

Standby assistance means the presence of another person, within arm's reach of the insured, that is necessary to prevent, by
physical intervention, injury while the insured is performing activities of daily living.

Substantial assistance means either hands-on assistance or standby assistance from someone who is physically present with
the insured.

Substantial supervision means continual supervision (which may include cueing by verbal prompting, gestures, or other
demonstrations) by another person nearby and in the same building that is necessary to protect the insured from threats to the
insured's health or safety. This includes, but is not limited to, threats that may result from wandering.

ICC20L200R
(Page 32 of 63)

REQUESTING AN ACCELERATION

While this rider is in force, you may request to receive a one-time chronic illness benefit. We will pay a chronic illness
benefit to you or your estate, unless you have otherwise designated or assigned this benefit, in a lump sum immediately after

we receive your acceleration request and satisfactory proof that the insured has a chronic illness.

If the insured dies after you elect to receive a chronic illness benefit, but before you have received such benefit, we will
cancel your election and pay the death benefit in accordance with the terms of the policy.

Proof that the insured is chronically ill will include a completed claim form and a written statement from a physician . We
will send you the claim form within 15 days of your acceleration request. If we do not send you the claim form within 15
days, you can meet the proof of loss requirement by giving us a written statement of your claim. In all events, we must
receive certification from a physician certifying that the insured is chronically ill. We reserve the right to request additional
medical information from the physician submitting the certification. If there is a disagreement between your physician and
the physician designated by us, a third medical opinion may be obtained, at our expense, by a mutually acceptable physician .
Such third medical opinion will be binding on both parties.

If you elect to receive a chronic illness benefit payment, this rider and the policy to which it is attached, will terminate upon
payment.

CHRONIC ILLNESS BENEFIT

A chronic illness benefit is an amount equal to:

a) the requested acceleration multiplied by an actuarial present value factor; minus

b) the present value of expected future unpaid premiums; minus
c) an administrative charge equal to $100.

The actuarial present value factor will be based on the life expectancy of the insured and the Accelerated Death Benefit
Interest Rate, determined as of the date of the requested acceleration. The life expectancy appraisal presumes that you will
undergo appropriate treatment for the condition that renders you chronically ill, consistent with generally accepted U.S.
medical standards, even if you choose not to undergo such treatment.

The Accelerated Death Benefit Interest Rate will not exceed the lesser of:

a) 6%; and
b) the greater of:
1. the then current yield on the 90-day Treasury Bills available at the date of the requested acceleration ; and
2. the Moody's Corporate Bond Yield Averages - Monthly Average Corporates - published by Moody's Investors
Services, Inc. or any successor to that service, subject to the approval of the Interstate Insurance Product
Regulation Commission, for the calendar month ending two months before the date of the requested
acceleration.

We will require the signature of the beneficiary, if the beneficiary designation then in effect is irrevocable, or any assignee
before we pay a benefit under this rider.

Upon payment of the chronic illness benefit, we will give you and any irrevocable beneficiary a statement demonstrating the
effect of the payment on your policy.

REINSTATEMENT

This rider will be reinstated if:

a) the policy to which this rider is attached lapses and is subsequently reinstated according to the policy's reinstatement
provision; and
b) this rider has not terminated as described in the TERMINATION section.

ICC20L200R

2602002A00
IP2A_P230713868702000061 1833000000101000000001010
(Page 33 of 63)

TERMINATION

This rider will terminate on the earliest of the following:

a) the date a benefit is paid under any Accelerated Death Benefit Rider attached to your policy;
b) the date the policy lapses;
c) the policy's expiration date;
d) if applicable to your policy, the date the policy becomes a reduced paid-up, as described in the policy;
e) the date we receive your written request to cancel coverage under this rider; or
f) the date the insured dies.

If the accelerated death benefit ends, this shall not prejudice the payment of benefits for any qualifying event that occurred
while the form was in force.

United of Omaha Life Insurance Company

ICC20L200R
(Page 34 of 63)

UNITED OF OMAHA LIFE INSURANCE COMPANY

3300 MUTUAL OF OMAHA PLAZA, OMAHA, NE 68175

ACCELERATED DEATH BENEFIT

FOR CRITICAL ILLNESS RIDER

This rider is part of the policy to which it is attached. It is subject to all of the policy provisions which are not inconsistent
with the provisions of this rider.

When a critical illness benefit is paid under the terms of this rider, the policy to which this rider is attached will
terminate.

Benefit payments for a critical illness benefit, as described in this rider, may only be made if the payment is subject to
favorable tax treatment by the federal government.

A critical illness benefit may be taxable. Receipt of this benefit may adversely affect your eligibility for Medicaid or
other government benefits or entitlements. Accelerated benefits do not and are not intended to qualify as long-term
care insurance. You should consult your personal tax advisor regarding the tax treatment of accelerated benefits.
You should contact a qualified advisor or the applicable government agency (such as the local State Medicaid office)
for advice regarding eligibility for Medicaid or other government benefits or entitlements before requesting this
benefit.

EFFECTIVE DATE

The effective date of this rider is the issue date of the policy.

DEFINITIONS

This section provides an alphabetical list of certain terms and their meanings as used in this rider or the policy. The
meanings apply to both the singular and plural versions of the defined terms.

means the amount of the requested acceleration that will be paid to you as defined in the CRITICAL
Critical illness benefit

ILLNESS BENEFIT section of this rider. The critical illness benefit is paid to you in a lump sum.

Critically ill means that within the last 12 months a physician has certified that the insured has one or more of the following
conditions:

a) AIDS:

1) Chronic HIV infection with consequent depletion of CD4 cell count to <200 cells/microL, despite usual anti-
retroviral therapy; (or)
2) Chronic HIV infection with consequent development of an AIDS-defining illness, as defined by the Centers for
Disease Control and Prevention at the time of claim, despite usual anti-retroviral therapy.

The following is a partial list of AIDS-defining conditions as outlined by the CDC (2018): Pulmonary or
esophageal andidiasis, pulmonary Pneumocystis, and Mycobacterium, and extrapulmonary invasive fungal
infections such as Coccidiomycosis or Cryptococcus, Cryptosporidium, Histoplasmosis, and Toxoplasmosis.
Opportunistic viral infections such as CMV retinitis, disseminated Herpes simplex, HIV encephalopathy. Some
cancers such as invasive Burkitt and immunoblastic lymphomas, and Kaposi sarcoma. Progressive multifocal
leukoencephalopathy, and HIV wasting syndrome.

b) Amyotrophic Lateral Sclerosis (ALS): The diagnosis of ALS must be made by a physician who is board certified
in the United States as a neurologist.

ICC20L199R

2603002A00
IP2A_P230713868702000061 1933000000101000000001020
(Page 35 of 63)

c) Dementia: A condition (including Alzheimer's Disease, Frontotemporal Dementia, and Lewy Body Dementia) by a
physician who is board certified in the United States as a neurologist or geritrician, and meets all of the following
criteria:

1. Medical evidence of significant and progressive cognitive decline in learning and memory, and decline in at
least one of the following:
i. Language
ii. Executive function (abstract thought, planning, initiating, sequencing, monitoring and stopping complex
behavior)
iii. Complex attention (distractibility, disorientation)
iv. Perceptual-motor (e.g. unable to use common daily objects such as comb, or silverware)
v. Social cognition (recognizing thoughts/emotions in self and others)
2. The cognitive deficits interfere with independence and require permanent daily supervision.
3. The deficits are of at least moderate severity, evidenced by a Mini Mental State exam score of 20/30 or less, and
there is evidence of worsening of cognitive function by serial tests, or by history, over at least 6 months. (Other
generally medically accepted cognitive evaluations may be used in place of MMSE).
4. The deficits do not occur exclusively in context of delirium and are not better explained by another mental or
neurological disorder (e.g. major depressive disorder, schizophrenia, stroke).

d) End Stage Renal Failure (Kidney Failure): The chronic irreversible failure of both kidneys' ability to function,
which results in the need for regular hemodialysis, peritoneal dialysis or renal transplantation. The diagnosis of
kidney failure must be made by a physician who is board certified in the United States in nephrology.

e) Life Threatening (Invasive) Cancer : A type of cancer clinically confirmed as a malignant tumor that
demonstrates uncontrolled growth with the spread of malignant cells and the invasion of tissue. Leukemia and
lymphoma are life threatening cancers.

Life threatening cancer does not include any of the following, regardless of the location in or on the body:

A malignant tumor wherein the tumor cells have not invaded neighboring tissue
Pre-malignant tumors
Lesions (such as but not limited to intraepithelial neoplasia)
Benign tumors
Polyps
Non-invasive cancer
Skin cancer other than invasive malignant melanoma or metastatic skin malignancies.

f) Major Organ Failure: The diagnosis, by a physician , of irreversible failure of the heart, both lungs, liver, both
kidneys, pancreas or bone marrow, with transplantation deemed medically necessary, followed by enrollment, in a
recognized organ or bone marrow transplant program in the United States, to be the recipient of a heart, lung, liver,
kidney, pancreas or bone marrow transplant.

g) Myocardial Infarction (Heart Attack) : An acute myocardial infarction requiring an inpatient hospital stay and
resulting in the death of a portion of heart muscle due to inadequate blood supply to the relevant area from a
blockage of one or more coronary arteries. Heart attack includes ST elevation, non-ST elevation, Q wave and
non-Q wave presentations. In order to be covered a concurrent rise and/or fall of cardiac biomarkers must be
present. The diagnosis of an acute myocardial infarction must be made by a physician who is board certified in the
United States in cardiology or internal medicine and based on both of the following:

A clinical setting consistent with symptoms of ischemic heart disease.

New electrocardiograph or cardiac imaging changes consistent with cardiac tissue death.
Development of new Q waves during or immediately following an intra-arterial cardiac procedure
including but not limited to coronary angiography and coronary angioplasty.

h) Severe Burns: A definite diagnosis of second and third degree burns over at least 20% of the total body surface
area. The diagnosis of severe burns must be made by a physician who is a specialist.

ICC20L199R
(Page 36 of 63)

i) Stroke: An acute cerebrovascular accident or infarction (death) of brain, spinal cord or retinal tissue caused by
hemorrhage, embolism or thrombosis producing measurable neurological deficit(s). Tissue damage should be
confirmed by neuroimaging testing (CT, MRI, MRA, PET or similar imaging technique). Stroke does not include
transient ischemic attack (TIA), chronic cerebrovascular insufficiency or neurologic impairment form trauma,
infection, hypoxemia or anoxia.

j) Surgical treatment of an aortic aneurysm : An operation in the treatment of an aneurysm or dissection of the
thoracic or abdominal aorta. Surgical intervention would include both open and endovascular repairs. This surgery
must be determined to be medically necessary and performed by a physician who is a specialist.

Family member means anyone who is related to you or the insured in any of the following ways: spouse , parent,
grandparent, child or grandchild, brother or sister, aunt or uncle, first cousin, nephew or niece (including adopted, in-law and
step-relatives).

Physician means a Doctor of Medicine or osteopathy as defined in Section 1861(r)(1) of the Social Security Act, other than
you, the insured, or a family member, duly licensed and legally qualified to diagnose and treat sickness and injury. He or she
must be providing services within the scope of his or her license.

Requested acceleration means the amount of the death benefit that you request be paid prior to the insured's death under the
REQUESTING AN ACCELERATION section of this rider. The requested acceleration amount must be 100% of the
policy's death benefit. The death benefit amount available for a requested acceleration will equal the greater of:

a) the face amount of this policy; or

b) if applicable to your policy, the minimum death benefit , as described in your policy, on the date of the acceleration
request.

We will adjust the death benefit amount available for a requested acceleration by:

a) adding any refund for a premium paid beyond the policy month in which a requested acceleration is paid; minus
b) if your policy offers loans, any policy loan outstanding; minus
c) any unpaid premium due.

Spouse means the person with whom you or the insured has entered into marriage, domestic partnership, civil union
partnership, or the equivalent as recognized and allowed by any applicable federal or state law.

REQUESTING AN ACCELERATION

While this rider is in force, you may request to receive a one-time critical illness benefit.

We will pay a critical illness benefit to you or your estate, unless you have otherwise designated or assigned this benefit, in a
lump sum immediately after we receive your acceleration request and satisfactory proof that the insured is critically ill.

If the insured dies after you elect to receive a critical illness benefit, but before you have received such benefit, we will
cancel your election and pay the death benefit in accordance with the terms of the policy.

Proof that the insured is critically ill will include a completed claim form and a written statement from a physician . We will
send you the claim form within 15 days of your acceleration request. If we do not send you the claim form within 15 days,
you can meet the proof of loss requirement by giving us a written statement of your claim. In all events, we must receive
certification from a physician certifying that the insured is critically ill. We reserve the right to request additional medical
information from the physician submitting the certification. If there is a disagreement between your physician and the
physician designated by us, a third medical opinion may be obtained, at our expense, by a mutually acceptable physician .

Such third medical opinion will be binding on both parties.

If you elect to receive a critical illness benefit payment, this rider and the policy to which it is attached, will terminate upon
payment.

ICC20L199R

2604002A00
IP2A_P230713868702000061 2033000000101000000001030
(Page 37 of 63)

CRITICAL ILLNESS BENEFIT

A critical illness benefit is an amount equal to:

a) the requested acceleration multiplied by an actuarial present value factor; minus

b) the present value of expected future unpaid premiums; minus
c) an administrative charge equal to $100.

The actuarial present value factor will be based on the life expectancy appraisal of the insured and the Accelerated Death
Benefit Interest Rate, determined as of the date of the requested acceleration. The life expectancy appraisal presumes that
you will undergo appropriate treatment for the condition that renders you critically ill, consistent with generally accepted
U.S. medical standards, even if you choose not to undergo such treatment.

The Accelerated Death Benefit Interest Rate will not exceed the lesser of:

a) 6%; and
b) the greater of:
1. the then current yield on the 90-day Treasury Bills available at the date of the requested acceleration ; and
2. the Moody's Corporate Bond Yield Averages - Monthly Average Corporates - published by Moody's Investors
Services, Inc. or any successor to that service, subject to the approval of the Interstate Insurance Product
Regulation Commission, for the calendar month ending two months before the date of the requested
acceleration.

We will require the signature of the beneficiary, if the beneficiary designation then in effect is irrevocable, or any assignee
before we pay a benefit under this rider.

Upon payment of the critical illness benefit, we will give you and any irrevocable beneficiary a statement demonstrating the
effect of the payment on your policy.

REINSTATEMENT

This rider will be reinstated if:

a) the policy to which this rider is attached lapses and is subsequently reinstated according to the policy's reinstatement
provision; and
b) this rider has not terminated as described in the TERMINATION section.

TERMINATION

This rider will terminate on the earliest of the following:

a) the date a benefit is paid under any Accelerated Death Benefit Rider attached to your policy;
b) the date the policy lapses;
c) the policy's expiration date;
d) if applicable to your policy, the date the policy becomes a reduced paid-up, as described in your policy;
e) the date we receive your written request to cancel coverage under this rider; or
f) the date the insured dies.

If the accelerated death benefit ends, this shall not prejudice the payment of benefits for any qualifying event that occurred
while the form was in force.

United of Omaha Life Insurance Company

ICC20L199R
(Page 38 of 63)

UNITED OF OMAHA LIFE INSURANCE COMPANY

WAIVER OF PREMIUM FOR UNEMPLOYMENT RIDER

This rider is part of the policy to which it is attached. It is subject to all of the policy provisions that are not inconsistent with

the provisions of this rider. If the provisions of this rider and those of the policy do not agree, the provisions of this rider

apply.

BENEFIT

We will waive premiums for this policy and all riders attached to it for one six-month period if the insured becomes
unemployed while this policy is in force. This one-time benefit is available beginning 24 months after the issue date.

To qualify, the insured must:

(a) receive state or federal unemployment benefits for four consecutive weeks; and
(b) provide proof of receiving such benefits within 90 days after the end of this four-week period.

When we receive this proof, we will waive premiums for six months. The waiver will begin on the premium due date
following the date we approve this claim.

Premiums waived under this provision may result in tax consequences to you. Please consult a tax advisor.

EFFECTIVE DATE

This rider is effective as of the policy issue date.

COST

There is no premium charge for this rider.

United of Omaha Life Insurance Company

D185LNA10R

2605002A00
IP2A_P230713868702000061 2133000000101000000001040
(Page 39 of 63)

.
(Page 40 of 63)

United of Omaha Life Insurance Company

RESIDENTIAL DAMAGE WAIVER OF PREMIUM RIDER

This Rider is part of the policy to which it is attached. It is subject to all of the policy provisions that are not inconsistent with

the Rider provisions. If the provisions of the Rider and those of the policy do not agree, the provisions of the Rider apply.

EFFECTIVE DATE

The effective date of this Rider is the policy's issue date.

DEFINITION

Physical Damage means damage to your dwelling itself and does not include personal property.

Primary Residence means the dwelling you own, actually live in, and is considered as your legal residence for income tax
purposes.

WAIVER OF PREMIUM BENEFIT

If your Primary Residence suffers Physical Damage in the amount of $25,000 or more, then we will waive premiums for this
policy and all Riders attached to it for one consecutive six-month period. This waiver will take effect upon our receipt of proof
of residential damage, as required below.

There is no premium or cost of insurance charge for this benefit.

This waiver may be exercised only once.

PROOF OF RESIDENTIAL DAMAGE

You must submit a certified copy of the estimate of damage report prepared by your property insurance company adjuster,
stating the amount of the damage to your Primary Residence. The certified copy must be submitted within 91 days of the date
of the adjuster's report. We reserve the right to obtain a second opinion by having your Primary Residence inspected by an
adjuster of our choice at our expense. We may rely upon our adjuster's opinion.

TERMINATION

This Rider will terminate on the earliest of the following:

(a) the date the residential waiver of premium is exercised;

(b) the date the policy terminates; or
(c) the expiration date of the policy.

United of Omaha Life Insurance Company

Form A735LNA06R

2606002A00
IP2A_P230713868702000061 2233000000101000000001050
(Page 41 of 63)

This page intentionally left blank

(Page 42 of 63)

United of Omaha Life Insurance Company

DISABILITY WAIVER OF PREMIUM RIDER

This Rider is part of the policy to which it is attached. It is subject to all of the policy provisions that are not inconsistent

with the Rider provisions. If the provisions of the Rider and those of the policy do not agree, the provisions of the Rider

apply.

DEFINITIONS

Complications of Pregnancy means:

(a) conditions, when the pregnancy is not terminated, whose diagnoses are distinct from pregnancy, which are
adversely affected by pregnancy or caused by pregnancy, such as acute nephritis, nephrosis, cardiac
decompensation, missed abortion and similar medical and surgical conditions of comparable severity; and
(b) cesarean section delivery, ectopic pregnancy which is terminated, spontaneous termination of pregnancy which
occurs during a period of gestation in which a viable birth is not possible, puerperal infection, eclampsia and
toxemia.

Complications of Pregnancy does not include false labor, occasional spotting, Physician-prescribed rest cure during the
period of pregnancy, morning sickness, hyperemesis gravidarum, pre-eclampsia and similar conditions associated with the
management of a difficult pregnancy not constituting a distinct medically-classified complication of pregnancy.

Elimination Period means 90 continuous days of Total Disability that must pass before the waiver of premium benefit
becomes available. The Elimination Period begins on the date of first Regular Medical Care during Total Disability. A new
Elimination Period will apply for any subsequent Total Disability from causes completely unrelated to a previous Total
Disability.

Injury means bodily harm which:

(a) is the direct result of an accident or trauma that occurs while the policy and this Rider are in force; and
(b) is not related to Sickness or any other cause.

Insured means the person named as Insured on the data pages of the policy.

Normal Childbirth or Normal Pregnancy means childbirth or pregnancy free of Complications of Pregnancy.

Physician means a person other than you, the Insured, or a member of the Insured's family, duly licensed and legally
qualified to diagnose and treat a Sickness or Injury. He or she must be providing services within the scope of his or her
license.

Regular Medical Care means:

(a) treatment, consultations, evaluations and diagnostic services provided by a Physician whose specialty is appropriate
for the Sickness or Injury causing the Insured's Total Disability;
(b) Physician treatment and services received in-person at a frequency that is appropriate according to standard medical
practice; and
(c) the most appropriate treatment necessary in order to achieve the maximum of medical improvement possible.

Form 2697L-1203 2607002A00

IP2A_P230713868702000061 2333000000101000000001060
(Page 43 of 63)

We may waive one or more of the above requirements at some point during the Insured's disability. We will provide
notification of such waiver in writing.

We may require the Insured to have the Insured's Physician provide us with a written document addressing the Insured's
evaluation and the treatment plan(s) which would be in accordance with medical standards appropriate for the Insured's
Sickness or Injury.

Sickness means an illness, disease or physical condition which:

(a) causes Total Disability beginning while the policy and this Rider are in force; and
(b) is not excluded from coverage.

Total Disability means that, due to Sickness or Injury, the Insured:

(a) is unable to perform the material and substantial duties of any occupation for which the Insured is qualified by
reason of education, training or experience;
(b) receives Regular Medical Care by a Physician; and
(c) does not engage in any employment or occupation for wage or profit.

EXCLUSIONS

We will not waive premiums under this Rider for Total Disability that:

(a) begins while the policy and this Rider are not in force;
(b) results from an act of declared or undeclared war;
(c) is caused by intentionally self-inflicted injury;
(d) results from the commission of or attempted commission of a felony;
(e) is caused by suicide or attempted suicide, while sane or insane;
(f) results from the Insured's air travel as a non-commercial airline pilot;
(g) is sustained while serving in the armed forces (upon notice to us of entry into the armed forces, any unearned
portion of the premium will be refunded);
(h) is due to Normal Childbirth, Normal Pregnancy or voluntarily induced abortion; (Waiver of premium for
Complications of Pregnancy is done on the same basis as any other Sickness)
(i) is due to the Insured's being intoxicated (as determined and defined by the laws of the jurisdiction in which the Total
Disability or cause of Total Disability occurred; for the purposes of this exclusion, the laws governing the operation
of motor vehicles while intoxicated will apply);
(j) is due to the Insured's being under the influence of any controlled substance (except for narcotics given on the
advice of a Physician).

WAIVER OF PREMIUM BENEFIT

If the Insured has a Sickness or an Injury that results in more than 90 continuous days of Total Disability, we will:

(a) waive the payment of each premium that becomes due after the end of the Elimination Period, as long as Total
Disability continues; and
(b) refund that part of any premium paid for the period of Total Disability after the end of the Elimination Period.
However, we will not refund premiums paid for a period more than six months before the date we receive notice.

Form 2697L-1203
(Page 44 of 63)

Premiums waived or refunded under this provision include premiums for the policy and all Riders.

Total Disability must begin while the policy and this Rider are in force and before the Expiration Date for this Rider shown
on the policy data pages.

After the waiver of premium benefit ends, you must again pay any premiums that become due in order to keep the policy in
force.

CLAIMS

Notice of Claim
_____________ _

You or the Insured may give any required notice or have someone else do it. The notice should give the Insured's name and
policy number as shown on the policy data pages. Notice should be mailed to us at Omaha, Nebraska, or to any of our
agents.

We must be given written notice of a claim within 20 days after Total Disability occurs or starts, or as soon as is reasonably
possible.

Claim Forms for Filing Proof of Total Disability

_________________________________________

When we receive your notice, we will send you claim forms for filing proof of Total Disability. If we do not send them
within 15 days, you can meet the proof of Total Disability requirement by giving us a written statement from the Insured's
Physician. You must provide the proof of Total Disability within 90 days after the date we send the claim forms.

Proof of Continued Total Disability

_____________________________ _

We may require proof that Total Disability continues. This proof may include that the Insured be examined, at our expense,
at reasonable intervals during the waiver of premium benefit period. If the Insured does not furnish proof within 90 days
after the date we send the claim forms, premiums will become payable when due. After the Insured has been Totally
Disabled for two years, the company will only require proof once per year.

GENERAL PROVISIONS

Effective Date
____________

The effective date of this Rider is the policy's issue date.

Premiums Subject to Change

_________________________

The Rider premium for the first policy year is shown on the policy data page. We may change the premium for this Rider on
or after the first policy anniversary. However, we can change the Rider premium only if the same change is made on all
Riders of this form issued on Insureds of the same risk class and rate class.

We will not change the Rider premium more often than once each policy year. Any change in Rider premiums will be
effective on a policy anniversary.

We must give you written notice of any change in the Rider premium at least 60 days before the effective date of the change.

Form 2697L-1203 2608002A00

IP2A_P230713868702000061 2433000000101000000001070
(Page 45 of 63)

______________
Incontestability

We will not contest the validity of this Rider after it has been in force during the lifetime of the Insured for two years from the
Rider effective date. With respect to statements made in any application for reinstatement, we will not contest this Rider after
it has been in force during the Insured's lifetime for two years after the effective date of reinstatement.

___________
Termination

This Rider will end on the earliest of the following:

(a) the Expiration Date for this Rider shown on the policy data pages;
(b) the date the policy ends; or
(c) the date we receive your written request to cancel the Rider. If you cancel this Rider, the total premium for the
policy will be reduced by the amount of premium for this Rider. Once you have canceled this Rider, you cannot
reinstate it.

Termination of the Rider will not affect any waiver of premium claim that began while the Rider was in force.

United of Omaha Life Insurance Company

Form 2697L-1203
(Page 46 of 63)

ACCIDENTAL DEATH BENEFIT RIDER

BENEFIT - When we receive proof that the Insured died while this rider was in force and that death resulted

directly and independently of all other causes from accidental bodily injury, we will pay to the beneficiary the

amount shown for this benefit on page 3. This amount will be in addition to all other benefits provided by this

policy.

EXCLUSIONS - This benefit will not be paid if death resulted from any of the following:

(a) injuries intentionally self-inflicted while sane or insane;

(b) injuries resulting from the commission of a felony by the Insured;

(c) injuries resulting from operating, riding in or descending from any kind of aircraft if the Insured:

(1) is a pilot, officer or member of the crew;

(2) is being flown for the purpose of descent from the aircraft while in flight;

(3) is giving or receiving any kind of training or instruction; or

(4) has any duties aboard the aircraft;

(d) injuries resulting from an act of declared or undeclared war;

(e) bodily or mental infirmity; or

(f) injuries sustained as a result of the Insured's intoxication.

INCONTESTABILITY - We will not contest the validity of this rider after it has been in force during the

lifetime of the Insured for two years from its date of issue. The date of issue of this rider is the date of issue of

this policy or the effective date shown for this rider on page 3 if added later.

TERMINATION - This rider will terminate at the end of:

(a) the years payable for this rider shown on page 3; or

(b) the grace period of an unpaid premium for this policy.

This rider may also be terminated by written request of the owner and return of this policy to us. The premium

for this policy will then be reduced by the amount of the premium shown for this rider on page 3.

GENERAL - If you have chosen a method for payment of the policy proceeds, that method will apply to any

amount payable under this rider unless you have specified otherwise.

This rider is a part of the policy to which it is attached. It is subject to all of the policy provisions which are not

inconsistent with the rider provisions. The premium and years payable for this rider are shown on page 3.

United of Omaha Life Insurance Company

Form 2145L-0989

2609002A00
IP2A_P230713868702000061 2533000000101000000001080
(Page 47 of 63)

This page intentionally left blank

(Page 48 of 63)

NOTICE CONCERNING COVERAGE

LIMITATIONS AND EXCLUSIONS UNDER THE NORTH CAROLINA
LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT

Residents of this state who purchase life insurance, annuities or health insurance should know
that the insurance companies and Health Maintenance Organizations (HMOs) licensed in this
state to write these types of insurance are members of the North Carolina Life and Health
Insurance Guaranty Association. The purpose of this association is to assure that policyholders
will be protected, within limits, in the unlikely event that a member insurer or HMO becomes
financially unable to meet its obligations. If this should happen, the guaranty association will
assess its other member companies for the money to pay the claims of the insured persons who
live in this state and, in some cases, to keep coverage in force. The valuable extra protection
provided by these insurers through the guaranty association is not unlimited, however. And, as
noted in the box below, this protection is not a substitute for consumers' care in selecting
companies that are well-managed and financially stable.

The North Carolina Life and Health Insurance Guaranty Association may not provide
coverage for this policy. If coverage is provided, it may be subject to substantial limitations
or exclusions, and require continued residency in North Carolina. You should not rely on
coverage by the North Carolina Life and Health Insurance Guaranty Association in
selecting an insurance company or in selecting an insurance policy.

Coverage is NOT provided for your policy or any portion of it that is not guaranteed by
the insurer or for which you have assumed the risk, such as a variable contract sold by
prospectus.

Insurance companies or their agents are required by law to give or send you this notice.
However, insurance companies and their agents are prohibited by law from using the
existence of the guaranty association to induce you to purchase any kind of insurance
policy.

The North Carolina Life and Health Insurance Guaranty Association

4441 Six Forks Rd Ste 106-153
Raleigh, North Carolina 27609-5729
https://www.nclifega.org/

North Carolina Department of Insurance, Consumer Services Division

1201 Mail Service Center
Raleigh, North Carolina 27699-1201

The state law that provides for this safety-net coverage is called the North Carolina Life and
Health Insurance Guaranty Association Act. On the back of this page is a brief summary of this
law's coverages, exclusions and limits. This summary does not cover all provisions of the law;
nor does it in any way change anyone's rights or obligations under the act or the rights or
obligations of the guaranty association.

GAN NC_0322_U

2610002A00
IP2A_P230713868702000061 2633000000101000000001090
(Page 49 of 63)

COVERAGE

Generally, individuals will be protected by the life and health guaranty association if they live in this
state and hold a life or health insurance contract, or an annuity, or if they are insured under a group
insurance contract, issued by a member insurer or HMO. The beneficiaries, payees or assignees of
insured persons are protected as well, even if they live in another state.

EXCLUSIONS FROM COVERAGE

However, persons holding such policies are not protected by this association if:

- They are eligible for protection under the laws of another state (this may occur when the
insolvent insurer was incorporated in another state whose guaranty association protects
insureds who live outside that state).
- The insurer was not authorized to do business in this state.
- Their policy was issued by a fraternal benefit society, a mandatory state pooling plan, a
mutual assessment company or similar plan in which the policyholder is subject to future
assessments, or by an insurance exchange.
- They acquired rights to receive payments through a structured settlement factoring
transaction.

The association also does not provide coverage for:

- Any policy or portion of a policy which is not guaranteed by the insurer or for which the
individual has assumed the risk, such as a variable contract sold by prospectus.
- Any policy of reinsurance (unless an assumption certificate was issued).
- Interest rate yields that exceed the average rate specified in the law.
- Dividends.
- Experience or other credits given in connection with the administration of a policy by a group
contractholder.
- Employers' plans to the extent they are self-funded (that is, not insured by an insurance
company, even if an insurance company administers them).
- Unallocated annuity contracts (which give rights to group contractholders, not individuals),
unless they fund a government lottery or a benefit plan of an employer, association or union,
except that unallocated annuities issued to employee benefit plans protected by the Federal
Pension Benefit Guaranty Corporation are not covered.
- A policy or contract commonly known as Medicare Part C, Medicare Part D, Medicaid or any
regulations issued pursuant thereto.

LIMITS ON AMOUNT OF COVERAGE

The act also limits the amount the association is obligated to pay out as follows:

(1) The guaranty association cannot pay out more than the insurance company would owe
under the policy or contract.
(2) Except as provided in (3), (4) and (5) below, the guaranty association will pay a
maximum of $300,000 per individual, per insolvency, no matter how many policies or
types of policies issued by the insolvent company.
(3) The guaranty association will pay a maximum of $500,000 with respect to a health
benefit plan.
(4) The guaranty association will pay a maximum of $1,000,000 with respect to the payee of
a structured settlement annuity.
(5) The guaranty association will pay a maximum of $5,000,000 to any one unallocated
annuity contract holder.

GAN NC_0322_U
(Page 50 of 63)

2611002A00
IP2A_P230713868702000061 2733000000101000000001100
(Page 51 of 63)
(Page 52 of 63)

2612002A00
IP2A_P230713868702000061 2833000000101000000001110
(Page 53 of 63)
(Page 54 of 63)

2613002A00
IP2A_P230713868702000061 2933000000101000000001120
(Page 55 of 63)

This page intentionally left blank

(Page 56 of 63)

2614002A00
IP2A_P230713868702000061 3033000000101000000001130
(Page 57 of 63)

This page intentionally left blank

(Page 58 of 63)

2615002A00
IP2A_P230713868702000061 3133000000101000000001140
(Page 59 of 63)

This page intentionally left blank

(Page 60 of 63)

2616002A00
IP2A_P230713868702000061 3233000000101000000001150
(Page 61 of 63)

This page intentionally left blank

(Page 62 of 63)

This page intentionally left blank

ICC13L117P

2617002A00
IP2A_P230713868702000061 3333000000101000000001160
(Page 63 of 63)

TERM LIFE INSURANCE POLICY

THIS IS A RENEWABLE TERM LIFE INSURANCE POLICY WITH AN INTERMEDIATE ENDOWMENT BENEFIT
PAYABLE AFTER THE INITIAL PREMIUM GUARANTEED PERIOD SHOWN ON THE DATA PAGES.

THIS POLICY CAN BE CONVERTED TO PERMANENT LIFE INSURANCE ANY TIME AFTER THE EARLIEST
CONVERSION DATE AND BEFORE THE LATEST CONVERSION DATE SHOWN ON THE DATA PAGES.

PREMIUMS ARE LEVEL AND GUARANTEED FOR THE INITIAL PREMIUM GUARANTEE PERIOD SHOWN
ON THE DATA PAGES AND WILL INCREASE THEREAFTER. THE DEATH BENEFIT IS LEVEL FOR ALL
POLICY YEARS.

COVERAGE ENDS ON THE EXPIRATION DATE SHOWN ON THE DATA PAGES.

THIS IS NOT A PARTICIPATING POLICY. NO DIVIDENDS WILL BE PAID.

ICC13L117P