John
Doe
5678 Elm Street
Nowhere, FL 67890
January 1, 2000
The Life Insurance Company
Re: Policy Number 12-3456-789
Dir Sir or Madam:
Please furnish an
illustration of hypothetical policy values for the above referenced life insurance
policy as follows:
·
A Ledger Illustration based on current pricing assumptions
as to mortality, expenses, and interest crediting rates and/or dividend scales,
and showing year-by-year hypothetical policy values as to planned periodic
premiums and/or policy loan interest paid in cash (if any), net cash surrender
values (net of any policy loans), net policy account values (if different
from cash surrender values), net death benefits, and policy loans (if any).
·
Detailed accounting/expense pages corresponding to the
above Ledger Illustration showing projected policy pricing elements including,
but not limited to, premium-based loads (if any), cash-value-based expenses
(if any), fixed-type charges (if any), projected current cost of insurance
charges, and dividends (if any). If
the illustration system for the above referenced product does not provide
detail for one or more of these policy expenses, please also furnish a product
guide and/or prospectus that summarizes these charges.
In both cases, please calculate hypothetical policy
values and expenses assuming the current planned periodic premium is continued
until such time as cash values are projected to endow for the original policy
face amount (e.g. calculate the earliest point at which the current planned
periodic premium may be stopped such that the projected cash value at endowment
is equal to or greater than the original policy face amount).
In addition, if the policy pays a declared interest
rate and/or dividend scale, please illustrate this current rate/scale. If policy earnings are based on performance
of variable life separate accounts, please illustrate a 10 % net
earnings rate (i.e. net of investment advisory/management fees and fund
operating expenses, but before mortality and expense risk charges or other
policy level cash-value-based charges are deducted).
Please send a hard copy of the above information to
directly to the address of record, and send a fax copy to (877) 847-1613. Thank you in advance for your prompt and
courteous response.
Sincerely,
Policyowner