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3048 LDP/UTRM (R93V01) 3-1031.21

VARIABLE UNIVERSAL LIFE, VARIABLE ANNUITY AND MARKET VALUE ANNUITY SURRENDER QUOTETransaction Number 3048

PURPOSE

This Mask requests a Variable Universal Life or VariableAnnuity Surrender Quotation through the Policy OwnerService System. It can also be used to request the Policy

Maintenance Cycle to quote or process a Variable Universal Lifeor Variable Annuity Surrender, or Market Value Annuity.

INPUT MASK

LPOS 101 01 JCH 15.26.26

DQTE 3048,UL2100016F INSURED - CHARLES BRANDON

SUSPEND OVERRIDE PROCESS IMAGE CORRES/CHECK DATE BATCH DOC-ID

0 N D N N 12-15-89 3JCH .....

AS-OF TYPE SELECT DIST RES SURR-CHG DP-DSK CLASS BASE SUB AGE

MM-DD-YY . N N N N 01 JMC . ... .. ...

TRN CHG N SURR-CHG AMT 00000000.00 TAX OVR Y GROSS/NET 1

ACCOUNT AMOUNT SURRENDER ACCOUNT AMOUNT SURRENDER

... 0000000.00 0000000.00 ... 0000000.00 0000000.00

... 0000000.00 0000000.00 ..... 0000000.00 0000000.00

... 0000000.00 0000000.00 ... 0000000.00 0000000.00

... 0000000.00 0000000.00 ... 0000000.00 0000000.00

------TYPE-----------

T - TOTAL SURRENDER

P - PARTIAL SURRENDER

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Name Req. Format Description

AS-OF(As-Of Date)

I mm-dd-yy This is the Effective Date of the Variable Universal Life or Variable AnnuityStatus Quote Transaction. The As-of Date must be equal or greater than thelast month-a-versary for Variable Universal Life policies. For VariableAnnuities, this date is initially displayed as the current Policy MaintenanceCycle Date and can be changed to the appropriate termination date.

TYPE(Surrender Type)

R c Enter the type of surrender desired. Permissible values are:

Code Meaning

T Total Surrender P Partial Surrender

SELECT CR c This field may be used to indicate that the surrender of value from a specificaccount is to be quoted. Permissible values are:

Code Meaning

S The total surrender value from the account identified within theAnnuity Account Deposit Accumulation Trailer (EM) is to beprocessed. This field is required when processing a totalsurrender with a Distribution Option of 'D'.

DIST(1099 Distribution)

0 c This field contains a code the 1099 Distribution Code describes why funds fromthis policy are distributed. This code will be converted to the I.R.S.Distribution Category Code that appears on the 1099 form. Permissible values

are:

Code Meaning

P Premature DistributionR Rollover

3048 LDP/UTRM (R93V01) 3-1031.22

3048

LDP/UTRM (R93V01) 3-1031.22.1

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NOTE: A value of 'R' in this field is valid only when the Product MarketCode Field in the Annuity Account Control Trailer contains a valueof '3' or '7' (IRA).

Code Meaning

G DisabilityD Death

When a value of 'D' is entered, the Process Code must be 'P', the SelectedAccounts Indicator Field must contain an 'S', the Override Surrender ChargeField must contain a 'Y' or 'A' and the Check/Correspondence Override Fieldmust contain a '3'.

Q Prohibited Transactions.

O Other

I Normal IRA, SEP, or DEC distributions.

E Excess contributions refunded plus earnings on such excesscontributions.

T PS 58 costs.

A Qualifies for 10-Year Averaging.

B Qualifies for Death Benefit Exclusion.


Code Meaning

C Qualifies for both A and B.

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H Direct rollover 'TO' IRA's from HR10/Keogh and TSA plans.K Direct rollover 'TO' other plans from HR10/Keogh and TSA

plans.

RES(Restrict Code)

0 c This field may be used to force the processing of the surrender transactionwhen:

The Restrict Code field of the Annuity Account Control Trailer contains avalue of '1'.

and/or the Surrender Code of the Policy Control Trailer contains a value of

'2'.

Permissible values are:

Code Meaning

N Do not override either Restrict Code or Suspend Code if notapplicable.

1 Override Restriction and/or Suspend Code.

SURR-CHG 0 c This field may be used to override any Surrender Charge normally assessedagainst this surrender. Permissible values are:

Code Meaning

N Do not override Surrender Charge or Market Value AdjustmentFactor. The normal Surrender Charge and Market ValueAdjustment Factor will be assessed.

3048 LDP/UTRM (R93V01) 3-1031.22.2

LDP/UTRM (Blank) (R93V01) 3-1031.22.3

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Code Meaning

Y Override Surrender Charge only. The amount of the SurrenderCharge must be entered in the Surrender Charge Amount Field.

DP-DSK(Department/Desk Code)

I DD-DDD This Department/Desk Code will be printed on the status if a PolicyMaintenance Cycle quotation is requested.

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If a Quote Transaction has been requested and a 'DOC-ID' entry has been madeindicating a Correspondence Request, this field will also be Routing Code forgenerated correspondence.

CLASS(Class Code)

R c Enter the Class Code. The Class Code initially displayed is the code from thePhase 1, Subphase 0 Coverage Trailer. It should be changed only if the Class

Code for the requested coverage is different than that shown.

BASE(Base Series Code)

R ccc Enter the User-defined Series Code. The Base Series Code initially displayed isthe code from the Phase 1, Subphase 0 Coverage Trailer. It should be changedonly if the Base Series Code for the requested coverage is different than thatshown.

SUB(Subseries Code)

I cc This is the User-Defined Subseries Code.

AGE(Issue Age)

R nnn Enter the Issue Age. The Issue Age initially displayed is the Issue Age from thePhase 1, Subphase 0 Coverage Trailer. It should be changed if the Issue Agefor the requested coverage is different than that shown.

3048 LDP/UTRM (R93V01) 3-1031.22.4

3048 LDP/UTRM (R93V01) 3-1031.23


TRN CHG(Transaction Charge)

0 c This field may be used to override any usual Transaction Charge. Permissiblevalues are:

Code Meaning

N Do not override Transaction Charge. The usual TransactionCharge will be assessed.

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Y Override Transaction Charge. No Transaction Charge will beassessed.

This field is not applicable to Market Value Annuities.

SURR-CHG AMT

(Surrender Charge Amount)

0 nnnnnnnn.nn This field is used to indicate the amount used as Surrender Charge if the normal

amount is being overridden. This field must be zero if the Override SurrenderCharge Code is 'N'. It must contain a valid numeric value if the OverrideSurrender Charge Code contains a 'Y'.


TAX OVR(Tax Override)

CR a This field contains a code which indicates whether or not the taxable income issubject to withholding. Permissible values are:

Code Meaning

Y Taxable Income subject to withholding.N Taxable Income not subject to withholding.X Non-Taxable Income.

GROSS/NET 0 c This field indicates whether the withdrawal amount is the Gross or Net Amount

to be processed. Permissible values are:

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Code Meaning

1 Gross Amount (Default)2 Net Amount

ACCOUNT(Account Identification)

0 ccc This field contains the code representing the Separate Account from which thevalue is to be surrendered.

AMOUNT D nnnnnnn.nn This field contains the value of the account expressed in dollars and cents.

SURRENDER(Surrender Amount)

0 nnnnnnn.nn If a Partial Surrender, this field should contain the amount to be surrenderedfrom the account represented by the Account Identification Code.

TRANSACTIONSPENDING

I nn cccc...ccc The left-most portion of this field shows the total number of transactionspending against this Policy Master Record. The right-hand portion of the fieldlists the pending Transaction Codes up to a maximum of eleven (11) codes.

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3048 LDP/UTRM (R93V0I) 3-1031.25

PARTIAL VARIABLE UNIVERSAL LIFE AND VARIABLE ANNUITY SURRENDERTransaction Number 3048

PURPOSE

This Mask is used to request a Partial Variable Universal Lifeor Variable Annuity Surrender Quotation. It can also be usedto request the Policy Maintenance to quote or process a Total

Variable Universal Life or Variable Annuity Surrender, if such arequest was not already generated through the input request.

OUTPUT MASK

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101 101 01 JCH 15.26.26



0 N D N N 12-15-89 3JCH .....


MM-DD-YY . N N N N 01 JCH . ... .. ...TRN CHG N SURR-CHG AMT 00000000.00 TAX OVR Y GROSS/NET 1

ACCOUNT AMOUNT SURRENDER ACCOUNT AMOUNT SURRENDER

... 0000000.00 0000100.00 ... 0000000.00 0000000.00

... 0000000.00 0000000.00 ... 0000000.00 0000000.00

... 0000000.00 0000100.00 ... 0000000.00 0000000.00

... 0000000.00 0000000.00 ... 0000000.00 0000000.00

--------TYPE-----------

T - TOTAL SURRENDER



PROJECTEDCASH VALUE

D nnnnnnn.nn This field contains the Gross Cash Value available for surrender.

MAXIMUMSURRENDER VALUE

D nnnnnnn.nn This field contains the maximum amount of 'Projected Cash Value' that canactually be surrendered. It equals the Projected Cash Value minus the PartialSurrender Charge minus the Transaction Charge.

SURRENDERCHARGE

D nnnnnnn.nn Applicable Partial Surrender Charge.

TRANSACTION CHARGE D nnnnnn.nn Applicable Transaction Charge.

TAXABLE INCOME CR nnnnnnnn.nn This amount represents the surrendered amount paid out that excluded the

insured's investment in the Contract.

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LOAN PAY-OFF D nnnnnnn.nn Applicable Policy Loan Pay-Off as of the Surrender Date.

SURR. VALUEREMAINING

D nnnnnnn.nn This field contains the Cash Value remaining after the requested surrender.

SPEC AMT OF INS.

REMAINING

D nnnnnnn.nn This field contains the specified Amount of Insurance remaining.

DEATH BENEFIT D nnnnnnn.nn Applicable Policy Death Benefit after the surrender occurs.

TAXES WITHHELD CR nnnnnnnn.nn This field contains the Amount of Taxes withheld.

MOST RECENT SAIDATE

D MM-DD-YY This field will appear only if the As-Of Date of the transaction is greater thanthe most recent date for which Separate Account Values are available. Thisdate represents the most recent Separate Account Valuation Date. Thesurrender values shown are calculated as-of this date.

3048 LDP/UTRM (R93V0l) 3-1031.26

3048 LDP/UTRM (R93V01) 3-1031.27

TOTAL VARIABLE UNIVERSAL LIFE AND VARIABLE ANNUITY SURRENDERTransaction Number 3048

PURPOSE

This Mask is used to request a Total Variable Universal Lifeor Variable Annuity Surrender Quotation. It can also be usedto request the Policy Maintenance to quote or process a Total

Variable Universal Life or Variable Annuity Surrender, if such arequest was not already generated through the input request.

OUTPUT MASK

101 101 01 JCH 15.26.26

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0 N D N N 12-15-89 3JCH .....


MM-DD-YY . N N N N 01 JCH . ... .. ...

TRN CHG N SURR-CHG AMT 00000000.00 TAX OVR Y GROSS/NET 1ACCOUNT AMOUNT SURRENDER ACCOUNT AMOUNT SURRENDER

... 0000000.00 0000100.00 ... 0000000.00 0000000.00

... 0000000.00 0000000.00 ... 0000000.00 0000000.00

... 0000000.00 0000100.00 ... 0000000.00 0000000.00

... 0000000.00 0000000.00 ... 0000000.00 0000000.00

--------TYPE-----------

T - TOTAL SURRENDER



TOTAL VALUESURRENDERED

D nnnnnnn.nn Total Gross Amount surrendered if process requested or amount available forsurrender if quote requested.

MAXIMUMSURRENDER VALUE

D nnnnnnnn.nn This field contains the maximum amount of 'Projected Cash Value' that canactually be surrendered. It equals the Projected Cash Value minus the PartialSurrender Charge minus the Transaction Charge.

SURRENDERCHARGE

D nnnnnnn.nn Applicable Surrender Charge.

NET SURRENDERVALUE

D nnnnnnnnn.nn This field contains the amount that will be disbursed for the surrender. It isthe Gross Policy Value, minus Surrender and Transaction Charges, minus anyLoan Pay-Off, and minus any Taxes Withheld.

LOAN PAY-OFF D nnnnnnn.nn Applicable Policy Loan Pay-Off as of the Surrender Date.

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TAXABLE INCOME CR nnnnnnnn.nn This amount represents the surrendered amount paid out that excluded theinsured's investment in the Contract.

TAXES WITHHELD CR nnnnnnnn.nn This field contains the amount of Taxes Withheld.

DEATH BENEFIT D nnnnnnn.nn Policy Death Benefit.

MOST RECENT SAIDATE

D MM-DD-YY This field will appear only if the As-Of Date of the transaction is greater thanthe most recent date for which Separate Account Values are available. Thisdate represents the most recent Separate Account Valuation Date. Thesurrender values shown are calculated as-of this date.

3048 LDP/UTRM (R92VSl) 3-1031.28

Documents

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