LIVE WELL Critical Illness Insurance Term [Period]

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Jim BoylePresident and Chief Executive Officer, Foresters

P.S. Don’t miss out on all the complimentary benefits valued Foresters members are entitled to. Sign up for MyForesters.com today!

T 800 828 1540F 877 329 4631

foresters.com

789 Don Mills RoadToronto, ON M3C 1T9Canada

¹ Under the policy, only the insured or annuitant is the member and entitled to member benefits. Please pass the new member Welcome Package that you received with this letter to the insured or annuitant.² Foresters member benefits are non-contractual, subject to eligibility requirements and limitations and may be changed or cancelled without notice.

[Month XX, 20XX]Certificate: [12345678]

Welcome to Foresters

Congratulations on making the important decision to protect your family’s future and well-being. At Foresters Financial™, you are part of an organization that offers you and your family an opportunity to live for today, plan for tomorrow and make a difference along the way.

Foresters is more than a financial services provider. We don't have shareholders; we are member-based. We invest in our members¹, their families and the communities where they live.

Our purpose is to champion the well-being of families through quality life insurance and investment products, unique member benefits² and inspiring community activities .

As part of this purpose, Foresters members and their families potentially have access to thousands of dollars in unique and complimentary benefits such as fun family events, competitive scholarships, and grants to support member-directed, community-based volunteer activities. Foresters members are the named insured on a Foresters life insurance policy or annuitant on a Foresters annuity.

Experiencing the many benefits of Foresters membership is both simple and rewarding. Sign up at MyForesters.com to take advantage of all the member benefits, including registering for complimentary fun family events and helpful webinars on topics such as budgeting and wills and estate planning.

If you have questions about your Foresters financial product, underwritten by Foresters Life Insurance Company, or member benefits, please contact our Service Centre by email at [email protected] or by phone at 800 828 1540 Monday to Friday, 8:00 a.m. to 8:00 p.m. EST.

All of us at Foresters look forward to sharing the benefits of membership with our members.

Sincerely,

Foresters Financial and Foresters are trade names and trademarks of The Independent Order of Foresters (a fraternal benefit society, 789 Don Mills Road, Toronto, Canada M3C 1T9) and its subsidiaries.

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http://foresters.com

http://MyForesters.com

http://MyForesters.com

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CI-LW-EN01-2020 Page 1 of 23

FORESTERS LIFE INSURANCE COMPANY789 Don Mills Road, Toronto, Ontario, Canada M3C 1T9

Insured: [JOHN DOE] Policy Number: [1234567]Policy Owner: [JANE DOE] Policy Date: [Month XX, 20XX]

LIVE WELL Critical Illness Insurance Term [Period]

This is a CRITICAL ILLNESS INSURANCE POLICY. It is not life insurance and provides no benefit that is payable for the death of the insured other than a return of eligible premium as described in the policy.

The insurer, Foresters Life Insurance Company (referred to as “we”, “our” or “us”), will, subject to the provisions of this policy, pay the benefit amount upon our receipt of proof that the insured has, while this policy is in effect, been diagnosed with, or undergone, a covered condition.

PREMIUMS due and years payable are shown in the Benefit and Premium Information Schedule in this policy.

This policy contains a provision removing or restricting the right of the insured to designate persons to whom or for whose benefit insurance money is to be payable. We will pay the critical illness benefit amount payable, if any, to you, the owner. You cannot name a beneficiary for this benefit.

PLEASE READ THIS POLICY CAREFULLY.

Right to Examine Policy – If you are not satisfied with this policy, you may return it to us within 10 days of first receiving it. You can do this by mailing it to the address for Foresters Life Insurance Company, or by returning it to one of our authorized representatives.

If this policy is returned to us during this time period, it will be deemed to be void from the policy date. Within 10 days after we receive it, we will refund, without interest, any premiums that you have paid to us for this policy.

Foresters Life Insurance Company is a member of Assuris

Assuris is the not for profit organization that protects Canadian policyholders if their life insurance company should fail. Find out more about Assuris by visiting www.assuris.ca.

Senior Vice President and Chief Financial Officer President and Chief Executive OfficerXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXX

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LIVE WELL Critical Illness Insurance Term [Period]

BENEFIT AND PREMIUM INFORMATION SCHEDULE

Coverage and benefits are provided by this policy, in consideration of a total premium that is payable in advance.

Policy Number: [1234567] Policy Date: [Month XX, 20XX]

Owner: [JANE DOE] Applicable Law: [Province]

Insured Sex Issue Age Insurance Class

[JOHN DOE] [M] [35] [Smoker]

Policy Type: [CRITICAL ILLNESS INSURANCE TERM TO AGE 80]

Benefit Amount: $[XX,XXX] Premium Mode: [Monthly]

Plan Name

Initial Modal Premium

Initial Annual Premium

Payment Period (Years)

[Product Name] $[XXX.XX] $[X,XXX.XX] [45]

Annual substandard ratings: [XXX% OF PREMIUM RATE] [$XXX.XX] FOR [YY] YEARS

Modal Policy Fee: $[0.00] Annual Policy Fee: $[0.00]

Optional Riders:

Rider NameCoverage/

Benefit AmountInitial Annual

PremiumPayment Period

(Years)

[RETURN OF PREMIUM ON SURRENDER/EXPIRY]

$[X,XXX.XX] [45]

[DISABILITY WAIVER OF PREMIUM]

$[X,XXX.XX] [30]

If “NA” is shown beside a rider, that means that it is not part of the insurance contract and there is no coverage or benefit provided under that rider.

Total Initial Modal Premium: $[XXX.XX] Total Initial Annual Premium: $[X,XXX.XX]

The total initial modal premium and the total initial annual premium shown above is as of the policy date and will change as shown in the Premium Schedule and will also change if there is a change in the premium mode or coverage such as increasing or decreasing the benefit amount, a rider ends, or is added after the policy date, or if the premium for a rider changes. These premiums are not reduced by the payment of a non-life-threatening illness benefit amount.

Annual Semi-Annual Quarterly MonthlyTotal Initial Premium $1,059.10 $540.14 $275.37 $92.67

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PREMIUM SCHEDULE

The premiums shown in this schedule are the annual premiums for the policy and each rider listed. If “not applicable” is shown under a rider, that means that it is not part of the insurance contract and there is no coverage or benefit provided under that rider.

Policy Number: [1234567] Policy Date: [Month XX, 20XX]

Annual PremiumsStart Date Policy Return of

Premium on Surrender/Expiry

Rider

Disability Waiver of

Premium Rider

Total Premium

[Month XX, 20XX] $[XXX.XX] $[XXX.XX] $[XXX.XX] $[XXX.XX][Month XX, 20XX] $[XXX.XX] $[XXX.XX] $[XXX.XX] $[XXX.XX][Month XX, 20XX] $[XXX.XX] $[XXX.XX] $[XXX.XX] $[XXX.XX][Month XX, 20XX] $[XXX.XX] $[XXX.XX] $[XXX.XX] $[XXX.XX][Month XX, 20XX] $[XXX.XX] $[XXX.XX] $[XXX.XX] $[XXX.XX][Month XX, 20XX] $[0.00] $[0.00] $[0.00] $[0.00]

To calculate the modal premium for a payment mode other than annual, multiply the annual premium shown by 0.52 for semi-annual, 0.26 for quarterly and 0.09 for monthly.

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This policy is part of a legal contract between us and the owner. The insurance contract sets forth, in detail, the rights and obligations for both you and us. Only the actual insurance contract provisions will control. It is important that you read your insurance contract carefully.

The benefit provided under each rider, if any, is described in that rider. Each rider is part of the insurance contract.

If you have questions about this policy or a rider, your understanding of them or about information that you have heard, seen or read relating to them, please call us. Our toll-free number is [1-800-828-1540].

Table of Contents

Terms Used in This Policy ................................................................................................................................. 6Benefits Provided by This Policy ........................................................................................................................ 8

When this Policy is in Effect ........................................................................................................................... 8Benefit ........................................................................................................................................................... 8Non-Life-Threatening Illness Benefit .............................................................................................................. 8Claims outside of Canada or the United States .............................................................................................. 9Covered Conditions ..................................................................................................................................... 10Non-Life-Threatening Illness Covered Conditions ........................................................................................ 12Return of Premium on Death Benefit ............................................................................................................ 13Exclusions .................................................................................................................................................... 14

Paying Premiums ............................................................................................................................................ 15Premium Amounts ....................................................................................................................................... 15Grace Period ................................................................................................................................................ 15Reinstating this Policy After it Has Ended due to Non-payment of Premium ................................................ 16

Exercising your Options under This Policy ....................................................................................................... 17Exchange Privilege ...................................................................................................................................... 17Changing the Insurance Class Applicable to an Insured .............................................................................. 18Cancelling this Policy or Rider ...................................................................................................................... 18

More Information about this Policy ................................................................................................................... 19This Policy is Part of an Insurance Contract between You and Foresters Life Insurance Company ............. 19When We Will Contest ................................................................................................................................. 19Misstatement of Age and Sex ...................................................................................................................... 19Ownership .................................................................................................................................................... 19Assignment .................................................................................................................................................. 20Currency ...................................................................................................................................................... 20Applicable Law ............................................................................................................................................. 20Limitation Period .......................................................................................................................................... 20Notifications ................................................................................................................................................. 21

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Statutory Conditions ........................................................................................................................................ 22Insurance Contract ....................................................................................................................................... 22Waiver ......................................................................................................................................................... 22Copy of Application ...................................................................................................................................... 22Material Facts .............................................................................................................................................. 22Notice and Proof of Claims........................................................................................................................... 22Failure to Give Notice or Proof ..................................................................................................................... 23Insurer to Furnish Forms for Proof of Claims ................................................................................................ 23Rights of Examination .................................................................................................................................. 23When Money Payable for Other than Loss of Time ...................................................................................... 23Limitations of Action ..................................................................................................................................... 23

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Terms Used in This Policy

The terms defined below have the specific meaning shown when used in this policy. Additional definitions may be provided in the provisions of this policy or the amendments, if any, attached to it, and riders. If the same term appears in an amendment or a rider it has the same meaning unless there is another definition for that term within that amendment or rider. When a provision is referred to in this policy we mean, unless specifically stated otherwise, the provision in this policy with that title. When a provision is referred to in a rider we mean, unless specifically stated otherwise, the provision in that rider with that title.

“Age” means the issue age plus the number of completed policy years.

“Application” means the application that was completed and signed for this policy and the application for each rider, if any.

“Artificial life support” means under the regular care of a licensed physician for nutritional, respiratory and/or cardiovascular support when irreversible cessation of all functions of the brain has occurred.

“Attached rider” means each rider, if any, listed, and for which a premium is shown, in the Benefit and Premium Information Schedule.

“Benefit amount” means the amount shown in the Benefit and Premium Information Schedule as the benefit amount, unless changed as shown in our records. The benefit amount will be reduced by each payment of the Non-Life-Threatening Illness Benefit.

“Covered condition” means a condition, disorder, illness or surgical procedure that is described in the Covered Conditions provision.

“Date we delivered” means the effective date of delivery being either:• the day of delivery, if hand delivered to the owner or the owner's address;• the fifth day after mailing, if sent by mail to the owner's address; or• the earlier of a) the day transmitted, if sent electronically to a number or address shown for the owner in

our records, and b) the day retrieved, if retrieved electronically by the owner, from a site identified byus.

“Designated office” means our head office or any other office, location or address that we notify you of, or publish, as being a designated office for the identified purpose.

“Eligible premiums” mean the sum of the premiums received by us for this policy including substandard ratings plus premiums for each rider. Eligible premiums do not include: a) premium amount due for the policy that is waived under any waiver of premium rider or similar benefit or is otherwise waived by us b) interest c) policy fees or d) premium paid for another policy even if this policy is an exchange from that other policy.

“Evidence of insurability” means information we obtain to decide insurability and, if so, on what terms. This includes but is not limited to the application.

“Issue age” means the insured’s age on their birthday nearest the policy date. The issue age is shown in the Benefit and Premium Information Schedule.

“Lapse” means the termination of this policy for non-payment, prior to the expiration of the grace period, of a total premium in default.

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“Insured” means the person who is insured under this policy, as shown in the Benefit and Premium Information Schedule. “Insurer”, “We”, “Us”, “Our” and “Company” mean Foresters Life Insurance Company. “Monthly anniversary” means the same day of the month as the policy date for each succeeding month that this policy remains in effect. “Moratorium period” is the period of time that begins on the later of the date this policy takes effect and the effective date of the last reinstatement, if any, of this policy, and ends 90 days after it begins. “Non-Life-Threatening illness covered condition” means a condition, disorder, illness or surgical procedure that is described in the Non-Life-Threatening Illness Covered Conditions provision. “Our records” means the records at our head office and records stored elsewhere on our behalf, with our consent. “Physician” means an individual who is legally licensed to practice medicine or surgery in Canada, the

United States or another jurisdiction that we may approve, and who is acting within the scope of that licence. The physician cannot be you or the insured, or a relative or business associate of either of you or the insured. “Policy” consists of each numbered page, starting with page 1 and ending with the last provision of the Statutory Conditions. “Policy anniversary” means the same day and month as the policy date for each succeeding year that this policy remains in effect. “Policy date” is the date from which policy anniversaries, policy years and premium due dates are determined. The policy date is shown in the Benefit and Premium Information Schedule. “Policy year” is the period of time that, for the first policy year, begins on the policy date and ends on the day before the first policy anniversary, and, for every other policy year, begins on a policy anniversary and ends on the day before the next policy anniversary. “Rider” means each attached rider, if any, and each rider added as an amendment, if any, to this policy after the policy date, as shown in our records. “Specialist” means a physician who has been trained in the specific area of medicine relevant to the covered condition or non-life-threatening illness covered condition for which a benefit is being claimed, and who has been certified by a specialty examining board. In circumstances where a specialist is unavailable we may, at our discretion, accept a diagnosis made by a qualified physician. “Survival period” is the period of time that begins on the date that the insured is diagnosed with, or undergoes, a covered condition or non-life-threatening illness covered condition, as applicable and ends 30 days later. Survival period does not include the number of days the insured is on artificial life support. “Survived” means alive and living without being on artificial life support. The insured will no longer be considered to be alive on the date that they experience irreversible cessation of all brain functions, as determined by generally accepted medical criteria. “You” and “Your” mean the owner shown in the Benefit and Premium Information Schedule of this policy, unless changed as described in the Ownership provision.

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Benefits Provided by This Policy

When this Policy is in Effect This policy takes effect on the policy date only if: (1) this policy has been delivered to you; (2) the first total premium was provided to us on or before the date this policy was delivered to you and that payment is honoured by the financial institution from which it is to be collected; (3) there has been no change in the insurability of the insured between the date the application for this policy was signed by the insured and the date this policy was delivered to you; and (4) when required by us, you accept, and if applicable sign and return to us, each amendment, addendum and exclusion, if any, required for the policy to take effect. Once in effect this policy will remain in effect until the earliest of the following dates:

a) The policy anniversary on which the insured is age 80;b) The date the insured dies;c) The effective date of surrender, as shown in our records, arising from your request to surrender this

policy;d) The date this policy lapses, as described in the Grace Period provision.e) The date that the benefit amount is paid.

This policy will end and not be in effect after the earliest of the above dates which means our liability under it will end on that date.

Benefit Subject to the terms and conditions of the insurance contract, we will pay the benefit amount to you upon our receipt of evidence, satisfactory to us, that the insured has:

a) Been diagnosed with, or undergone, a covered condition, while this policy is in effect; andb) Survived to the end of the survival period.

The benefit amount payable, if any, will be paid as a lump sum. After the payment of the benefit amount this policy will end.

Non-Life-Threatening Illness Benefit Subject to the terms and conditions of the insurance contract, we will pay the non-life-threatening illness benefit amount to you upon our receipt of evidence, satisfactory to us, that the insured has:

a) Been diagnosed with, or undergone, a non-life-threatening illness covered condition, while this policy is in effect; and

b) Survived to the end of the survival period. The non-life-threatening illness benefit amount is the lesser of:

a) 15% of the benefit amount; andb) $50,000.

The non-life-threatening illness benefit is payable a maximum of two (2) times, provided each payment must occur for a different non-life-threatening illness benefit covered condition. Payment of the non-life-threatening illness benefit will not cause the policy to end. The benefit amount will be reduced by the amount of each payment of the non-life-threatening illness benefit.

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The non-life-threatening illness benefit will not be payable if any non-life-threatening illness covered condition occurs during the survival period for a covered condition, unless the insured does not complete that survival period. Making a Claim Written notice of claim, for a benefit payment under this policy, must be received by us for us to act upon it. The notice should contain enough information to identify the insured. After we receive notice of claim, we will send you the forms that are to be used to file a claim under this policy. We must receive written proof, satisfactory to us, that the insured has been diagnosed with, or undergone a covered condition or a non-life-threatening illness covered condition, for which the claim is made. That proof must include certification by the applicable specialist of his/her diagnosis of the applicable covered condition, or a non-life-threatening illness covered condition, or determination that the surgery or procedure was medically necessary where that surgery or procedure is an element of the covered condition or non-life-threatening illness covered condition for which the claim is made. We reserve the right to require proof, satisfactory to us, of the date of birth and sex of the insured before paying a claim.

Claims outside of Canada or the United States If a covered condition or non-life-threatening illness covered condition is diagnosed or surgery or procedure undergone while the insured is outside of Canada or the United States, then no benefit payment will be made under this policy unless, in addition to the requirements set out in the insurance contract:

a) We are provided with the insured’s medical records that we request;b) Those medical records provide confirmation, satisfactory to us, that the same diagnosis would have

been made, or the same surgery or procedure would have been advised, if the insured had been in Canada or the United States; and

c) If required by us the insured undergoes a medical examination by a physician we appoint.

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Covered Conditions Coverage is provided under this policy for the conditions, disorders, illnesses and surgeries described below: Cancer is defined as the definite diagnosis of a malignant tumour. This tumour must be characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. Types of cancer include carcinoma, melanoma, leukemia, lymphoma, and sarcoma. The diagnosis of Cancer must be made by a specialist and must be confirmed by a pathology report. For purposes of this policy:

• T1a or T1b prostate cancer means a clinically inapparent tumour that was not palpable on digital rectal examination and was incidentally found in resected prostatic tissue.

• The term gastrointestinal stromal tumours (GIST) classified as AJCC Stage 1 means: o Gastric and omental GISTs that are less than or equal to 10 cm in greatest dimension with five

or fewer mitoses per 5 mm2, or 50 per HPF; oro Small intestinal, esophageal, colorectal, mesenteric and peritoneal GISTs that are less than or

equal to 5 cm in greatest dimension with 5 or fewer mitoses per 5 mm2, or 50 per HPF;• The terms Tis, Ta, T1a, T1b, T1 and AJCC Stage 1 are as defined in the American Joint Committee on

Cancer (AJCC) cancer staging manual, 8th Edition, 2018.• The term Rai stage 0 is as defined in KR Rai, A Sawitsky, EP Cronkite, AD Chanana, RN Levy and BS

Pasternack: Clinical staging of chronic lymphocytic leukemia. Blood 46:219, 1975. Exclusions: No benefit will be payable under this condition for the following:

• Lesions described as benign, non-invasive, pre-malignant, of low and/or uncertain malignant potential, borderline, carcinoma in situ, or tumors classified as Tis or Ta;

• Malignant melanoma of skin that is less than or equal to 1.0mm in thickness, unless it is ulcerated or is accompanied by lymph node or distant metastasis;

• Any non-melanoma skin cancer, without lymph node or distant metastasis. This includes but is not limited to, cutaneous T cell lymphoma, basal cell carcinoma, squamous cell carcinoma or Merkel cell carcinoma;

• Prostate cancer classified as T1a or T1b, without lymph node or distant metastasis;• Papillary thyroid cancer or follicular thyroid cancer, or both, that is less than or equal to 2.0cm in

greatest dimension and classified as T1, without lymph node or distant metastasis;• Chronic lymphocytic leukemia classified as Rai stage 0 without enlargement of lymph nodes, spleen or

liver and with normal red blood cell and platelet counts;• Gastro-intestinal stromal tumours classified as AJCC Stage 1;• Grade 1 neuroendocrine tumours (carcinoid) confined to the affected organ, treated with surgery alone

and requiring no additional treatment, other than medication to counteract the effects from hormonal oversecretion by the tumour; or

• Thymomas (stage 1) confined to the thymus, without evidence of invasion into the capsule or spread beyond the thymus.

No benefit will be payable under this condition during the moratorium period if the Insured has any of the following:

• Signs, symptoms or investigations leading directly or indirectly to a diagnosis of any cancer (covered or not covered under this policy), regardless of when the diagnosis is made; or

• A diagnosis of any cancer (covered or not covered under this policy). Medical information about the diagnosis and any signs, symptoms or investigations leading to the diagnosis, must be reported to the Company within 6 months of the date of the diagnosis. If this information is not provided within this period, the Company has the right to deny any claim for Cancer or, any critical illness caused by any cancer or its treatment.

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Coronary Artery Bypass Surgery is defined as the undergoing of heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass graft(s). The surgery must be determined to be medically necessary by a specialist. Exclusions: No benefit will be payable under this condition for:

• Angioplasty;• Intra-arterial procedures;• Percutaneous trans-catheter procedures; or• Non-surgical procedures.

Heart Attack (acute myocardial infarction) is defined as a definite diagnosis of death of heart muscle due to obstruction of blood flow, that results in: A rise and fall of cardiac biomarkers to levels considered diagnostic of acute myocardial infarction, with at least one of the following:

• Heart attack symptoms;• New electrocardiographic (ECG) changes consistent with a heart attack;• Development of new pathological Q waves on ECG following an intra-arterial cardiac procedure

including, but not limited to, coronary angiography and/or angioplasty. The diagnosis of heart attack (acute myocardial infarction) must be made by a specialist. Exclusions: No benefit will be payable under this condition for:

• ECG changes suggestive of a prior myocardial infarction;• Other acute coronary syndromes, including angina pectoris and unstable angina; or• Elevated cardiac biomarkers and/or symptoms that are due to medical procedures or diagnoses other

than heart attack. Stroke (cerebrovascular accident resulting in persistent neurological deficits) is defined as a definite diagnosis of an acute cerebrovascular event caused by intra-cranial thrombosis, haemorrhage, or embolism, with:

• Acute onset of new neurological symptoms, and• New objective neurological deficits on clinical examination,

persisting continuously for more than 30 days following the date of diagnosis. These new symptoms and deficits must be corroborated by diagnostic imaging testing showing changes that are consistent in character, location and timing with the new neurological deficits. The diagnosis of stroke must be made by a specialist. For purposes of this policy, neurological deficits must be detectable by a specialist and may include, but are not restricted to, measurable loss of hearing, measurable loss of vision , measurable changes in neuro-cognitive function, objective loss of sensation, paralysis, localized weakness, dysarthria (difficulty with pronunciation), dysphasia, (difficulty with speech) dysphagia (difficulty swallowing), impaired gait (difficulty walking), difficulty with balance, lack of coordination, or new-onset seizures undergoing treatment. Headache or fatigue will not be considered a neurological deficit. Exclusion: No benefit will be payable under this condition for:

• Transient Ischaemic Attacks;• Intracerebral vascular events due to trauma;• Ischaemic disorders of the vestibular system;• Death of tissue of the optic nerve or retina without total loss of vision of that eye; or,• Lacunar infarcts which do not meet the definition of stroke as described above.

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Non-Life-Threatening Illness Covered Conditions Chronic Lymphocytic Leukemia (CLL) Rai Stage 0 is defined as a definite diagnosis of Rai stage 0 chronic lymphocytic leukemia (CLL). For purposes of the policy, the term Rai staging is to be applied as set out in KR Rai, A Sawitsky, EP Conkite, AD Chanana, RN Levy and BS Pasternack: Clinical staging of chronic lymphocytic leukemia. Blood 46:219, 1975. The condition must be diagnosed by a specialist. No benefit will be payable for Monoclonal Lymphocytosis of Undetermined Significance (MLUS). Coronary angioplasty is defined as the undergoing of an interventional procedure to unblock or widen a coronary artery that supplies blood to the heart to allow an uninterrupted flow of blood. The procedure must be determined to be medically necessary by a specialist. Ductal carcinoma in situ of the breast is defined as a definite diagnosis of ductal carcinoma in situ of the breast. The condition must be diagnosed by a specialist and confirmed by biopsy. Papillary or Follicular Thyroid Cancer Stage T1 is defined as a definite diagnosis of papillary thyroid cancer or follicular thyroid cancer, or both, that is less than or equal to 2.0 cm in greatest diameter and classified as T1, without lymph node or distant metastasis. The condition must be diagnosed by a specialist and confirmed by a biopsy. Stage A (T1a or T1b) Prostate Cancer is defined as a definite diagnosis of stage A (T1a or T1b) prostate cancer. The condition must be diagnosed by a specialist. Stage 1 Malignant Melanoma is defined as a definite diagnosis of Stage 1A or 1B malignant melanoma that is 1.0 mm or less in depth and non-ulcerated. The condition must be diagnosed by a specialist. No benefit will be payable for malignant melanoma in situ. Gastrointestinal Stromal Tumours is defined as tumours classified as AJCC Stage 1. The condition must be diagnosed by a specialist. Grade 1 Neuroendocrine Tumours (Carcinoid) is defined as tumours confined to the affected organ, treated with surgery alone and requiring no additional treatment, other than perioperative medication to counteract the effects from hormonal oversecretion by the tumour. The condition must be diagnosed by a specialist. For purposes of the non-life-threatening illness covered conditions, the terms:

a) Tis, Ta, T1a, T1b, T1, Grade 1 and AJCC Stage 1 are to be applied as defined in the American Joint Committee on Cancer (AJCC) cancer staging manual, 7th Edition, 2010; and

b) Rai staging is to be applied as set out in KR Rai, A Sawitsky, EP Cronkite, AD Chanana, RN Levy and BS Pasternack: Clinical staging of chronic lymphocytic leukemia. Blood 46:219, 1975.

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Return of Premium on Death Benefit Subject to the terms and conditions of the insurance contract, we will pay, the eligible premiums, without interest, upon our receipt of proof, satisfactory to us, of the insured’s death. That death must occur while this policy is in effect. We will not pay the eligible premium if the benefit amount or a non-life-threatening illness benefit has been paid under this policy. You may designate one, or more than one, primary or contingent beneficiary, for the Return of Premium on Death benefit. Each initial primary and contingent beneficiary, if any, is named in the application. You may name a new beneficiary at any time, while this policy is in effect, by submitting a change of beneficiary request to us. If you have named an irrevocable beneficiary, then to change that beneficiary, or their share of the eligible premiums, you will need to provide either the signed consent of that irrevocable beneficiary or, where permitted by law, a court order instead of that beneficiary’s consent. Each surviving primary beneficiary will be paid their share of the eligible premium payable by us, if any, under this policy. That share is shown in the application unless changed, as shown in our records. If a primary beneficiary is deceased on the date that the eligible premium is payable, that beneficiary’s share will be split among the surviving primary beneficiaries. That split will be based upon the ratio of the specified percentages for those surviving beneficiaries to the total percentage for those survivors. If no percentages are specified, then the eligible premium will be split equally among the surviving primary beneficiaries. If no primary beneficiary is alive on the date that the eligible premium is payable, then each surviving contingent beneficiary, if any, will be paid their share of the eligible premium payable by us, if any, in the same manner as described above for the primary beneficiary. If no beneficiary survives the insured or if no beneficiary is designated, this payment will be made to you or your estate.

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Exclusions In addition to the specific exclusions in the Covered Conditions and Non-Life-Threatening Illness Covered Conditions, no benefit amount or non-life-threatening illness benefit amount will be payable if the covered condition or non-life- threatening illness covered condition results, directly or indirectly, from any of the following :

a) Attempted suicide or intentionally self-inflicted injuries, whether or not the insured has a mental illness or understands or intends the consequences of their action(s);

b) Voluntary participation in a riot or civil commotion.c) Committing or attempting to commit a felony.d) Involvement in an illegal occupation.e) War or act of war, whether declared or undeclared.f) Exposure to abnormal hazards because of service in the armed forces of any country or association

of countries, whether war is declared or not and whether on active duty or not.g) The intentional administration, injection, or taking of a drug, hypnotic or narcotic, unless

administered on the advice of, and at the frequency and dosage prescribed by, a physician or, in the case of a legal, non-prescribed drug, as recommended by the drug manufacturer.

h) A motorized vehicle accident if the insured was the operator of the motorized vehicle and one or more of the following exists: a. A test or report completed by or at the direction of a medical professional, coroner, law

enforcement, government agency or representative, based on a sampling obtained from the body of the insured within 24 hours of the accident, indicates the presence of either or both of the following: 1. A narcotic in the body of the insured, regardless of the measurement or quantity.2. A concentration of alcohol or tetrahydrocabinol (TCH) in the insured’s blood in excess of the

quantity specified in the applicable legislation, where the accident occurred, as an offense for the operation of that type of motorized vehicle.

o A medical professional, coroner, law enforcement or government report indicates that, as a result of testing, it was determined that the insured was operating the motorized vehicle while impaired, intoxicated or under the influence of alcohol or an intoxicant, above the legal limit where the accident occurred, or a narcotic.

For purposes of exclusion (h) a narcotic does not include a prescribed or legal, non-prescribed drug that was consumed by the insured as recommended by the drug manufacturer and, if a prescribed drug, as instructed by the licensed physician who prescribed, and pharmacy that dispensed, that drug, including restrictions related to the operation of a motorized vehicle. In addition to the above, if this policy was issued as the result of exercising an exchange privilege, the exclusions under the policy exchanged from will apply to this policy.

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Paying Premiums

Premium Amounts The initial premium for the policy and each attached rider, and the number of years payable for each, are shown in the Benefit and Premium Information Schedule. The total premium is shown in the Benefit and Premium Information Schedule. The initial and total premium will change due to coverage changes such as increasing or decreasing the benefit amount, a rider ends, or is added after the policy date, or if the premium for a rider changes. The total premium is not reduced by the payment of a non-life-threatening illness benefit amount. Premiums are payable in advance. The first total premium is due on the policy date. You will then need to pay each total premium when due to keep this policy in effect. Other than the first total premium, each total premium is due, without notice from us, on the premium due date for that total premium. The premium due dates are based on the payment mode in effect. If the payment mode in effect is annual, the premium due dates will be on each policy anniversary. If the payment mode in effect is more often than annual, these dates will fall on the same day of the month as the policy date, based on that payment mode. For example, if the payment mode in effect is monthly and your policy date is March 4, your premium due dates will be on the 4th of each month. The payment mode and payment method in effect is the mode and method elected in the application, unless changed as shown in our records. Subject to our administrative rules in effect at that time, you may change the payment mode or method by submitting a request to us at our designated office. The premium will be adjusted for the new payment mode. The sum of the premiums payable over a policy year will depend on the payment mode in effect. That sum may be less if you pay based on a payment mode other than the monthly payment mode. Total premiums may be paid by mail sent to our Canadian mailing address or to our designated office and each is considered paid on the business day we receive it at our designated office. You may also make payment to our Executive Secretary. If requested, we will provide a receipt for the total premium paid, signed by our Executive Secretary.

Grace Period After the first total premium is paid as due, we will allow a period of 31 days after the premium due date for payment of each subsequent total premium. This is the grace period. If a total premium is not paid on or before its due date, that total premium is in default. If that total premium is still unpaid at the expiration of the grace period, this policy will automatically lapse. If the insured is diagnosed with, or undergoes, a covered condition or non-life-threatening covered condition during the grace period and the claim is approved, we will deduct unpaid premium from the benefit amount payable. No benefit is payable for a covered condition, or a non-life-threatening illness covered condition, that is diagnosed, or undergone, while this policy is not in effect.

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Reinstating this Policy After it Has Ended due to Non-payment of Premium This policy may be reinstated within two years of the effective date of lapse, as shown in our records. Reinstatement requires: (1) a signed application; (2) evidence of insurability of (a) the good health and (b) other aspects of the insurability of the insured; and (3) payment of the unpaid premium plus interest, at the lower of the rate determined by us or as prescribed by applicable law. The unpaid premium will be the sum of:

a) The total premiums due but not paid in full on or before the effective date of lapse; plusb) The total premiums that would have been due, from the effective date of lapse to the effective date of

reinstatement, as shown in our records, if this policy had not lapsed. Reinstatement is subject to our approval. If we approve reinstatement of this policy, the moratorium period and the two-year contestability period will begin anew from the effective date of reinstatement.

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Exercising your Options under This Policy

Exchange Privilege If this policy is a Live Well Term 10 or a Live Well Term 20, you may exchange it for a Live Well Term to Age 80 if offered by us at the time of exchange. This Exchange Privilege is available on or after the second (2nd) policy anniversary, and will be processed without evidence of insurability, subject to our administrative rules and the following conditions:

a) You must submit a written request for exchange to us, no sooner than thirty (30) days before the second (2nd) policy anniversary.

b) Premiums must be paid to the effective date of the exchange.c) If you are requesting an exchange for a Live Well Term to Age 80 policy, the exchange must occur prior

to the earlier of the fifth (5th) policy anniversary, and the policy anniversary nearest the insured's fifty-fifth (55th) birthday.

d) This policy cannot be exchanged if it was issued under the Exchange Privilege of a previous critical illness insurance policy.

e) This policy cannot be exchanged while premiums are being waived under a Disability Waiver of Premium Rider. This Exchange Privilege cannot be extended should the privilege expire while premiums are being waived.

This policy will end on the date the new policy takes effect under this Exchange Privilege. The following conditions will apply to the new policy:

1) The new policy will be the Live Well Term to Age 80 we offer at the time of the exchange.2) Policy years under the new policy will be calculated from the policy date of the new policy.3) The conditions and provisions of the new policy will apply from the date the new policy takes effect,

except that our right to contest the validity of the new policy will continue to apply from the later of the effective date or the last reinstatement date of this policy.

4) The evidence of insurability, including the application for this policy and the application for reinstatement, if any, of this policy will become part of the new policy and can be relied upon by us to contest the new policy.

5) In addition to each exclusion in the new policy, each exclusion in this policy will become part of the new policy.

6) The benefit amount under the new policy cannot exceed the benefit amount under this policy at the time of exchange and is subject to the minimum amount we allow for the new policy.

7) Each rider included in this policy may be included in the new policy if we offer it with the new policy. A new rider may be included in the new policy only with our consent and may be subject to evidence of insurability.

8) The premium rates applicable to the insured under the new policy will be based on: a. The benefit amount under the new policy and each of its riders, if applicable;b. The insured's attained age on the effective date of the exchange;c. The premium rates then in effect for the new policy and each of its riders, if applicable;d. The insured's rating class used in calculating the premiums for this policy and each of its riders,

if applicable; ande. The insured's applicable insurance class used in calculating the premiums for this policy and

each of its riders, if applicable.

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Changing the Insurance Class Applicable to an Insured You may submit a written request after this policy is in effect to change the insured's insurance class from a smoker class to a non-smoker class. We will consider such a request no more than once per year. This request is subject to our administrative rules and the following conditions:

1) We offer non-smoker premium rates at the time of your request.2) You submit evidence of insurability we consider satisfactory as to the smoking habit of the insured,

including our smoking habits declaration. The insured must meet our definition of a non-smoker at the time of the request.

3) You submit other evidence of insurability requested by us, such as but not limited to, a completed non-medical declaration of health for the insured in a form acceptable to us, as well as other medical evidence we might request, and such form and evidence is satisfactory to us.

4) We reserve the right to request payment of a fee we set from time to time for underwriting expenses. We will advise you of the amount of this fee before we process your request.

A change of insurance class will be effective on the effective date as shown in our records. We will adjust the premiums effective on that day, based on the issue age in effect on the policy date. Reducing the Benefit Amount You may request that we reduce the benefit amount, subject to our administrative rules and the following conditions:

• Premiums are paid to the effective date of the reduction.• The minimum decrease allowed is $10,000, and the remaining benefit amount must not be less than

the minimum specified in our administrative rules. The reduced benefit amount will be effective on the effective date as shown in our records. We will adjust the premiums effective on that day.

Cancelling this Policy or Rider You can cancel this policy or a rider by written request to us. The effective date of your cancellation will be the effective date as shown in our records. We will refund the unused portion of the premium except we will not refund premium if the last payment mode was monthly.

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More Information about this Policy

This Policy is Part of an Insurance Contract between You and Foresters Life Insurance Company If we fail to enforce a term or condition of the insurance contract, we still retain our right to enforce all terms and conditions in the future. No agent or person, other than an authorized officer of Foresters Life Insurance Company, has the authority to waive or agree to change a condition or provision of the insurance contract. A change to the insurance contract must be in writing and signed by a least one of our officers authorized for that purpose. We will not be bound by a promise or representation made before or after the policy date made by, or to, an agent or person other than as specified above.

When We Will Contest Except for fraud, we will not contest the validity of the policy, based on statements made in the application or any other written statements or answers furnished as evidence of insurability, after it has been in effect during the lifetime of the insured for two years from the policy date. Fraud includes, but is not limited to, a material misrepresentation of the smoking habits of the insured. In addition, if you reinstate this policy or make a change or addition to it, then we can contest the reinstatement, change or addition based on statements made in the application for that reinstatement, change or addition or any other written statements or answers furnished as evidence of insurability. Except for fraud, we will not contest a change, addition or reinstatement that has been in effect during the lifetime of the insured for two years from the effective date of that change, addition or reinstatement, as shown in our records. When we contest the validity of the policy we may treat it as void and refuse to pay a benefit.

Misstatement of Age and Sex If the date of birth or sex of the insured has been misstated, the benefit amount and each rider benefit amount, if any, shall be increased or decreased, at any time, to the amount, as determined by us, that would have been provided by the premium paid for that coverage, using the correct age and sex. However, where age affects the start or termination of coverage correct age will govern. If we would not have issued this policy because the insured’s correct age on the policy date did not meet our then current age requirements, we will declare this policy void and return the premiums paid, without interest, to you.

Ownership The owner of the insurance contract may exercise the options or rights provided to the owner under it, unless limited by statute or by the rights of an assignee or irrevocable beneficiary. You may request a change of owner, while the insured is alive and this policy is in effect. A change of owner is not effective if prohibited by law. We are not responsible for the validity or effect of a change of owner. Unless otherwise specified by you, the change of owner will be effective as of the date the request is signed and is subject to payment(s) made or action(s) taken by us prior to our receipt of this request.

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If the insured is not the owner and if the owner dies or ceases to exist, while this policy is in effect, the contingent owner, if named, becomes the owner of the insurance contract, as of the date that the owner died or ceased to exist. This transfer to the contingent owner is not effective if prohibited by law. If there is no surviving contingent owner, the owner’s estate (if the owner is a natural person) or the owner’s successor in interest (if the owner is a non-natural person) will become the owner.

Assignment You may assign the insurance contract by submitting notice of the assignment to us. Unless otherwise specified by you, the assignment will be effective as of the date the notice of assignment is signed by you and is subject to payments made or other actions taken by us before the assignment was received by us. We are not responsible for the validity or the effect of an assignment.

Currency The amounts payable under this policy, either to us or by us, are payable in Canadian dollars.

Applicable Law This policy is governed by the laws of the province or territory where the policy was made, which is where you signed the application in the absence of evidence to the contrary. That jurisdiction’s conflict of laws rules will not apply.

Limitation Period A person entitled to make a claim under this policy may begin a lawsuit to enforce their claim up to two years after the date that the claim arises, or longer if permitted by applicable law. Currently, the applicable laws with respect to limitation periods are as follows, depending on which province or territory’s laws apply to this policy: Every action or proceeding against an insurer for the recovery of insurance money payable under this policy is absolutely barred unless commenced within the time set out in:

• The Insurance Act in effect in the relevant province or territory, for policies governed by the laws of Alberta, British Columbia, Manitoba, New Brunswick, Nova Scotia, Prince Edward Island, Yukon, Northwest Territories, or Nunavut;

• The Limitations Act in effect in Saskatchewan or Newfoundland, for policies governed by the laws of those provinces;

• The Limitations Act, 2002, for policies governed by Ontario law;• The Civil Code, for policies governed by Quebec law.

However, please note that laws with respect to limitation periods may change from time to time, so it’s important to check the most recent laws when a claim arises.

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Notifications Notification(s) we send to you about the insurance contract will be sent to your last address shown in our records. You must notify us of a change in address for you or the insured. If premiums are being paid under a pre-authorized debit plan you must notify us of a change in banking information. Notifications about the insurance contract may, with your consent, be sent or provided to you by electronic means, if permitted by our administrative practices. Notifications and requests that you make to us may, if permitted by, and subject to, our administrative practices in effect at that time, be by electronic means. Notifications and requests that you make to us must, if required by us, be made using our then current form for making such notification or request. Every notification or request that you make to us must be signed by you, if required by us, and received by us for us to act on it. Each will be deemed received by us as of the date shown in our records.

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Statutory Conditions

Insurance Contract The application, this policy, any document attached to this policy when issued, and any amendment to the insurance contract agreed upon in writing after the policy is issued, constitute the entire contract, and no agent has authority to change the insurance contract or waive any of its provisions.

Waiver (Not applicable if this policy’s applicable law jurisdiction is Alberta, British Columbia, Manitoba, Ontario or Saskatchewan) - The insurer shall be deemed not to have waived any condition of the insurance contract, either in whole or in part, unless the waiver is clearly expressed in writing signed by the insurer.

Copy of Application The insurer shall, upon request, furnish to the insured or to a claimant under the insurance contract a copy of the application

Material Facts No statement made by the insured at the time of application for the insurance contract shall be used in defence of a claim under or to avoid the insurance contract unless it is contained in the application or any other written statements or answers furnished as evidence of insurability

Notice and Proof of Claims The owner, the insured or the agent of either of them, shall:

a) Not later than 30 days from the date a claim arises under the contract, give written notice of claim to the insurer,

i. by delivery of the notice, or by sending it by registered mail to the head office or chief agency of the insurer in the province or territory, or

ii. by delivery of the notice to an authorized agent of the insurer in the province or territory;b) Within 90 days from the date a claim arises under the contract, furnish to the insurer such proof, as is

reasonably possible in the circumstances, of, i. the happening of the covered condition,ii. the right of the claimant to receive payment, andiii. the claimant’s age; and

c) If so required by the insurer, furnish a satisfactory certificate as to the cause or nature of the covered condition for which claim is made under the contract.

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Failure to Give Notice or Proof Failure to give notice of claim or furnish proof of claim within the time prescribed by this statutory condition does not invalidate the claim if the notice or proof is given or furnished as soon as reasonably possible, and in no event later than one year, or in Saskatchewan not later than the limitation period set out in The Limitations Act, from the date a claim arises under the insurance contract, and it is shown that it was not reasonably possible to give notice or furnish proof within the time so prescribed.

Insurer to Furnish Forms for Proof of Claims The insurer shall furnish forms for proof of claim within 15 days after receiving notice of claim, but where the claimant has not received the forms within that time the claimant may submit his or her proof of claim in the form of a written statement of the cause or nature of the covered condition giving rise to the claim.

Rights of Examination As a condition precedent to recovery of insurance money under this contract,

a) the claimant must give the insurer an opportunity to examine the person of the insured when and so often as it reasonably requires while the claim is pending;

b) in the case of death of the insured, the insurer may require an autopsy subject to any law of the applicable jurisdiction relating to autopsies; and

c) in Saskatchewan, the insurer shall bear the costs of any examination or autopsy and shall provide copies of reports of any examination or autopsy to the insured or the insured’s representative.

When Money Payable for Other than Loss of Time All money payable under the insurance contract, other than benefits for loss of time, shall be paid by the insurer within 60 days after it has received proof of claim.

Limitations of Action (Not applicable if this policy’s applicable law jurisdiction is Alberta, British Columbia, Manitoba, Ontario, Quebec or Saskatchewan) - An action or proceeding against the insurer for the recovery of a claim under the insurance contract shall not be commenced more than two years after the date the insurance money became payable or would have become payable if it had been a valid claim.

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RETURN OF PREMIUM ON SURRENDER OR EXPIRY This rider, while in effect, forms part of the insurance contract. Unless amended by this rider, policy provisions and policy definitions apply to this rider.

Definitions used in this rider “Policy expiry date” means the policy anniversary on which the insured is age 80. “Return of premium date” means each policy anniversary twenty (20) or more years after the rider date and before the policy expiry date. “Rider benefit amount” means the sum of the eligible premiums paid, without interest. “Rider date” means the date that this rider comes into effect as described in the When this Rider is in Effect provision.

When this Rider is in Effect This rider comes into effect on the same date that the policy comes into effect. Once in effect, this rider will remain in effect until the earliest of the following dates:

a) The effective date of cancellation, as shown in our records, arising from your request to cancel this rider;

b) The date that the benefit amount, or a non-life-threatening illness benefit, is paid under the policy;

c) The date the policy is no longer in effect, as described in the policy. This rider ends and will not be in effect after the earliest of the above dates. This means that our liability ends and no amount would be paid under this rider.

Premiums Premium amounts for this rider and the period of years for which they are payable are shown in the Benefit and Premium Information Schedule of the policy. While this rider is in effect, the premium for this rider is included in the total premium. Subject to the When this Rider is in Effect provision, to keep this rider in effect, you need to pay the total premium when due, as described in the policy.

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Benefit Subject to the terms and conditions of the insurance contract, we will pay a benefit under this rider to your or your estate:

a) as a result of the owner's written request for a full surrender of the insurance contract to be effective on the return of premium date identified in the request. This is called the Return of Premium on Surrender Benefit; or

b) as a result of the policy ending on the policy expiry date. This is called the Return of Premium on Expiry Benefit.

Rider Benefit Amount for Surrender The Return of Premium on Surrender Benefit is an optional benefit. That benefit is not automatically payable on full surrender of the insurance contract. That benefit is only available on the owner's written request for a full surrender of the insurance contract, to be effective on a return of premium date, and that specifically requests this benefit. That return of premium date will also be the effective date of surrender of the insurance contract. The amount payable under this benefit is equal to the rider benefit amount for the period from the rider date to the applicable return of premium date, multiplied by the applicable percentage from the table below minus each payment made under the Juvenile Critical Illness Insurance Rider.

Number of policy anniversaries since the Rider Date

%

20 55%21 60%22 65%23 70%24 75%25+ 80%

Return of Premium on Expiry Benefit The Return of Premium on Expiry Benefit will become payable on the policy expiry date. The amount payable under this benefit is equal to the rider benefit amount for the period from the rider date to the policy expiry date minus each payment made by us under the Juvenile Critical Illness Insurance Rider.

Conditions for Benefit Payment We will pay the applicable benefit under this rider if:

a) for the Return of Premium on Surrender Benefit under this rider, the owner's written request specifically requesting this benefit is received by us as shown in our records between 60 days before the next, and 30 days after the last, return of premium date;

b) you are living on the applicable return of premium date or policy expiry date, and have not experienced irreversible cessation of all functions of the brain; and

c) the policy and this rider are both in effect on the applicable return of premium date or the policy expiry date.

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Incontestability Except for fraud, we will not contest the validity of this rider, based upon statements made in the application after it has been in effect, during the lifetime of the insured, for two years. Similarly, except for fraud, statements made in an application for reinstatement of this rider will be incontestable two years after the effective date, as shown in our records, of such reinstatement.

When we contest the validity of this rider we may treat it as void and refuse to pay a benefit under this rider.

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DISABILITY WAIVER OF PREMIUM RIDER

This rider, while in effect, forms part of the insurance contract. Unless amended by this rider, policy provisions and policy definitions apply to this rider.

Definitions used in this rider

“Appropriate physician’s care” means the most appropriate treatment by a physician, according to existing standards of medical practice, for the injury or sickness which is the cause of the insured’s total disability.

“Injury” means bodily harm, loss or damage sustained as a direct result of an accident while this rider is in effect.

“Sickness” means an illness or disease that first manifests itself while this rider is in effect, or before this rider takes effect but only if we have been fully and accurately advised in the application, or otherwise in writing, as shown in our records, before this rider takes effect, of the information known or reasonably available to you regarding the insured’s sickness, including his or her symptoms.

“Total disability” or “totally disabled” means that, due directly to injury or sickness and independently of another cause, the insured is unable to perform the essential duties of his or her regular occupation, is not engaged in another gainful occupation, and is receiving appropriate physician’s care.

After the payment of premiums has been waived for a period of twenty-four (24) months due to the same total disability, including each recurrence of that total disability, then total disability means that, due directly to injury or sickness and independently of another cause, the insured is unable to engage in a gainful occupation for which he or she is reasonably fitted by education, training or experience, and continues to be under appropriate physician’s care.

When this Rider is in Effect

This rider comes into effect on the same date that the policy comes into effect. Once in effect, this rider will remain in effect until the earliest of the following dates:

a) The policy anniversary nearest the sixty-fifth (65th) birthday of the insured;b) The date of cancellation, as shown in our records, arising from your request to cancel this

rider;c) The date the policy is no longer in effect, as described in the policy.

This rider ends and will not be in effect after the earliest of the above dates. This means that our liability ends and no amount would be paid under this rider.

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Disability Waiver of Premium Benefit When the insured has been continuously totally disabled for at least six (6) months, subject to the terms and conditions of the insurance contract, we will waive the monthly premiums while the insured is totally disabled, starting with the first monthly premium due after the date total disability began. Total disability must begin while this rider is in effect and prior to the policy anniversary nearest the insured’s sixty-fifth (65th) birthday. We must receive proof of the insured’s total disability before we waive a premium. To keep your policy in effect, you should continue to pay premiums on each premium due date while the insured is totally disabled and before a premium may be waived. If a claim is approved, the total premium paid during this six (6) month period will be refunded.

Claiming the Disability Waiver of Premium Benefit We must receive written notice of claim within sixty (60) days from the onset of total disability, while this rider is in effect and while the insured is alive. We must then receive, within six (6) months from the onset of total disability, evidence we consider sufficient to establish the total disability. We will supply the forms required for notice of claim and proof of claim upon request. Failure to give notice of claim or to provide evidence to support a claim within the periods of time prescribed above does not necessarily invalidate that claim if notice and proof of claim are submitted within one (1) year of the onset of total disability, and it can be demonstrated to us that it was not reasonably possible to provide these within the prescribed periods. If the policy ends due to non-payment of premium as described in the Grace Period policy provision and while the insured is totally disabled, a claim under this rider will not be invalid because the policy ends. However, you must reinstate the policy before we will approve the claim, as described in the policy. If the claim under this rider is otherwise valid, it will be allowed on reinstatement.

Proof of Continuing Total Disability During the first two (2) years of total disability, as often as we require, we may request proof that the insured continues to be totally disabled. As part of this proof, we may require the insured to be examined by a physician of our choice, as often as we require. After this two (2) year period, if we deem the total disability to be permanent, proof and a medical examination will not be required more than once a year.

When the Disability Waiver of Premium Benefit Begins and Ends Subject to the terms and conditions of the insurance contract, we will waive the monthly premiums starting with the first monthly premium due after the date total disability began. If the premium payment mode is annual, we will automatically change it to a monthly payment mode. Once on monthly payment mode, it will remain monthly, even after premium is no longer waived due to total disability, unless you request another payment mode approved by us. The waiver of premium will end on the monthly anniversary following the earliest of:

a) The date the insured is no longer totally disabled;b) The date we determine that the insured has failed to attend a medical exam when we requested it; andc) The date we determine that the insured has failed to provide proof that he or she is totally disabled

when we requested it.

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Recurrence of Total Disability If the insured ceases to be totally disabled, and subsequently becomes totally disabled within ninety (90) days of the last total disability, we will consider this a recurrence of total disability only if we determine that the subsequent total disability is related to the last total disability. If we approve a claim for a recurrence of total disability, we will waive premiums effective the next monthly anniversary. If we determine that the subsequent total disability is not a recurrence of the last total disability, the insured will be required to give notice and proof of disability as if no prior total disability had existed. No premiums will be waived until the insured has again been continuously totally disabled for six (6) months, as described in this rider.

Continuing Benefits Beyond Age Sixty-Five If the insured is totally disabled and we are waiving the monthly premium at the policy anniversary nearest his or her sixty-fifth (65th) birthday, we will continue to waive the premium under the terms of this rider while the insured remains totally disabled and the policy remains in effect.

When we will not Waive Premiums We will not waive premiums if the insured’s total disability resulted, either directly or indirectly, from any of the following:

a) Attempted suicide or intentionally self-inflicted injury, whether sane or insane;b) The commission or attempted commission by the insured of a criminal offence, whether or not the

insured is charged with an offence, or for provocation of an assault;c) An event related to the insured’s operation of heavy machinery, a motor vehicle or other conveyance

while the concentration of alcohol and/or tetrahydrocannabinol (THC) in the blood exceeds the legal limit for operating a motor vehicle in the jurisdiction where that event occurred.;

d) Excessive or repeated or persistent use of alcohol, or an event, illness or treatment related to the repeated or persistent use of alcohol;

e) An event, illness or treatment related to the voluntary ingestion of an illegal drug, or to the use, inhalation or ingestion of an illicit substance;

f) Injection or taking of a drug, hypnotic or narcotic, unless administered on the advice of, and at the frequency and dosage prescribed by, a physician and as dispensed by the pharmacy or, in the case of a legal non- prescribed drug, as recommended by the drug manufacturer;

g) Poisoning or inhalation of gas or fumes, whether voluntary or involuntary;h) Normal pregnancy or childbirth. Disabling complications of pregnancy or childbirth are not excluded; ori) A condition, sickness or activity that we have excluded by name or specific description in an

endorsement or amendment to this policy.We will not waive or refund the premiums that became due more than one (1) year prior to our receipt of written notice of claim. If total disability begins during the grace period, as described in Grace Period policy provision, and a premium is in default, we will not waive the payment of that premium.

Incontestability Except for fraud, we will not contest the validity of this rider, based upon statements made in the application after it has been in effect, during the lifetime of the insured, for two years. Similarly, except for fraud, statements made in an application for reinstatement of this rider will be incontestable two years after the effective date, as shown in our records, of such reinstatement.

When we contest the validity of this rider we may treat it as void and refuse to waive premiums under this rider.

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EThis is to certify that

Insured

A valued customer of FORESTERS LIFE INSURANCE COMPANY, is eligible to receive, at no cost, access to the Expert Medical Opinion program through ADVANCE MEDICAL.

Granted on September 23, 2020

Executive Vice President, General Manager, Advance Medical

This certificate does not form part of your insurance policy.

Expert Medical Opinion is provided solely by Advance Medical, Inc, subject to eligibility requirements and limitations and may be changed or canceled at any time without notice. This Program is not a policy benefit and accordingly Foresters Life Insurance Company is not responsible for this Program and has no liability in relation to the expert medical opinion or any of the services provided, or functions performed, under the Program.

408469 CAN (05/12)

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CHRIS JORDAN

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EExpert Medical Opinion will answer questions about a medical decision, diagnosis, condition, or treatment for you and your family.

Quickly finding the right expertise when dealing with a complex, critical, or chronic disease is a very important factor for achieving the best possible outcome - medically, emotionally, and financially.

Expert Medical Opinion offers you the unique opportunity to have your medical situation analyzed by some of the world’s leading expects. This collaboration of medical specialists ensures that the options for care have been vetted, discussed, and described for you or your caregiver. Additionally, you may have access to a superior level of personal support through a dedicated Physician Case Manager within ADVANCE MEDICAL. The Expert Medical Opinion program engages experts on a case-by-case basis so that the patient can have a relevant expert for his or her case even when the clinical frontier is constantly evolving. ADVANCE MEDICAL has worked with thousands of reference physicians in all aspects of disease. By having the world’s leading medical experts analyze your medical case, your care will reflect some of the best thinking in medicine, without the need to travel or even necessarily disrupting the existing patient-physician relationship.

Call when you needexpert medical advice:

1-888-218-9029

3You and your family means Eligible Policyholder, Eligible Policyholder’s spouse, domestic partner, and dependent children to age 18.

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Work with a dedicated Physician Case Manager who will be your advocate and advisor throughout the process.

With your permission, your medical records will be collected on your behalf.

Have world - class specialists review your medical data, provide their insights, and answer your questions.

Know that your plan forward is based on the opinions of some of the world’s leading medical experts - all without having to make appointments or travel.

Free for you and your family.

When Expert Medical Opinion should be used:• Diagnosis for serious, complex, or

rare condition• Treatment recommendation is risky

medication or major surgery• Any uncertainty about the diagnosis• Numerous possible treatments are

available• Cause of persistent symptoms is not

found• Key questions have not been

answered• Uncertainty about physician’s

experience

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EForesters Privacy Practices for all Foresters Customers and Members in Household

Our commitmentFor 140 years, Foresters Financial™ has worked to enhance the well-being of members, their families and the communities where they live. Our customer and member relationships are based on trust. We are providing you with this information about our privacy practices information to help keep you up to date on our commitment to you regarding the collection, use and disclosure of your personal information. Foresters collection, use and disclosure of your Personal Information, as described here, will be with your consent, or as authorized by law. Your consent may be expressed or in some situations implied. Your consent may be in writing, given verbally, electronically or through an authorized representative.

Definitions"Foresters", "we", "our" or "us" means The Independent Order of Foresters, as well as its wholly owned subsidiaries, including Foresters Life Insurance Company. "Personal Information" is identifiable information about you. "You" and "your" means an individual who owns, or is insured under, a certificate or policy or has made an application to us for membership or signed an application in respect of a product, member benefit or service (collectively referred to as "Services") offered by us.

What we collectAs applicable, we may collect Personal Information from you or from third parties such as:− Identity information including your name, address, date of birth and government issued

identification numbers such as from a valid driver's license or passport− Health information such as answers to medical questions on an insurance application, medical records from your doctor or prescription history− Financial information such as income, assets, occupation and bank accounts used to pay for Services− Information about beneficial owners, intermediaries, beneficiaries or other persons such as trustees, executors or corporate representatives− Contact information such as your telephone number, mobile or fax number or e-mail

address

We collect personal information in applications or other forms and through other means of communications, such as by telephone, mail or the internet. Information provided by telephonemay be recorded or monitored so that we have a record of that information and to assist with quality assurance.

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How we use it

The purpose for our collection, use and disclosure of Personal Information may include, asapplicable, to:− Understand your needs− Determine your eligibility for our Services− Offer you the full range of Services that may meet your changing needs− Administer and manage our Services− Test, audit and update our processes and Services− Develop new Services and processes− Investigate and pay claims and process transactions− Arrange and hold fraternal and community events and activities and to operate our Branch system− Maintain records− Market our Services, including telemarketing and sending you commercial electronic messages− Inform you of events or activities− Identify and mitigate potential risks or losses to us, including fraud

We may disclose your Personal Information to others in pursuing our goal of making a wide range of products and services available to you. If you do not wish us to disclose yourPersonal Information for this purpose, you can simply opt out by contacting us.

How we protect your personal informationWe provide your Personal Information to our employees, advisors, agencies, representatives, affiliates and service providers, who, in some situations, may be in jurisdictions outside Canada. Personal Information outside Canada is subject to the laws ofthose other jurisdictions, such as access by law enforcement and national securityauthorities in those jurisdictions. We have specified physical, electronic and proceduralsafeguards to protect your Personal Information. When Personal Information is provided tothird parties, we require them to protect the information in a manner that is consistent withour privacy policy and practices. Access and accuracyYou are entitled to access your Personal Information contained in your file and, whenapplicable, to have it corrected. There may be a modest charge for providing this informationto you. We may be prohibited from providing you with all information, such as when prohibited by law. If you are aware that we have information about you that is inaccurate, you should contact usimmediately. Sometimes, we may still feel the information in our records is correct. You maydisagree and have the right to challenge our decision by contacting our Chief Privacy Officer. Further information and how to get in touchWe may amend, from time to time, our privacy policies and the practices described here totake into consideration changes in legislation or other situations that may arise. We will postupdated Privacy Practices on our website or we may send you this information by mail orelectronically.If you have questions or concerns about Foresters privacy policy or practices, please contactus toll free at 1 800 828 1540 or by mail to our Chief Privacy Officer, 789 Don Mills Road,Toronto, ON M3C 1T9.

Page 2 of 2Foresters Financial and Foresters are trade names and trademarks of The Independent Order of Foresters (a fraternal benefit society, 789 Don Mills Road, Toronto, Canada M3C 1T9) and its subsidiaries. 105874 CAN (01/17)

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LIVE WELL Critical Illness Insurance Term [Period]