State Farm Life Insurance Company Disclosure
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State Farm Life Insurance Company DISCLOSURE
THIS IS AN ILLUSTRATION ONLY. AN ILLUSTRATION IS NOT INTENDED TO PREDICT ACTUAL PERFORMANCE. INTEREST RATES, DIVIDENDS, AND VALUES SET FORTH IN THE ILLUSTRATION ARE NOT GUARANTEED, EXCEPT FOR THOSE ITEMS CLEARLY LABELED AS GUARANTEED.
Life Insurance Illustration
Plan: Insured: Premium Class: Initial Basic Amount: Death Benefit: Premium Mode:
Universal Life Date: Joe Sample Prepared by: Male, Age 0 Agency: Juvenile $3,000,000 Option 1 - Death Benefit Remains Level License No: Phone No: Fax No: Special Monthly
November 9, 2009 Jake Stewart State Farm Insurance 821 Folsom St, Suite 101 San Francisco, CA 94107 0E85157 (415)982-9033 (415)982-3905
This illustration was produced to be used in California.
Summary of Illustrated Coverages and Premium Benefits and Riders:
$3,000,000 Universal Life Waiver of Monthly Deduction for Disability
The total first year premium outlay illustrated is $6,987.12. The initial premium is $582.26 each month. Please review this illustration for additional changes in illustrated premiums and coverages in years 2 and later.
Description of Coverage Plan
Universal Life (Form Number 08030 - 05) is a flexible premium adjustable life insurance policy. A death benefit is payable when the Insured dies. Flexible premiums are payable to the Insured's age 121.
How This Plan Works
You start with a planned premium and death benefit. You may change either in the future subject to policy provisions. When you pay premiums, we deduct a 5% premium charge. The remaining premium is added to the account value. From this account value we deduct each month: (A) the current cost of insurance including the charges for any riders, and (B) a current monthly expense charge of $8.00. During each of the first 24 months following issue or an increase, an issue charge will be deducted from the account value. The issue charge is $0.10 per $1000 of the initial Basic Amount and each increase, each subject to a maximum of $50.00 per month. The account value earns interest at the current interest rate, but a different rate may be credited to any account value which you have borrowed. The current interest rate is increased by 0.50% on the unloaned account value that exceeds 10% of the Basic Amount. Surrender charges apply. The current monthly cost of insurance rates and monthly expense charge may be changed by the company at any time, but will never be more than the maximums given in the policy. The maximum monthly expense charge is $8.00 in policy years one through five, and $10.00 thereafter. The current interest rate can be changed by the company on a monthly basis, but will never be less than the guaranteed rate of 4%. This policy is participating, but no dividends are anticipated.
Important Tax Information
This policy complies with the definition of life insurance in Internal Revenue Code Section 7702. This means that the premium illustrated does not exceed the greater of the Guideline Single Premium or the cumulative Guideline Annual Premium. Payment of the guideline annual premium will not provide coverage to age 121 under the contract, on the guaranteed basis. This illustration should not be relied on for tax advice. The tax status of this policy should be reviewed with the policyowner's legal and tax advisors. Guideline Single Premium at issue: $73,131 Guideline Annual Premium at issue: $8,529
UL001 (07/2008)
State Farm Life Insurance Company One State Farm Plaza Bloomington, IL 61710
Page 1 of 8
Life Insurance Illustration
Plan: Insured: Premium Class:
Universal Life Joe Sample Male, Age 0 Juvenile
Initial Basic Amount: Death Benefit: Premium Mode:
$3,000,000 Option 1 Special Monthly
Description of Coverage If at any time during the first 7 years, the total premiums paid exceed the MEC Reference Premium shown below times the number of years the policy has been in force, the policy will be considered a Modified Endowment Contract. This means distributions, which include cash withdrawals, policy loans, and assignments may be subject to Federal Income Tax to the extent there is a gain in the contract. An additional 10% penalty tax may also apply prior to the policyowner's age 59 1/2. Increases in coverages will require a new premium test with a new 7 year test period. Reductions in coverages during a 7 year test period will generally result in a lower MEC Reference Premium retroactive to the beginning of the 7 year test period. Planned premiums after the 1st year shown on this illustration have not been checked to determine if the MEC Reference Premium limit has been exceeded. MEC Reference Premium at issue: $31,080 Waiver of Monthly Deduction for Disability
This rider (Form Number 08206 - 05) provides for the waiver of all monthly deductions so long as the Insured is totally disabled as defined in the policy.
Definitions Juvenile
Basic Amount
Available for ages 0 through 19. Insurance costs used in this illustration assume that the Insured qualifies for Non-Tobacco rates beginning with the first renewal date on or after age 20. To receive these Non-Tobacco rates, the owner must apply and the Insured be approved for the Non-Tobacco classification. The Initial Basic Amount plus any increases less any decreases.
Monthly Deductions
The sum of the monthly cost of insurance charges, the monthly expense charge, the issue charge, and charges for any riders.
Guaranteed Values
These values are calculated using the illustrated premiums, 5% premium expense charge, guaranteed interest rate of 4% and the maximum monthly deductions.
Non-Guaranteed Intermediate Values
These values are calculated using the illustrated premiums, 5% premium expense charge, average of the illustrated and guaranteed interest rates, and the average of the current and maximum monthly deductions. The intermediate values are not guaranteed. They demonstrate the impact of changes in company experience.
Non-Guaranteed Illustrated Values
These values are calculated using the illustrated premiums, 5% premium expense charge, illustrated interest rates, and current monthly deductions. The illustrated interest rate has been increased by 0.50% on the unloaned account value that exceeds 10% of the Basic Amount. These values are not guaranteed.
Annualized Premium Outlay Total Annualized Premium Outlay
UL001 (07/2008)
The actual cash outlay each year. The sum of each year's annualized premium outlay. State Farm Life Insurance Company One State Farm Plaza, Bloomington, IL 61710
Page 2 of 8
Life Insurance Illustration
Plan: Insured: Premium Class:
Universal Life Joe Sample Male, Age 0 Juvenile
Initial Basic Amount: Death Benefit: Premium Mode:
$3,000,000 Option 1 Special Monthly
Definitions Account Value Cash Surrender Value Death Benefit
Option 1
This is the accumulation of premiums shown less a 5% expense charge and monthly deductions. This value is the account value less the applicable surrender charge. Surrender charges apply for 15 policy years following issue or an increase in the Basic Amount of insurance. This is the amount payable at the death of the Insured. Any increase or decrease must be approved by the Company, subject to policy provisions. Future increases are illustrated using the premium class of the base policy, subject to the minimum amount requirements as of the date of the illustration. Under Option 1, the death benefit is the Basic Amount of insurance. The death benefit may be increased due to Internal Revenue Code provisions. Changes in the Death Benefit Option can result in the Basic Amount being lowered below the Policy's Minimum Basic Amount. In these cases, the Minimum Basic Amount stated in the policy will be amended to reflect a reduced Minimum Basic Amount.
This illustration assumes that the currently illustrated non-guaranteed elements will continue unchanged for all years shown. This is not likely to occur, and actual results may be more or less favorable than those shown. The assumptions on which they are based are subject to change by the Company. Cash values and death benefits shown are end of year values. Premiums are assumed to be paid when due. This illustration contains a general description of coverage. A complete statement of coverage is found in the policy.
Interest Adjusted Cost Indices at 5.00% Guaranteed
Illustrated
10 Year
20 Year
10 Year
20 Year
Surrender Cost Index
0.59
0.73
0.49
0.53
Net Payment Index
2.21
2.20
2.21
2.20
Equivalent Level Annual Dividend
N/A
N/A
N/A
N/A
These indices are computed by the formulas prescribed by the National Association of Insurance Commissioners and reflect the time value of money at 5%. These indices do not include the cost of additional benefits.
Not FDIC Insured
UL001 (07/2008)
- No Bank Guarantee - May Lose Value
State Farm Life Insurance Company One State Farm Plaza, Bloomington, IL 61710
Page 3 of 8
Life Insurance Illustration
Plan: Insured: Premium Class:
Universal Life Joe Sample Male, Age 0 Juvenile
Initial Basic Amount: Death Benefit: Premium Mode:
Guaranteed and Non-Guaranteed Values
End of Year Age
$3,000,000 Option 1 Special Monthly
Non-Guaranteed
Guaranteed Values
Intermediate Values
Illustrated Values
Guaranteed Interest Rate: 4.00%
Interest Rate: 4.50%
Interest Rate: 5.00%
Annualized Premium Outlay
Cash Surrender Value
Death Benefit
Cash Surrender Value
Death Benefit
Cash Surrender Value
Death Benefit
5
5
6,540
26,341
3,000,000
26,799
3,000,000
27,283
3,000,000
10
10
6,540
64,346
3,000,000
66,336
3,000,000
68,430
3,000,000
20
20
6,540
152,642
3,000,000
162,833
3,000,000
173,800
3,000,000
65
65
6,540
815,551
3,000,000
1,366,354
3,000,000
2,115,241
3,000,000
70
70
6,540
769,624
3,000,000
1,601,268
3,000,000
2,741,402
3,180,026
80
80
6,540
0**
0**
2,087,172
3,000,000
4,645,050
4,877,302
85
85
6,540
0
0
2,315,263
3,000,000
6,010,233
6,310,744
**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis.
I have received a copy of this illustration and understand that any non-guaranteed elements illustrated are subject to change and could be either higher or lower. The agent has told me they are not guaranteed.
Applicant
Date
I certify that this illustration has been presented to the applicant and that I have explained that any non-guaranteed elements illustrated are subject to change. I have made no statements that are inconsistent with the illustration.
Agent
UL001 (07/2008)
Date
State Farm Life Insurance Company One State Farm Plaza, Bloomington, IL 61710
Page 4 of 8
Life Insurance Illustration
Plan: Insured: Premium Class:
Universal Life Joe Sample Male, Age 0 Juvenile
Initial Basic Amount: Death Benefit: Premium Mode:
$3,000,000 Option 1 Special Monthly
Guaranteed and Non-Guaranteed Values Guaranteed Values Guaranteed Interest 4.00% Total End Annualized Annualized of Premium Premium Year Age Outlay Outlay
Non-Guaranteed Illustrated Values Illustrated Interest 5.00%
Account Value
Cash Surrender Value
Death Benefit
Account Value
Cash Surrender Value
Death Benefit
1 2 3 4 5
1 2 3 4 5
6,987 6,987 6,540 6,540 6,540
6,987 13,974 20,514 27,054 33,594
5,420 11,058 17,106 23,397 29,941
3,620 7,458 13,506 19,797 26,341
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
5,482 11,239 17,469 24,012 30,883
3,682 7,639 13,869 20,412 27,283
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
6 7 8 9 10
6 7 8 9 10
6,540 6,540 6,540 6,540 6,540
40,134 46,674 53,214 59,754 66,294
36,718 43,738 51,041 58,637 66,506
33,118 40,498 48,161 56,117 64,346
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
38,094 45,638 53,561 61,881 70,590
34,494 42,398 50,681 59,361 68,430
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
11 12 13 14 15
11 12 13 14 15
6,540 6,540 6,540 6,540 6,540
72,834 79,374 85,914 92,454 98,994
74,663 83,028 91,551 100,237 108,915
72,863 81,588 90,471 99,517 108,555
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
79,707 89,170 98,935 109,022 119,276
77,907 87,730 97,855 108,302 118,916
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
16 17 18 19 20
16 17 18 19 20
6,540 6,540 6,540 6,540 6,540
105,534 112,074 118,614 125,154 131,694
117,527 126,133 134,763 143,567 152,642
117,527 126,133 134,763 143,567 152,642
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
129,647 140,204 150,987 162,153 173,800
129,647 140,204 150,987 162,153 173,800
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
21 22 23 24 25
21 22 23 24 25
6,540 6,540 6,540 6,540 6,540
138,234 144,774 151,314 157,854 164,394
162,027 171,765 181,873 192,333 203,161
162,027 171,765 181,873 192,333 203,161
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
186,123 199,071 212,677 226,946 241,908
186,123 199,071 212,677 226,946 241,908
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
26 27 28 29 30
26 27 28 29 30
6,540 6,540 6,540 6,540 6,540
170,934 177,474 184,014 190,554 197,094
214,344 225,840 237,721 250,120 263,054
214,344 225,840 237,721 250,120 263,054
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
257,551 273,988 291,258 309,414 328,569
257,551 273,988 291,258 309,414 328,569
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
31 32 33 34 35
31 32 33 34 35
6,540 6,540 6,540 6,540 6,540
203,634 210,174 216,714 223,254 229,794
276,545 290,618 305,234 320,390 336,078
276,545 290,618 305,234 320,390 336,078
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
348,790 370,131 392,636 416,320 441,273
348,790 370,131 392,636 416,320 441,273
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis. These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.
UL001 (07/2008)
State Farm Life Insurance Company One State Farm Plaza, Bloomington, IL 61710
Page 5 of 8
Life Insurance Illustration
Plan: Insured: Premium Class:
Universal Life Joe Sample Male, Age 0 Juvenile
Initial Basic Amount: Death Benefit: Premium Mode:
$3,000,000 Option 1 Special Monthly
Guaranteed and Non-Guaranteed Values Guaranteed Values Guaranteed Interest 4.00% Total End Annualized Annualized of Premium Premium Year Age Outlay Outlay
Non-Guaranteed Illustrated Values Illustrated Interest 5.00%
Account Value
Cash Surrender Value
Death Benefit
Account Value
Cash Surrender Value
Death Benefit
36 37 38 39 40
36 37 38 39 40
6,540 6,540 6,540 6,540 6,540
236,334 242,874 249,414 255,954 262,494
352,261 368,906 386,003 403,516 421,468
352,261 368,906 386,003 403,516 421,468
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
467,486 495,032 523,940 554,236 586,032
467,486 495,032 523,940 554,236 586,032
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
41 42 43 44 45
41 42 43 44 45
6,540 6,540 6,540 6,540 6,540
269,034 275,574 282,114 288,654 295,194
439,793 458,457 477,397 496,522 515,756
439,793 458,457 477,397 496,522 515,756
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
619,337 654,201 690,641 728,694 768,463
619,337 654,201 690,641 728,694 768,463
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
46 47 48 49 50
46 47 48 49 50
6,540 6,540 6,540 6,540 6,540
301,734 308,274 314,814 321,354 327,894
535,098 554,524 574,122 594,021 614,097
535,098 554,524 574,122 594,021 614,097
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
810,116 853,729 899,372 947,171 997,231
810,116 853,729 899,372 947,171 997,231
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
51 52 53 54 55
51 52 53 54 55
6,540 6,540 6,540 6,540 6,540
334,434 340,974 347,514 354,054 360,594
634,232 654,207 673,760 692,631 710,414
634,232 654,207 673,760 692,631 710,414
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
1,049,632 1,104,481 1,161,857 1,221,807 1,284,449
1,049,632 1,104,481 1,161,857 1,221,807 1,284,449
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
56 57 58 59 60
56 57 58 59 60
6,540 6,540 6,540 6,540 6,540
367,134 373,674 380,214 386,754 393,294
726,713 741,333 754,252 765,240 772,838
726,713 741,333 754,252 765,240 772,838
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
1,349,801 1,418,093 1,489,529 1,564,195 1,641,848
1,349,801 1,418,093 1,489,529 1,564,195 1,641,848
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
61 62 63 64 65
61 62 63 64 65
6,540 6,540 6,540 6,540 6,540
399,834 406,374 412,914 419,454 425,994
786,355 797,844 806,767 812,778 815,551
786,355 797,844 806,767 812,778 815,551
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
1,727,031 1,816,641 1,910,964 2,010,351 2,115,241
1,727,031 1,816,641 1,910,964 2,010,351 2,115,241
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
66 67 68 69 70
66 67 68 69 70
6,540 6,540 6,540 6,540 6,540
432,534 439,074 445,614 452,154 458,694
814,810 810,321 801,672 788,359 769,624
814,810 810,321 801,672 788,359 769,624
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
2,226,146 2,343,630 2,468,396 2,601,188 2,741,402
2,226,146 2,343,630 2,468,396 2,601,188 2,741,402
3,000,000 3,000,000 3,000,000 3,043,389 3,180,026
**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis. These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.
UL001 (07/2008)
State Farm Life Insurance Company One State Farm Plaza, Bloomington, IL 61710
Page 6 of 8
Life Insurance Illustration
Plan: Insured: Premium Class:
Universal Life Joe Sample Male, Age 0 Juvenile
Initial Basic Amount: Death Benefit: Premium Mode:
$3,000,000 Option 1 Special Monthly
Guaranteed and Non-Guaranteed Values Non-Guaranteed Illustrated Values Illustrated Interest 5.00%
Guaranteed Values Guaranteed Interest 4.00% Total End Annualized Annualized of Premium Premium Year Age Outlay Outlay
Account Value
Cash Surrender Value
Death Benefit
Account Value
Cash Surrender Value
Death Benefit
71 72 73 74 75
71 72 73 74 75
6,540 6,540 6,540 6,540 6,540
465,234 471,774 478,314 484,854 491,394
744,309 710,571 666,448 610,439 540,487
744,309 710,571 666,448 610,439 540,487
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
2,888,635 3,043,842 3,207,689 3,381,054 3,564,864
2,888,635 3,043,842 3,207,689 3,381,054 3,564,864
3,321,930 3,439,541 3,560,535 3,685,348 3,814,405
76 77 78 79 80
76 77 78 79 80
6,540 6,540 6,540 6,540 6,540
497,934 504,474 511,014 517,554 524,094
453,885 346,942 214,428 49,558 0**
453,885 346,942 214,428 49,558 0**
3,000,000 3,000,000 3,000,000 3,000,000 0**
3,760,172 3,965,439 4,181,107 4,407,515 4,645,050
3,760,172 3,965,439 4,181,107 4,407,515 4,645,050
3,948,181 4,163,710 4,390,162 4,627,890 4,877,302
81 82 83 84 85
81 82 83 84 85
6,540 6,540 6,540 6,540 6,540
530,634 537,174 543,714 550,254 556,794
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
4,894,082 5,154,866 5,427,677 5,712,741 6,010,233
4,894,082 5,154,866 5,427,677 5,712,741 6,010,233
5,138,786 5,412,609 5,699,061 5,998,378 6,310,744
86 87 88 89 90
86 87 88 89 90
6,540 6,540 6,540 6,540 6,540
563,334 569,874 576,414 582,954 589,494
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
6,320,276 6,642,973 6,978,468 7,326,918 7,688,026
6,320,276 6,642,973 6,978,468 7,326,918 7,688,026
6,636,289 6,975,121 7,327,391 7,693,264 8,072,427
91 92 93 94 95
91 92 93 94 95
6,540 6,540 6,540 6,540 6,540
596,034 602,574 609,114 615,654 622,194
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8,061,747 8,461,210 8,890,319 9,354,805 9,860,755
8,061,747 8,461,210 8,890,319 9,354,805 9,860,755
8,464,834 8,799,658 9,157,028 9,541,901 9,959,362
96 96 97 97 98 98 99 99 100 100
6,540 6,540 6,540 6,540 6,540
628,734 635,274 641,814 648,354 654,894
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
10,407,927 10,985,194 11,594,210 12,236,723 12,914,573
10,407,927 10,985,194 11,594,210 12,236,723 12,914,573
10,407,927 10,985,194 11,594,210 12,236,723 12,914,573
101 102 103 104 105
6,540 6,540 6,540 6,540 6,540
661,434 667,974 674,514 681,054 687,594
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
13,629,705 14,384,170 15,180,130 16,019,868 16,905,792
13,629,705 14,384,170 15,180,130 16,019,868 16,905,792
13,629,705 14,384,170 15,180,130 16,019,868 16,905,792
101 102 103 104 105
**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis. These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.
UL001 (07/2008)
State Farm Life Insurance Company One State Farm Plaza, Bloomington, IL 61710
Page 7 of 8
Life Insurance Illustration
Plan: Insured: Premium Class:
Universal Life Joe Sample Male, Age 0 Juvenile
Initial Basic Amount: Death Benefit: Premium Mode:
$3,000,000 Option 1 Special Monthly
Guaranteed and Non-Guaranteed Values Non-Guaranteed Illustrated Values Illustrated Interest 5.00%
Guaranteed Values Guaranteed Interest 4.00% Total End Annualized Annualized of Premium Premium Year Age Outlay Outlay
Account Value
Cash Surrender Value
Death Benefit
Account Value
Cash Surrender Value
Death Benefit
106 107 108 109 110
106 107 108 109 110
6,540 6,540 6,540 6,540 6,540
694,134 700,674 707,214 713,754 720,294
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
17,840,441 18,826,497 19,866,785 20,964,289 22,122,156
17,840,441 18,826,497 19,866,785 20,964,289 22,122,156
17,840,441 18,826,497 19,866,785 20,964,289 22,122,156
111 112 113 114 115
111 112 113 114 115
6,540 6,540 6,540 6,540 6,540
726,834 733,374 739,914 746,454 752,994
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23,343,705 24,632,440 25,992,055 27,426,449 28,939,735
23,343,705 24,632,440 25,992,055 27,426,449 28,939,735
23,343,705 24,632,440 25,992,055 27,426,449 28,939,735
116 117 118 119 120
116 117 118 119 120
6,540 6,540 6,540 6,540 6,540
759,534 766,074 772,614 779,154 785,694
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
30,536,251 32,220,576 33,997,539 35,872,235 37,850,039
30,536,251 32,220,576 33,997,539 35,872,235 37,850,039
30,536,251 32,220,576 33,997,539 35,872,235 37,850,039
121 121
6,540
792,234
0
0
0
39,936,622
39,936,622
39,936,622
**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis. These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.
UL001 (07/2008)
State Farm Life Insurance Company One State Farm Plaza, Bloomington, IL 61710
Page 8 of 8
TRADITIONAL PRODUCT DISCLOSURE ACKNOWLEDGEMENT
I,
, acknowledge that I have been advised of and understand the
disclosures below. I have been encouraged to ask any questions that I have concerning these disclosures. I have applied to purchase from one of the State Farm Life insurance companies the following product:
Universal Life
. I understand that the life companies are affiliated
with State Farm Bank, but that the product offered is not being offered by the Bank. If anyone asserts that this product is federally insured or guaranteed, or is as safe as an insured deposit, I should call the Office of Thrift Supervision Regional Director at (404) 888-0771.
I understand that the insurance product I am purchasing: *
IS NOT INSURED BY THE FDIC;
*
IS NOT A DEPOSIT OR OTHER OBLIGATION OF ANY BANK AND IS NOT GUARANTEED BY THE BANK OR BY THE FEDERAL GOVERNMENT;
*
INVOLVES INVESTMENT RISKS, INCLUDING POSSIBLE LOSS OF PRINCIPAL INVESTED.
Dated
Signature of Customer
Signature of Agent
Issued By: State Farm Life Insurance Company (Not licensed in New York or Wisconsin) State Farm Life and Accident Assurance Company (Licensed in New York and Wisconsin) Home Offices: Bloomington, IL
THIS IS AN ILLUSTRATION ONLY. AN ILLUSTRATION IS NOT INTENDED TO PREDICT ACTUAL PERFORMANCE. INTEREST RATES, DIVIDENDS, AND VALUES SET FORTH IN THE ILLUSTRATION ARE NOT GUARANTEED, EXCEPT FOR THOSE ITEMS CLEARLY LABELED AS GUARANTEED.
Life Insurance Illustration
Plan: Insured: Premium Class: Initial Basic Amount: Death Benefit: Premium Mode:
Universal Life Date: Joe Sample Prepared by: Male, Age 0 Agency: Juvenile $3,000,000 Option 1 - Death Benefit Remains Level License No: Phone No: Fax No: Special Monthly
November 9, 2009 Jake Stewart State Farm Insurance 821 Folsom St, Suite 101 San Francisco, CA 94107 0E85157 (415)982-9033 (415)982-3905
This illustration was produced to be used in California.
Summary of Illustrated Coverages and Premium Benefits and Riders:
$3,000,000 Universal Life Waiver of Monthly Deduction for Disability
The total first year premium outlay illustrated is $6,987.12. The initial premium is $582.26 each month. Please review this illustration for additional changes in illustrated premiums and coverages in years 2 and later.
Description of Coverage Plan
Universal Life (Form Number 08030 - 05) is a flexible premium adjustable life insurance policy. A death benefit is payable when the Insured dies. Flexible premiums are payable to the Insured's age 121.
How This Plan Works
You start with a planned premium and death benefit. You may change either in the future subject to policy provisions. When you pay premiums, we deduct a 5% premium charge. The remaining premium is added to the account value. From this account value we deduct each month: (A) the current cost of insurance including the charges for any riders, and (B) a current monthly expense charge of $8.00. During each of the first 24 months following issue or an increase, an issue charge will be deducted from the account value. The issue charge is $0.10 per $1000 of the initial Basic Amount and each increase, each subject to a maximum of $50.00 per month. The account value earns interest at the current interest rate, but a different rate may be credited to any account value which you have borrowed. The current interest rate is increased by 0.50% on the unloaned account value that exceeds 10% of the Basic Amount. Surrender charges apply. The current monthly cost of insurance rates and monthly expense charge may be changed by the company at any time, but will never be more than the maximums given in the policy. The maximum monthly expense charge is $8.00 in policy years one through five, and $10.00 thereafter. The current interest rate can be changed by the company on a monthly basis, but will never be less than the guaranteed rate of 4%. This policy is participating, but no dividends are anticipated.
Important Tax Information
This policy complies with the definition of life insurance in Internal Revenue Code Section 7702. This means that the premium illustrated does not exceed the greater of the Guideline Single Premium or the cumulative Guideline Annual Premium. Payment of the guideline annual premium will not provide coverage to age 121 under the contract, on the guaranteed basis. This illustration should not be relied on for tax advice. The tax status of this policy should be reviewed with the policyowner's legal and tax advisors. Guideline Single Premium at issue: $73,131 Guideline Annual Premium at issue: $8,529
UL001 (07/2008)
State Farm Life Insurance Company One State Farm Plaza Bloomington, IL 61710
Page 1 of 8
Life Insurance Illustration
Plan: Insured: Premium Class:
Universal Life Joe Sample Male, Age 0 Juvenile
Initial Basic Amount: Death Benefit: Premium Mode:
$3,000,000 Option 1 Special Monthly
Description of Coverage If at any time during the first 7 years, the total premiums paid exceed the MEC Reference Premium shown below times the number of years the policy has been in force, the policy will be considered a Modified Endowment Contract. This means distributions, which include cash withdrawals, policy loans, and assignments may be subject to Federal Income Tax to the extent there is a gain in the contract. An additional 10% penalty tax may also apply prior to the policyowner's age 59 1/2. Increases in coverages will require a new premium test with a new 7 year test period. Reductions in coverages during a 7 year test period will generally result in a lower MEC Reference Premium retroactive to the beginning of the 7 year test period. Planned premiums after the 1st year shown on this illustration have not been checked to determine if the MEC Reference Premium limit has been exceeded. MEC Reference Premium at issue: $31,080 Waiver of Monthly Deduction for Disability
This rider (Form Number 08206 - 05) provides for the waiver of all monthly deductions so long as the Insured is totally disabled as defined in the policy.
Definitions Juvenile
Basic Amount
Available for ages 0 through 19. Insurance costs used in this illustration assume that the Insured qualifies for Non-Tobacco rates beginning with the first renewal date on or after age 20. To receive these Non-Tobacco rates, the owner must apply and the Insured be approved for the Non-Tobacco classification. The Initial Basic Amount plus any increases less any decreases.
Monthly Deductions
The sum of the monthly cost of insurance charges, the monthly expense charge, the issue charge, and charges for any riders.
Guaranteed Values
These values are calculated using the illustrated premiums, 5% premium expense charge, guaranteed interest rate of 4% and the maximum monthly deductions.
Non-Guaranteed Intermediate Values
These values are calculated using the illustrated premiums, 5% premium expense charge, average of the illustrated and guaranteed interest rates, and the average of the current and maximum monthly deductions. The intermediate values are not guaranteed. They demonstrate the impact of changes in company experience.
Non-Guaranteed Illustrated Values
These values are calculated using the illustrated premiums, 5% premium expense charge, illustrated interest rates, and current monthly deductions. The illustrated interest rate has been increased by 0.50% on the unloaned account value that exceeds 10% of the Basic Amount. These values are not guaranteed.
Annualized Premium Outlay Total Annualized Premium Outlay
UL001 (07/2008)
The actual cash outlay each year. The sum of each year's annualized premium outlay. State Farm Life Insurance Company One State Farm Plaza, Bloomington, IL 61710
Page 2 of 8
Life Insurance Illustration
Plan: Insured: Premium Class:
Universal Life Joe Sample Male, Age 0 Juvenile
Initial Basic Amount: Death Benefit: Premium Mode:
$3,000,000 Option 1 Special Monthly
Definitions Account Value Cash Surrender Value Death Benefit
Option 1
This is the accumulation of premiums shown less a 5% expense charge and monthly deductions. This value is the account value less the applicable surrender charge. Surrender charges apply for 15 policy years following issue or an increase in the Basic Amount of insurance. This is the amount payable at the death of the Insured. Any increase or decrease must be approved by the Company, subject to policy provisions. Future increases are illustrated using the premium class of the base policy, subject to the minimum amount requirements as of the date of the illustration. Under Option 1, the death benefit is the Basic Amount of insurance. The death benefit may be increased due to Internal Revenue Code provisions. Changes in the Death Benefit Option can result in the Basic Amount being lowered below the Policy's Minimum Basic Amount. In these cases, the Minimum Basic Amount stated in the policy will be amended to reflect a reduced Minimum Basic Amount.
This illustration assumes that the currently illustrated non-guaranteed elements will continue unchanged for all years shown. This is not likely to occur, and actual results may be more or less favorable than those shown. The assumptions on which they are based are subject to change by the Company. Cash values and death benefits shown are end of year values. Premiums are assumed to be paid when due. This illustration contains a general description of coverage. A complete statement of coverage is found in the policy.
Interest Adjusted Cost Indices at 5.00% Guaranteed
Illustrated
10 Year
20 Year
10 Year
20 Year
Surrender Cost Index
0.59
0.73
0.49
0.53
Net Payment Index
2.21
2.20
2.21
2.20
Equivalent Level Annual Dividend
N/A
N/A
N/A
N/A
These indices are computed by the formulas prescribed by the National Association of Insurance Commissioners and reflect the time value of money at 5%. These indices do not include the cost of additional benefits.
Not FDIC Insured
UL001 (07/2008)
- No Bank Guarantee - May Lose Value
State Farm Life Insurance Company One State Farm Plaza, Bloomington, IL 61710
Page 3 of 8
Life Insurance Illustration
Plan: Insured: Premium Class:
Universal Life Joe Sample Male, Age 0 Juvenile
Initial Basic Amount: Death Benefit: Premium Mode:
Guaranteed and Non-Guaranteed Values
End of Year Age
$3,000,000 Option 1 Special Monthly
Non-Guaranteed
Guaranteed Values
Intermediate Values
Illustrated Values
Guaranteed Interest Rate: 4.00%
Interest Rate: 4.50%
Interest Rate: 5.00%
Annualized Premium Outlay
Cash Surrender Value
Death Benefit
Cash Surrender Value
Death Benefit
Cash Surrender Value
Death Benefit
5
5
6,540
26,341
3,000,000
26,799
3,000,000
27,283
3,000,000
10
10
6,540
64,346
3,000,000
66,336
3,000,000
68,430
3,000,000
20
20
6,540
152,642
3,000,000
162,833
3,000,000
173,800
3,000,000
65
65
6,540
815,551
3,000,000
1,366,354
3,000,000
2,115,241
3,000,000
70
70
6,540
769,624
3,000,000
1,601,268
3,000,000
2,741,402
3,180,026
80
80
6,540
0**
0**
2,087,172
3,000,000
4,645,050
4,877,302
85
85
6,540
0
0
2,315,263
3,000,000
6,010,233
6,310,744
**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis.
I have received a copy of this illustration and understand that any non-guaranteed elements illustrated are subject to change and could be either higher or lower. The agent has told me they are not guaranteed.
Applicant
Date
I certify that this illustration has been presented to the applicant and that I have explained that any non-guaranteed elements illustrated are subject to change. I have made no statements that are inconsistent with the illustration.
Agent
UL001 (07/2008)
Date
State Farm Life Insurance Company One State Farm Plaza, Bloomington, IL 61710
Page 4 of 8
Life Insurance Illustration
Plan: Insured: Premium Class:
Universal Life Joe Sample Male, Age 0 Juvenile
Initial Basic Amount: Death Benefit: Premium Mode:
$3,000,000 Option 1 Special Monthly
Guaranteed and Non-Guaranteed Values Guaranteed Values Guaranteed Interest 4.00% Total End Annualized Annualized of Premium Premium Year Age Outlay Outlay
Non-Guaranteed Illustrated Values Illustrated Interest 5.00%
Account Value
Cash Surrender Value
Death Benefit
Account Value
Cash Surrender Value
Death Benefit
1 2 3 4 5
1 2 3 4 5
6,987 6,987 6,540 6,540 6,540
6,987 13,974 20,514 27,054 33,594
5,420 11,058 17,106 23,397 29,941
3,620 7,458 13,506 19,797 26,341
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
5,482 11,239 17,469 24,012 30,883
3,682 7,639 13,869 20,412 27,283
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
6 7 8 9 10
6 7 8 9 10
6,540 6,540 6,540 6,540 6,540
40,134 46,674 53,214 59,754 66,294
36,718 43,738 51,041 58,637 66,506
33,118 40,498 48,161 56,117 64,346
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
38,094 45,638 53,561 61,881 70,590
34,494 42,398 50,681 59,361 68,430
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
11 12 13 14 15
11 12 13 14 15
6,540 6,540 6,540 6,540 6,540
72,834 79,374 85,914 92,454 98,994
74,663 83,028 91,551 100,237 108,915
72,863 81,588 90,471 99,517 108,555
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
79,707 89,170 98,935 109,022 119,276
77,907 87,730 97,855 108,302 118,916
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
16 17 18 19 20
16 17 18 19 20
6,540 6,540 6,540 6,540 6,540
105,534 112,074 118,614 125,154 131,694
117,527 126,133 134,763 143,567 152,642
117,527 126,133 134,763 143,567 152,642
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
129,647 140,204 150,987 162,153 173,800
129,647 140,204 150,987 162,153 173,800
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
21 22 23 24 25
21 22 23 24 25
6,540 6,540 6,540 6,540 6,540
138,234 144,774 151,314 157,854 164,394
162,027 171,765 181,873 192,333 203,161
162,027 171,765 181,873 192,333 203,161
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
186,123 199,071 212,677 226,946 241,908
186,123 199,071 212,677 226,946 241,908
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
26 27 28 29 30
26 27 28 29 30
6,540 6,540 6,540 6,540 6,540
170,934 177,474 184,014 190,554 197,094
214,344 225,840 237,721 250,120 263,054
214,344 225,840 237,721 250,120 263,054
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
257,551 273,988 291,258 309,414 328,569
257,551 273,988 291,258 309,414 328,569
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
31 32 33 34 35
31 32 33 34 35
6,540 6,540 6,540 6,540 6,540
203,634 210,174 216,714 223,254 229,794
276,545 290,618 305,234 320,390 336,078
276,545 290,618 305,234 320,390 336,078
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
348,790 370,131 392,636 416,320 441,273
348,790 370,131 392,636 416,320 441,273
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis. These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.
UL001 (07/2008)
State Farm Life Insurance Company One State Farm Plaza, Bloomington, IL 61710
Page 5 of 8
Life Insurance Illustration
Plan: Insured: Premium Class:
Universal Life Joe Sample Male, Age 0 Juvenile
Initial Basic Amount: Death Benefit: Premium Mode:
$3,000,000 Option 1 Special Monthly
Guaranteed and Non-Guaranteed Values Guaranteed Values Guaranteed Interest 4.00% Total End Annualized Annualized of Premium Premium Year Age Outlay Outlay
Non-Guaranteed Illustrated Values Illustrated Interest 5.00%
Account Value
Cash Surrender Value
Death Benefit
Account Value
Cash Surrender Value
Death Benefit
36 37 38 39 40
36 37 38 39 40
6,540 6,540 6,540 6,540 6,540
236,334 242,874 249,414 255,954 262,494
352,261 368,906 386,003 403,516 421,468
352,261 368,906 386,003 403,516 421,468
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
467,486 495,032 523,940 554,236 586,032
467,486 495,032 523,940 554,236 586,032
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
41 42 43 44 45
41 42 43 44 45
6,540 6,540 6,540 6,540 6,540
269,034 275,574 282,114 288,654 295,194
439,793 458,457 477,397 496,522 515,756
439,793 458,457 477,397 496,522 515,756
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
619,337 654,201 690,641 728,694 768,463
619,337 654,201 690,641 728,694 768,463
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
46 47 48 49 50
46 47 48 49 50
6,540 6,540 6,540 6,540 6,540
301,734 308,274 314,814 321,354 327,894
535,098 554,524 574,122 594,021 614,097
535,098 554,524 574,122 594,021 614,097
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
810,116 853,729 899,372 947,171 997,231
810,116 853,729 899,372 947,171 997,231
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
51 52 53 54 55
51 52 53 54 55
6,540 6,540 6,540 6,540 6,540
334,434 340,974 347,514 354,054 360,594
634,232 654,207 673,760 692,631 710,414
634,232 654,207 673,760 692,631 710,414
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
1,049,632 1,104,481 1,161,857 1,221,807 1,284,449
1,049,632 1,104,481 1,161,857 1,221,807 1,284,449
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
56 57 58 59 60
56 57 58 59 60
6,540 6,540 6,540 6,540 6,540
367,134 373,674 380,214 386,754 393,294
726,713 741,333 754,252 765,240 772,838
726,713 741,333 754,252 765,240 772,838
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
1,349,801 1,418,093 1,489,529 1,564,195 1,641,848
1,349,801 1,418,093 1,489,529 1,564,195 1,641,848
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
61 62 63 64 65
61 62 63 64 65
6,540 6,540 6,540 6,540 6,540
399,834 406,374 412,914 419,454 425,994
786,355 797,844 806,767 812,778 815,551
786,355 797,844 806,767 812,778 815,551
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
1,727,031 1,816,641 1,910,964 2,010,351 2,115,241
1,727,031 1,816,641 1,910,964 2,010,351 2,115,241
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
66 67 68 69 70
66 67 68 69 70
6,540 6,540 6,540 6,540 6,540
432,534 439,074 445,614 452,154 458,694
814,810 810,321 801,672 788,359 769,624
814,810 810,321 801,672 788,359 769,624
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
2,226,146 2,343,630 2,468,396 2,601,188 2,741,402
2,226,146 2,343,630 2,468,396 2,601,188 2,741,402
3,000,000 3,000,000 3,000,000 3,043,389 3,180,026
**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis. These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.
UL001 (07/2008)
State Farm Life Insurance Company One State Farm Plaza, Bloomington, IL 61710
Page 6 of 8
Life Insurance Illustration
Plan: Insured: Premium Class:
Universal Life Joe Sample Male, Age 0 Juvenile
Initial Basic Amount: Death Benefit: Premium Mode:
$3,000,000 Option 1 Special Monthly
Guaranteed and Non-Guaranteed Values Non-Guaranteed Illustrated Values Illustrated Interest 5.00%
Guaranteed Values Guaranteed Interest 4.00% Total End Annualized Annualized of Premium Premium Year Age Outlay Outlay
Account Value
Cash Surrender Value
Death Benefit
Account Value
Cash Surrender Value
Death Benefit
71 72 73 74 75
71 72 73 74 75
6,540 6,540 6,540 6,540 6,540
465,234 471,774 478,314 484,854 491,394
744,309 710,571 666,448 610,439 540,487
744,309 710,571 666,448 610,439 540,487
3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
2,888,635 3,043,842 3,207,689 3,381,054 3,564,864
2,888,635 3,043,842 3,207,689 3,381,054 3,564,864
3,321,930 3,439,541 3,560,535 3,685,348 3,814,405
76 77 78 79 80
76 77 78 79 80
6,540 6,540 6,540 6,540 6,540
497,934 504,474 511,014 517,554 524,094
453,885 346,942 214,428 49,558 0**
453,885 346,942 214,428 49,558 0**
3,000,000 3,000,000 3,000,000 3,000,000 0**
3,760,172 3,965,439 4,181,107 4,407,515 4,645,050
3,760,172 3,965,439 4,181,107 4,407,515 4,645,050
3,948,181 4,163,710 4,390,162 4,627,890 4,877,302
81 82 83 84 85
81 82 83 84 85
6,540 6,540 6,540 6,540 6,540
530,634 537,174 543,714 550,254 556,794
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
4,894,082 5,154,866 5,427,677 5,712,741 6,010,233
4,894,082 5,154,866 5,427,677 5,712,741 6,010,233
5,138,786 5,412,609 5,699,061 5,998,378 6,310,744
86 87 88 89 90
86 87 88 89 90
6,540 6,540 6,540 6,540 6,540
563,334 569,874 576,414 582,954 589,494
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
6,320,276 6,642,973 6,978,468 7,326,918 7,688,026
6,320,276 6,642,973 6,978,468 7,326,918 7,688,026
6,636,289 6,975,121 7,327,391 7,693,264 8,072,427
91 92 93 94 95
91 92 93 94 95
6,540 6,540 6,540 6,540 6,540
596,034 602,574 609,114 615,654 622,194
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8,061,747 8,461,210 8,890,319 9,354,805 9,860,755
8,061,747 8,461,210 8,890,319 9,354,805 9,860,755
8,464,834 8,799,658 9,157,028 9,541,901 9,959,362
96 96 97 97 98 98 99 99 100 100
6,540 6,540 6,540 6,540 6,540
628,734 635,274 641,814 648,354 654,894
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
10,407,927 10,985,194 11,594,210 12,236,723 12,914,573
10,407,927 10,985,194 11,594,210 12,236,723 12,914,573
10,407,927 10,985,194 11,594,210 12,236,723 12,914,573
101 102 103 104 105
6,540 6,540 6,540 6,540 6,540
661,434 667,974 674,514 681,054 687,594
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
13,629,705 14,384,170 15,180,130 16,019,868 16,905,792
13,629,705 14,384,170 15,180,130 16,019,868 16,905,792
13,629,705 14,384,170 15,180,130 16,019,868 16,905,792
101 102 103 104 105
**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis. These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.
UL001 (07/2008)
State Farm Life Insurance Company One State Farm Plaza, Bloomington, IL 61710
Page 7 of 8
Life Insurance Illustration
Plan: Insured: Premium Class:
Universal Life Joe Sample Male, Age 0 Juvenile
Initial Basic Amount: Death Benefit: Premium Mode:
$3,000,000 Option 1 Special Monthly
Guaranteed and Non-Guaranteed Values Non-Guaranteed Illustrated Values Illustrated Interest 5.00%
Guaranteed Values Guaranteed Interest 4.00% Total End Annualized Annualized of Premium Premium Year Age Outlay Outlay
Account Value
Cash Surrender Value
Death Benefit
Account Value
Cash Surrender Value
Death Benefit
106 107 108 109 110
106 107 108 109 110
6,540 6,540 6,540 6,540 6,540
694,134 700,674 707,214 713,754 720,294
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
17,840,441 18,826,497 19,866,785 20,964,289 22,122,156
17,840,441 18,826,497 19,866,785 20,964,289 22,122,156
17,840,441 18,826,497 19,866,785 20,964,289 22,122,156
111 112 113 114 115
111 112 113 114 115
6,540 6,540 6,540 6,540 6,540
726,834 733,374 739,914 746,454 752,994
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23,343,705 24,632,440 25,992,055 27,426,449 28,939,735
23,343,705 24,632,440 25,992,055 27,426,449 28,939,735
23,343,705 24,632,440 25,992,055 27,426,449 28,939,735
116 117 118 119 120
116 117 118 119 120
6,540 6,540 6,540 6,540 6,540
759,534 766,074 772,614 779,154 785,694
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
30,536,251 32,220,576 33,997,539 35,872,235 37,850,039
30,536,251 32,220,576 33,997,539 35,872,235 37,850,039
30,536,251 32,220,576 33,997,539 35,872,235 37,850,039
121 121
6,540
792,234
0
0
0
39,936,622
39,936,622
39,936,622
**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis. These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.
UL001 (07/2008)
State Farm Life Insurance Company One State Farm Plaza, Bloomington, IL 61710
Page 8 of 8
TRADITIONAL PRODUCT DISCLOSURE ACKNOWLEDGEMENT
I,
, acknowledge that I have been advised of and understand the
disclosures below. I have been encouraged to ask any questions that I have concerning these disclosures. I have applied to purchase from one of the State Farm Life insurance companies the following product:
Universal Life
. I understand that the life companies are affiliated
with State Farm Bank, but that the product offered is not being offered by the Bank. If anyone asserts that this product is federally insured or guaranteed, or is as safe as an insured deposit, I should call the Office of Thrift Supervision Regional Director at (404) 888-0771.
I understand that the insurance product I am purchasing: *
IS NOT INSURED BY THE FDIC;
*
IS NOT A DEPOSIT OR OTHER OBLIGATION OF ANY BANK AND IS NOT GUARANTEED BY THE BANK OR BY THE FEDERAL GOVERNMENT;
*
INVOLVES INVESTMENT RISKS, INCLUDING POSSIBLE LOSS OF PRINCIPAL INVESTED.
Dated
Signature of Customer
Signature of Agent
Issued By: State Farm Life Insurance Company (Not licensed in New York or Wisconsin) State Farm Life and Accident Assurance Company (Licensed in New York and Wisconsin) Home Offices: Bloomington, IL
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