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LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. Easy Choice Whole Life

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Page 1: LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. · LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. ... SIMPLIFIED ISSUE APPLICATION FOR INDIVIDUAL LIFE INSURANCE EMC NATIONAL LIFE COMPANY

LEGACY PLANNING. SIMPLE SOLUTION.EASY CHOICE.

Easy Choice Whole Life

Page 2: LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. · LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. ... SIMPLIFIED ISSUE APPLICATION FOR INDIVIDUAL LIFE INSURANCE EMC NATIONAL LIFE COMPANY

“...DESIGNEDTO KEEP THINGS

SIMPLE.”

Page 3: LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. · LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. ... SIMPLIFIED ISSUE APPLICATION FOR INDIVIDUAL LIFE INSURANCE EMC NATIONAL LIFE COMPANY

THE POWER OF PEACE OF MIND

Planning for final expenses, covering debts and leaving a legacy are stressful decisions many people avoid. However, making choices about these matters does not have to be difficult. EMC National Life has a simple solution–Easy Choice Whole Life. Many people believe that obtaining life insurance becomes more difficult as they get older. While that may be the case for other insurance products, Easy Choice Whole Life is designed to keep things simple.

Easy Choice Whole Life does not require a medical exam. The process is easy; your client completes a basic application and, if he or she qualifies, coverage will be swiftly issued. This policy provides a guaranteed death benefit and guaranteed cash values. By selecting a coverage amount that meets your client’s planning needs, Easy Choice Whole Life will give your client peace of mind that his or her obligations have been met.

Affordable Protection

for Long-Term Needs:

Final expenses

Lifetime protection (if all premiums are paid)

Builds cash value that can be used as an emergency fund

Options for the future (surrender value or reduced paid-up insurance)

PolicyHighlights:

No medical exams

Simplified underwriting

Short form application

Issue ages 18-80

Benefit amounts from $5,000 - $50,000*

Guaranteed cash values, level death benefit and level premiums

Accelerated Death Benefit and Seat Belt Benefit Riders included, in states where approved, at no additional cost

*Maximum benefit amount varies by issue age

Page 4: LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. · LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. ... SIMPLIFIED ISSUE APPLICATION FOR INDIVIDUAL LIFE INSURANCE EMC NATIONAL LIFE COMPANY

Annual Rates per $1,000

Issue Age

Male Nonsmoker

Male Smoker

Female Nonsmoker

Female Smoker

Issue Age

Male Nonsmoker

Male Smoker

Female Nonsmoker

Female Smoker

18 2.89 4.59 2.17 3.44 51 26.60 41.61 19.62 30.51

19 2.89 4.59 2.17 3.44 52 28.03 43.80 20.52 31.94

20 2.89 4.59 2.17 3.44 53 29.45 46.08 21.51 33.41

21 2.89 4.59 2.17 3.44 54 30.88 48.40 22.57 34.94

22 2.89 4.59 2.17 3.44 55 32.40 50.84 23.69 36.53

23 2.89 4.59 2.17 3.44 56 33.95 53.30 24.87 38.26

24 2.89 4.59 2.17 3.44 57 35.54 55.77 26.11 40.07

25 2.89 4.59 2.17 3.44 58 37.19 58.37 27.40 41.97

26 3.01 4.77 2.26 3.58 59 38.96 61.23 28.76 43.96

27 3.21 5.09 2.41 3.82 60 40.89 64.49 30.16 46.02

28 3.48 5.53 2.61 4.15 61 42.92 68.05 31.60 48.10

29 3.75 5.96 2.81 4.47 62 45.04 71.83 33.07 50.20

30 4.03 6.40 3.02 4.80 63 47.30 75.95 34.61 52.41

31 4.24 6.73 3.18 5.05 64 49.80 80.57 36.24 54.83

32 4.54 7.20 3.41 5.40 65 52.60 85.79 38.02 57.55

33 5.00 7.93 3.75 5.95 66 55.72 91.60 39.89 60.47

34 5.52 8.76 4.14 6.57 67 59.09 97.92 41.84 63.53

35 6.11 9.70 4.58 7.28 68 62.72 104.78 43.92 66.87

36 6.71 10.65 5.03 7.99 69 66.59 112.19 46.20 70.65

37 7.45 11.82 5.59 8.87 70 70.68 120.18 48.74 75.00

38 8.36 13.27 6.27 9.95 71 74.96 128.60 51.51 79.86

39 9.39 14.90 7.04 11.18 72 79.44 137.45 54.49 85.13

40 10.57 16.77 7.93 12.58 73 84.17 146.94 57.69 90.91

41 11.93 18.93 8.95 14.20 74 89.21 157.28 61.16 97.31

42 13.21 20.97 9.91 15.73 75 94.62 168.72 64.92 104.45

43 14.39 22.84 10.79 17.13 76 100.36 181.13 68.96 112.27

44 15.69 24.90 11.77 18.68 77 106.38 194.36 73.25 120.68

45 17.09 27.12 12.82 20.34 78 112.76 208.59 77.81 129.79

46 18.55 29.45 13.91 22.09 79 119.55 223.98 82.69 139.68

47 20.17 32.01 15.13 24.01 80 126.83 240.73 87.92 150.43

48 21.93 34.81 16.45 26.11

49 23.69 37.60 17.77 28.20

50 25.23 39.51 18.75 29.13

EASY CHOICE WHOLE LIFE PREMIUMS- ADD $20 POLICY FEE

40-Year-Old, Female, Nonsmoker, $25,000 Benefit Amount

$7.93 x 25 + $20 = $218.25 Annual Premium

Annual Premium x Mode Factor = Mode Premium

$218.25 x .089 = $19.42 monthly

$218.25 x .265 = $57.84 quarterly

$218.25 x .52 = $113.49 semiannually

Example:

Maximum Benefit Amount Based On Issue Age

Ages 18-50 $50,000 maximum benefitAges 51-80 $25,000 maximum benefit Maximum benefit amount varies when applying for multiple products or policies

Page 5: LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. · LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. ... SIMPLIFIED ISSUE APPLICATION FOR INDIVIDUAL LIFE INSURANCE EMC NATIONAL LIFE COMPANY

ICC14EAP064 (4-14) Page 1 of 2

SIMPLIFIED ISSUE APPLICATION FOR INDIVIDUAL LIFE INSURANCE EMC NATIONAL LIFE COMPANY PO Box 9144 Des Moines, Iowa 50306-9144

7. PREMIUM OPTIONS

Mode: qPlanned Premium $ qAnnual qSemiannual qQuarterly qMonthly (not available on Direct Bill)

Form: qCheck Plan qDirect Bill qList Bill qABS#___________

1. PROPOSED INSURED First Name Middle Name Last Name Social Security Number

Mailing Address qFemale Date of Birth Age qMale

City State Zip + 4 Digit Telephone Number

Are you a U.S. citizen? qYes qNo If no, provide details on a separate sheet and send copy of permanent resident visa card.

2. BENEFICIARY INFORMATION

Name (First, M.I., Last) Date of Birth Social Security Number Relationship %

Primary Contingent

( )

6. AMOUNT OF INSURANCE

q5-Year Term: $ ($5,000 - $100,000 Ages 18-50) ($5,000 - $50,000 Ages 51-70)

qLevel Whole Life: $ ($5,000 - $50,000 Ages 18-50) ($5,000 - $25,000 Ages 51-80)

Have you smoked one or more cigarettes within the last 12 months? qYes qNo

5. ADDITIONAL PERSON TO RECEIVE LAPSE NOTIFICATION (if desired)

Full Name Address / City / State / Zip Relationship

4. PAYOR (specify one) qInsured qOwner qOther

If Other, provide: Full Name Address / City / State / Zip Relationship

PRINT IN BLACK INK

8. LIFE INSURANCE / ANNUITIES IN FORCE (List below, including any existing EMCNL policies.) q Check if none in force.

Person Insured Company Policy Number Life Amount ADB To Be Replaced q Yes q No

q Yes q No

Is this policy being purchased to replace any existing life insurance policy or annuity contract? q Yes q No Replacement forms may need to be completed and sent with the application as required by your state.

3. OWNER (if other than Insured)

Full Name Address / City / State / Zip Social Security # Date of Birth Relationship

Page 6: LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. · LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. ... SIMPLIFIED ISSUE APPLICATION FOR INDIVIDUAL LIFE INSURANCE EMC NATIONAL LIFE COMPANY

ICC14EAP064 (4-14) Page 2 of 2

ANY “YES” RESPONSE WILL AUTOMATICALLY MAKE THE PROPOSED INSURED INELIGIBLE FOR COVERAGE UNDER THIS APPLICATION; A FULLY UNDERWRITTEN APPLICATION WOULD NEED TO BE COMPLETED FOR ADDITIONAL UNDERWRITING CONSIDERATION.

A. Within the past 10 years, have you been diagnosed, treated or tested positive for or been given medical advice by a member of the medical profession for: Yes No

(1) Cancer (except basal skin cancer), disease or disorder of the heart, coronary arteries or heart valves, diabetes or stroke? .......................................................................................................................................... q q

(2) Any chronic or progressive disease of the (a) kidneys, (b) liver, (c) lung (exclude asthma with less than weekly episodes), (d) pancreas, (e) bone marrow or (f) stomach or intestines?............................................. q q

(3) Any brain, nervous system or neuromuscular disease, connective tissue disorders, permanent memory loss, intellectual disability, bipolar disorder or schizophrenia? ........................................................................ q q

(4) Human Immunodeficiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC)? ...................................................................................................................... q q

B. Within the past 5 years, have you: (1) Been advised by a member of the medical profession to get specified medical care which was

not completed, such as any hospitalization, surgery or diagnostic tests, except those tests related to the Human Immunodeficiency Virus (AIDS Virus)?..................................................................................... q q

(2) Applied for life insurance which was declined? ............................................................................................... q q

10.

STATEMENTS AND AGREEMENTS I understand all of the questions that I have read on this application, and that all the statements and answers herein are true and complete to the best of my knowledge and belief. I agree that this application will be the basis for, and will become part of, any policy that is issued by EMC National Life Company (the Company) and that no information about me will be considered to have been given to the Company unless it is stated in the application. I agree that the information on this application will be relied on to determine insurability and that incorrect or untrue information may result in coverage being voided, subject to the incontestability provision in the policy. I understand that the agent has no authority to approve the application, change the policy or waive any policy provisions. I agree that the requested insurance will start upon the date of this application only if: (a) the first premium is paid in full while I am alive and in the same health as described above; and (b) all questions under 10A and 10B are answered “No,” and my health is as described in this application. Otherwise, the insurance will not take effect until a policy is issued by the Company and the first premium is paid. Should the application be declined, the amount paid will be refunded.

FRAUD NOTICE / WARNINGAny person who knowingly submits a false statement in an application or files a claim containing false or deceptive statements may be guilty of insurance fraud and subject to penalties under state law.

XProposed Insured’s Signature Signed at City / State Date

XProposed Owner’s Signature (if other than Insured)

9. ADDITIONAL INFORMATION

11.

REQUIRED AGENT’S REPORT Yes NoA. Have you seen the person proposed for coverage? ................................................................................................ q q If not, please explain. _______________________________________________________________________B. Have you accurately recorded information given to you by the person proposed for coverage? ............................... q qC. To the best of your knowledge, will the insurance applied for replace any existing annuity / life policy(ies)? ......... q qD. As applicable, have you given to the applicant disclosure / replacement notices as required by your state? ......... q q I certify that I have verified the personal information of the applicant by viewing state issued driver’s license or other government issued picture I.D. card. I further certify that the proposed insured appeared to me to be lucid and able to fully understand all of the questions on this application.

XAgent’s Signature (witness) Agent’s Printed Name Date Agent’s Contract Number

12.

Page 7: LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. · LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. ... SIMPLIFIED ISSUE APPLICATION FOR INDIVIDUAL LIFE INSURANCE EMC NATIONAL LIFE COMPANY

LP623 (7-03) Easy Choice Page 1 of 2Easy Choice

1. Do you (applicant) have any existing Life Insurance policies or Annuity contracts in force? G G (Please sign and date below.)

_______________________________________ _____________________________________ Applicant Signature Date Agent Signature Date

2. If you answered NO, the remainder of this form does not apply to you or your agent, but your agent is required to submit this form to EMC National Life Company with your application.

3. If you answered YES, your agent must present the following IMPORTANT NOTICE to you, not later than at the time of taking your application, and unless you indicate below, must read it aloud to you.

I do not want this NOTICE read aloud to me. _______ (Applicant must initial only if they do not want the notice read aloud.)

IMPORTANT NOTICE CONCERNING REPLACEMENT OF LIFE INSURANCE OR ANNUITIES

This document must be signed by the applicant and agent, and a copy must be left with the applicant.

You are contemplating the purchase of a life insurance policy or annuity contract. In some cases this purchase may involve discontinuing or changing an existing policy or contract. If so, a replacement is occurring. A replacement occurs when a new policy or contract is purchased and, in connection with the sale, you discontinue making premium payments on the existing policy or contract, or an existing policy or contract is surrendered, forfeited, assigned to the replacing insurer, or otherwise terminated.

Financed purchases are also considered replacements. A financed purchase occurs when the purchase of a new life insurance policy involves the use of funds obtained by the withdrawal or surrender of or borrowing some or all of the policy values, including accumulated dividends, of an existing policy, to pay all or part of any premium or payment due on the new policy. A financed purchase will reduce the value of your existing policy and may reduce the amount paid upon death of the insured.

You should carefully consider whether a replacement is in your best interest. You will pay acquisition costs and there may be surrender costs deducted from your policy or contract. You may be able to make changes to your existing policy or contract to meet your insurance needs at less cost.

We want you to understand the effects of replacements before you make your purchase decision and ask that you answer the following questions and consider the questions on the back page of this form. (1) Are you considering discontinuing making premium payments, surrendering, forfeiting, assigning to the insurer, or otherwise terminating your existing policy or contract? G YES G NO; (2) Are you considering using funds from your existing policies or contracts to pay premiums due on the new policy or contract? G YES G NO; If you answered “YES” to either of these questions, list below each existing policy or contract you are contemplating replacing.

Indicate whether each policy will be replaced or used as a source of financing:

Name Company Name and Address Contract/Policy # Replaced Financing

1. __________________________________________________________________________ G G

2. __________________________________________________________________________ G G

3. __________________________________________________________________________ G G

Reason for replacement _______________________________________________________________________________

_________________________________________________________________________________________________

YES NO

PO Box 9144Des Moines, IA 50306-9144800-232-5818

www.EMCNationalLife.com

Page 8: LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. · LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. ... SIMPLIFIED ISSUE APPLICATION FOR INDIVIDUAL LIFE INSURANCE EMC NATIONAL LIFE COMPANY

Easy ChoiceLP623 (7-03) Easy Choice Page 2 of 2

Make sure you know the facts. A replacement may not be in your best interest, or your decision could be a good one. You should make a careful comparison of the costs and benefits of your existing policy or contract and the proposed policy or contract. One way to do this is to ask the company or agent that sold you your existing policy or contract to provide you with information concerning your existing policy or contract. This may include an illustration of how your existing policy or contract is working now and how it would perform in the future based on certain assumptions. Illustrations should not, however, be used as a sole basis to compare policies or contracts. [If you request one, an in-force illustration, policy summary or available disclosure documents must be sent to you by the existing insurer]. Ask for and retain all sales material used by the agent in the sales presentation. Be sure that you are making an informed decision. You should discuss the following with your agent to determine whether replacement or financing your purchase makes sense.

PREMIUMS: Are they affordable and could they change? Since you are older, are the premiums higher for the proposed new policy? How long will you have to pay premiums on the new policy and on the old policy?

POLICY VALUES: New policies usually take longer to build cash values and to pay dividends and acquisition costs for the old policy may have been paid. What costs will you incur for the new policy? What surrender charges do the policies have? What expense and sales charges will you pay on the new policy? Does the new policy provide more insurance coverage?

INSURABILITY: If your health has changed since you bought your old policy, the new one could cost you more, or you could be turned down. You may need a medical exam for the new policy. Claims on most new policies can be denied for up to two years because of inaccurate statements of a material nature and the suicide limitations can begin again on new coverage.

IF YOU ARE KEEPING BOTH THE OLD AND NEW POLICY How will keeping both the old and new policy affect the premium payment on your existing policy? Will you be able to pay for both policies, or will a loan or values from the old policy be used to pay premiums for the new policy? Will a loan be deducted from death benefits?

IF YOU ARE SURRENDERING AN ANNUITY OR INTEREST SENSITIVE LIFE PRODUCT: Will you pay surrender charges on your old contract? What are the interest rate guarantees for the new contract? Have you compared the contract charges or other policy expenses?

OTHER ISSUES TO CONSIDER FOR ALL TRANSACTIONS: You should consult your tax advisor to determine what the tax consequences will be. Will it be a tax-free exchange? Is there a benefit from favorable “grandfathered” treatment of the old policy under the federal tax code? You should also determine if the existing company is willing to modify the old policy. How does the quality and financial stability of the new company compare to the existing company?

AGENT: EMC National Life Company’s position on the acceptability of replacements is that applicants are entitled to receive full and fair disclosure of all relevant facts when a replacement is contemplated. There are often advantages to both plans that the applicant should be aware of to make an informed decision. You should discuss all of the above relevant items with the applicant to help determine the appropriateness of any contemplated replacement.

If a replacement is contemplated, is the transaction in accordance with the above position of EMC National Life Company? ______ Yes ______ No

This document must be signed by the applicant and agent, and a copy must be left with the applicant.

I certify that the responses herein are, to the best of my knowledge, accurate: _________________________________________________________ _______________________________________ Applicant(s) Signature Date Applicant(s) Printed Name

________________________________________________________ _______________________________________ Agent Signature Date Agent Printed Name

AGENT NOTICE: You must leave with the applicant, at the time an application is completed, the original or a copy of all sales material used. A copy of any electronically presented sales material must be provided to the policyholder in printed form no later than at the time of policy or contract delivery. You must also provide EMCNL a copy of all individualized sales material used, including illustrations, and identify below all company approved sales material used:

G Preprinted material (describe) _____________________________________________________________________

G Electronically presented material (describe) __________________________________________________________

G Other (describe) ________________________________________________________________________________

______________________________________________________________________________________________

Page 9: LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. · LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. ... SIMPLIFIED ISSUE APPLICATION FOR INDIVIDUAL LIFE INSURANCE EMC NATIONAL LIFE COMPANY

INS41 (7-13) EMC, flag design and Count on EMC Reg. U.S. Pat. & Tm. Off.

CHECK PLAN AUTHORIZATION (Complete if paying by Check Plan.)

Name of Financial Institution Name on the Account

Signature of Account Holder/Policy Payor Date

Existing EMCNL POLICY NO. (if any) NAME (Insured)

1.

2.

3.

ATTACH VOIDED CHECK HERENo Deposit Slips, Please!

X

TRANSIT NUMBER FIELD

This must agree with the financial institution signature card. Include name of firm if checks are drawn on a business account.

I hereby request the privilege of paying premiums to EMC National Life Company, its successors and assigns (hereinafter referred to as the company) under the company’s Check Plan and hereby authorize the company to initiate variable entries to my checking/savings account for the purpose of paying said premiums from the above named account.

1.) Note: A deduction will process immediately for any premium(s) that are past due. All subsequent deductions will correspond to the policy date.

2.) The draft date will correspond to the policy date.

3.) If this is your initial premium, do you want it drafted from your account upon approval of your application and activation of your policy? q Yes q No

4.) The privilege of paying premiums under this plan may be revoked by the company if any entry is not paid upon presentation.

5.) This plan shall not be construed as a modification of grace periods or of any other provisions of the policies except that during the continuance of this plan, the company shall not be required to give notice of monthly premiums becoming due on any of the policies issued to the undersigned.

6.) The payment of premiums under this plan may be discontinued by the company or the undersigned upon thirty (30) days written notice.

7.) This plan shall apply to the applications or other policies listed below that are to be included on this payment.

ACCOUNT #

Address of Financial Institution City, State, Zip+4 of Financial Institution

q Checking Account OR q Savings Account

PO Box 9144 Des Moines, IA 50306-9144800-232-5818www.EMCNationalLife.com

Page 10: LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. · LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. ... SIMPLIFIED ISSUE APPLICATION FOR INDIVIDUAL LIFE INSURANCE EMC NATIONAL LIFE COMPANY

Intentionally Left Blank

Page 11: LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. · LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. ... SIMPLIFIED ISSUE APPLICATION FOR INDIVIDUAL LIFE INSURANCE EMC NATIONAL LIFE COMPANY
Page 12: LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. · LEGACY PLANNING. SIMPLE SOLUTION. EASY CHOICE. ... SIMPLIFIED ISSUE APPLICATION FOR INDIVIDUAL LIFE INSURANCE EMC NATIONAL LIFE COMPANY

EMC, flag design and Count on EMC Reg. U.S. Pat. & Tm. Off.EMK365 G (2-15)

PO Box 9202Des Moines, IA 50306-9202800-232-5818

www.EMCNationalLife.com

This brochure provides an overview only of the Easy Choice Whole Life Insurance product. The policy, the riders and their provisions may vary or be unavailable in some states. Please refer to policy form ICC12ELP026/ELP026 and rider forms ELR246 and LP740 for all contractual provisions, benefits and limitations.

Riders (available in states where approved)ACCELERATED DEATH BENEFIT RIDER–ELR246In the event the insured is diagnosed with a terminal illness, the policyowner can receive benefits up to 75% of the face amount to a maximum of $250,000. Automatically available at no charge in states where approved. Not approved in PA, VT and WA.

SEAT BELT BENEFIT RIDER–LP740An additional benefit amount will be paid if the company receives satisfactory proof the insured died while driving or riding in a private passenger vehicle in a covered accident. The vehicle must be equipped with seat belt(s) and the seat belt(s) must have been in actual use by the insured at the time of the accident. The additional benefit amount will be 10% of the amount of insurance shown on the policy specification page up to a maximum of $10,000. This rider is automatically included without charge in states where approved. Not approved in AK, CA, CT, DC, GA, HI, MD, MA, MT, OR, PA, TN, UT, VA and WA.