Exhibit 10.12

 

[Form of Personalized Policy Description Under
Supplemental Disability Insurance Plan]

 

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Personalized Policy Description for:

 

[Name of Executive Officer]

 

NetBank, Inc.

 

POLICY I

 

 

 

 

 

Policy Number:

 

 

Policy Form:

 

601 Income III Choice, GR

Monthly Benefit Amount:

 

$3,000.00

MNDA:

 

2 Year Aggregate

Residual:

 

To Age 65 Residual

Elimination Period:

 

180 Days

Benefit Period:

 

To age 65

Issue Date:

 

03/01/03

Annual Premium:

 

$

 

POLICY II

 

 

 

 

 

Policy Number:

 

 

Policy Form:

 

601 Income III Choice, GR

MONTHLY BENEFIT AMOUNT:

 

$2,000.00

MNDA:

 

2 Year Aggregate

Residual:

 

To Age 65 Residual

Elimination Period:

 

180 Days

Benefit Period:

 

To age 65

Issue Date:

 

03/01/03

Annual Premium:

 

$

 

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