<PAGE>

                                                               Exhibit 10(xxiii)

                             CERTIFICATE SCHEDULE


GROUP NUMBER: 960000945G
POLICYHOLDER: CT-0000000004
EMPLOYER: THE MEAD CORPORATION

CERTIFICATE NUMBER: 005722786A
INSURED: _____________________


CERTIFICATE DATE: JAN 01, 2000
ISSUE AGE OF THE INSURED: ____________
RATING CLASS: UNISMOKE


FACE AMOUNT:________________
MINIMUM FACE AMOUNT: $100,000
MINIMUM INCREASE IN FACE AMOUNT: 25,000
DEATH BENEFIT OPTION: OPTION B
ANNUAL PLANNED PERIODIC PREMIUM:____________

ELIGIBILITY PERIOD: 0 DAYS

LOAN INTEREST RATE PER YEAR, PAYABLE IN ARREARS: 8%
MINIMUM LOAN AMOUNT: $500

PREMIUM EXPENSE CHARGE: ACTUAL STATE PREMIUM TAX RATE, CURRENTLY

MAXIMUM ADMINISTRATION EXPENSE CHARGE PER CERTIFICATE: $4.00 PER MONTH

MORTALITY TABLE:
  100% OF THE 1980 COMMISSIONERS STANDARD ORDINARY MORTALITY TABLE B,
  AGE LAST BIRTHDAY

GUARANTEED INTEREST RATE: 4% PER YEAR, MONTHLY EQUIVALENT 00327

COVERAGE IS PROVIDED FROM THE EFFECTIVE DATE OF THE CERTIFICATE TO THE INSUREDS
AGE 95 OR THE INSUREDS PRIOR DEATH. WHEN ANY OF THE ADDITIONAL BENEFITS ABOVE
CEASE, THE MONTHLY DEDUCTION WILL BE REDUCED BY THE COST OF THAT ADDITIONAL
BENEFIT COVERAGE WILL EXPIRE PRIOR TO THE INSUREDS AGE 95 IF PREMIUMS PAID AND
INTEREST CREDITED ARE INSUFFICIENT TO CONTINUE COVERAGE TO SUCH TIME.
<PAGE>

                        CERTIFICATE SCHEDULE CONTINUED

EXCESS INTEREST RATE:

     FOR LOANED PORTIONS OF THE FUND VALUE:

     THE EXCESS INTEREST RATE FOR LOANED PORTIONS OF THE FUND VALUE WILL BE
     DECLARED BY OUR BOARD OF DIRECTORS AND WILL BE BASED ON OUR ESTIMATES OF
     FUTURE INVESTMENT EARNINGS. THE RATE WILL BE DECLARED IN ADVANCE AND
     GUARANTEED FOR A PERIOD OF AT LEAST ONE MONTH. HOWEVER, THE RATE APPLIED
     WILL NOT BE LESS THAN THE GUARANTEED INTEREST RATE.

     FOR UNLOANED PORTIONS OF THE FUND VALUE:

     THE FOLLOWING RULES APPLY DURING THE FIRST TEN YEARS THAT THE CERTIFICATE
     IS INFORCE.

          NEW MONEY: THE EXCESS INTEREST RATE PLUS THE GUARANTEED RATE WILL NOT
          BE LESS THAN THE YIELD ON FIVE-YEAR TREASURY BONDS FOR THE FIRST FULL
          WEEK OF THE MONTH PRECEDING THE CALENDAR QUARTER FOR WHICH THE NEW
          MONEY EXCESS INTEREST RATE IS DECLARED. THE RATE SO DECLARED WILL BE
          APPLICABLE FOR NEW MONEY RECEIVED DURING THIS CALENDAR QUARTER UNTIL
          THE BEGINNING OF THE CORRESPONDING CALENDAR QUARTER IN THE NEXT
          CALENDAR YEAR. AT THAT TIME, NEW MONEY BECOMES OLD MONEY. FOR PURPOSES
          OF THIS RULE, NEW MONEY IS ANY PREMIUM RECEIVED DURING THE CALENDAR
          QUARTER.

          OLD MONEY: THE EXCESS INTEREST RATE PLUS THE GUARANTEED RATE FOR THE
          UNLOANED PORTIONS OF THE FUND VALUE WILL NOT BE LESS THAN THE AVERAGE
          OF THE YIELD ON FIVE-YEAR TREASURY BONDS FOR THE FIRST FULL WEEK OF
          EACH CALENDAR QUARTER FOR THE TWENTY MOST RECENT CALENDAR QUARTERS,
          NOT INCLUDING THE QUARTER FOR WHICH THE CURRENT EXCESS INTEREST RATE
          IS DECLARED, LESS TWO TENTHS OF ONE PERCENT.

          NOT WITHSTANDING THE ABOVE, IF THE AVERAGE YIELD AS DEFINED ABOVE IS
          LESS THAN 5%, THEN OUR BOARD OF DIRECTORS MAY, AT ITS DISCRETION,
          CREDIT INTEREST AT THE GUARANTEED RATE ONLY, WITH NO EXCESS INTEREST.

THE YIELD FOR THE FIVE-YEAR TREASURY BONDS WILL BE THE YIELD AS PUBLISHED IN THE
"SALOMON BROTHERS BOND MARKET ROUND-UP". IN THE EVENT THAT THE "SALOMON BROTHERS
BOND MARKET ROUND-UP" DISCONTINUES PUBLICATION OF THE YIELD, THEN OUR BOARD OF
DIRECTORS MAY SUBSTITUTE ANOTHER REFERENCE SOURCE FOR THE RATE, AT THEIR
DISCRETION. IN THE EVENT THAT THE UNITED STATES GOVERNMENT NO LONGER ISSUES
FIVE-YEAR TREASURY BONDS, THEN OUR BOARD OF DIRECTORS MAY SUBSTITUTE ANOTHER
TYPE OF UNITED STATES GOVERNMENT OBLIGATION, AT THEIR SOLE DISCRETION.

<PAGE>

                        CERTIFICATE SCHEDULE CONTINUED

     AFTER THE FIRST TEN YEARS THAT THE CERTIFICATE IS INFORCE, THE EXCESS
     INTEREST RATE FOR UNLOANED PORTION OF THE FUND VALUE WILL BE DECLARED BY
     OUR BOARD OF DIRECTORS AND WILL BE BASED ON OUR ESTIMATES OF OUR FUTURE
     INVESTMENT EARNINGS. THE RATE WILL BE DECLARED IN ADVANCE AND GUARANTEED
     FOR A PERIOD OF AT LEAST ONE MONTH. HOWEVER, THE RATE APPLIED WILL NOT BE
     LESS THAN THE GUARANTEED INTEREST RATE.

REDUCED PAID-UP COVERAGE - MORTALITY TABLE AND GUARANTEED INTEREST RATE:
     100% OF THE 1980 COMMISSIONERS STANDARD ORDINARY MORTALITY TABLE B. AGE
     LAST BIRTHDAY
     GUARANTEED INTEREST RATE:  4.0%
     PER YEAR:  MONTHLY EQUIVALENT .00327


<PAGE>

                          TABLE OF SURRENDER CHARGES



               CERTIFICATE                            % INITIAL
                 YEAR                              SURRENDER CHARGE

                   1                                     100%
                   2                                      80%
                   3                                      60%
                   4                                      40%
                   5                                      20%
               THEREAFTER                                  0%


SURRENDER CHARGE: $ 3.08 PER $1,000 OF FACE AMOUNT


MINIMUM PARTIAL SURRENDER AMOUNT: $500
<PAGE>

                                  TITLE PAGE


INSURED:________________________


BENEFICIARY

TO________________________WIFE OF THE INSURED, AS PRIMARY, TO __________________
AND ___________________, CHILDREN OF THE INSURED AS SECONDARIES IN EQUAL SHARES.





OWNER

___________________________
<PAGE>

                               TABLE OF CONTENTS


                                                                            Page

Definitions................................................................... 4

General Provisions............................................................ 4

     Owner

     Beneficiary

Premium Provisions............................................................ 6

Grace Period.................................................................. 7

     Reinstatement

Proceeds...................................................................... 8

Death Benefit Provisions...................................................... 8

Optional Changes In An Insured's Coverage..................................... 9

Certificate Values............................................................10

Continuation Of Insurance.....................................................12

Surrender Provisions..........................................................12

Certificate Loans.............................................................14

Termination Or Discontinuance.................................................15

Income Settlement Options.....................................................15

Endorsements, If Any

Riders, If Any

<PAGE>

                        CERTIFICATE SCHEDULE CONTINUED


                        TABLE OF DEATH BENEFIT FACTORS
                      PER $1,000 OF INSURED'S FACE AMOUNT

          ATTAINED                                ATTAINED
             AGE              FACTORS                AGE              FACTORS
             18                 7.04                 57                 2.10
             19                 6.83                 58                 2.04
             20                 6.63                 59                 1.99
             21                 6.44                 60                 1.94
             22                 6.25                 61                 1.89
             23                 6.06                 62                 1.84
             24                 5.88                 63                 1.80
             25                 5.69                 64                 1.75
             26                 5.52                 65                 1.71
             27                 5.34                 66                 1.67
             28                 5.17                 67                 1.64
             29                 5.00                 68                 1.60
             30                 4.84                 69                 1.57
             31                 4.68                 70                 1.53
             32                 4.53                 71                 1.50
             33                 4.38                 72                 1.47
             34                 4.24                 73                 1.44
             35                 4.10                 74                 1.42
             36                 3.97                 75                 1.39
             37                 3.84                 76                 1.37
             38                 3.72                 77                 1.35
             39                 3.60                 78                 1.32
             40                 3.48                 79                 1.30
             41                 3.37                 80                 1.29
             42                 3.27                 81                 1.27
             43                 3.17                 82                 1.25
             44                 3.07                 83                 1.23
             45                 2.97                 84                 1.22
             46                 2.88                 85                 1.20
             47                 2.80                 86                 1.19
             48                 2.71                 87                 1.17
             49                 2.63                 88                 1.16
             50                 2.56                 89                 1.14
             51                 2.48                 90                 1.13
             52                 2.41                 91                 1.11
             53                 2.34                 92                 1.09
             54                 2.28                 93                 1.07
             55                 2.21                 94                 1.04
             56                 2.15                 95                 1.00

                                                                          Page 1

<PAGE>

                        CERTIFICATE SCHEDULE CONTINUED

          TABLE OF MONTHLY GUARANTEED MAXIMUM COST OF INSURANCE RATES
                      PER $1,000 AMOUNT OF TERM INSURANCE

<TABLE>
<CAPTION>
     ATTAINED                            ATTAINED
       AGE              RATE               AGE               RATE
<S>                     <C>                <C>              <C>
        18              0.138               57               1.005
        19              0.143               58               1.088
        20              0.145               59               1.178
        21              0.145               60               1.280
        22              0.143               61               1.394
        23              0.142               62               1.526
        24              0.139               63               1.675
        25              0.137               64               1.839
        26              0.135               65               2.016
        27              0.134               66               2.203
        28              0.135               67               2.400
        29              0.137               68               2.610
        30              0.139               69               2.842
        31              0.143               70               3.103
        32              0.149               71               3.405
        33              0.156               72               3.753
        34              0.163               73               4.149
        35              0.173               74               4.586
        36              0.185               75               5.055
        37              0.198               76               5.548
        38              0.214               77               6.059
        39              0.233               78               6.594
        40              0.253               79               7.170
        41              0.274               80               7.808
        42              0.298               81               8.527
        43              0.322               82               9.343
        44              0.348               83              10.252
        45              0.377               84              11.235
        46              0.407               85              12.274
        47              0.438               86              13.356
        48              0.473               87              14.478
        49              0.510               88              15.640
        50              0.553               89              16.852
        51              0.600               90              18.132
        52              0.653               91              19.516
        53              0.714               92              21.058
        54              0.781               93              22.898
        55              0.852               94              25.343
        56              0.927
</TABLE>

                                                                          Page 2
<PAGE>

                        CERTIFICATE SCHEDULE CONTINUED

For amounts which were fully underwritten, the risk factors below apply to the
attained age rate table.

<TABLE>
<CAPTION>
Class of Risk  Risk Factor    Class of Risk  Risk Factor    Class of Risk  Risk Factor
-------------  -----------    -------------  -----------    -------------  ----------
<S>            <C>            <C>            <C>            <C>            <C>
Standard          1.00        Class F           2.50        Class L           4.00
Class A           1.25        Class G           2.75        Class M           4.25
Class B           1.50        Class H           3.00        Class N           4.50
Class C           1.75        Class I           3.25        Class O           4.75
Class D           2.00        Class J           3.50        Class P           5.00
Class E           2.25        Class K           3.75
</TABLE>


For guaranteed Issue, the guaranteed monthly cost of insurance rate is 100% of
the above attained age rate table. For simplified acceptance, the guaranteed
monthly cost of insurance rate is 100% of the above attained age rate table
unless a greater class of risk factor is applicable.


                                                                          Page 3
<PAGE>

DEFINITIONS

WE, OUR, US, COMPANY - Connecticut Mutual Life Insurance Company.

YOU OR YOUR - the Owner shown in the Certificate Schedule.

HOME OFFICE - Our office at 140 Garden Street, Hartford, Connecticut 06154.

AGE - age last birthday.

ATTAINED AGE - the Issue Age of an Insured shown on the Certificate Schedule
increased by the number Certificate Years lapsed.

CERTIFICATE YEAR, CERTIFICATE ANNIVERSARY, CERTIFICATE MONTH - The Certificate
Date is the date coverage begins for an Insured. Certificate months, years and
anniversaries are computed from the Certificate Date.

MONTHLY ANNIVERSARY DAY - the same day of each calendar month as the Certificate
Date.

INSURED means the insured shown in the Certificate Schedule.

AGE 95 means the Certificate Anniversary on or next following the Insured's 95th
birthday.

DEBT means any outstanding Loan, plus any Loan Interest due or accrued.

WRITTEN REQUEST - a request in writing in a form satisfactory to us and received
at our Home Office, 140 Garden Street, Hartford, Connecticut 06154.

GENERAL PROVISIONS

Certificate
This Certificate contains a summary of the terms of the Policy. Any changes or
amendments to the Policy which affect the coverage under this Certificate will
be described in an endorsement to this Certificate or a revised Certificate
furnished to you. This Certificate supersedes and replaces any previously issued
Certificate.

 .  All statements made by the Policyholder or by an Owner or an Insured will be
   deemed representations and not warranties. No statement made by any Insured
   will be used in any contest of coverage under the Policy unless a copy of the
   instrument containing such statement has been furnished to the Insured, if
   living, otherwise to the Beneficiary of the coverage being contested.

 .  No change in any Certificate will be valid unless it is submitted in writing
   and until it is approved by one of our officers.

 .  No agent may change or waive any provision of the Policy or this Certificate
   issued under the Policy.

 .  We may modify the terms and conditions of the Policy or this Certificate to
   conform to any new law or regulation affecting the Policy.


                                                                          Page 4
<PAGE>

Owner
The Owner has the exclusive right to exercise all rights and privileges and to
receive all benefits under the Certificate during the lifetime of the Insured.

If no Owner designated under this Certificate is living and the Policy does not
provide otherwise, the Owner will be the successor in interest to said Owner.

 . If the Owner is an entity (other than a natural person) which ceases to exist,
  the Owner will be the successor in interest to said Owner.

Beneficiary
The Beneficiary is the Beneficiary shown in the Certificate Schedule unless
later changed.

 . If no beneficiary survives an Insured, the Beneficiary will be the estate of
  the Insured, unless the Certificate states otherwise.
 . The interest of any Beneficiary will be subject to:
  (1) any assignment of this Certificate which is binding on us; and
  (2) any optional settlement agreement in effect at an Insured's death.

Change of Owner or Beneficiary
 . While the Insured is alive you can change the Owner or the Beneficiary. Any
  request for a change must be in writing to us.
 . The change will take effect on the date the request is signed whether or not
  the Insured is living when we receive the request at our Home Office. However,
  the change will be subject to any payment made or actions taken by us before
  receiving the request.

Misstatement of Age
If the age of the Insured has been misstated, we will adjust the amount of any
Death Benefit payable. The Death Benefit will be the benefit that would be
purchased by the most recent mortality charge at the Insured's correct age.

Incontestability
We cannot contest an Insured's coverage after it has been in force during the
lifetime of the Insured for a period of two years from the Certificate Date.

We cannot contest any optional increase in an Insured's coverage after the
increase has been in force during the Insured's lifetime for two years after the
Effective Date of the increase. After this Certificate has been in force for two
years, any contest of an increase will be based solely on the application for
such increase.

Suicide
If an Insured dies by suicide, whether sane or insane, within one year from the
Certificate Date, the proceeds we will pay will be limited to the premiums paid
less any Debt and less any Partial Surrenders.

If an Insured dies by suicide, whether sane or insane, within one year from the
Effective Date of any optional increase in Face Amount, the amount we will pay
with respect to such increase will be limited to its cost.

                                                                          Page 5



<PAGE>

Assignment
You may assign this Certificate. Written notice of the terms of transfer or a
copy of any assignment must be filed at our Home Office. Until we receive such
notice we will not be required to take notice of or be responsible for any
transfer of interest in this Certificate by an assignment, agreement or
otherwise.

 .  We will not be responsible for the validity of any assignment.
 .  Any assignment made after the Insured's death will be valid only with our
   consent.

Periodic Report
At least once a year we will furnish you a report which includes:

(1) the current status of this Certificate;
(2) all transactions in connection with this Certificate since the last report;
    and
(3) any other information required by the state in which this Certificate was
    delivered.

Illustration of Benefits and Values
Upon written request we will send you an illustration of future benefits and
values illustrated on both a guaranteed and current basis. The illustration may
also be based upon such assumptions as you may specify. We may limit the number
of such illustrations in any Certificate Year. We reserve the right to charge a
fee not to exceed $10.00 for each illustration.

Claims of Creditors
To the extent allowed by law, the amount held and the payments made by us shall
not be subject to the claims of any Insured's, Owner's or Beneficiary's
creditors.

PREMIUM PROVISIONS

Payment of Premiums
The initial premium for the Insured's coverage under the Group Policy must be
paid before the Certificate Date. Such premium is payable in advance at our Home
Office. The Policyholder may request a receipt signed by our President or
Secretary and countersigned by our authorized agent.

Certificate Planned Periodic Premiums
The Insured's planned periodic premium amount and frequency are shown on the
Certificate Schedule. Changes in frequency and increases or decreases in amount
of Planned Periodic Premium payments may be made by you. We reserve the right to
limit any increase in Planned Periodic Premiums as described in the Certificate
Premium Limits provision.

Certificate Unscheduled Premiums
Any premium we receive under this Certificate in an amount different from the
Planned Periodic Premium will be considered an unscheduled premium. Unscheduled
premium payments can be made at any time while this Certificate is in Force.
They will be credited to the Certificate Fund Value on the date we receive them,
subject to the limits described below.

Certificate Premium Limits
We may refuse to accept any Certificate Premium payment in any Certificate Year
which:
(1) would result in an increase in an Insured's Death Benefit by more than it
    would increase the Fund Value as a result of the application of the Death
    Benefit Factors, unless we receive evidence satisfactory to us of the
    Insured's insurability; or


                                                                          Page 6
<PAGE>

(2) would prevent the coverage under the Certificate from continuing to qualify
    as life insurance under the Internal Revenue Code of 1954, as amended.

If any premiums in excess of the limits described above are accepted, we may
return them to you as soon as we determine that they are in violation of any of
these limits.

GRACE PERIOD

Grace Period for Payment of Certificate Premiums
If on any Certificate Monthly Anniversary Day, the Fund Value less any Debt, is
not enough to cover the Monthly Deduction for the following month, a grace
period of 61 days will be allowed for payment of any balance needed for the
Monthly Deduction. If the balance needed is not paid within the grace period,
the coverage under this Certificate will end without value at the end of the
grace period. Notice of the required premium will be mailed to you and to any
Assignee of record at your last known address(es) at least 30 days before the
end of the grace period. If the Insured should die during the Grace Period, the
death proceeds will be reduced by the required premium.

Reinstatement
If this Certificate terminates other than by maturity, or death of the Insured,
you may reinstate it within 5 years after the date of termination. We require
the following:

(1) a written application for reinstatement;
(2) evidence of the Insured's insurability satisfactory to us;
(3) payment of the amount that remained unpaid at the end of the grace period;
(4) a premium large enough to pay Monthly Deductions for at least three months
    from the date of reinstatement.

The Certificate date of reinstatement will be the Certificate Monthly
Anniversary on or next following our approval. If the Insured's coverage before
the end of the grace period includes benefits provided by rider, such benefits
will be reinstated subject to the terms of the rider.

The Fund Value on the date of reinstatement will be the amount provided by the
Net Certificate Premium paid on reinstatement less the monthly deduction for the
first certificate month following reinstatement. The Surrender Charge for the
reinstated Policy will be based on the number of years the Insured's coverage
was in force before the reinstatement. The time the coverage was not in force
will not be counted.

DIVIDENDS
Each year, we will ascertain the surplus, if any, to be allotted on the Policy
as a dividend. It will be allotted as of the end of each Policy Year. If this
Policy ends, any surplus to be allotted as a final dividend may be reduced to
provide for a terminal claim reserve. The dividend and terminal claim reserve
will be in accordance with our rules then in effect.

The Certificate Owner may elect to have any surplus allotted on the Policy:
(1) to be paid in cash to the Certificate Owner; or
(2) to be used to pay any premium for coverage under the Policy; or
(3) to be converted into a participating paid-up addition to the face amount of
    the Certificate.
The Certificate Owner may, at any time, surrender to us for cash any such
dividends outstanding. The cash amount will be equal to the reserve of the
paid-up additions.

Any dividends paid under the Policy will be used for the sole benefit of the
Insureds.

                                                                          Page 7
<PAGE>

We do not expect to pay dividends on the Policy.

PROCEEDS

General
Proceeds means the amount payable on the Maturity Date, upon Surrender or at the
death of the Insured prior to the Maturity Date.

 .  If the Insured is alive on the Certificate Maturity Date, the proceeds will
   be the Fund Value on that date, less any Debt.
 .  If the Certificate is surrendered before the Certificate Maturity Date, the
   proceeds will be the Surrender Value.
 .  The proceeds on the death of an Insured will be the Death Benefit, plus any
   insurance provided by an additional benefit rider on the life of the Insured,
   less any Debt. The Death Benefit is described in the Death Benefit provision.
 .  Proceeds may be subject to adjustment as provided in the Misstatement of Age,
   Suicide and Grace Period provisions.

Settlement
 .  All amounts payable by us are payable only at our Home Office.
 .  Unless an optional settlement agreement is elected, proceeds will be paid in
   a single sum.
 .  We may require the return of the Certificate before paying proceeds.

Interest on Death Proceeds
We will pay interest on death proceeds paid in a single sum from the Insured's
date of death to the date of payment. The rate of interest will not be less than
the current rate credited on death proceeds left on deposit with us under the
regular interest option or the rate required by law, but in no case less than 3%
a year.

DEATH BENEFIT PROVISIONS

Death Benefit
The Death Benefit will depend on the Death Benefit option in effect on the date
of the Insured's death.

Option A.
The Death Benefit is the Face Amount on the date of death, or, if greater, the
Fund Value on the date of death multiplied by the Death Benefit Factor for the
Insured's Attained Age at death.

Option B.
The Death Benefit is the Face Amount plus the Fund Value on the date of death,
or, if greater, the Fund Value on the date of death multiplied by Death
Benefit factor for the Insured's Attained Age at death.

 .  The Death Benefit Factors are listed in the Certificate Schedule.
 .  The Death Benefit Option in effect is shown in Insured's Certificate
   Schedule.

Face Amount
The Initial Face Amount and the Minimum Face Amount are shown in the Certificate
Schedule. You may request a change in the Face Amount as described in the
Optional Changes in Face Amount provision.

                                                                          Page 8
<PAGE>

OPTIONAL CHANGES IN COVERAGE

Optional Changes in Face Amount
The existing Face Amount may be increased or decreased by written request from
you. Any change will be effective on the Certificate Monthly Anniversary Day on
or next following the date we approve the request, unless you request a later
date. No change in the Face Amount is allowed in the first Certificate Year. We
will issue an endorsement to this Certificate to reflect any change.

 . Decreases
  Any decrease in Face Amount is subject to the following conditions.

  (1) no decrease is permitted until the first Certificate Anniversary;
  (2) the Face Amount in effect after a decrease may never be less than the
      Minimum Face Amount.
  (3) any decrease will reduce the Face Amount in the following order:
      (a) against any increases beginning with the most recent; and then
      (b) against the Initial Face Amount.

 . Increases
  Any increase in Face Amount is subject to the following conditions:

  (1) submission of an application for an increase and satisfactory evidence of
      insurability of the Insured.
  (2) if the Fund Value, less any Debt, is not sufficient to continue the
      coverage in force for three months at guaranteed rates of mortality and
      interest, a premium sufficient to increase the Fund Value to such amount
      is required.
  (3) the minimum amount of any increase in Face Amount is shown in the
      Certificate Schedule.

 . Increases are not available if the Certificate Monthly Deduction is being
  waived under the terms of a waive rider.

Changing to Reduced Paid-Up Coverage
Prior to the Certificate Maturity Date, you may elect that the Insured's
coverage under the Group Policy be changed to a reduced paid-up status. The
following conditions will apply:

 . The election must be made by a written request.

 . If Death Benefit Option B is in effect on the date of request, it will be
  changed to Death Benefit Option A immediately prior to the Effective Date of
  the paid-up coverage and the Face Amount after such change shall be equal to
  the Face Amount prior to such change plus the Fund Value on the date of
  change.

 . The Cash Value will be applied as a net single premium at the Insured's
  Attained Age to determine a paid-up Face Amount.

 . The maximum amount of Cash Value that may be applied without evidence of
  insurability is the amount needed to provide a paid-up Face Amount not greater
  than the Death Benefit immediately prior to the Effective Date of the paid-up
  coverage. If the entire Cash Value is not applied to purchase the paid-up Face
  Amount, any excess Surrender Value will be refunded to the Insured.

 . The Cash Value must be an amount that will provide a paid-up Face Amount of
  not less than the Minimum Face Amount shown on the Certificate Schedule.

                                                                          Page 9
<PAGE>

The election will go into effect on the Certificate Monthly Anniversary Date on
or next following the date we receive your election request.

 .  Once the election for reduced paid-up coverage goes into effect:
   (1) we will not accept any further Certificate Premiums for the Insured's
       coverage;
   (2) no further optional changes in the Insured's coverage may be made;
   (3) any Debt which existed on the date the coverage was changed to a reduced
       paid-up status will be continued under the paid-up coverage and any loan
       interest will be due and payable as described in the Certificate Loans
       provision; and
   (4) any additional benefits provided by rider will terminate.
   (5) This Certificate may be reinstated as described in the Reinstatement
       provision.

 .  We will issue an endorsement to the Certificate to reflect the election of
   the paid-up option.

 .  The endorsement will show the new paid-up Face Amount and the guaranteed cash
   value at age 95.

 .  If the entire Surrender Value is not applied to purchase the paid-up
   insurance, the excess Surrender Value will be refunded to you.

 .  The guaranteed net single premium rates will be based on the attained age and
   rating class of the Insured and the mortality table and guaranteed interest
   rate for the Reduced Paid-Up Coverage as shown in the Certificate Schedule.
   We may use a lower net single premium rate at our discretion.

 .  The paid-up coverage may be surrendered for its cash value less any debt at
   any time. The cash value of the paid-up coverage will equal the present value
   of future guaranteed benefits based on the mortality table and interest rate
   that are shown in the certificate schedule determined on the date of the
   change. If the paid-up coverage is surrendered within 30 days after a
   Certificate Anniversary, the cash value will not be less than the value on
   such anniversary.

 .  The paid-up coverage will be eligible for dividends.

CERTIFICATE VALUES

Fund Value
The Fund Value on the Certificate Date is the Initial Certificate Net Premium
paid less the Monthly Deduction for the first Certificate Month.

On any Certificate Monthly Anniversary Day, the Fund Value of an Insured's
coverage will be equal to:

(1) the Fund Value on the prior Monthly Anniversary Day; plus
(2) one month's interest on item (1); plus
(3) the sum of net certificate premiums received at our Home Office since the
    prior Monthly Anniversary Day; plus
(4) interest on item (3) from the date of receipt to the Certificate Monthly
    Anniversary Day; less
(5) any Partial Surrenders plus Surrender Charge made on the Monthly Anniversary
    Day; less
(6) the Monthly Deduction due on the Certificate Monthly Anniversary Day.

On any other day the Fund Value will be calculated in a consistent manner.

                                                                         Page 10
<PAGE>

Net Certificate Premium
The net certificate premium is the premium paid less the Premium Expense Charge
shown in the Certificate Schedule.

Monthly Deduction
The Monthly Deduction due on any Monthly Anniversary Day is:

(1) the Cost of Insurance for the following month; plus
(2) the cost of any additional benefits provided by the rider for the following
    month; plus
(3) the Administration Expense Charge shown in the Certificate Schedule.

Fund Value Interest Rate Calculations
 .   On each Certificate Monthly Anniversary Day we will credit interest
    separately to the portion of the Fund Value equal to any existing Debt and
    to the balance of the Fund Value.

 .   The Guaranteed Interest Rate is shown on the Certificate Schedule.

Excess Interest Rate
 .   An interest rate in excess of the Guaranteed Interest Rate may be applied in
    the calculation of the Fund Value. Descriptions of how the excess interest
    rate for the Loaned and Unloaned portions of the Fund Value are shown on the
    Certificate Schedule.

 .   In no event will the interest rate credited to the Fund Value be less than
    the Guaranteed Interest Rate shown on the Certificate Schedule.

 .   All interest rates stated are effective annual rates. They will be applied
    to properly reflect the date of receipt of any Certificate Planned Periodic
    Premiums and any changes in Debt during a Certificate Month.

Cost of Insurance
The Cost of Insurance for an Insured is determined on a monthly basis on each
Certificate Monthly Anniversary Day. The Cost of Insurance is determined
separately for each of the following, in the order shown:

(1) the Initial Face Amount as follows:
    (a) that part which is on a guaranteed issue basis; next
    (b) that part which is on a simplified issue basis; next
    (c) that part which is fully underwritten;

(2) each increase in Face Amount, successively, in the order in which it took
    effect; and

(3) any portion of the Insured's Death Benefit which is a result of the Death
    Benefit being equal to the Fund Value multiplied by the Death Benefit
    Factor.

The Cost of Insurance for each of (1), (2) and (3) above is calculated by
multiplying its Cost of Insurance Rate by its Amount at Risk.

The "Amount at Risk" at the beginning of the Certificate Month is the difference
between:
(a) the Insured's Death Benefit that would have been payable in the event of the
    Insured's death on that day divided by one plus the Guaranteed Monthly
    Equivalent Interest Rate; and

                                                                         Page 11
<PAGE>

(b)  the Fund Value at the beginning of the Certificate Month, decreased by the
     monthly deduction for any additional benefit riders.
The Fund Value for the Insured's coverage as described in (b) is applied in the
order shown above in (1), (2) and (3) to determine the Amount at Risk for each.
If the Fund Value when so applied equals or exceeds the Initial Face Amount
there is no Amount at Risk for that Initial Face Amount and no Cost of Insurance
for it. If the Fund Value when so applied equals or exceeds the Initial Face
Amount plus an increase in Face Amount, there is no Amount at Risk for that
increase and no cost of Insurance for it.

Cost of Insurance Rate
The monthly Cost of Insurance Rate is based on the Insured's attained age and
rating class. The rating class for the Insured's Initial Face Amount is the
Insured's rating class on the Certificate Date as shown in the Certificate
Schedule. The Insured's rating class for optional increases in Face Amount is
the Insured's rating class on the Effective Date of the Increase in Face Amount.
The rating class with the most recent Effective Date will apply to any portion
of the Death Benefit which is a result of the Death Benefit being equal to the
Fund Value on the date of death multiplied by the Death Benefit Factor.

Monthly Cost of Insurance Rates will be determined by us based on our
expectations as to future mortality, interest, expenses, and persistency. We can
change the rates from time to time, but they will never be more than the Monthly
Guaranteed Cost of Insurance Rates shown on the Certificate Schedule. Any change
in rates, and the way in which they are determined, will be made on a uniform
basis for Insureds of the same age and rating class. We will file any such
changes with the insurance supervisory official of the state in which the
Certificate is delivered.

Cash Value
The Cash Value is the Fund Value less any Surrender Charge.

CONTINUATION OF INSURANCE
If Certificate premium payments are not continued, the coverage under this
Certificate will be continued as long as the Fund Value less any Debt is
sufficient to cover any Monthly Deductions. The coverage will not be continued
beyond the Certificate Maturity Date. If the Insured is living on the
Certificate Maturity Date, the Fund Value, if any, less any Debt will be paid to
you.

The planned periodic premium may not provide coverage to the Certificate
Maturity Date even if the planned periodic premium is paid as scheduled. The
period for which coverage under the Certificate will continue will be effected
by the following:

(a)  the amount, timing and frequency of premium payments;
(b)  change in the Face Amount and Death Benefit Options;
(c)  change in interest credits and Monthly Deduction charges;
(d)  deductions for additional riders; and
(e)  any Partial Surrenders or loans.

SURRENDER PROVISIONS

Surrender Value
The Insured's coverage may be surrendered by you for its Surrender Value at any
time while the Insured is living and before the Maturity Date.

The Surrender Value is the Cash Value less any Debt.

                                                                         Page 12
<PAGE>

We may postpone payment for up to 6 months after we receive your request unless
the surrender is to pay premiums to us.  We will not defer a payment for more
than 6 months after we receive your written request. If we defer a payment for
10 working days or more, we will pay interest at a rate not less than 3% a year
for the period the payment is deferred.

Surrender Charge
The Surrender Charge is a charge made against the Fund Value in the event of
Total or Partial Surrender.  The amounts and durations of the Surrender Charges
are shown in the Table of Surrender Charges shown in the Certificate Schedule.

The Surrender Charges applicable to the Initial Face Amount are the charges
shown in the Table of Surrender Charges.

For any requested increase in the Face Amount that is approved, Surrender
Charges will apply to the amount of the increase.  Such charges will be the
charges shown in the Table of Surrender Charges effective on the date the
requested increase is approved and for the duration shown in the Table of
Surrender Charges.

For a Partial Surrender a Surrender Charge will be made against the amount of
the Fund Value that is surrendered.  This Surrender Charge will be applied if
the amount of the Partial Surrender is greater than 25% of the Fund Value in any
certificate year.  This charge will be in proportion to the charge for the total
Surrender Value.  The proportion will be computed as the amount of Surrender
Value that is surrendered divided by the total Surrender Value.  When a partial
Surrender is made, future Surrender Charges will be reduced in the same
proportion.

Any requested decrease in the Face Amount will not reduce the applicable
Surrender Charges.

Surrender
 .  You may surrender this Certificate by:
   (1) filing a written request in a form acceptable to us; and
   (2) returning the Certificate to our Home Office.

 .  The date of surrender will be the Certificate Monthly Anniversary on or next
   following our receipt of the request.

 .  The surrender proceeds equal the Surrender Value on the date of surrender.
   However, the surrender proceeds within 30 days after a Certificate
   Anniversary will not be less than:
   (1) the surrender proceeds on that Certificate Anniversary; plus
   (2) any unscheduled premiums received since that Anniversary but not yet
       credited; less
   (3) any increase in Debt or any partial surrender since that Anniversary.

 .  This Certificate of Insurance will terminate as of the date of surrender.

Partial Surrender
You may make a Partial Surrender of the Surrender Value by written request. The
date of the Partial Surrender will be the Monthly Anniversary Day on or next
following our receipt of the request.

 .  Partial Surrenders are subject to the following conditions:
   (1) Partial Surrenders are not allowed before the first Certificate
       Anniversary.
   (2) The amount of any Partial Surrender must be at least the Minimum Partial
       Surrender amount shown in the Certificate Schedule.



                                                                        Page 13



<PAGE>

     (3) A Partial Surrender may not result in a remaining Cash Value equal to
         less than twelve Monthly Deductions.

 .    The amount of a Partial Surrender, plus the Surrender Charge, will be
     deducted from the Fund Value. This will result in a reduction of the Cash
     Value and Death Benefit.

If Death Benefit Option A is in effect on the Monthly Anniversary Day on which a
Partial Surrender is made, the Face Amount will be reduced by the amount of the
Partial Surrender. The reduction will apply first against any increases
beginning with the most recent and then against the Initial Face Amount.

Partial withdrawals are not allowed if the resulting decrease in the specified
amount goes below the minimum shown in the following schedule.

Basis of Values
Minimum Cash Values are based on the mortality table and Guaranteed Interest
Rate shown in the Certificate Schedule.

The Cash Values are not less than the minimum values required by the law in the
state in which this Certificate is delivered. Where required, the method of
determining Cash Values has been filed with the insurance supervisory official
of the state in which this Certificate is delivered.

CERTIFICATE LOANS

General
On or after the first Certificate Anniversary, while the Certificate is in
force, you may, by written request, borrow against it. We will lend any sum up
to the Certificate's Maximum Loan Value, less existing Debt. This Certificate
will be the sole security for the loan.

Maximum Loan Value
The Maximum Loan Value on any date is the Cash Value on such date less three
Monthly Deductions.

Interest Rate
A loan bears interest at the Loan Interest Rate shown on the Certificate
Schedule.

Interest accrues daily from the date of the loan and is due at the end of each
Certificate Year. If the interest is not paid when it is due, it will be added
to the loan and will bear interest at the same loan rate.

Minimum Loan Amount
The Minimum Loan Amount as shown on the Certificate Schedule.

Repayment
You may repay all or part of a Certificate Loan at any time while the Insured is
alive and the insurance is in force. Every payment to us will be considered a
premium payment unless clearly marked for Debt repayment.

Termination
This Certificate will terminate if Debt equals or exceeds the Cash Value unless
an additional premium or loan repayment is made. The due date for such payment
will be the 61st day after the date when Debt first equals or exceeds the Cash
Value. We will mail 30 days notice of pending termination to your last known
address

                                                                         Page 14
<PAGE>

and the last known address(es) of any assignee of record. The notice will
indicate the loan repayment or premium required to keep this Certificate in
force. Unless we receive such amount by the 62nd day, the Certificate will
terminate without value on that date.

We may postpone payment for up to 6 months after we receive your request unless
the loan is to pay premiums to us. We will not defer a payment for more than 6
months after we receive your written request.

TERMINATION OR DISCONTINUANCE

Termination of the Policy
The Policy will terminate without the right of reinstatement on the date the
coverage ends for the last remaining Insured under the Policy.

Continuation of Insured's Coverage After Discontinuance
If the Group Policy is discontinued, any insurance then in effect will remain in
force under the Policy, provided it is not cancelled or surrendered by the
Owner. The continuance of the coverage is subject to the Continuation of
Insurance provision of this Certificate. All insurance that is continued will be
automatically changed from deduction from wages to a direct billing status.
Certificate Premiums will then be payable directly to us.

Individual Termination
The Insured's coverage under the Policy will terminate when one of the following
occur:

(1) the Insured dies;
(2) the Insured's coverage matures;
(3) the date the Insured's coverage ends without value;
(4) the date the Insured's coverage is surrendered for its Surrender Value; or
(5) the date the Group Policy terminates or is discontinued, except as provided
    in the Continuance of Insured's Coverage After Discontinuance provision.

If, for any reason, contributions for coverage are no longer being deducted from
wages, the status of the insurance under this Certificate will change from
deduction of contributions to direct billing.

INCOME SETTLEMENT OPTIONS

If elected, we will pay proceeds under the terms of an optional settlement
agreement, rather than in a single sum. You may elect such an agreement before
proceeds become payable. If proceeds are at least $10,000, the payee may elect
such an agreement if none is in effect. The following options are available.

Option 1. Installments for a Special Period. Equal payments for a stated number
of years, not more than 30. The amount is shown in the Option 1 Table.

Option 2. Life Income. Equal monthly payments while the payee is alive, as shown
in the Option 2 Table. Payments with or without installments certain may be
elected.

Option 3. Interest. Interest payments while the payee is alive or for a shorter
period. Interest will be paid at an effective rate of 3% per year. Payments are
increased by any additional interest earnings we may apportion. For each $1,000
of proceeds, interest payments equal $30 annually, $14.89 semi-annually, $7.42
quarterly and $2.47 monthly.

                                                                         Page 15





<PAGE>

Option 4. Installments of Specified Amount. Equal annual, semi-annual, quarterly
or monthly payments for a stated amount. Payments will be made until the
proceeds and interest are all paid out. The total yearly amount paid must be at
least 6% of the original proceeds. Any unpaid balance left with us will be
increased by interest at 3% a year. We will also add any additional interest
earnings we may apportion.

Option 5. Life Income With Installment Refund. Equal monthly payments as shown
in the Option 5 Table. Payments will be made until the total amount paid equals
the proceeds and as long thereafter as the payee lives.

Option 6. Joint Life Income for the Payee and One Other Person With Two-Thirds
to Survivor. (One Hundred and Twenty Months Certain). Based on the Option 6
Table, we will pay a joint income to the payee and one other person designated
at exercise of this option. We will pay the income for 120 months certain, and
as long afterwards as both payees are living. After the death of either payee,
and following payment of any remaining income certain, monthly payments equal to
two-thirds of monthly income will be continued to the surviving payee for life.
The Alternate Life Income and Payment Provisions paragraphs apply to this
option.

Alternate Life Income
If Option 2, 5 or 6 is elected, the payee may elect to receive an alternate life
income. This is instead of receiving income based upon the rates shown in the
following tables. The election must be made at the time the income is to begin.

 .  The alternate life income will be more than the monthly income provided by a
   new single premium immediate annuity (first payment immediate), based upon
   our published rate then in use.

Payment Provisions
 .  If an optional settlement agreement becomes effective, we will issue a
   supplementary contract in exchange for this Certificate and agreement. The
   contract will show the rights and benefits provided by the agreement.

 .  We may change the payment basis to quarterly, semi-annual, or annual if any
   payment is less than $50.

 .  Payments under Option 2, 5 and 6 will be subject to proof of the payees' age.

 .  The first installment under Options 1, 2, 4, 5 and 6 is due as of the date
   the proceeds become payable.

 .  Installments certain under Options 1, 2, 5 and 6 are computed at 3% interest
   compounded annually. This does not apply when alternate life income is
   selected.

Installments certain, after the first, will be increased by additional interest
earnings we may apportion. If the alternate life income is elected, we will not
increase payments certain by additional interest earnings.

                                                                         Page 16
<PAGE>

                  -----------------------------------------
                             INSTALLMENTS CERTAIN
                          FOR EACH $1000 OF PROCEEDS
                  -----------------------------------------
                                   OPTION 1
                  -----------------------------------------
                       Number     Annual        Monthly
                       of Years  Installment  Installment
                  -----------------------------------------
                         1       $1000.00       $84.47
                         2         507.39        42.86
                         3         343.23        28.99
                         4         261.19        22.06
                         5         212.00        17.91
                         6         179.22        15.14
                         7         155.83        13.16
                         8         138.31        11.68
                         9         124.69        10.53
                         10        113.82         9.61
                         11        104.93         8.86
                         12         97.54         8.24
                         13         91.29         7.71
                         14         85.95         7.26
                         15         81.33         6.87
                         16         77.29         6.53
                         17         73.74         6.23
                         18         70.59         5.96
                         19         67.78         5.73
                         20         65.25         5.51
                         21         62.98         5.32
                         22         60.92         5.15
                         23         59.04         4.99
                         24         57.33         4.84
                         25         55.76         4.71
                         26         54.31         4.59
                         27         52.97         4.47
                         28         51.74         4.37
                         29         50.60         4.27
                         30         49.53         4.18
                  -----------------------------------------
                    Semiannual installments are 50.37% of
                    the annual installments. Quarterly
                    installments are 25.28% of the annual
                    installments.
                  -----------------------------------------

                                                                         Page 17
<PAGE>

<TABLE>
<CAPTION>
------------------------------------------------------------------------------------------------------------------------
                                       MONTHLY LIFE INCOME PER $1,000 OF PROCEEDS
------------------------------------------------------------------------------------------------------------------------
                           OPTION 2                OPTION 5                          OPTION 2                 OPTION 5
                ---------------------------------------------               --------------------------------------------
  PAYEE            Without          Number of        With         PAYEE       Without        Number of          With
   Age          Installments         Monthly      Installment      Age      Installments      Monthly        Installment
 Nearest          Certain          Installments     Refund       Nearest      Certain       Installments       Refund
Birthday                             Certain                    Birthday                      Certain
                                       120                                                      120
------------------------------------------------------------------------------------------------------------------------
<S>             <C>                <C>            <C>           <C>         <C>             <C>              <C>
   20              $3.00              $2.99          $2.98         55         $ 4.49           $4.44            $4.27
   21               3.01               3.01           2.99         56           4.58            4.52             4.34
   22               3.03               3.03           3.01         57           4.68            4.61             4.42
   23               3.05               3.05           3.03         58           4.79            4.71             4.50
   24               3.07               3.07           3.05         59           4.90            4.81             4.58

   25               3.09               3.09           3.07         60           5.01            4.91             4.67
   26               3.12               3.11           3.09         61           5.14            5.02             4.76
   27               3.14               3.14           3.11         62           5.27            5.14             4.86
   28               3.16               3.16           3.14         63           5.42            5.26             4.96
   29               3.19               3.18           3.16         64           5.57            5.39             5.07

   30               3.21               3.21           3.18         65           5.74            5.53             5.19
   31               3.24               3.24           3.21         66           5.91            5.67             5.31
   32               3.27               3.27           3.23         67           6.10            5.81             5.43
   33               3.30               3.30           3.26         68           6.30            5.96             5.56
   34               3.33               3.33           3.29         69           6.51            6.12             5.70

   35               3.37               3.36           3.32         70           6.74            6.28             5.85
   36               3.40               3.39           3.35         71           6.98            6.44             6.00
   37               3.44               3.43           3.38         72           7.24            6.61             6.16
   38               3.47               3.47           3.42         73           7.51            6.79             6.33
   39               3.51               3.51           3.45         74           7.81            6.96             6.51

   40               3.56               3.55           3.49         75           8.12            7.14             6.70
   41               3.60               3.59           3.53         76           8.46            7.31             6.90
   42               3.65               3.63           3.56         77           8.82            7.49             7.10
   43               3.69               3.68           3.61         78           9.21            7.67             7.32
   44               3.74               3.73           3.65         79           9.62            7.84             7.58

   45               3.80               3.78           3.69         80          10.07            8.01             7.80
   46               3.85               3.83           3.74         81          10.54            8.17             8.05
   47               3.91               3.89           3.79         82          11.05            8.33             8.32
   48               3.97               3.94           3.84         83          11.59            8.48             8.60
   49               4.03               4.01           3.89         84          12.16            8.62             8.90

   50               4.10               4.07           3.95         85          12.78            8.75             9.22
   51               4.17               4.14           4.01      and over
   52               4.25               4.21           4.07
   53               4.32               4.28           4.13
   54               4.41               4.36           4.20
------------------------------------------------------------------------------------------------------------------------
</TABLE>

                                                                         Page 18
<PAGE>

<TABLE>
<CAPTION>
--------------------------------------------------------------------------------------
             MONTHLY INCOME FOR EACH $1,000 OF PROCEEDS - OPTION 6
--------------------------------------------------------------------------------------
 FIRST
 PAYEE                 SECOND PAYEE - Age Nearest Birthday
        ------------------------------------------------------------------------------
  Age
 Nearest
Birthday   50     51     52     53     54     55     56     57     58     59     60
--------------------------------------------------------------------------------------
<S>      <C>    <C>    <C>    <C>    <C>    <C>    <C>    <C>    <C>    <C>    <C>
   45    $3.63  $3.66  $3.68  $3.70  $3.72  $3.74  $3.77  $3.79  $3.82  $3.84  $3.86
   46     3.66   3.68   3.70   3.73   3.75   3.77   3.80   3.82   3.85   3.87   3.90
   47     3.69   3.71   3.73   3.75   3.78   3.80   3.83   3.85   3.88   3.90   3.93
   48     3.71   3.73   3.76   3.78   3.81   3.83   3.86   3.88   3.91   3.94   3.96
   49     3.74   3.76   3.79   3.81   3.84   3.86   3.89   3.92   3.94   3.97   4.00

   50     3.77   3.79   3.82   3.84   3.87   3.89   3.92   3.95   3.98   4.00   4.03
   51     3.79   3.82   3.85   3.87   3.90   3.93   3.96   3.98   4.01   4.04   4.07
   52     3.82   3.85   3.88   3.90   3.93   3.96   3.99   4.02   4.05   4.08   4.11
   53     3.85   3.88   3.91   3.94   3.97   3.99   4.02   4.05   4.08   4.12   4.15
   54     3.88   3.91   3.94   3.97   4.00   4.03   4.06   4.09   4.12   4.16   4.19

   55     3.91   3.94   3.97   4.00   4.03   4.07   4.10   4.13   4.16   4.20   4.23
   56     3.94   3.97   4.01   4.04   4.07   4.10   4.13   4.17   4.20   4.24   4.27
   57     3.97   4.01   4.04   4.07   4.11   4.14   4.17   4.21   4.24   4.28   4.32
   58     4.01   4.04   4.07   4.11   4.14   4.18   4.21   4.25   4.29   4.32   4.36
   59     4.04   4.07   4.11   4.14   4.18   4.22   4.25   4.29   4.33   4.37   4.41

   60     4.07   4.11   4.14   4.18   4.22   4.26   4.29   4.33   4.37   4.41   4.45
   61     4.11   4.14   4.18   4.22   4.26   4.30   4.34   4.38   4.42   4.46   4.50
   62     4.14   4.18   4.22   4.26   4.30   4.34   4.38   4.42   4.46   4.51   4.55
   63     4.18   4.21   4.25   4.29   4.34   4.38   4.42   4.47   4.51   4.56   4.60
   64     4.21   4.25   4.29   4.33   4.38   4.42   4.47   4.51   4.56   4.60   4.65

   65     4.25   4.29   4.33   4.37   4.42   4.46   4.51   4.56   4.61   4.65   4.70
   66     4.28   4.33   4.37   4.41   4.46   4.51   4.55   4.60   4.65   4.71   4.76
   67     4.32   4.36   4.41   4.45   4.50   4.55   4.60   4.65   4.70   4.76   4.81
   68     4.36   4.40   4.45   4.50   4.54   4.59   4.65   4.70   4.75   4.81   4.87
   69     4.39   4.44   4.49   4.54   4.59   4.64   4.69   4.75   4.80   4.86   4.92

   70     4.43   4.48   4.53   4.58   4.63   4.68   4.74   4.80   4.85   4.91   4.97
--------------------------------------------------------------------------------------
</TABLE>

            *Second Payee - Ages 61 to 70 appears on the next page.

The rate for any combination of ages not stated in the table will be furnished
                                  on request.

                                                                         Page 19
<PAGE>

------------------------------------------------------------------------
            MONTHLY INCOME FOR EACH $1,000 OF PROCEEDS - OPTION 6.
------------------------------------------------------------------------
  FIRST
  PAYEE                SECOND PAYEE - Age Nearest Birthday
           -------------------------------------------------------------
   Age
 Nearest
Birthday       61    62    63    64    65    66    67    68    69    70
------------------------------------------------------------------------
   45        $3.89 $3.91 $3.94 $3.97 $3.99 $4.02 $4.04 $4.07 $4.09 $4.12
   46         3.92  3.95  3.97  4.00  4.03  4.05  4.08  4.10  4.13  4.16
   47         3.95  3.98  4.01  4.03  4.06  4.09  4.12  4.14  4.17  4.19
   48         3.99  4.02  4.04  4.07  4.10  4.13  4.15  4.18  4.21  4.24
   49         4.02  4.05  4.08  4.11  4.14  4.17  4.19  4.22  4.25  4.28

   50         4.06  4.09  4.12  4.15  4.18  4.21  4.24  4.27  4.29  4.32
   51         4.10  4.13  4.16  4.19  4.22  4.25  4.28  4.31  4.34  4.37
   52         4.14  4.17  4.20  4.23  4.26  4.29  4.32  4.36  4.39  4.42
   53         4.18  4.21  4.24  4.27  4.31  4.34  4.37  4.40  4.43  4.47
   54         4.22  4.25  4.29  4.32  4.35  4.39  4.42  4.45  4.48  4.52

   55         4.26  4.30  4.33  4.37  4.40  4.44  4.47  4.50  4.54  5.57
   56         4.31  4.34  4.38  4.41  4.45  4.49  4.52  4.56  4.59  4.63
   57         4.35  4.39  4.43  4.46  4.50  4.54  4.57  4.61  4.65  4.68
   58         4.40  4.44  4.48  4.51  4.55  4.59  4.63  4.67  4.71  4.74
   59         4.45  4.49  4.53  4.57  4.61  4.65  4.69  4.73  4.77  4.80

   60         4.49  4.54  4.58  4.62  4.66  4.70  4.75  4.79  4.83  4.87
   61         4.54  4.59  4.63  4.68  4.72  4.76  4.81  4.85  4.89  4.94
   62         4.60  4.64  4.69  4.73  4.78  4.82  4.87  4.91  4.96  5.00
   63         4.65  4.70  4.74  4.79  4.84  4.89  4.93  4.98  5.03  5.07
   64         4.70  4.75  4.80  4.85  4.90  4.95  5.00  5.05  5.10  5.15

   65         4.76  4.81  4.86  4.91  4.96  5.02  5.07  5.12  5.17  5.22
   66         4.81  4.86  4.92  4.97  5.03  5.08  5.14  5.19  5.25  5.30
   67         4.87  4.92  4.98  5.04  5.09  5.15  5.21  5.27  5.32  5.38
   68         4.92  4.98  5.04  5.10  5.16  5.22  5.28  5.34  5.40  5.46
   69         4.98  5.04  5.10  5.16  5.23  5.29  5.35  5.42  5.48  5.54

   70         5.04  5.10  5.17  5.23  5.30  5.36  5.43  5.50  5.56  5.63
------------------------------------------------------------------------

         The rate for any combination of ages not stated in the table
                         will be furnished on request.

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