Document:

CAROLINA FINANCIAL CORPORATION

2013 EQUITY INCENTIVE PLAN

Section 1.General
Purpose of Plan; Definitions.

The name of this plan
is the Carolina Financial Corporation 2013 Equity Incentive Plan (the “Plan”). The Plan was approved by the Board of
Directors on January 16, 2013 (the “Effective Date”) and subsequently adopted by the shareholders of the Carolina
Financial Corporation on April 24, 2013. The purpose of the Plan is to enable the Company and its Subsidiaries to attract and retain
highly qualified personnel who will contribute to the Company’s success and to provide incentives to Participants to increase
shareholder value and therefore further align the interests of the Participants with those of the shareholders to benefit all shareholders
of the Company.

For purposes of the
Plan, the following terms shall be defined as set forth below:

(a)“Administrator”
means the Board and/or the Committee, as the case may be, to the extent that it administers the Plan, as set forth in Section 2
below.

(b)“Award”
means any award granted under the Plan as further described in Sections 6 and 7 below.

(c)“Award
Agreement” means, with respect to each Award, the signed written agreement between the Company and the Participant setting
forth the terms and conditions applicable to the Award.

(d)“Board”
means the Board of Directors of the Company.

(e)“Cause”
shall mean with respect to the Company or Participating Employer which employs the Participant or for which such Participant primarily
performs services, termination because of personal dishonesty, incompetence, willful misconduct, any breach of fiduciary duty involving
personal profit, intentional failure to perform stated duties, willful violation of any law, rule, or regulation (other than traffic
violations, regulations that do not adversely affect the Company or its employees, or similar offenses) or final cease-and-desist
order, or material breach of any provision of an agreement with the Company. In determining incompetence, the acts or omissions
shall be measured against standards generally prevailing in the community banking industry. No act or failure to act shall be considered
“willful” unless done, or omitted to be done, not in good faith and without reasonable belief that the Participant’s
action or omission was in the best interest of the Company. The determination of “Cause” may be made by the Administrator
solely for purposes of this Plan and without regard to any other purpose of the Company.

(f)“Change
in Control” means the first to occur of any one of the events:

    	 

    	 

    

(i)the date
any Person (as such term is defined in Section 3(a)(9) of the Securities Exchange Act of 1934 (the “Exchange Act”)
and as used in Sections 13(d)(3) and 14(d)(2) of the Exchange Act) or more than one Person acting as a group (as determined under
Treasury Regulation §1.409A-3(i)(5)(v)(B), acquires ownership of the stock of the Company that, together with stock held by
such Person or group, constitutes more than 50 percent of the total fair market value or total voting power of the stock of such
Company;

(ii)the
date any one Person, or more than one Person acting as a group (as defined under Treasury Regulation §1.409A-3(i)(5)(v)(B)),
acquires (or has acquired during the 12-month period ending on the date of the most recent acquisition by such Person or Persons)
ownership of stock of the corporation possessing 30 percent or more of the total voting power of the stock of such corporation;

(iii)the
date individuals who, as of the Effective Date, constituted the Board (the “Incumbent Board”) cease for any reason
to constitute at least a majority of the Board; provided, however, that any individual becoming a director subsequent
to the Effective Date whose election, or nomination for election by the Company’s shareholders, was approved by a vote of
at least two-thirds of the directors then comprising the Incumbent Board (either by a specific vote or by approval of the proxy
statement of the Company in which such person is named as a nominee for director, without objection to such nomination) shall be
considered as though such individual were a member-of the Incumbent Board, but excluding or this purpose any such individual whose
initial assumption of office occurs as a result of either an actual or threatened election contest or other actual or threatened
solicitation of proxies or consents by or on behalf of a Person other than the Board; or

(iv)the
date that any Person or more than one Person acting as a group (as defined under Treasury Regulation §1.409A-3(i)(5)(v)(B))
acquires (or has acquired during the 12-month period ending on the date of the most recent acquisition by such Person or Persons)
assets from the Company that have a total gross fair market value equal to or more than 40 percent of the total gross fair market
value of all assets of the Company immediately before such acquisition or acquisitions; or

(g)“Code”
means the Internal Revenue Code of 1986 or any successor thereto.

(h)“Committee”
means the Compensation Committee of the Board or, if applicable, any other committee the Board may appoint to administer the Plan.
If at any time or to any extent the Board shall not administer the Plan, then the functions of the Board specified in the Plan
may be exercised by the Committee. The Committee shall be comprised of three or more “outside” directors, within the
meaning of section 162(m) of the Internal Revenue Code, who are also “non-employee directors” as defined in Rule 16b-3
under the Securities Exchange Act of 1934 and “independent directors” as defined by NASDAQ Listing Rule 5605(a)(2).

    	 

    	 

    

(i)“Common
Stock” or “Stock” means the common stock, par value $0.01 per share, of the Company.

(j)“Company”
means Carolina Financial Corporation, a Delaware corporation (or any successor corporation that assumes this Plan, either contractually
or by operation of law).

(k)“Eligible
Recipient” means an officer, director, employee, consultant, or advisor of the Company or any subsidiary.

(l)“Exercise
Price” means the per. Share price at which a Participant holding an Award of Options may purchase Shares issuable with
respect to such Award of Options, if any.

(m)“Fair
Market Value” on any date shall mean:

(i)if the
Common Stock is readily tradable on an established securities market (as defined in Treasury Regulation §1.897-1(m)), the
closing sales price of the Common Stock on such date on the securities exchange having the greatest volume of trading in the Common
Stock during the 30-day period preceding the day the value is to be determined or, if there is no reported closing sales price
on such date, the next preceding date on which there was a reported closing price; or

(ii)if the
Common Stock also is not traded on the over-the-counter market (as defined in Treasury Regulation §1.897-1(m)), the fair market
value as determined in good faith by the Board or the Committee by application of a reasonable valuation method consistently applied
and taking into consideration all available information material to the value of the Company; factors to be considered may include,
as applicable, independent third party valuations of the Common Stock, trading activity of the Common Stock known by the Board
or the Committee, whether on the over-the-counter market or through private transactions, the value of the tangible and intangible
assets of the Company, the present value of future cash-flows of the Company, the market value of stock or equity interests in
similar corporations which can be readily determined through objective means (such as through trading prices on an established
securities market or an amount paid in an arm’s length private transaction), and other relevant factors such as control premiums
or discounts for lack of marketability. For purposes of the foregoing, a valuation prepared in accordance with any of the methods
set forth in Treasury Regulation § 1.409A-1(b)(5)(iv)(B)(2) consistently used, shall be rebuttably presumed to result in a
reasonable valuation. This paragraph is intended to comply with the definition of “fair market value” contained in
Treasury Regulation § 1.409A-1(b)(5)(iv) and should be interpreted consistently therewith.

    	 

    	 

    

(n)“Grant
Date” means the later of (a) the date on which the Administrator completes the corporate action authorizing the grant
of an Award or such later date specified by the Administrator or (b) the date on which all conditions precedent to an Award have
been satisfied, provided that conditions to the exercisability or vesting of Awards shall not defer the Grant Date.

(o)“Incentive
Stock Option” or “ISO” means any Option intended to qualify as an “incentive stock option”
within the meaning of Section 422 of the Code.

(p)“Nonqualified
Stock Option” or “NOSO” means any Option that is not an Incentive Stock Option, including any Option
that provides (as of the time such Option is granted) that it will not be treated as an Incentive Stock Option.

(q)“Option”
means an option to purchase Shares granted pursuant to Section 6 of the Plan.

(r)“Participant”
means any Eligible Recipient selected by the Administrator, pursuant to the Administrator’s authority in Section 2 of the
Plan, to receive an Award.

(s)“Participating
Employer” means any member of the following group, which includes the Company, if such member agrees, in writing, to
be bound by the terms of the Plan:

(i)a controlled
group of corporations, within the meaning of Code Section 414(b),

(ii)a group
of trades or businesses under common control, within the meaning of Code Section 414(c),

(iii)an
affiliated service group, within the meaning of Code Section 414(m), or

(iv)a trade
or business required to be aggregated pursuant to Code Section 414(o).

Each Participating Employer is identified
in Appendix A. The Company shall amend Appendix A as needed to reflect a Participating Employer ‘s adoption of the Plan or
withdrawal from the Plan, without any need to otherwise amend the Plan. Amendment of Appendix A may be made by any authorized officer
or designated representative of the Company and shall not require approval of the Board.

    	 

    	 

    

(t)“Performance
Goals” means the restrictions, based upon the achievement of performance goals, established by the Administrator. Such
Performance Goals may be based upon any individual Participant or Company criteria or metric that the Administrator may determine.
Performance for any goal can be measured on an absolute basis (i.e., versus the Company’s budget or prior year result) or
relative to a peer group or industry index, as well as over a 1-year or multi-year period. In any event, the Administrator shall
have the authority to adjust any Performance Goal for unusual or non-recurring events in any manner permitted under Section 162(m)
of the Code.

(u)“Performance
Period” is a period not less than one calendar year, beginning not earlier than the year in which such Performance Award
is granted, which may be referred to herein and by the Administrator by use of the calendar year in which a particular Performance
Period commences; provided however that the Administrator shall have the authority to adjust a Performance Period for unusual or
non-recurring events to a period of not less than six months.

(v)“Permanent
and Total Disability” shall have the same meaning as given to that term by Treasury Regulation Section 1.409A-3(i)(4)
and any regulations or rulings promulgated thereunder.

(w)“Qualified
Domestic Relations Order” shall-have the-meaning-set forth in the Code or in the Employee Retirement Income Security
Act of 1974, or the rules and regulations promulgated under the Code or such Act.

(x)“Restricted
Stock” means Shares subject to certain restrictions granted pursuant to Section 7 of the Plan.

(y)“Shares”
means shares of Common Stock reserved for issuance under the Plan, as adjusted pursuant to Sections 3 or 4 of the Plan, and any
successor security.

(z)“Substitute
Awards” means Awards granted or shares of Common Stock issued by the Company in substitution or exchange for awards previously
granted by an Acquired Entity.

(aa)“Treasury
Regulations” means regulations promulgated by the United States Department of Treasury pursuant to the Code, including
proposed or temporary regulations as applicable.

Section 2.Administration.

The Plan shall be
administered by the Administrator (unless and to the extent that the Board directs the Committee not to administer the Plan). Pursuant
to the terms of the Plan, the Board or the Committee, as the case may be from time to time, shall serve as the Administrator and
shall have the power and authority:

(a)to select those
Eligible Recipients who shall be Participants;

    	 

    	 

    

(b)to determine
whether and the extent to which Awards are to be granted to Participants under the Plan;

(c)to determine
the number of Shares to be covered by or subject to each Award granted under the Plan;

(d)to determine
the terms and conditions, not inconsistent with the terms of the Plan, of each Award granted under the Plan; and

(e)to determine
the terms and conditions, not inconsistent with the terms of the Plan, that shall govern all written instruments evidencing Awards
granted under the Plan, including Award Agreements.

The Administrator
shall have the authority, in its sole discretion, to: adopt, alter, and repeal such administrative rules, guidelines and practices
governing the Plan as it shall from time to time deem advisable; correct any defect, supply any omission, reconcile any inconsistency,
and resolve any ambiguity in, and otherwise interpret, the terms and provisions of the Plan and any Award issued under the Plan
(and any Award Agreement relating thereto); and otherwise supervise the administration of the Plan. All decisions made by the Administrator
pursuant to the provisions of the Plan shall be final, conclusive and binding on all persons, including the Company and the Participants.

Notwithstanding the
above, and subject to Sections 3, 4, 6, 8, 9, and 12, outstanding Options granted under the Plan shall not be repriced without
approval by the Company’s shareholders. In particular, neither the Board nor the Administrator may take any action: (1) to
amend the terms of an outstanding Option to reduce the Exercise Price thereof, cancel an Option and replace it with a new Option
with a lower Exercise Price, or that has an economic effect that is the same as any such reduction or cancellation or (2) to cancel
an outstanding Option having an Exercise Price above the then-current Fair Market Value of the Stock in exchange for the grant
of another type of Award, without, in each such case, first obtaining approval of the shareholders of the Company of such action.

Section 3.Shares
Subject to the Plan.

Subject to Section
4 of the Plan, the total number of Shares reserved and available for issuance under the Plan shall be 250,000 Share. Such Shares
may consist n whole-or-in-part, of authorized and unissued shares or treasury shares. At all times the Company shall reserve and
keep available a sufficient number of shares as shall be required to satisfy the requirements of all outstanding Options under
the Plan. No fractional Shares shall be issued or delivered pursuant to the Plan. The Administrator shall determine whether cash,
additional Awards or other securities or property shall be issued or paid in lieu of fractional Shares or whether any fractional
shares should be rounded, forfeited or otherwise eliminated.

(a)Options.
The maximum aggregated number of shares of Stock that may be subject to Options granted in any calendar year to any one Participant
shall be 250,000 shares.

    	 

    	 

    

(b)Restricted
Stock. The maximum aggregate number of shares of Stock that may be subject to Awards of Restricted Stock or Restricted Stock
Units granted in any calendar year to any one Participant shall be 250,000 shares.

(c)Compliance
with Section 162(m) of the Code. To the extent required by Section 162(m) of the Code, Shares subject to Options which are
canceled shall continue to be counted against the limits set forth in paragraphs (a) and (b) immediately preceding.

(d)Reissuance
of Shares.

Shares of Common Stock
covered by an Award shall not be counted as used unless and until they are actually issued and delivered to a Participant. If any
Award lapses, expires, terminates or is canceled prior to the issuance of shares thereunder or if shares of Common Stock are issued
under the Plan to a Participant and thereafter are forfeited to or otherwise reacquired by the Company, the shares subject to such
Awards and the forfeited or reacquired shares shall again be available for issuance under the Plan. Any shares of Common Stock
(i) tendered by a Participant or retained by the Company as full or partial payment to the Company for the purchase price of the
Award, or (ii) covered by an Award that is settled in cash or in a manner that some or all of the shares covered by the Award are
not issued, shall among other actions, result in such shares being available for Awards under the Plan. The number of shares of
Common Stock available for issuance under the Plan shall not be reduced to reflect any dividends or dividend equivalents that are
reinvested into additional shares of Common Stock or credited as additional shares of Common stock subject or paid with respect
to an Award.

(e)Performance
Goals. The Administrator, in its discretion, may set restrictions based upon the achievement of Performance Goals, including,
but not limited to, the purpose of qualifying Awards as “performance-based compensation” under Section 162(m) of the
Code. When granting any Award other than an Option, the Administrator may designate such Award as a Qualified Performance-Based
Award, based upon a determination that (i) the recipient is or may be a “covered employee” (within the meaning of Section
162(m)(3) of the Code) with respect to such Award, and (ii) the Administrator wishes such Award to qualify for exemption under
Section 162(m) of the Code, and the terms of any such Award (and of the grant thereof) shall be consistent with such designation
(including, without limitation, that all such Awards be granted by a committee composed solely of “outside directors”).
To the extent required to comply with Section 162(m) of the Code, no later than 90 days following the commencement of a Performance
Period or, if earlier, by the expiration of 25% of a Performance Period, the Administrator will designate one or more Performance
Periods, determine the Participants for the Performance Periods and establish the Performance Goals for the Performance Periods.
The Administrator also has the authority to provide for accelerated vesting of any Award based on the achievement of Performance
Goals pursuant to the performance criteria specified for such Award. In the event that applicable tax and/or securities laws change
to permit the Administrator discretion to alter the governing performance criteria without obtaining shareholder approval of such
changes, the Administrator shall have sole discretion to make such changes without obtaining shareholder approval. In granting
Awards which are intended to qualify under Section 162(m) of the Code, the Administrator may follow any procedures determined by
it from time to time to be necessary or appropriate to ensure qualification of the Award under Section 162(m) of the Code. Notwithstanding
any other provision of the Plan, payment or vesting of any Performance Award shall not be made until the applicable Performance
Goals have been satisfied and any other material terms of such Award were in fact satisfied. The Administrator shall certify in
writing the attainment of each Performance Goal. Notwithstanding any provision of the Plan to the contrary, with respect to any
Performance Award, (a) the Administrator may not adjust, downwards or upwards, any amount payable, or other benefits granted, issued,
retained, and/or vested pursuant to such an Award on account of satisfaction of the applicable Performance Goals; provided that
the Administrator may reduce or eliminate the performance compensation or other economic benefit that was due upon attainment of
the Performance Goal (exercise of “negative discretion”) but such decrease does not increase the amount payable to
any other employee, and (b) the Administrator may not waive the achievement of the applicable Performance Goals, except in the
case of the Participant’s death or disability, or a Change of Control.

    	 

    	 

    

(f)Substitute
Awards. Notwithstanding any other provision of the Plan to the contrary, the Administrator may grant Substitute Awards under
the Plan. In the event that a written agreement between the Company and an Acquired Entity pursuant to which a merger or consolidation
is completed and approved by the Board and that agreement sets forth the terms and conditions of the substitution for or assumption
of outstanding awards of the Acquired Entity, those terms and conditions shall be deemed to be the action of the Administrator
without any further action by the Administrator, and the persons holding such awards shall be deemed to be the Participants.

(g)Administrator’s
Discretion to Accelerate Vesting of Awards. Except upon the occurrence of a Change in Control (which is governed by the provisions
of Section 9 hereof), the Administrator may, in its discretion and as of a date determined by the Administrator, fully vest any
or all Awards awarded to a Participant pursuant to an Award and, upon such vesting, all restrictions applicable to such Award shall
terminate as of such date. Any action by the Administrator pursuant to this section may vary among individual Participants and
may vary among the Awards held by any individual Participant. Notwithstanding the preceding provisions of this section, the Administrator
may not take any action described in this section (i) with respect to an Award that has been granted to a “covered Employee”
(within the meaning of Treasury Regulation Section 1.162-27(c)(2)) if such Award is intended to meet the exception for performance-based
compensation under Section 162(m) of the Code, or (ii) if such action shall cause any Award hereunder which is or becomes subject
to Section 409A of the Code to fail to comply with the requirements of Section 409A of the Code.

(h)Forfeiture
by Order of Regulatory Agency. If the Company’s or any of its financial institution subsidiaries’ capital falls
below the minimum requirements contained in 12 CFR Section 3 or below a higher requirement as determined by the Company’s
or such subsidiary’s primary bank regulatory agency, such agency may direct the Company to require Participants to exercise
or forfeit some or all of their Awards. All Awards granted under this Plan are subject to the terms of any such directive.

    	 

    	 

    

Section 4.Corporate
Transactions.

Subject to the provisions
of Section 9 hereof relating to a Change in Control, in the event of any merger, consolidation, combination, reorganization, recapitalization,
reclassification, extraordinary cash dividend, stock dividend, stock split, reverse stock split, or other change in corporate structure,
the Administrator shall make an equitable substitution or proportionate adjustment in (i) the aggregate number of Shares reserved
for issuance under the Plan, and (ii) the kind, number, and Exercise Price of Shares (or other cash or property) issuable with
respect to outstanding Options granted under the Plan (which may become, without limitation, shares of an acquiring entity or other
successor corporation that assumes this Plan), and (iii) the kind and number of Shares subject to any outstanding Awards of Restricted
Stock granted under the Plan (which may become, without limitation, shares of an acquiring entity or other successor corporation
that assumes this Plan), in each case as may be determined by the Administrator, in its sole discretion; provided, that
with respect to ISOs, any adjustment shall be made in accordance with the provisions of Section 424(h) of the Code and any regulations
or guidance promulgated thereunder; and provided, further, that no such adjustment shall cause any Award hereunder which is or
becomes subject to Section 409A of the Code to fail to comply with the requirements of Section 409A of the Code.

Section 5.Eligibility.

The Participants under
the Plan shall be selected from time to time by the Administrator, in its sole discretion, from among the Eligible Recipients.
The Administrator shall have the authority to grant Awards under the Plan to the Eligible Recipients; provided, however,
that only current employees may be granted ISOs.

Section 6.Options.

Options may be-granted
alone or in addition to other Awards granted under the Plan. Any Option granted under the Plan shall be substantially in the form
as the Administrator may from time to time approve, and the provisions of each Option need not be the same with respect to each
Participant. Participants who are granted Options shall enter into an Award Agreement with the Company in such form as the Administrator
shall determine, which Award Agreement shall set forth, among other things, the Exercise Price of the Option, the term of the Option
and provisions regarding exercisability of the Option granted in connection with such Award Agreement.

Options granted under
the Plan may be of two types: (i) Incentive Stock Options and (ii) Nonqualified Stock Options. If and to the extent any Option
granted under the Plan intended to qualify as an ISO does not qualify as an ISO, such Option shall constitute a separate NQSO.
A grant of an ISO can only be made to an Eligible Recipient who is also an employee within the meaning of Section 422(a)(2) of
the Code.

    	 

    	 

    

Options granted under
the Plan shall be subject to the following terms and conditions and shall contain such additional terms and conditions, not inconsistent
with the terms of the Plan, as the Administrator shall deem desirable:

(a)Option Exercise
Price. The Exercise Price of Shares issuable with respect to an Option shall be determined by the Administrator in its sole
discretion, provided, however, that such Exercise Price shall not be less than 100% of the Fair Market Value on the
date of grant, except in the case of Substitute Awards. If a Participant owns or is deemed to own (by reason of the attribution
rules applicable under Section 424(d) of the Code) more than 10% of the combined voting power of all classes of stock of the Company
or any subsidiary and an ISO is granted to such Participant, the Exercise Price of such ISO shall be no less than 110% of the Fair
Market Value on the date such Option is granted.

(b)Option Term.
The term of each Option shall be fixed by the Administrator, but no Option shall be exercisable more than 10 years after the date
such Option is granted; provided, however, that if an employee owns or is deemed to own (by reason of the attribution
rules of Section 424(d) of the Code) more than 10% of the combined voting power of all classes of stock of the Company or any subsidiary
and an ISO is granted to such employee, the term of such ISO (to the extent required by the Code at the time of grant) shall be
no more than five years from the date of grant.

(c)Exercisability.
Options shall be exercisable at such time or times and subject to such terms and conditions as shall be determined by the Administrator
at the time of grant. Specifically such terms and conditions may include (1) the attainment of one or more Performance Goals established
by the Administrator, (2) the Participant’s continued employment with the Company or any subsidiary, or continued service
as a director, consultant or advisor of the Company or any subsidiary, for a specified period of time, (3) the occurrence of any
other event or the satisfaction of any other condition specified by the Administrator in its sole discretion, or (4) a combination
of any of the foregoing. The Administrator may provide that any Option shall be exercisable only in installments, and the Administrator
may waive such installment exercise provisions at any time, in whole or in part, based on such factors as the Administrator may
determine, all in its sole discretion. An Option designated as an Incentive Stock Option shall cease to qualify for favorable tax
treatment as an Incentive Stock Option to the extent it is exercised (if permitted by the terms of the Option) (i) more than three
months after the date of a Participant’s termination of employment if termination was for reasons other than death or disability,
(ii) more than one year after the date of a Participant’s termination of employment if termination was by reason of disability,
or (iii) more than six months following the first day of a Participant’s leave of absence that exceeds three months, unless
the Participant’s reemployment rights are guaranteed by statute or contract.

(d)Method of
Exercise. Subject to Sections 6(c) and 8 of the Plan, vested Options may be exercised in whole or in part at any time during
the Option term, by giving notice as described in the applicable Award Agreement. As determined by the Administrator in its sole
discretion, payment in whole or in part may also be made: (i) to the extent permitted by applicable law, by means of any cashless
exercise procedure approved by the Administrator, including by means of a net exercise whereby the Company issues net Shares and
the remaining balance of the Shares to satisfy the Participant’s tax withholding obligations; (ii) in the form of unrestricted
shares of Common Stock already owned by the Participant (based on the Fair Market Value on the date the Option is exercised); provided,
however, that in the case of an ISO, the right to make payment in the form of already owned shares of Common Stock may be authorized
only at the time of grant; (iii) any other form of consideration approved by the Administrator and permitted by applicable law;
or(iv) any combination of the foregoing A Participant shall generally have the rights to dividends and any other rights of a shareholder
with respect to the Shares subject to the Option only after the Participant has given written notice of exercise, has paid in full
for such Shares, and, if requested, has given the representation described in paragraph (b) of Section 12 of the Plan.

    	 

    	 

    

(e)Non-Transferability
of Options. Except as otherwise provided in the Award Agreement and subject to Section 8 of the Plan, Options may not be sold,
pledged, assigned, hypothecated, transferred, or disposed of in any manner other than by will, or by the laws of descent and distribution,
except that NQSOs may be transferred if and to the extent set forth in an Award Agreement.

(f)Annual Limit
on Incentive Stock Options. To the extent that the aggregate Fair Market Value (determined as of the date the ISO is granted)
of Shares with respect to which ISOs granted to a Participant under this Plan and all other equity compensation plans of the Company
or any subsidiary become exercisable for the first time by the Participant during any calendar year exceeds $100,000 (as determined
in accordance with Section 422(d) of the Code), the number of Shares attributable to the amount of such Fair Market Value exceeding
$100,000 shall be treated as issuable with respect to NQSOs. The maximum aggregate number of ISOs that may be issued under the
Plan is 250,000.

(g)Taxation
of Incentive Stock Options.

(i)In order
to obtain certain tax benefits afforded to Incentive Stock Options under Section 422 of the Code, the Participant must hold the
shares acquired upon the exercise of an Incentive Stock Option for two years after the Grant Date and one year after the date of
exercise.

(ii)A Participant
may be subject to the alternative minimum tax at the time of exercise of an Incentive Stock Option. The Participant shall give
the Company prompt notice of any disposition of shares acquired on the exercise of an Incentive Stock Option prior to the expiration
of such holding periods.

(h)Certain
Successor Options. To the extent not inconsistent with the terms, limitations and conditions of Section 422 of the Code and
any regulations promulgated with respect thereto, an Option issued in respect of an option held by an employee to acquire stock
of any entity acquired, by merger or otherwise, by the Company (or any subsidiary of the Company) may contain terms that differ
from those stated in this Section 6, but solely to the extent necessary to preserve for any such employee the rights and benefits
contained in such predecessor option, or to satisfy the requirements of Section 424(a) of the Code.

    	 

    	 

    

(i)Code Definitions.
For purposes of this Section 6, “disability,” “parent corporation” and “subsidiary corporation”
shall have the meanings attributed to those terms for purposes of Section 422 of the Code.

Section 7.Restricted
Stock.

(a)Awards of Restricted
Stock may be granted either alone or in addition to other Awards granted under the Plan. The Administrator shall determine the
Eligible Recipients to whom, and the time or times at which, awards of Restricted Stock shall be made; the number of Shares to
be awarded with respect to an Award of Restricted Stock; and the Restricted Period (as defined in Section 7(c) of this Plan) applicable
to an Award of Restricted Stock. Award Agreements with respect to Restricted Stock shall be in such form as the Administrator may
from time to time approve, and the provisions of Awards of Restricted Stock need not be the same with respect to each Participant.
An Award of Restricted Stock shall be subject to such terms and conditions not inconsistent with the Plan as the Administrator
shall impose and shall be evidenced by an Award Agreement.

(a)Stock Certificates.
Subject to Section 7(c) below, with respect to each Participant who is granted an Award of Restricted Stock, the Company shall
either (i) issue a stock certificate in respect of such Award of Restricted Stock, which certificate shall be registered in the
name of the Participant and shall bear an appropriate legend referring to the terms, conditions, and restrictions applicable tom
such Award of Restricted Stock; or (ii) enter such Award of Restricted Stock in book entry form (with appropriate restrictions
noted with respect thereto), such method to be determined by the Administrator in its sole discretion. The Company may require
that any stock certificates evidencing Restricted Stock granted under the Plan be held in the custody of the Company until the
restrictions thereon shall have lapsed, and that, as a condition of any Award of Restricted Stock, the Participant shall have delivered
a stock power, endorsed in blank, relating to the Shares covered by such Award of Restricted Stock.

(b)Restrictions
and Conditions Applicable to Restricted Stock. An Award of Restricted Stock granted pursuant to this Section 7 shall be subject
to the following restrictions and conditions:

(i)Subject
to the provisions of the Plan and the Award Agreement governing any such Award of Restricted Stock, during such period as may be
set by the Administrator commencing on the date of grant of the Award, the Participant shall not be permitted to sell, transfer,
pledge, or assign such Shares of Restricted Stock (such period, the “Restricted Period”); provided, however, that the
Administrator may, in its sole discretion, provide for the lapse of such restrictions in installments and may accelerate or waive
such restrictions in whole or in part based on such factors and such circumstances as the Administrator may determine, in its sole
discretion. Notwithstanding the preceding provision of this section, the Administrator may not take any action described in this
section (i) with respect to an Award that has been granted to a “covered Employee” (within the meaning of Treasury
Regulation Section 1.162-27(c)(2)) if such Award is intended to meet the exception for performance-based compensation under Section
162(m) of the Code, or (ii) if such action shall cause any Award hereunder which is or becomes subject to Section 409A of the Code
to fail to comply with the requirements of Section 409A of the Code. Such restrictions shall be determined by the Administrator
in its sole discretion, and the Administrator may provide that such restrictions lapse upon (1) the attainment of one or more Performance
Goals established by the Administrator, (2) the Participant’s continued employment with the Company or any subsidiary, or
continued service as a director, consultant or advisor of the Company or any subsidiary, for a specified period of time, (3) the
occurrence of any other event or the satisfaction of any other condition specified by the Administrator in its sole discretion,
or (4) a combination of any of the foregoing.

    	 

    	 

    

(ii)Subject
to paragraph (b) of Section 12 of the Plan and/or unless otherwise provided in an Award Agreement, a Participant awarded Restricted
Stock under the Plan generally shall have the rights of a shareholder of the Company with respect to such Restricted Stock during
the Restricted Period (including, without limitation, the right to vote the Restricted Stock and to receive dividends thereon).

Section 8.Termination
of Employment or Service.

Unless otherwise set
forth in Section 12 of the Plan or as may otherwise be set forth in an Award Agreement, if a Participant’s employment with
or service as an officer, director, employee, consultant, or advisor of the Company or of any subsidiary: (a) terminates for any
reason and on the date of termination of employment or service the Participant is not vested as to his or her entire Award, the
Shares issuable with respect to the unvested portion of such Award shall be forfeited; and (b) terminates for the reasons described
below and on the date of termination of employment or service the Participant is vested as to any Options, then if such termination
is (i) by reason of his or her death or Permanent and Total Disability, any vested Option may thereafter be exercised for a period
of twelve months following termination of employment or service; (ii) for Cause, then any vested Option shall cease to be exercisable
and shall terminate; or (iii) for any other reason than listed in subsections (b)(i) and (b)(ii) above, then any vested Option
may thereafter be exercised for a period of 90 days following termination of employment or service. If, and to the extent that,
after termination of employment or service, the Participant does not exercise his or her Option within the applicable time stated
above, the unexercised Option shall terminate.

Section 9.Change
in Control.

Unless otherwise determined in an Award
Agreement, in the event of a Change in Control:

    	 

    	 

    

(a)Effective immediately
prior to the occurrence of the Change in Control, (i) each outstanding Award shall become fully vested and, if applicable, exercisable,
(ii) the restrictions and forfeiture conditions applicable to any such Award granted shall lapse, and (iii) any performance conditions
imposed with respect to Awards shall be deemed to be fully achieved.

(b)The Administrator
may notify all Participants that all outstanding Awards shall be assumed by the acquiring entity or substituted on an equitable
basis with awards issued by the acquiring entity. For purposes of this Section 9, an Award shall be considered assumed or substituted
for if, following the Change in Control, the Award remains subject to the same terms and conditions that were applicable to the
Award immediately prior to the Change in Control except that, if the Award related to Shares, the Award instead confers the right
to receive common stock or other securities of the acquiring entity.

(c)Notwithstanding
any other provision of the Plan, in the event of a Change in Control, except as would otherwise result in adverse tax consequences
under Section 409A of the Code, the Board may, in its sole discretion, provide that each Award shall, immediately upon the occurrence
of a Change in Control, be cancelled in exchange for a payment in cash or securities in an amount equal to (i) the excess (if any)
of the consideration paid per Share in the Change in Control (as determined by the Administrator in its sole discretion) over the
exercise or purchase price (if any) per Share subject to the Award multiplied by (ii) the number of Shares subject to the Award
(if the consideration paid per share in the Change in Control is deemed by the Administrator to be less than the Exercise Price
or purchase price (if any) per Share subject to an Award, then such Awards may be deemed to have been paid in full and canceled
by the Administrator).

Section 10.Amendment
and Termination.

The Board may amend,
alter, or discontinue the Plan, but no amendment, alteration, or discontinuation that would materially impair the rights of a Participant
under any Award granted or Award Agreement in effect under the Plan shall be made without such Participant’s consent. The
Administrator may accept surrender of outstanding Awards and grant new Awards in substitution for them; provided, that the Administrator
will not, without prior shareholder approval, exchange underwater Options or otherwise modify the exercise price or purchase price
of any Option or Award that has the effect of being a repricing. To the extent necessary and desirable, approval of the Company’s
shareholders shall be obtained for any amendment that would:

(a)increase the
total number of Shares reserved for issuance under the Plan; or

(b)change the
class of officers, directors, employees, consultants, and advisors eligible to participate in the Plan.

The Administrator
may amend the terms of any Award granted under the Plan, prospectively or retroactively, but, subject to Section 4 of the Plan,
no such amendment shall impair the rights of any Participant without his or her consent. Notwithstanding the previous sentence,
the Administrator reserves the right to amend the terms of any Award or Award Agreement as may be necessary or appropriate to avoid
adverse tax consequences under Section 409A of the Code or to comply with any requirements under the Company’s “clawback”
policy regarding incentive compensation, or such “clawback” requirements under the Sarbanes-Oxley Act of 2002 or the
Dodd-Frank Wall Street Reform and Consumer Protection Act, as amended from time to time.

    	 

    	 

    

Section 11.Unfunded
Status of Plan.

The Plan is intended
to constitute an “unfunded” plan. With respect to any payments not yet made to a Participant by the Company, nothing
contained herein shall give any such Participant any rights that are greater than those of a general unsecured creditor of the
Company.

Section 12.General Provisions.

(a)Shares shall
not be issued pursuant to the exercise or settlement of any Award granted under the Plan unless the exercise or settlement of such
Award and the issuance and delivery of such Shares pursuant to such Award shall comply with all relevant provisions of law, including,
without limitation, the Securities Act of 1933, the Securities Exchange Act of 1934, withholding tax requirements and the requirements
of any stock exchange upon which the Common Stock may then be listed, and shall be further subject to the approval of counsel for
the Company with respect to such compliance. The Company may rely on an opinion of its counsel as to such compliance. Any share
certificate issued to evidence Common Stock for which an Award is exercised or issued may bear such legends and statements as the
Administrator may deem advisable to assure compliance with Federal and state laws and regulations.

(b)The Administrator
may require each person acquiring Shares granted under the Plan to represent to and agree with the Company in writing that such
person is acquiring the Shares without a view to distribution thereof. All certificates for Shares delivered under the Plan shall
be subject to such stock-transfer orders and other restrictions as the Administrator may deem advisable under the rules, regulations,
and other requirements of the Securities and Exchange Commission, any stock exchange upon which the Common Stock is then listed,
and any applicable Federal or state securities law. The certificates for such Shares may include the legend set forth below, or
any other legend that the Administrator deems appropriate to reflect any restrictions on transfer for such Shares.

“THE ISSUANCE OF THE SHARES
REPRESENTED BY THIS CERTIFICATE HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933. THE SHARES HAVE BEEN ACQUIRED FOR INVESTMENT
AND MAY NOT BE SOLD, TRANSFERRED OR ASSIGNED IN THE ABSENCE OF EITHER AN EFFECTIVE REGISTRATION STATEMENT FOR THESE SHARES UNDER
THE SECURITIES ACT OF 1933 OR AN OPINION OF COUNSEL THAT REGISTRATION IS NOT REQUIRED UNDER THE ACT.”

    	 

    	 

    

(c)Nothing contained
in the Plan shall prevent the Board from adopting other or additional compensation arrangements. The adoption of the Plan or granting
of an Award shall not confer upon any Eligible Recipient any right to continued employment with or service to the Company or any
subsidiary, as the case may be, nor shall it interfere in any way with the right of the Company or any subsidiary to terminate
the employment or service of any Eligible Recipient at any time.

(d)Unless otherwise
set forth in an applicable Award Agreement, a Participant may elect, no later than the date as of which the value of an Award becomes
includible in the gross income of the Participant for Federal income tax purposes (the “withholding date”), to have
the Company withhold vested whole shares of Common Stock deliverable upon the exercise of an Option or the vesting of the Restricted
Stock to satisfy (in whole or in part) the amount, if any, that the Company or any subsidiary is required to withhold for taxes;
provided, however, that the amount of shares of Common Stock so withheld shall have a Fair Market Value (as of the
withholding date) that is not in excess of the amount determined by the Company to be equal to the applicable minimum statutorily
required withholding tax payments. Any such election shall be irrevocable.

To the extent that
a Participant does not make such an election, or such election does not fully satisfy such minimum statutorily required withholding
tax payments, then (x) the Company may require that the Participant pay to the Company, or make arrangements satisfactory to the
Company regarding payment of, any Federal, state, or local taxes of any kind required by law to be withheld with respect to such
Award, as a condition of the exercise of any Option, (y) the Company may withhold vested whole shares of Common Stock deliverable
upon exercise of an Option or vesting of the Restricted Stock to satisfy (in whole or in part) the amount, if any, that the Company
or any subsidiary is required to withhold for taxes; provided, however, that the amount of shares of Common Stock
so withheld shall have a Fair Market Value (as of the withholding date) that is not in excess of the amount determined by the Company
to be equal to the applicable minimum statutorily required withholding tax payments, and (z) the Company shall have the right to
deduct from any payment of any kind otherwise due to a Participant up to an amount equal to any federal, state or local taxes of
any kind required by law to be withheld in connection with the granting, vesting or exercise of an Award (not to exceed the amount
determined by the Company to be the applicable minimum statutorily required withholding tax payments). Upon request, the Participant
shall reimburse the Company for any taxes that the Company withholds that are not otherwise reimbursed as contemplated above in
this Section 12(d).

(e)No member of
the Board or the Administrator, nor any officer or employee of the Company acting on behalf of the Board or the Administrator,
shall be personally liable for any action, determination, or interpretation taken or made in good faith with respect to the Plan,
and all members of the Board or the Administrator and each and any officer or employee of the Company acting on their behalf shall,
to the extent permitted by law, be fully indemnified and protected by the Company in respect of any such action, determination,
or interpretation. Except to the extent prohibited by applicable law, the Administrator may delegate to one or more individuals
the day-to-day administration of the Plan and any of the functions assigned to it in this Plan. Such delegation may be revoked
at any time.

    	 

    	 

    

(f)If a Participant
is an officer or director of the Company within the meaning of Section 16, Awards granted hereunder shall be subject to all conditions
required under Rule 16b-3, or any successor rule(s) promulgated under the Securities Exchange Act of 1934, to qualify the Award
for any exemption from the provisions of Section 16 available under such Rule. Such conditions are hereby incorporated herein by
reference and shall be set forth in the agreement with the Participant, which describes the Award.

(g)The Company
shall be under no obligation to effect the registration pursuant to the Securities Act of 1933 of any shares of Stock to be issued
hereunder or to effect similar compliance under any state laws. Notwithstanding anything herein to the contrary, the Company shall
not be obligated to cause to be issued or delivered any shares of Stock pursuant to the Plan unless and until the Company is advised
by its counsel that the issuance and delivery of such shares is in compliance with all applicable laws, regulations or governmental
authority and the requirements of any securities exchange on which shares of Stock are traded. The Administrator may require, as
a condition of the issuance and delivery of shares of Stock pursuant to the terms hereof, that the recipient of such shares make
such covenants, agreements and representations, and that such shares, if certificated, bear such legends, and if dematerialized,
be so restricted, in each case, as the Administrator, in its sole discretion, deems necessary or desirable.

Section 13.Section
409A of the Code.

Notwithstanding any
provision in the Plan to the contrary, no payment or distribution under this Plan that constitutes an item of deferred compensation
under Section 409A of the Code and becomes payable by reason of a Participant’s termination of employment or service with
the Company will be made to such Participant unless such Participant’s termination of employment or service constitutes a
“separation from service” (as defined in Section 409A of the Code). For purposes of this Plan, each amount to be paid
or benefit to be provided shall be construed as a separate identified payment for purposes of Section 409A of the Code. If a participant
is a “specified employee” (as defined in Section 409A of the Code), then to the extent necessary to avoid the imposition
of taxes under Section 409A of the Code, such Participant shall not be entitled to any payments upon a termination of his or her
employment or service until the earlier of: (i) the expiration of the six-month period measured from the date of such Participant’s
“separation from service” or (ii) the date of such Participant’s death. Upon the expiration of the applicable
waiting period set forth in the preceding sentence, all payments and benefits deferred pursuant to this Section 13 (whether they
would have otherwise been payable in a single lump sum or in installments in the absence of such deferral) shall be paid to such
Participant in a lump sum as soon as practicable, but in no event later than 60 calendar days, following such expired period, and
any remaining payments due under this Plan will be paid in accordance with the normal payment dates specified for them herein.

    	 

    	 

    

Section 14.Notice.

All notices, requests,
waivers, and other communications required or permitted hereunder shall in writing and shall be either personally delivered, sent
by reputable overnight courier service or mailed by first class mail, return receipt requested, to the recipient at the address
below:

Carolina Financial Corporation

288 Meeting Street

Charleston, SC 29401

Attn: Jerry L. Rexroad, President
& CEO

or such other address or the attention
of such other person as the recipient party shall have specified by prior written notice to the sending party, or sent by other
electronic means. All such notices, requests, waivers and other communications shall be deemed to have been effectively given:
(a) when personally delivered to the party to be notified; (b) when sent by confirmed facsimile to the party to be notified; (c)
five (5) business days after deposit in the United States Mail postage prepared by certified or registered mail with return receipt
requested at any time other than during a general discontinuance of postal service due to strike, lockout, or otherwise (in which
case such notice, request, waiver or other communication shall be effectively given upon receipt) and addressed to the party to
be notified as set forth above; or (d) two (2) business days after deposit with a national overnight delivery service, postage
prepaid, addressed to the party to be notified as set forth above with next-business-day delivery guaranteed. A party may change
its or his notice address given above by giving the other party ten (10) days’ written notice of the new address in the manner
set forth above.

Section 15.Governing
Law and Interpretation.

The Plan and all Awards
made and actions taken thereunder shall be governed by and construed in accordance with the laws of the State of South Carolina,
without reference to principles of conflict of laws.

Section 16.Severability.

If, for any reason,
any provision of this Plan is held invalid, such invalidity shall not affect any other provision of this Plan not held so invalid,
and each such other provision shall to the full extent consistent with law continue in full force and effect. If any provision
of this Plan shall be held invalid in part, such invalidity shall in no way affect the rest of such provision not held so invalid,
and the rest of such provision, together with all other provisions of this Plan, shall to the full extent consistent with law continue
in full force and effect.

Section 17.Term
of Plan.

    	 

    	 

    

The Plan shall be
effective as of the Effective Date. No Award shall be granted pursuant to the Plan on or after the tenth anniversary of the Effective
Date, but Awards granted under the Plan prior to the tenth anniversary of the Effective Date may extend beyond the tenth anniversary
of the Effective Date pursuant to the terms of the Award as provided for under the Plan and the terms of the applicable Award Agreement.

*****

IN WITNESS WHEREOF,
the Board of Directors of the Company has adopted this Carolina Financial Corporation 2013 Equity Incentive Plan, to be executed
on behalf of the Company by a duly designated officer of the Company, as of the day and year first above written as the Effective
Date.

	 	CAROLINA FINANCIAL CORPORATION
	 	 	 
	 	By:  	 /s/ Jerry L. Rexroad
	 	 	 
	 	Name:  	Jerry L. Rexroad
	 	 	 
	 	Title:  	President & CEO

  

 

    	 

    	 

    

Appendix A

 

Participating Employers

 

Carolina Financial Corporation

CresCom Bank

Crescent Mortgage Company

Carolina Services Corporation of CharlestonJefferson Pilot

Financial

 

Jefferson Pilot Financial Insurance Company,
One Granite Place P.O. Box 515, Concord, New Hampshire 03302

 

Jefferson Pilot Financial Insurance Company
(A stock company, herein called the Company), will pay the Death Benefit specified on page 6 to the Beneficiary on receipt of due
proof of the Insured's death, subject to the provisions of this and the following pages, all of which are a part of this policy.

 

This is a Flexible Premium Variable Life Insurance
Policy. The Specified Amount may be increased or decreased by the Owner. Net Premiums will be allocated to the General Account
or to one or more divisions of JPF Separate Account A (herein called Separate Account A) as determined by the Owner.

 

THE POLICY'S ACCUMULATION VALUE IN EACH DIVISION
OF SEPARATE ACCOUNT A IS BASED ON THE INVESTMENT EXPERIENCE OF THAT DIVISION AND MAY INCREASE OR DECREASE DAILY, THE ACCUMULATION
VALUE IS NOT CU ARANTEED AS TO DOLLAR AMOUNT.

 

The policy's accumulation value in the General
Account will earn interest daily at a minimum guaranteed effective rate of 4 1⁄2%. Interest in excess of the guaranteed rate
may be applied in the calculation of the accumulat8ion value at such increased rates as the Company may determine.

 

THE AMOUNT OF DEATH BENEFIT OR THE DUREATION
OF THE DEATH BENEFIT MAY VARY UNDER THE CONDITIONS DESRIBED ON PAGES 6 AND 7 .

 

This policy is a legal contract between the
Owner and Jefferson Pilot Financial Insurance Company.

 

READ YOUR POLICY CAREFULLY

 

RIGHT TO CANCEL – Please examine this
policy carefully. The Owner may cancel this policy by returning it to Jefferson Pilot Financial Insurance company or to the agent
through whom it was purchased within 10 days after the date the Owner receives the policy, within 45 days of the date of the execution
of the application for insurance, or within 10 days after mailing or personal delivery of a Notice of the Right Withdrawal, whichever
is later. If the policy is returned, it will be deemed void from the beginning and any premium paid for it will be refunded within
7 days. If this policy is issued as a replacement for a policy issued by us or another insurer, the time period in which you have
to review the policy and return it to us for cancellation is extended to 20 days after the date the Owner received the policy,
and is extended to 20 days after mailing or personal delivery of a Notice of the Right of Withdrawal, whichever is later.

 

Executed for the Company at its Service Office
in Concord, New Hampshire, as of the policy date.

 

	Chief Executive Officer	Secretary

 

Insured:

Number:

 

    	 

    	 

    

Flexible Premium Variable Life Insurance Policy.
Flexible Premiums Payable Until the Maturity Date or Until Prior Death. Adjustable Death Benefit. Insurance Payable at Death, Some
Benefits Reflect Investment Results. Additional Benefits, if any, as indicated on Page 3. Non-Participating. No Dividends.

 

    	 

    	 

    

GUIDE TO POLICY PROVISIONS

 

 

 

 

A copy of the application will be found after
page 18. Any other benefit agreements will also be found after page 18.

 

    	 

    	 

    

BENEFICIARY AS STATED IN APPLICATION UNLESS
LATER CHANGED.

 

	LIFE INSURANCE	PLANNED PERIODIC PREMIUM

 

INITIAL SPECIFIED AMOUNT

 

PLAN OF INSURANCE                              FLEXIBLE PREMIUM VARIABLE
LIFE

 

IT IS POSSIBLE THAT COVERAGE WILL EXPIRE PRIOR
TO THE MATURITY DATE CHOSEN WHEN EITHER NO PREMIUMS ARE PAID FOLLOWING PAYMENT OF THE INITIAL PREMIUM OR SUBSEQUENT PREMIUMS ARE
INSUFFICIENT TO CO NTINUE COVERAGE TO SUCH DATE. IF CURRENT VALUES CHANGE, THIS WILL ALSO AFFECT COVERAGE.

 

THE POLICY'S ACCUMULATION VALUE IN THE GENERAL
ACCOUNT WILL EARN INTEREST DAILY AT A MINIMUM GUARANTEED EFFECTIVE RATE OF 4-1/2%. THE POLICY'S ACCUMULATION VALUE HELD IN THE
GENERAL ACCOUNT FOR POLICY LOAN COLLATERAL WILL EARN INTEREST DAILY AT THE LESSER OF AN EFFECTIVE RATE OF 6.00% OR THE INTEREST
RATE CURRENTLY CREDITED.

 

ALLOCATIONS OF NET PREMIUM:

 

 

 

SELECTED EXPENSE CHARGES:

 

1)

 

		2)	A MONTHLY ADMINISTRATIVE CHARGE. THIS CHARGE IS EQUAL TO $6.00 PER MONTH IN EACH POLICY YEAR.

 

		3)	COST OF INSURANCE AS DEFINED ON PAGE
16.

 

		4)	MORTALITY AND EXPENSE RISK CHARGE AS
DEFINED ON PAGE 15.

 

		5)	SURRENDER CHARGE ON WITHDRAWAL OR SURRENDER AS DEFINED ON PAGE 14.

 

    	 

    	 

    

MAXIMUM SURRENDER PREMIUMS

PER $1,000 INITIAL SPECIFIED AMOUNT OR

PER $1,000 OF INCREASE IN THE SPECIFIED AMOUNT

 

	ISSUE AGE OR AGE AT INCREASE	PREMIUM	ISSUE AGE OR AGE AT INCREASE	PREMIUM	ISSUE AGE OR AGE AT INCREASE	PREMIUM

 

 

    	 

    	 

    

TABLE OF MONTHLY GUARANTEED COST OF

INSURANCE RATES PER $1000

POLICY NUMBER 51601445IN

 

 

	Age	Monthly Rate	Age	Monthly Rate	Age	Monthly Rate

 

 

    	 

    	 

    

PREMIUM PROVISIONS

 

Premium Payments – An initial
premium is due and payable on the policy date. The initial premium must be large enough, after the deduction of the premium expense
charge, to cover monthly deductions for at least three months. All premiums are payable at the Home Office of the Company or to
an authorized agent of the Company in exchange for a receipt. This receipt must be signed by an elected officer of the Company
and countersigned by such agent. The Company will not accept a premium payment less than $25.

 

Planned Periodic Premium and Premium Frequency
– The Planned Periodic Premium and Premium Frequency, as shown on page 3, are selected by the Owner. The Planned Periodic
Premium is the amount of premium the Owner intends to pay. The Premium Frequency is how often the Owner intends to pay the Planned
Periodic Premium. Payment of the Planned Periodic Premium is at the option of the Owner.

 

The Company will send Planned Periodic Premium
payment reminder not ices. If the mode of premium payment is preauthorized check, government allotment or payroll deduction, notice
of any Planned Periodic Premium due till not be sent.

 

Changes in Premium Frequency and increases
or decreases in the Planned Periodic Premium may be made by the Owner by providing written notification to the Company. The Company
reserves the right to limit the amount of any increase.

 

Net Premium – the net premium
is equal to the premium paid multiplied by 95.5%. the deduction of 2.5% is a premium tax charge

 

Allocation of Net Premiums – The
Owner will determine the allocation of the net premiums among the General Account and the divisions of Separate Account A. The
minimum percentage that may be allocated to any of these accounts if 10%.

 

Unscheduled Premiums – Premium
payments in addition to the Planned Periodic Premium may be made at any time prior to the Maturity Date. The Company reserves the
right to limit the number and amount of additional premium payments.

 

If there is an existing policy loan, premium
payments in the amount of the Planned Periodic Premium, received at the Premium Frequency, will be applied as premium. Premium
or premium payments received other than at the Premium Frequency, will first be applied as policy loan repayments, then as premium
when the policy loan is repaid.

 

Grace Period – The Company will
allow a grace period of 61 days. Such grace period will begin on the day that the Company sends notice to the Owner and to the
assignee, if any, that the cash value less any policy debt on a Monthly Anniversary Day is not enough to cover the monthly deduction
for the month following such Monthly Anniversary Day. The cash value and monthly deduction are defined in the n on forfeiture Provisions
section.

 

The policy will terminate without value at
the end of the grace period unless a premium large enough, after the deduction of the premium expense charge, to cover monthly
deductions for at least three months is paid by the end of the grace period.

 

If the insured dies during the grace period,
the Company will deduct any overdue monthly deduction, which is applicable to the grace period, from the proceeds of the policy.

 

    	 

    	 

    

Reinstatement – If this policy terminates as provided in the G race Period provision, it may be reinstated by the
Owner at any time within five years after the date of termination. Reinstatement must occur before the maturity date. Reinstatement
is subject to the following requirements:

 

		(1)	Receipt of satisfactory evidence of insurability by the Company

 

		(2)	Payment of a premium large enough, after the deduction of the premium expense charge, to cover:

 

		(a)	Monthly deductions for at least three policy months following the effective date of reinstatement.

 

		(b)	Any due and unpaid monthly administrative charges

 

		(3)	Payment or reinstatement of any debt against the policy which existed on the date of termination.

 

The effective date of a re instated policy
shall be the date the Company approves the application for reinstatement. Prior to receipt of the required premium or reinstatement,
the accumulation value of the policy on the date of reinstatement shall be the accumulation value on the date of termination. The
surrender factor in effect on reinstatement shall be as defined in the Surrender Charge section.

 

DEATH BENEFIT PROVISIONS

 

Death Benefit – The death benefit provided
by this policy depends on the Death Benefit Option in effect on the date of death. The Death Benefit Option for this policy is
shown on page 3.

 

Option 1 – Under Option 1, the death
benefit shall be the greater of:

 

(1)The Specified Amount, or

 

(2)the accumulation value on the date of
death multiplied by the corridor percentage.

 

Option II – Under Option II, the death
benefit shall be equal to the Specified Amount plus the accumulation value on the date of death. However, the death benefit can
never be less than the accumulation value on the date of death multiplied by the corridor percentage.

 

 

    	 

    	 

    

The corridor percentage depends on the attained
age of the Insured on the date of death.

 

 

	Attained Age	Corridor Percentage	Attained Age	Corridor Percentage	Attained Age	Corridor Percentage	Attained Age	Corridor Percentage
	40 & below	250%	52	171%	64	122%	91	104%
	41	243	53	164	65	120	92	103
	42	236	54	157	66	119	93	102
	43	229	55	150	67	118	94	101
	44	222	56	146	68	117	95	100
	45	215	57	142	69	116	 	 
	46	209	58	138	70	115	 	 
	47	203	59	134	71	113	 	 
	48	197	60	130	72	111	 	 
	49	191	61	128	73	109	 	 
	50	185	62	126	74	107	 	 
	51	178	63	124	75-90	105	 	 

 

Changes in Existing Coverage –
The Initial Specified Amount is shown on page 3. At any time after the first policy anniversary, the Owner may, by written request,
increase or decrease the Specified Amount. Any change is subject to the following conditions:

 

		(1)	Any decrease will become effective on the Monthly Anniversary Day that coincides with or next follows
receipt of the request. Any such decrease will be deducted in the following order:

 

		(a)	From the most recent Specified Amount In crease, if any;

 

		(b)	Successively from the next most recent Specified Amount increase, if any;

 

		(c)	From the Initial specified Amount.

 

		(2)	Any request for an increase must be applied for on a supplemental application and shall be subject
to evidence of insurability satisfactory to the Company. The minimum increase in Specified Amount is $25,000.

 

		(3)	Any change approved b y the Company will become effective on the effective date shown in the Supplemental
Policy Specifications page, subject to deduction of the first month's cost of insurance therefor from the accumulation value of
this policy.

 

		(4)	The Owner may request in writing to change the Death Benefit Option. If the request is to change
from Option I to Option II, the Specified Amount will be decreased by the amount of the accumulation value. Evidence of insurability
satisfactory to the Company will be required on a change from Option I to Option II. If the request is to change from Option II
to Option I, the Specified Amount will be increased by the amount of the accumulation value. The effective date of either change
shall be the Monthly Anniversary Day that coincides with or next follows the day the request for change is received.

 

		(5)	The minimum decrease in Specified Amount, by the Owner, is $25,000. No such decrease may reduce
the Specified Amount below $100,000.

 

Change of the Maturity Date –
The Maturity Date may be changed, upon written request by the Owner. The new Maturity Date may be any policy anniversary after
the end of the tenth policy year and before the policy anniversary nearest the insured's 95th birthday. However, the
new Maturity Date must be at least twelve months from the date the Company received a written request therefor from the Owner.

 

    	 

    	 

    

GENERAL PROVISIONS

 

The Contract – This contract is
made in consideration of the application and the payment of an initial premium sufficient to keep this policy in force for at least
two months. A copy of the application is attached as a part of this policy. The entire contract consists of this policy and the
application (and any supplemental applications for additional Specified Amounts). All statements in an application shall be deemed
representations and not warranties. No statement shall be used to contest this policy or to defend against a claim unless it is
contained in the application or in a supplemental application, and a copy of such application is attached to the policy when issued
or made a part of the policy when changes in the Specified Amount become effective.

 

Ownership of Policy – The insured
shall be the Owner of the policy unless stated otherwise in the contract or changed at a later date. During the lifetime of the
insured all rights under this policy will be exercised by the Owner if the Owner has reserved the right to change the beneficiary.
The Owner may name a new Owner or name a Contingent Owner. The Owner may change a Contingent Owner. If the Owner does not survive
the insured, the Contingent Owner will, if living, become the Owner. Upon proper written notice of the Owner or beneficiary will
be voided. Unless otherwise stated, all rights under this policy are vested in the Owner or in the Owner’s assigns.

 

Incontestability – After two years
from its date, this policy shall be incontestable as to statements made in the application. If an increase in the Specified Amount
becomes effective after the policy date, such increase will be incontestable as to statements made in application for increase
after two years from its effective date.

 

Suicide – This policy does not
cover the risk of suicide within two years from the policy date, whether the Insured is sane or insane. In such event, the only
liability of the Company will be refund of premiums paid without interest less any policy loan and less any partial surrender.

 

This policy does not cover the risk of suicide,
whether sane or insane, within two years from the effective date of any increase in the Specified Amount with respect to such increase.
In such event, the only liability of the Company will be a refund of the cost of insurance for such increase.

 

Misstatement of Age or Sex – If
the Insured’s age or sex has been misstated in the application, we will adjust the proceeds to reflect the correct age or
sex. In such event, the Death Benefit we will pay will be equal to:

 

		(1)	The Accumulation Value on the date of death of the Insured less any
outstanding debt; plus 

 

		(2)	The Death Benefit , less the Accumulation Value on the date of death
of the insured, multiplied by the ratio of (a) the cost of insurance actually deducted at the beginning of the policy month in
which death occurs, to (b) the cost of insurance that should have been deducted based on the correct age or sex. 

 

If the Insured’s age or sex has been
misstated in the application, the amount payable under any rider by reason of death of the Insured shall be that amount of insurance
which the rider cost, for the policy month during which such death occurred, would have purchased had the cost of the benefits
provided under the rider been calculated using the correct rider cost of the correct age or sex.

 

If prior to the death of the Insured, it is
found that the Insured’s age or sex has been misstated in the application or the policy or a rider, the policy Cash Value
will be recalculated from issue, using mortality charges based on the correct age or sex.

 

    	 

    	 

    

Beneficiary – At any time prior
to the death of the insured, the Owner may name or change a revocable beneficiary. If no beneficiary has been named, the Owner
will be the beneficiary. A change of the Owner or beneficiary must be made in writing. To be binding on the Company, the change
must be signed by the Owner and any irrevocable beneficiary and must be filed at the Home Office. Any such change shall take effect
as of the date it was signed, subject to any payment made or other action taken by the Company before the change was filed. Unless
otherwise provided, the proceeds to be paid at the death of the Insured shall be paid in equal shares to those named beneficiaries
who survive the insured. Payment will be made in the following order: (1) the primary beneficiaries, (2) any secondary beneficiaries,
if no primary beneficiary survives the Insured, (3) any tertiary beneficiaries, if no primary or secondary beneficiary survives
the Insured, (4) Owner, (5) the executors, administrators, or assigns of the Owner, if no named beneficiary survives the insured.
The terms “children” or “lawful children” of a person, when used to name beneficiaries, shall include only
lawful children born to or legally adopted by that person.

 

Assignment – No assignment of
this policy will be binding upon the Company until it has been filed at its Home Office. Each assignment will be subject to any
payments made or action taken by the Company before it was filed. The Company will not be responsible for any assignment being
valid or sufficient.

 

Proceeds – Proceeds means the
amount payable on the maturity date, on the surrender of this policy before the maturity date or upon the death of the Insured.

 

The proceeds payable on the death of the insured
shall be the death benefit, less any debt. If the policy is surrendered, the proceeds shall be the cash value, less any debt. On
the maturity date the proceeds shall be the cash value, less any debt. The proceeds are subject to the adjustment provided in the
Misstatement of Age, Incontestability and Suicide provisions of this policy.

 

Payment of Proceeds – Unless an
optional mode of settlement is elected, the proceeds payable on the death of the insured shall be paid in one sum to the beneficiary.

 

Unless an optional mode of settlement is elected,
any proceeds payable on the maturity date or upon surrender of this policy shall be paid in one sum to the Owner.

 

Postponement of Payments – The
Company will usually pay any amounts payable on surrender, withdrawal, or policy loan allocated to Separate Account A within seven
days after written notice is received. The Company will usually pay any death benefit proceeds within seven days after the Company
receives due proof of death. Payment of any amount payable on surrender, withdrawal, policy loan, or death may be postponed whenever:

 

		(1)	The New York Stock Exchange is closed other than customary week-end
and holiday closings, or trading on the New York Stock Exchange is restricted as determined by the Securities and Exchange Commission;

 

		(2)	The Securities and Exchange Commission, by order, permits postponement
for the protection of policyowners; or 

 

		(3)	An emergency exists as determined by the Securities and Exchange
Commission, as a result of which disposal of securities is not reasonably practicable or it is not reasonably practicable to determine
the value of the next assets practicable to determine the value of the next assets of Separate Account A. 

 

Transfers may also be postponed under these
circumstances.

 

The Company may defer the portion of any transfer,
amount payable on surrender, withdrawal or policy loan from the General Account for not more than six months. However, no payment
from the General Account to pay premiums on policies with the Company will be deferred.

 

    	 

    	 

    

Age – Age of the Insured, as used
herein, refers to the age nearest birthday on the policy date. Attained age of the Insured means the age nearest birthday on the
last policy anniversary.

 

Modification – Only an elected
officer of the Company can, on behalf of the Company, change or modify this policy or waive any of the Company’s rights or
requirements. Any such changes must be made in writing.

 

Policy Date – The date shown on
page 3, which is the date requested by the Owner or the later of the date of application or the date of any required medical examination.
The policy date is the date from which policy years, policy months, and policy anniversaries will be determined.

 

Effective Date of Coverage – The
effective date of coverage under this policy shall be as follows:

 

		(1)	For all coverage provided in the original application, the effective
date shall be the policy date. 

 

		(2)	For any increase or addition to coverage, the effective date shall
be the date shown on the Supplemental Policy Specifications page. The effective date for such coverage shall begin on the policy
Monthly Anniversary Day that coincides with or next follows the date the application for the increase or addition is approved by
the Company. 

 

Termination – All coverage under
this policy shall terminate when any one of the following events occurs:

 

		(1)	The Owner requests that coverage terminate. (Such request will require
a surrender of this policy.) 

 

		(2)	The Insured dies. 

 

		(3)	The policy matures. 

 

		(4)	The grace period ends. 

 

Maturity Date – Unless otherwise
specified, the maturity date will be the policy anniversary nearest the Insured’s 95th birthday. Coverage may
expire before the maturity date if no premiums are paid after the initial premium or future premiums are not enough to continue
coverage to such date.

 

Annual Report – Each year a report
will be sent to the Owner which shows the current cash value, premiums paid and all charges since the last report, and outstanding
policy loans.

 

Non-Participating – This policy
does not share in any surplus distribution of the Company. No dividends are payable.

 

Specified Amount – The face amount
of the policy, which is the minimum death benefit payable under the policy.

 

POLICY LOANS

 

Policy Loans – After the first
policy anniversary, a loan will be granted upon the sole security and assignment of this policy to the Company. The maximum loan
amount is 90% of the cash value on the date of the loan. Any prior debts to the Company against this policy will be deducted from
the amount advanced under the loan. Any outstanding debt will be deducted from the proceeds payable at the Insured’s death,
on maturity, or on surrender.

 

The Owner may allocate the policy loan among
the General Account and the divisions of Separate Account A. If the Owner does not specify the allocation, then the policy loan
will be allocated among the General Account and the divisions of Separate Account A in the same proportion that the accumulation
value in the General Account, less any debt, and the accumulation value in each division bears to the total accumulation value
of the policy, less any debt, on the date of the policy loan. Accumulation value in each division equal to the policy loan allocated
to each division will be transferred to the General Account and reduce the accumulation value in that division. If loan interest
is not paid when due, an amount of accumulation value equal to the loan interest will also be transferred.

 

    	 

    	 

    

If the policy debt exceeds the policy's accumulation
value in the General Account, the Company win transfer accumulation value equal to the excess debt from the divisions of Separate
Account A to the Genera[ Account as security for the excess debt The amount transferred will be allocated among the divisions in
the same proportion that the accumulation value in each division bears to the policy's total accumulation value in all divisions
of Separate Account A.

 

Policy loan Interest - Interest on policy
loans is payable at the effective rate of 8%, or at any lower rate established by the Company for any period during which the loan
is outstanding. Loan Interest accrues on a daily basis from the date of the loan and is payable at the end of each policy year.
loan interest unpaid on a policy anniversary becomes loan principal.

 

The Company shall provide at least 30 days
written notice to the Owner (or any other party designated by the Owner to receive notice under this policy) and any assignee recorded
at the Home Office of any increase in the interest fate on loans outstanding 40 or more days prior to the effective date of the
increase. As to loans made during the 40 days before the effective date of the policy loan interest rate increase, the Company
shall notify the Owner and any assignee at the time the loan is made.

 

The effective date of any increase in such
interest rate shall not be less than one year after the effective date of the establishment of the previous rate. If the interest
rate is increased, the amount of such increase shall not exceed one percent per year.

 

Interest accrues on a daily basis from the
date of the loan and is compounded annually. Interest unpaid on a policy anniversary becomes loan principal.

 

Debt - As used in this policy, debt
means the principal of any loan outstanding against this policy, plus any accrued loan interest.

 

If the policy debt exceeds the cash value,
the Company will send a notice by mail to the Owner and to the assignee, if any, at their addresses last reported to the Company.
If the excess Is not paid within 61 days from the date the notice is mailed, the policy will terminate without value.

 

Policy Loan Repayment - Any debt may
be repaid, in whole or in part, at any time while this policy is in force. When a loan repayment is made, accumulation value securing
the debt in the General Account equal to the loan repayment will be allocated among toe General Account and divisions of Separate
Account A using the same percentages used to allocate net premiums.

 

    	 

    	 

    

SEPARATE ACCOUNT PROVISIONS

 

Separate Account - The variable benefits
under this policy are provided through investments in Separate Account A. The Company established Separate Account A as a separate
investment account to support variable life insurance contracts. The Company will not allocate assets to Separate Account A to
support the operation of any contracts or policies that are not variable life insurance.

 

The assets of Separate Account A are owned
by the Company. However, these assets are not part of the Company's General Account. Income, gains and losses, whether or not realized,
from assets allocated to Separate Account A will be credited to or charged against the account without regard to the Company's
other income, gains or losses.

 

Assets equal to the reserves and other liabilities
of Separate Account A will not be charged with liabilities that arise from any other business the Company may conduct The Company
shall have the right to transfer to its General Account any assets of Separate Account A which are in excess of such reserves and
other policy liabilities.

 

Separate Account A Is registered with the Securities
and Exchange Commission as a unit investment trust under the Investment Company Act of 1940. Separate Account A is also subject
to the laws of Our domiciliary state which regulate the operations of insurance companies incorporated in Our domiciliary state.
The investment policy of Separate Account A will not be changed without the approval of the Insurance Commissioner of Our domiciliary
state. The approval process is on file with the Insurance Commissioner of the state in which this policy was delivered.

 

Divisions - Separate Account A has several
divisions. Each division will buy shares of a separate series of Jefferson Pilot Variable Fund, Inc., American Century Variable
Portfolios, Inc., American Funds Insurance Series, The Ayco Series Trust, Fidelity Variable Insurance Products Fund, Franklin Templeton
Variable Insurance Products Trust, MFS Variable Insurance Trust, PIMCO Variable Insurance Trust, ProFunda VP, Scudder Investment
VIT Funds, T. Rowe Price Equity Series, Inc., Vanguard Variable insurance Fund, Inc. Each series represents a separate investment
portfolio of Jefferson Pilot Variable Fund, Inc., American Century Variable Portfolios, Inc., American Funds Insurance Series,
The Ayco Series Trust, Fidelity Variable Insurance Products Fund, Franklin Templeton Variable Insurance Products Trust, MFS Variable
Insurance Trust, PIMCO Variable Insurance Trust, ProFunds VP, Scudder Investment VIT Funds, T. Rowe Price Equity Series, Inc.,
Vanguard Variable Insurance Fund, Inc. All divisions of Separate Account A are shown on page 3. The Owner will determine the percentage
of net premiums which will be allocated to each division.

 

Income, gains and losses, whether or not realized,
from the assets of each division of Separate Account A are credited to or charged against that division without regard to income,
gains or losses in other divisions of Separate Account A or in the General Account.

 

The Company will value the assets of each division
of Separate Account A at the end of each valuation period. A valuation period is the period between two successive valuation dates.
A valuation date is each day that the New York Stock Exchange is open for business or any other day in which there is material
change in the value of the assets in Separate Account A.

 

Transfers - The Owner may transfer amounts
between the General Account and the divisions of Separate Account A or among the divisions of Separate Account A by sending a written
request to the Company. The total amount transferred must be at least $250. No amounts under $250 may he transferred out of any
division of Separate Account A or the General account unless such lesser amount constitutes the entire balance. A transfer charge
equal to the lesser of $25 or 10% of the amount transferred will be imposed each time amounts are transferred, except with respect
to policy loans. The transfer charge will be deducted from the amount that is transferred. The Company will make transfers so that
the accumulation value on the date of transfer will not be affected by the transfer except to the extent of the transfer charge.
The Company may revoke or modify the transfer privilege at any time, including the minimum amount transferable and the transfer
charge.

 

    	 

    	 

    

As long as any portion of the policy's accumulation
value is allocated to a division of Separate Account A, the policy's accumulation value and cash value will reflect the investment
performance of the chosen division(s) of Separate Account A. The death benefit may also reflect the performance of the chosen division(s)
of Separate Account A.

 

At any time, the Owner may transfer 100% of
the policy's accumulation value to the General Account While 100% of the policy's accumulation value is allocated to the General
Account, minimum benefits for the policy will be fixed and guaranteed.

 

No transfer charge will be imposed for a transfer
of all accumulation value in Separate Account A to the General Account. However, any transfer from the General Account to the division(s)
of Separate Account A will be subject to the transfer charge.

 

Addition, Deletion, or Substitution of Investments
- The Company reserves the right, subject to compliance with applicable law, to make additions to, deletions from, or substitutions
for the shares of a series that are held by Separate Account A or that Separate Account A may purchase. The Company reserves the
right to eliminate the shares of any of the series of Jefferson Pilot Variable Fund, Inc., American Century Variable Portfolios,
Inc., American funds Insurance Series, The Ayco Series Fidelity Variable Insurance Products fund, Franklin Templeton Variable Insurance
Products Trust, MFS Variable Insurance Trust, PIMCO Variable Insurance Trust, ProFunds VP, Scudder Investment VIT Funds, T. Rowe
Price Equity Series, inc. and Vanguard Variable Insurance Fund, Inc., and to substitute shares of another series of Jefferson Pilot
Variable Fund, Inc., American Century Variable Portfolios, Inc., American Funds Insurance Series, The Ayco Series Trust, Fidelity
Variable Insurance Products Fund, Franklin Templeton Variable Insurance Products Trust, MFS Variable Insurance Trust, PIMCO Variable
Insurance Trust, ProFunds VP, Scudder Investment VIT Funds, T. Rowe Price Equity Series, Inc. and Vanguard Variable insurance Fund,
Inc., or of another open-end, registered investment company, if the shares or series are no longer available for Investment or
if in the Company's Judgment, further investment in any eligible series should become inappropriate in view of the purposes of
the policy. The Company will not substitute any shares attributable to the Owner's interest in a division of Separate Account A
without notice to the Owner and prior approval of the Securities and Exchange Commission, to the extent required by the Investment
Company Act of 1940. This shall not prevent Separate Account A from purchasing other securities for other series or classes of
policies, or from permitting conversion between series or classes of policies or contracts on the basis of requests made by owners.
The Company reserves the right to establish additional divisions of Separate Account A, each of which would Invest in a new series
of Jefferson Pilot Variable Fund, Inc., American Century Variable Portfolios, Inc., American Funds Insurance Series, The Ayeo Series
Trust, Fidelity Variable insurance Products fund, Franklin Templeton Variable Insurance Products Trust, MFS Variable Insurance
Trust, PIMCO Variable Insurance Trust, Pro Funds VP, Scudder Investment VIT Funds, T, Rowe Price Equity Series, Inc. and Vanguard
Variable Insurance Fund, inc, or in shares of another open-end investment company. The Company also reserves the right to eliminate
existing divisions of Separate Account A.

 

It the Company considers it to be in the best
Interest of persons having voting privileges under the policies, Separate Account A may be operated as a management company under
the investment Company Act of 1940; or it may be deregistered under that Act in the event registration is no longer required or
it may be combined with other separate accounts.

 

    	 

    	 

    

NONFORFEITURE VALUES

 

Accumulation Value - The accumulation
value of the policy is equal to the total of the policy's accumulation value in the General Account and the policy's accumulation
value in divisions of Separate Account A.

 

Cash Value - The cash value is equal
to the accumulation value less a surrender charge.

 

Surrender Charge - The surrender charge
for the initial Specified Amount is calculated by multiplying the surrender factor (shown below) by the lesser of (1) or (2), where:

 

(1) is the
total premium paid in the first policy year;

 

(2) is the
Maximum Surrender Premium for the issue age, as shown in the table on page 3A, multiplied by the Initial Specified Amount.

 

The surrender factor will vary by policy year
according to the following table:

 

Policy Year 1-5 6 7 8 9 10 11 and later

 

Surrender Factor .30 .25 .20 .15 .10 .05 0

 

An additional surrender charge will be assessed
for any increase in the Specified Amount. The additional charge is calculated by multiplying the surrender factor (shown below)
by the lesser of (i) or (2), where:

 

(1) is (a) times (b) divided by (c).where:

 

(a) is the increase in
the Specified Amount;

 

(b) is the sum
of the cash value just prior to the Increase in the Specified Amount and the total premiums received in the twelve months just
following the increase in the Specified Amount;

 

(c) is the Specified
Amount after the increase in the Specified Amount;

 

(2) is the Maximum
Surrender Premium for the attained age of the Insured on the effective date of the increase in the Specified Amount, as shown on
page 3A, multiplied by the increase in the Specified Amount.

 

The surrender factor is based on how long the
increase has been in effect according to the following table:

 

Increase Year 1-5 6 7 8 9 10 11 and later

 

Surrender Factor .15 .125 .10 .075 .05 .025
0

 

The surrender charge in affect at any time
is the sum of the surrender charge for the Initial Specified Amount plus the additional surrender charge for any increase in the
Specified Amount. If the Specified Amount is decreased, the surrender charge will not decrease.

 

Separate Account Accumulation Values
- The accumulation value in each division on the policy date is equal to the portion of the net premium which has been paid and
allocated to that division, less the portion of the first monthly deduction allocated to the policy's accumulation value in that
division.

 

At the end of each valuation period after the
policy date, the policy's accumulation value in a division Is equal to (1) plus (2) plus (3) minus (4) minus (5) where:

 

(1) is the
accumulation value in the division on the preceding valuation date multiplied by the Net Investment Factor for the current valuation
period.

 

(2) is any
net premium received during the current valuation period which is allocated to the division.

 

(3) is all
accumulation values transferred to the division from another division or the General Account during the current valuation period.

 

    	 

    	 

    

(4) is all
accumulation values transferred from the division to another division or the General Account and accumulation values transferred
to secure a policy debt during the current valuation period.

 

(5) is all
withdrawals from the division during the current valuation period.

 

In addition, whenever a valuation period includes
the Monthly Anniversary Day, the accumulation value at the end of such period is reduced by the portion of the monthly deduction
allocated to the division.

 

Net Investment Factor - The Net Investment
Factor measures the investment performance of a division during a valuation period. The Net Investment Factor for each division
for a valuation period is calculated as (a) divided by (b), minus (c) where:

 

(a) is (1)
the value of the assets in the division at the end of the preceding valuation period, plus (2) the investment income and capital
gains, realized or unrealized, credited to the assets in the valuation period for which the net investment factor is being determined,
minus (3) the capital losses, realized or unrealized, charged against those assets during the valuation period, minus (4) any amount
charged against each division for taxes, or any amount the Company sets aside during the valuation period as a reserve for taxes
attributable to the operation or maintenance of each division.

 

(b) is the
value of the assets in the division at the end of the preceding valuation period.

 

(c) is a charge
not to exceed .0024657% for each day in the valuation period. This corresponds to .9% per year for mortality and expense risks.

 

General Account Accumulation Value -
The accumulation value In the General Account on the policy date is equal to the portion of the net premium which has been paid
and allocated to the General Account, less the portion of the first monthly deduction allocated to the General Account.

 

On each Monthly Anniversary Day, the accumulation
value in the General Account is equal to (1) plus (2) plus (3) plus (4) minus (5) minus (6) minus (7) where:

 

(1) is the
accumulation value in the General Account on the preceding Monthly Anniversary Day.

 

(2) is one
month's interest on item (1).

 

(3) is any
net premium received since the preceding Monthly Anniversary Day plus interest from the date the net premium is received to the
Monthly Anniversary Day.

 

(4) is the
sum of all accumulation values transferred to the General Account division of Separate Account A since the preceding Monthly Anniversary
Day and Interest from the date the accumulation value is transferred to the Monthly Anniversary Day.

 

(5) is the
sum of all accumulation values transferred from the General Account to a division of Separate Account A since the preceding Monthly
Anniversary Day and interest from the date the accumulation value is transferred to the Monthly Anniversary Day.

 

(6) is all
withdrawals from the General Account since the preceding Monthly Anniversary Day plus Interest from the date of the withdrawal
to the Monthly Anniversary Day.

 

(7) is the
portion of the monthly deduction allocated to the accumulation value in the General Account, to cover the policy month following
the Monthly Anniversary Day.

 

    	 

    	 

    

On any elate other than a Monthly Anniversary
Day, the accumulation value will be calculated on a consistent basis.

 

General Account interest Rate - The
policy's accumulation value in the General Account will earn interest daily at a minimum guaranteed effective rate of 4 1/2%. Interest
in excess of the guaranteed rate may be applied in the calculation of the accumulation value at such increased rates as the Company
may determine. The policy's accumulation value held in the General Account for policy loan collateral will earn interest daily
at the lesser of an effective rata of 6% or the interest rate currently credited.

 

Monthly Deduction - The monthly deduction
for a policy month shall be equal to (1) plus (2), where:

 

(1) is the
cost of insurance (as described below) and the cost of additional benefits provided by rider for the policy month.

 

(2) is a monthly
administrative charge. This charge is equal to $6.00 per month in each policy year.

 

The monthly for a policy month shall be equal
to (1) plus (2), where:

 

(1) is the
cost of insurance (as described below) and the cost of additional benefits provided by rider for the policy month.

 

(2) is a monthly
administrative charge. This charge is equal to $6.00 per month in each policy year.

 

The monthly deduction for a policy month will
be allocated among the General Account and the divisions of Separate Account A in the same proportion that the accumulation value
in the General Account less any debt and the accumulation value in each division bears to the total accumulation value of the policy,
less any debt, at the beginning of the policy month.

 

Cost of Insurance - The cost of insurance
for the Insured is determined on a monthly oasis. The cost of Insurance is determined separately for the initial Specified Amount
and each subsequent increase in Specified Amount. The cost of insurance is calculated as (1), multiplied by the result of (2) minus
(3), where:

 

(1) is the
cost of insurance rate as described in the Cost of Insurance Rates provision.

 

(2) is the
death benefit at tile beginning of the policy month, divided by 1.0036748.

 

(3) is the
accumulation value at the beginning of the policy month, prior to the monthly deduction for the cost of insurance.

 

If the Death Benefit Option is Option I and
there have been increases in the Specified Amount then the accumulation value shall be first considered a part of the Initial Specified
Amount If the accumulation value exceeds the Initial Specified Amount, it shall then be considered a part of the additional Specified
Amounts resulting from increases in the order of such increases.

 

Cost of Insurance Rates - The monthly
cost of insurance rate is based on the sex, Issue age, policy year, and rating class of the Insured. Monthly cost of insurance
rates will be determined by the Company based upon expectations as to future mortality experience. Any change in cost of insurance
rates will apply to all individuals of the same class as the Insured. The rating class will be determined separately for the Initial
Specified Amount and for any increase in Specified Amount that requires evidence of insurability. However, the cost of insurance
rates can never be greater than those shown in the Table of Monthly Guaranteed Cost of Insurance Rates. Such guaranteed maximum
rates are based on the Commissioners 1980 Standard Ordinary Mortality Table.

 

    	 

    	 

    

Insufficient Cash Value - If the cash
value less any debt on a Monthly Anniversary Day is insufficient to cover the monthly deduction for the month following such Monthly
Anniversary Day, the policy shall terminate as provided in the Grace Period provision.

 

Continuation of Insurance - In the event
Planned Periodic Premium payments are not continued, insurance coverage under this policy and any benefits provided by rider will
be continued until the cash value, less any debt, is insufficient to cover the monthly deduction, as provided in the Grace Period
provision. This provision shall not continue the policy beyond the Maturity Date nor continue any rider beyond the date for its
termination, as provided in the rider. If the cash value is sufficient to continue this policy to the Maturity Date, then any remaining
cash value will be paid to the Owner if the Insured is then living.

 

Surrender - Upon written request the
Owner may surrender this po1icy at any time during the lifetime of the Insured and before the Maturity Date. The amount payable
on surrender of this policy shall be the cash value on the date the Company receives the request for surrender, less any debt.

 

Withdrawal of Cash Value (Withdrawal)
- Upon written request the Owner may make a withdrawal from this policy. Any withdrawal is subject to the following conditions:

 

(1) The amount
withdrawn may not exceed the cash value less any outstanding debt.

 

(2) The minimum
amount that may be withdrawn is $750.

 

(3) A charge
equal to the lesser of $25 or 2% of the amount of the withdrawal will be deducted from the amount of each withdrawal.

 

(4) The accumulation
value will be reduced by the sum of the withdrawal and a pro-rata portion of the surrender charge in effect on the date of the
withdrawal. The remaining accumulation value and schedule of surrender charges will be determined by multiplying each of
these values by a numerical factor. This numerical factor is equal to

 

Amount of Withdrawal

1 - [___________________________________]

Cash Value
Immediately Before Withdrawal

 

(5) The Death
Benefit will be reduced by an amount equal to the reduction in the accumulation value. This will result in a reduction of the Specified
Amount if the Death Benefit is Option 1 by an amount equal to the reduction in the accumulation value. The Specified Amount remaining
In force after any withdrawal must be at least $10,000.

 

The Owner may allocate the withdrawal among
the General Account and the divisions of Separate Account A. If the Owner does not specify the allocation, then the withdrawal
will be allocated among the General Account and the divisions of Separate Account A in the same proportion that the accumulation
value in the General Account. less any debt, and the accumulation value in each division bears to the total accumulation value
of the policy, less any debt, on the date of the withdrawal,

 

Basis of Computations - Minimum cash
values and reserves in the General Account are based on the Commissioners 1980 Standard Ordinary Mortality Table with interest
at 4 1/2% per year.

The method used in computing cash values and
reserves in Separate Account A is in accordance with actuarial procedures that recognize the variable nature of Separate Account
A. The method used is such that if the Net Investment Factor, lass one, for all divisions of Separate Account A, at all times from
the policy date, is equal to an effective annual interest rate of 4 1/2% then the cash values and reserves in Separate Account
A will be at least equal to the minimum cash values and reserves, which would have been required by the law of the state in which
this policy is delivered, of an equivalent policy in which all net premiums have been allocated to the General Account.

 

    	 

    	 

    

All values under this policy are not less than
the values required by the state in which this policy was delivered. A detailed statement of the method of computation of cash
values under this policy has been filed with the insurance department of the state in which this policy was delivered.

 

Illustration of Benefits and Values
- The Company will provide illustrations of death benefits and cash values at any time after the policy date upon written request
by the Owner and payment of a nominal fee. The fee payable will be the one then in effect for this service; however, such fee can
never exceed $25. The first illustration in any policy year will be furnished free of charge. This illustration will be based on
the existing cash value at the time of request and maximum cost of insurance rates. Additional illustrations win be made based
on the existing cash value and current mortality assumptions.

 

SETTLEMENT OPTIONS

 

Election of an Option – Any proceeds
to be paid under this policy may be paid as an income under any one of the options stated below. The election of an option or change
of prior election must be made in writing to the Company at its Home Office. If an option is not chosen by the Owner prior to the
death of the insured, the primary beneficiary may make such election.

 

Unless the Company agrees otherwise, any such
payments will be made only to a natural person taking in his own right. An option may be elected only if the amount of the proceeds
is $2,000 or more. The Company may change the interval of payments to 3, 6 or 12 months, if necessary to increase the guaranteed
payments to at least $20.00 each.

 

Option A – Installments of
a Specified Amount – Payments of an agreed amount to be made each month until the proceeds and interest are exhausted.

 

Option B – Installments for a Specified
Period – Payments to be made each month for an agreed number of years.

 

Option C – Life Income –
Payments to be made each month for the lifetime of the payee. It is guaranteed that payments will be made for a minimum of 10,
15, or 20 years as agreed upon.

 

Option D – Interest – Payment
of interest on the proceeds held by the Company. The amount of interest payment is calculated at the compound rate of 3% per year.
Interest payments will be made in 12-, 6-, 3-, or 1-month intervals as agreed upon.

 

Supplementary Contract – When
the proceeds of this policy becomes payable, a supplementary contract setting forth the terms of the option chosen will be issued
to the payee. The first payment under Option A, B, or C shall be payable on the effective date of such option. The first payment
under Option D shall be payable at the end of the first agreed payment interval.

 

Interest – The interest rat for
Options A, B, and D will not be less than 3% per year. The interest rate for Option C will not be less than 2 1/2% per year. Interest
in addition to that stated may be paid or credited from time to time under any option but only at the sole discretion of the Company.

 

Withdrawal Value – Unless otherwise
stated in the election of an option, the payee shall have right to receive the withdrawal value under that option.

 

For Options A and D the withdrawal value shall
be any unpaid balance of proceeds plus accrued interest.

 

    	 

    	 

    

For Option B the withdrawal value shall be
the commuted value of the remaining payments. Such value will be calculated on the same basis as the original payments.

 

For Option C the withdrawal value shall be
the commuted value of the remaining payments. Such value will be calculated on the same basis as the original payments. To receive
this value, the payee must submit evidence of insurability. Such evidence must be satisfactory to the Company. Otherwise, the withdrawal
value shall be the commuted value of any remaining guaranteed payments. In this event the payments will be resumed at the end of
the guaranteed period if the payee should be alive on that date. The payments will then continue for the lifetime of the payee.

 

Under any of these options, the payee shall
have the right to receive the withdrawal value in partial amounts. However, the partial amounts shall not be less than the smaller
of the withdrawal value or $100.

 

Death of Payee – If the payee
dies before the proceeds are exhausted or the prescribed payments made, a final payment will be made in one sum to the estate of
the last surviving payee. The amount to be paid will be calculated as described for the applicable option in the Withdrawal Value
Provision.

 

Limitation on Rights of Payee and Claims
of Creditors – Neither the amount retained under an option nor any payment made under an option can be assigned or pledged.
To the extent permitted by law such amounts or payments shall not subject to claims of creditors or legal process.

 

    	 

    	 

    

EXTENSION OF MATURITY DATE RIDER

 

Effective Date –

 

This rider is part of the policy to which it
is attached. It takes effect on the effective date of the policy unless a later effective date is shown above. In this rider, “we”,
“us” or “our” means Jefferson Pilot Financial Insurance Company; “you” means the Owner of the
policy; and “insured” means the person named on the Data Page.

 

The Maturity Date may be extended beyond that
date otherwise defined in the policy by written request. The new Maturity Date will be that requested by you. If you elect to extend
the original Maturity Date, you may revoke this election in writing at any time prior to the original Maturity Date.

 

After the original Maturity Date:

 

		(1)	No new premiums will be accepted by us;

		(2)	We will continue to credit interest to the policy’s Accumulation Value of the General Account
in the same manner;

		(3)	The Accumulation Value in each division of Separate Account A will continue to be calculated in
the same manner;

		(4)	The Death Benefit will always be equal to the Accumulation Value of the policy;

		(5)	Interest on any policy loans will continue to accrue and become part of any debt;

		(6)	We will deduct no more cost of insurance
charges.

 

 

	Chief Executive Officer	Secretary

 

    	 

    	 

    

AMENDMENT

 

 

This amendment is a part of the policy to which
it is attached and it takes effect on the Policy Date of the policy. This amendment is subject to the terms and conditions of the
policy unless otherwise stated herein. The policy is amended as follows:

 

The separate series of funds identified in
the first paragraph of the Divisions section on Page 12 and in the first and second paragraph of the Addition, Deletion,
or Substitution of Investment section on Page 13 of the SEPARATE ACCOUNT PROVISIONS of Your policy have been changed
to:

 

Lincoln Variable Insurance Products Trust,
American Century Variable Portfolios, Inc., American Funds Insurance Series, Delaware VIP Trust, DWS Investments VIT Funds, Fidelity
Variable Insurance Products Fund, Franklin Templeton Variable Insurance Products Trust, Goldman Sachs Variable Insurance Trust,
MFS Variable Insurance Trust, PIMCO Variable Insurance Trust, ProFunds VP, Vanguard Variable Insurance Fund, Inc.

 

This amendment will terminate upon termination
of the policy.

 

 

Secretary

 

    	 

    	 

    

GENERAL PROVISIONS RIDER

 

Jefferson Pilot Financial Insurance Company
issues this Rider as a part of the policy to which it is attached. This Rider is issued in consideration of the application and
payment of the initial premium for the policy. There is no premium charge for this Rider. The following sections of the policy
are changed:

 

		(1)	The last sentence in sub-paragraph 5 under Changes in Existing Coverage on Page 7 is changed to
“No such decrease may reduce the Specified Amount below $25,000.00”;

 

		(2)	The following sub-paragraph under Changes in Existing Coverage on Page 7 is added:

 

		(6)	The Specified Amount cannot be increased at any time after the Insured reaches the age of 85.

 

		(3)	The entire section Policy Loans on Page 11 is replaced by the following section:

 

Policy Loans – After the first
policy anniversary, a loan will be granted upon the sole security and assignment of this policy to the Company. The maximum loan
amount is 90% of the cash value on the date of the loan less any debt. Cash value is defined under Nonforfeiture Values on Page
14. Any debt will be deducted from the proceeds payable at the Insured’s death, on maturity, or on surrender.

 

The Owner may allocate the policy loan among
the General Account and the divisions of Separate Account A. If the Owner does not specify the allocation, then the policy loan
will be allocated among the General Account and the divisions of Separate Account A in the same proportion that the accumulation
value in the General Account, less any debt, and the accumulation value in each division bears to the total accumulation value
of the policy, less any debt, on the date of the policy loan. Accumulation value in each division equal to the policy loan allocated
to each division will be transferred to the General Account and reduce the accumulation value in that division. If loan interest
is not paid when due, an amount of accumulation value equal to the loan interest will also be transferred.

 

If the policy debt exceeds the policy's accumulation
value in the General Account, the Company will transfer accumulation value equal to the excess debt from the divisions of Separate
Account A to the General Account as security for the excess debt. The amount transferred will be allocated among the divisions
in the same proportion that the accumulation value in each division bears to the policy's total accumulation value in all division
of Separate Account A.

 

Types of Policy Loans – Type A and
Type B – There are two (2) types of policy loans which the Company will grant to the Owner – Type A and Type B.
The type of loan which the Company will grant depends upon the amount of unloaned Type A balance available at the time the loan
is taken. The unloaned Type A balance if 90% of the cash value, less the threshold, and less the sum of any outstanding Type A
loans as defined below. The threshold is the Guideline Single Premium for this policy at issue as defined in Section 7702 of the
Internal Revenue Code of 1986 entitled "Life Insurance Contract Defined". If the Specified Amount as defined on Page
10 of this policy increases, the threshold will be increased to the threshold at issue times the ratio of the largest specified
Amount ever existing on the policy to the Initial Specified Amount. If the Specified Amount decreases, the threshold will not change.

 

A Type A Loan is a policy loan granted by the
Company when the unloaned Type A balance before the loan is taken exceeds the loan requested.

 

A Type B Loan is a policy loan granted by the
Company when the unloaned Type A balance before the loan is taken is less than or equal to zero.

 

    	 

    	 

    

When the unloaned Type A balance before the
loan is taken exceeds zero, but is less than the loan requested, a Type A Loan equal to the unloaned Type A balance will be granted
by the Company. The remainder of the requested loan will be a Type B Loan.

 

The Company will grant a Type A Loan first
before a Type B Loan. Once a policy loan is granted, it remains a Type A or a Type B until it is repaid.

 

Policy Loan Interest – The interest
charged by the Company on a policy loan depends upon the type of loan granted. On a Type A Loan the Company will charge an effective
interest rate of two (2) percentage points lower than the effective interest rate charged at the time by the Company for a Type
B Loan.

 

On a Type B Loan the Company will charge interest
at the effective maximum rate of 8%, or at any lower rate established by the Company for any period during which the loan is outstanding.

 

Loan Interest accrues on a daily basis from
the date of the loan and is payable at the end of each policy year. Loan interest unpaid on a policy anniversary becomes loan principal.
The Company shall provide at least 30 days written notice to the Owner (or any other party designated by the Owner to receive notice
under this policy) and any assignee recorded at the Home Office of any increase in the interest rate on loans outstanding 40 or
more days prior to the effective date of the increase. As to loans made during the 40 days before the effective date of the policy
loan interest rate increase, the Company shall notify the Owner and any assignee at the time the loan is made.

 

The effective date of any increase in such
interest rate shall not be less than twelve months after the effective date of the establishment of the previous rate. If the interest
rate is increased, the amount of such increase shall not exceed o ne percent per year. Interest accrues on a daily basis from the
date of the loan and is compounded annually. Interest unpaid on a policy anniversary becomes loan principal.

 

Debt – As used in this policy,
debt means the principal of any loan outstanding against this policy, plus any accrued loan interest. If the policy debt exceeds
the cash value, the Company will send a notice by mail to the Owner and to the assignee, if any, at their addresses last reported
to the Company. If the excess is not paid within 61 days from the date the notice is mailed, the policy will terminate without
value.

 

Policy Loan Repayment – Any debt
may be repaid, in whole or in part, at any time while this policy is in force. When a loan repayment is made, accumulation value
securing the debt in the General Account equal to the loan repayment will be allocated among the General Account and divisions
of Separate Account A u sing the same percentages used to allocate net premiums. Repayments will be used to reduce policy loans
until fully paid in the following order:

 

(1) Any or all Type B Loans; then

 

(2) Any or all Type A Loans.

 

 

    	 

    	 

    

AMENDMENT

 

This Amendment becomes a part of the policy
to which it is attached and is effective on the Policy Date of the policy. This Amendment terminates upon termination of the policy.

 

The paragraph entitled Basis of Computations
in the Nonforfeiture Values is hereby deleted and is replaced by the following:

 

Basis of Computations - Minimum cash
values in the General Account are based on the Commissioners 1980 Standard Ordinary Mortality Table with interest at 4.50% per
year. Reserves in the General Account are based on the Commissioners 1980 Standard Ordinary Mortality Table with interest at 4.00%
per year.

 

The method used in computing cash values and
reserves in Separate Account A is in accordance with actuarial procedures that recognize the variable nature of Separate Account
A. The method used is such that if the Net Investment Factor, less one, for all divisions of Separate Account A, at all times from
the policy date, is equal to an effective annual interest rate of 4.50% for cash values and 4.00% for reserves, then the cash values
and reserves in Separate Account A will be at least equal to the minimum cash values and reserves, which would have been required
by the law of the state in which this policy is delivered, of an equivalent policy in which all net premiums have been allocated
to the General Account.

 

All values under this policy are not less than
the values required by the state in which this policy was delivered. A detailed statement of the method of computation of cash
values under this policy has been filed with the insurance department of the state in which this policy was delivered.

 

Secretary

    	 

    	 

    

SETTLEMENT OPTIONS

TABLES OF MONTHLY INSTALLMENTS UNDER OPTION
B OR C

 

Monthly installments are shown for each $1,000
of net proceeds applied. The ages shown are ages nearest birthday when the first monthly installment is payable.

 

OPTION B TABLE

INSTALLMENTS FOR A SPECIFIED PERIOD

 

	Years	Monthly Installment	Years	Monthly Installment	Years	Monthly Installment	Years	Monthly Installment	Years	Monthly Installment
	1	$84.47	7	$13.16	13	$7.71	19	$5.73	25	$4.71
	2	42.86	8	11.68	14	7.26	20	5.51	26	4.59
	3	28.99	9	10.53	15	6.87	21	5.32	27	4.48
	4	22.06	10	9.61	16	6.53	22	5.15	28	4.37
	5	17.91	11	8.86	17	6.23	23	4.99	29	4.27
	6	15.41	12	8.24	18	5.96	24	4.84	30	4.18
	Multiply the monthly installment by 11.84 for annual, by 5.96 for semi-annual or by 2.99 for quarterly installments.  

 

	
        OPTION C TABLE

        LIFE INCOME

	
        Attained

        Age of Payee
	MONTHLY INSTALLMENTS	
        Attained

        Age of Payee
	MONTHLY INSTALLMENTS
	 	 	GUARANTEED	 	 	GUARANTEED
	Male	Female	10 Years	15 Years	20 Years	Male	Female	10 Years	15 Years	20 Years
	16 or Under	21 or Under	
         

        $2.83
	
         

        $2.82
	
         

        $2.81
	
         

        51
	
         

        56
	
         

        $4.60
	
         

        $4.44
	
         

        $4.24

	17	22	2.85	2.84	2.84	52	57	4.69	4.52	4.30
	18	23	2.88	2.87	2.86	53	58	4.79	4.60	4.36
	19	24	2.90	2.89	2.88	54	59	4.90	4.69	4.41
	20	25	2.93	2.92	2.91	55	60	5.01	4.77	4.47
	21	26	2.95	2.95	2.93	56	61	5.12	4.86	4.53
	22	27	2.98	2.97	2.96	57	62	5.23	4.94	4.59
	23	28	3.01	3.00	2.99	58	63	5.35	5.03	4.64
	24	29	3.04	3.03	3.02	59	64	5.48	5.12	4.70
	25	30	3.08	3.07	3.05	60	65	5.61	5.21	4.75
	 	 	 	 	 	 	 	 	 	 
	26	31	3.11	3.10	3.08	61	66	5.74	5.30	4.80
	27	32	3.14	3.13	3.11	62	67	5.87	5.39	4.85
	28	33	3.18	3.17	3.15	63	68	6.01	5.48	4.90
	29	34	3.22	3.20	3.18	64	69	6.16	5.56	4.94
	30	35	3.26	3.24	3.22	65	70	6.30	5.65	4.98
	31	36	3.30	3.28	3.25	66	71	6.45	5.73	5.02
	32	37	3.34	3.32	3.29	67	72	6.60	5.82	5.05
	33	38	3.39	3.36	3.33	68	73	6.76	5.90	5.09
	34	39	3.43	3.41	3.37	69	74	6.91	5.97	5.12
	35	40	3.48	3.45	3.41	70	75	7.07	6.05	5.14
	 	 	 	 	 	 	 	 	 	 
	36	41	3.53	3.50	3.45	71	76	7.23	6.12	5.17
	37	42	3.59	3.55	3.50	72	77	7.38	6.18	5.19
	38	43	3.64	3.60	3.54	73	78	7.54	6.24	5.20
	39	44	3.70	3.65	3.59	74	79	7.69	6.30	5.22
	40	45	3.76	3.71	3.64	75	80	7.84	6.35	5.23
	41	46	3.82	3.77	3.69	76	81	7.98	6.39	5.24
	42	47	3.88	3.82	3.74	77	82	8.13	6.43	5.25
	43	48	3.95	3.88	3.79	78	83	8.26	6.47	5.26
	44	49	4.02	3.95	3.84	79	84	8.39	6.50	5.26
	45	50	4.09	4.01	3.90	80 or 	85 or	8.51	6.53	5.27
	46	51	4.17	4.08	3.95	Over	Over	 	 	 
	47	52	4.25	4.15	4.01	 	 	 	 	 
	48	53	4.33	4.22	4.07	 	 	 	 	 
	49	54	4.42	4.29	4.12	 	 	 	 	 
	50	55	4.50	4.37	4.18	 	 	 	 	 
	Multiply the monthly installment by 11.80 for annual, 5.93 for semi-annual or by 2.98 for quarterly installments.

 

    	 

    	 

    

 

	Jefferson Pilot	Jefferson Pilot Financial Insurance Company , PO Box 515, Concord, NH 03302-0515 (hereinafter referred to as “the Company”)

 

PREMIUM ALLOCATION & DISCLOSURE FORM
FOR VARIABLE UNIVERSAL LIFE INSURANCE (Completed Form Must Accompany Application for Life Insurance)

 

	Name of Owner: 	 	 	 
	 	First	Middle Initial	Last
	 	 	 	 
	Name of Insured(s):  	 	 	 
	 	First	Middle Initial	Last
	 	 	 	 
	 	 	 	 
	 	First	Middle Initial	Last

 

Section I: Disclosure for Variable Universal
Life Insurance 

I have applied for a variable universal life
insurance policy (“Policy”). I have received a prospectus, which describes the Policy’s provisions in detail.

 

My Representative has reviewed each of the
items in Subsections A through E with me, and I understand:

 

		A.	Most variable universal life insurance policies have the following
general features (but Policy features, definitions and details will vary by insurance company and Product): 

 

		1.	What am I buying: A variable universal life insurance policy.

 

		2.	Where my payments go: My payments are premiums for the Policy.
After the insurer takes out certain charges from each payment, I can direct the net payments to the fixed account (if available)
and/or sub-accounts I select. Each sub-account invests in a professionally managed portfolio with a particular investment objective.
I am assuming investment risk for all funds placed in sub-accounts. The funds placed in a fixed account are guaranteed and backed
by the claims paying ability of the insurance company. 

 

		3.	Monthly Policy Deductions: Most variable universal life policies
deduct charges from the policy’s cash value monthly or periodically; these cover an administrative charge, the cost of insurance
rates and any option (rider) benefits. In most variable universal life policies, the cost of insurance rates are set by the insured’s
risk class and vary by the insured’s age each year. 

 

		4.	Sub-account and portfolio fees: Other fees and expenses are
charged against the assets of the selected sub-accounts and the portfolios in which they invest. 

 

		5.	Does the cash value of my policy keep changing: Yes. Future
Policy cash values may be more or less than the premiums paid. They will depend on: 

 

		•	Actual investment results of sub-accounts and/or the interest credited
to the Fixed Account (if selected); 

		•	The cost of insurance rate and other regular deductions; 

		•	The amount and timing of my premium payments and any cash withdrawals
or loans I take; and 

		•	Any changes I make to the Policy. 

    	 

    	 

    

 

		6.	Surrender, loans and partial withdrawals have limits and charges:
I can surrender my Policy at any time. In most policies, the value I would receive on surrender is the cash value of the Policy,
less any surrender charges, less any outstanding policy loans. Surrender charges may significantly affect the amount available
for loans and withdrawals, and they may apply for a number of years. Loans and partial withdrawals may have other limits, conditions
and/or charges; and they will reduce the death benefit payable and the cash value available to cover the policy deductions. Surrenders
and/or withdrawals of cash values may cause the Policy to lapse unless additional premium dollars are paid in. The prospectus describes
these limits, conditions, effects and charges in detail. 

 

		B.	Illustrations: Any policy illustration is hypothetical and
based on assumptions. Illustrations are intended to show how a policy would work under different scenarios and not to project results.
Actual rates of return and policy results are not guaranteed and will vary [payments placed in the fixed account carry some guarantees
for specified periods of time). 

 

		C.	Taxes: Jefferson Pilot Financial Insurance Company does not
give tax or legal advice. I will consult with my own professional tax or legal advisor about my own tax situation if necessary.
The Prospectus discusses Federal tax matters under current tax law as they pertain to the policy. 

 

		D.	My needs and objectives:

 

		a.	The policy is designed for long-term buyers who seek life insurance
benefits and a choice of investment options for its cash value. I have reviewed my insureable needs and financial objectives with
my Representative. I have an adequate cash reserve for emergencies outside of this policy. I have determined that my payments are
affordable and the Policy, including the designated sub-accounts, is appropriate for my insurance and financial needs and objectives.

 

		b.	This policy is intended to be purchased as a funding vehicle for
(check one):

 

		 ̈  Income Replacement	 ̈Supplemental
Retirement Income ̈Estate Plan

		 ̈  Charitable Gift	 ̈Split Dollar ̈Deferred
Compensation

		 ̈  Key Person	 ̈Bonus Plan ̈Business
Continuity

		 ̈  Other	

 

		E.	Prospectus: I have been given a currently effective prospectus
and have had sufficient opportunity to review it. My representative has satisfactorily answered my questions, if any, that I have
regarding the proposed policy. 

 

Section II: Allocation of Net Premiums (5%
is the minimum allowed for any sub-account used. Use whole numbers only – no fractions or decimals. Total sum of percentage
allocations must equal 100%.)

 

    	 

    	 

    

 

	Fund	Advisor/Subadvisor	Percentage	Fund No.
	ProFund VT Technology	ProFund Advisors, LLC	 %	082
	Vanguard VIF Small Company Growth	The Vanguard Group	 %	078
	ProFund VP Financial	ProFund Advisors, LLC	 %	083
	JPVF Growth	Jefferson Pilot Investment Advisory Corporation subadvised by Strong Capital Management, Inc.	 %	026
	American Funds Growth	Capital Research and Management Co.	 %	088
	Fidelity VIP Growth	Fidelity Management Research Co.	 %	043
	Soudder VIT Small Cap Index	Deutsche Asset Management	 %	081
	JPVF Small Company	Jefferson Pilot Investment Advisory Corporation subadvised by Lord, Abbett & Company	 %	031
	Fidelity VIP Mid Cap	Fidelity Management and Research Co.	 %	087
	ProFund VP Healthcare	ProFund Advisors, LLC	 %	076
	T. Rowe Price Mid-Cap Growth	T Rowe Price Associates	 %	076
	JPVF Mid-Cap Growth	Jefferson Pilot Investment Advisory Corporation subadvised by Turner Investment Partners, Inc.	 %	071
	JPVF Strategic Growth	Jefferson Pilot Investment Advisory Corporation subadvised by T Rowe Price Associates, Inc.	 %	021
	MFS Research	MFS Investment Management	 %	035
	Franklin Small Cap Value	Franklin Advisory Services, LLC	 %	085
	JPVF Mid-Cap Value	Jefferson Pilot Investment Advisory Corporation subadvised by Wellington Management Company, LLP	 %	072
	JPVF Capital Growth	Jefferson Pilot Investment Advisory Corporation subadvised by Janus Capital Management, LLC	 %	041
	Vanguard VIF Mid-Cap Index	The Vanguard Group	 %	079
	Ayco Growth Fund	The Ayco Company, LP	 %	074
	JPVF Small-Cap Value	Jefferson Pilot Investment Advisory Corporation subadvised by Dalton, Greiner, Hartman, Maher & Co.	 %	070
	American Century VP Int’l Fund	American Century Investments	 %	073
	American Century VP Value	American Century Investments	 %	077
	Fidelity VIP Equity-Income	Fidelity Management and Research Co.	 %	044
	JPVF Value	Jefferson Pilot Investment Advisory Corporation subadvised by Credit Suisse Asset Management, LLC	 %	037
	American Funds Growth-Income	Capital Research and Management Co.	 %	089

 

    	 

    	 

    

	Fund	Advisor/Subadvisor	Percentage	Fund No.
	Templeton Foreign Securities Fund	Templeton Investment Counsel, LLC	 %	024
	JPVF International Equity	Jefferson Pilot Investment Advisory Corporation subadvised by Marsico Capital Management	 %	025
	MFS Utilities	MFS Investment Management	 %	036
	JPVF S&P 500 Index	Jefferson Pilot Investment Advisory Corporation subadvised by Barclays Global Fund Advisors	 %	049
	JPVF World Growth Stock	Jefferson Pilot Investment Advisory Corporation subadvised by Templeton Investment Counsel, LLC	 %	006
	Fidelity VIP Contrafund	Fidelity Management and Research Co.	 %	047
	Vanguard VIF REIT Index	The Vanguard Group	 %	080
	JPVF High Yield Bond	Jefferson Pilot Investment Advisory Corporation subadvised by MFS Investment Management	 %	028
	JPVF Balanced	Jefferson Pilot Investment Advisory Corporation subadvised by Janus Capital Management, LLC	 %	045
	PIMCO Total Return	PIMCO	 %	075
	Fidelity VIP Investment Grade Bond	Fidelity Management and Research Co.	 %	086
	JPVF Money Market	Jefferson Pilot Investment Advisory Corporation subadvised by MFS Investment Management	 %	011
	Other	 	 %	 
	General Account	 	 %	050
	Total	 	 %	 

 

 

	 	 	 
	Signature of Owner                                        Date	 	 
	 	 	 
	Meiton	 	 
	Name of Owner (Please Print)	 	 
	 	 	 
	 	 	 
	Social Security or Tax ID Number	 	Owner’s
Brokerage Account Number
	 	 	 

I declare that I have reviewed each of these
______ with the Owner.

 

	 	 	 
	Signature of Registered Representative      Date	 	Rep
Number
	 	 	 
	 	 	 
	Name of Registered Representative (Please Print)	 	 
	 	 	 

I have reviewed this transaction and find it
suitable for the client.

 

	 	 	 
	Signature of Approving Principal      Date	 	 
	 	 	 
	 	 	 
	Name of Principal (Please Print)	 	 
	 	 	 

 

    	 

    	 

    

 

	Jefferson Pilot	Jefferson Pilot Financial Insurance Company , PO Box 515, Concord, NH 03302-0515 (hereinafter referred to as “the Company”)

 

APPLICATION SUPPLEMENT FOR VARIABLE LIFE
INSURANCE

 

Instructions: For use with individual and survivorship
life products. Complete information for both Proposed insureds, where requested, if applying for Joint and last Survivor Flexible
Premium Variable Life.

 

The Variable Life Premium Allocation Form shall
also be completed and attached.

 

	A. 	1)	Proposed Insured:	 	 	Birthdate:	 	/	 	/	 
	 	 	 	 	 	 	 	 	 	 	 
	 	2)	Proposed Insured:	 	 	Birthdate:	 	/	 	/	 
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 

 

		B.	Premium Payor (Complete if the Premium Payor is other than the Proposed
Insured(s))

 

	 	1. 	Name of Payor:	 
	 	 	 	 
	 	2. 	Relationship to Proposed Insured(s):	 
	 	 	 	 

 

 

		C.	Monthly Charges 

 

Monthly insurance and administrative
charges will be deducted from the General Account and divisions of the Separate Account on a pro rata basis unless the box is checked
below:

 

 ̈
Deduct all charges from the                      division (any single division or the General Account may be noted).

 

COMPLETE THIS SECTION ONLY IF APPLYING FOR
INDIVIDUAL FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE:

 

		D.	Death Benefit Qualification Test

 

Please choose the Death Benefit
Qualification Test. Once a test has been selected it may not be changed during the life of the contract.

 

 ̈
Cash Value Accumulation Test            ̈ Guideline Premium Test

 

		E.	Suitability

 

	 	Yes	No	 	 
	 	 	 	 	 
	 	 ̈	 ̈	1.	Have you, the Proposed insured(s) and the Owner, if other than the Proposed insured(s), received a current Prospectus dated                              for the policy applied for?  
	 	 	 	 	 
	 	 ̈	 ̈	2.	Do you understand that the amount and duration of the death benefit may vary depending on the investment performance of funds in the Separate Account?  
	 	 	 	 	 
	 	 ̈	 ̈	3.	Do you understand that the cash values may increase or decrease, depending on the investment performance of the funds held in the Separate Account?  
	 	 	 	 	 
	 	 ̈	 ̈	4.	With this in mind, do you believe that the policy applied for is in accord with your insurance objective and your anticipated financial needs?  
	 	 	 	 	 

 

    	 

    	 

    

 

	
        Jefferson
        Pilot

        Financial
	
        Elite

        LifeComp®

 

 

Elite LifeComp® AGREEMENT FOR UNIVERSAL
LIFE POLICY

 

The parties to this Elite LifeComp®
Agreement request that the provisions of this form be included in the Insurer’s file for the life insurance policy identified
below. Any previous designations of beneficiary or contingent beneficiary and election of settlement options are hereby revoked.

 

	
        Policy No.

         

         

         
	Or New Application Date	On the Life of Named Insured(s)

 

I.DEFINITIONS Where the
terms below appear, they are defined as follows:

 

“INSURER” means the following company:
(select one)

 

	 ̈	Jefferson-Pilot Life	 	 ̈	Jefferson Pilot Financial
	 	Insurance Company	 	 	Insurance Company
	 	P.O. Box 21008	 	 	One Granite Place, P.O. Box 515
	 	Greensboro, NC 27420	 	 	Concord, NH 03302-0515

 

 

 

“Co-Owner”

 

 

“Employer”

 

 

“Co-Beneficiary”

 

 

 

 

 

 

“Net Premiums”: For the
purpose of this Agreement, the term “Net Premiums” means the total premiums paid on the policy by the Employer plus
accrued interest thereon, any partial withdrawals made by the Employer, and any other amounts received by the Employer from the
Co-Owner to reduce the Co-Owner’s obligation under the outstanding Employer loan plus an effective annual rate of ______%
or the actual growth in policy values for the year, if less. In no event will the Net Premiums be less than the outstanding employer
loan plus any accrued but unpaid interest on the employer loan.

 

    	 

    	 

    

“Insured”: For purposes
of this Agreement, the term “Insured” means that individual (named in the space provided above) on whose life the insurance
coverage is provided, or where the insurance policy provides coverage on the lives of two individuals, “Insured” shall
refer to both individuals on whose lives the coverage applies.

 

II.Payment of Premiums and Interest

 

With regard to policy premiums and interest
on the Employer loan, the Employer and Co-Owner agree:

 

		·	The Employer’s portion of any premium contribution shall constitute
a loan to the Co-Owner. 

		·	Any voluntary additional premium contributions by the Co-Owner paid
indirectly to the insurer through the Employer shall not be part of the Employer’s Net Premiums. The Co-Owner is obligated
for interest on the employer loan at the Applicable Federal Rate, as determined under IRC §7872 and regulations thereunder.

 

III.Division of Death Proceeds

 

This agreement contemplates a division of death
proceeds between two beneficiaries: the Employer and the Co-Beneficiary.

 

Upon payment of the death proceeds while this
Elite LifeComp® Agreement is in effect: (Select one)

 

	1.	 ̈	The Employer shall receive death proceeds equal to the Net Premiums as defined in Section 1 of this document.  Notwithstanding, in no event shall the Co-Beneficiary be entitled to receive an amount which is less than the Policy Value or Cash Value less the total of Net Premiums and any policy loans by the Co-Owner even if the Employer’s defined share of the proceeds must be reduced accordingly.  
	 	 	 
	2.	 ̈	The Employee shall receive death proceeds equal to the sum of ____________ plus the Net Premiums as defined in Section 1 of this document.  Notwithstanding, in no event shall the Co-Beneficiary be entitled to receive an amount which is less than the Policy Value or Cash Value less the total of Net Premiums and any policy loans by the Co-Owner even if the Employer’s defined share of the proceeds must be reduced accordingly.  

 

Regardless of the option selected above, the
amount payable to the Co-Beneficiary shall be referred to as “Co-Beneficiary Death Proceeds.”

 

Insurer shall pay the entire net death proceeds
in one sum to the joint order of the Employer, the Co-Beneficiary, and any collateral assignee. Payment by insurer in accordance
with the above will fully and finally discharge insurer for the amount so paid.

 

IV.Ownership Rights

 

Unless otherwise state herein, the Employer,
acting alone, may exercise the following rights:

 

    	 

    	 

    
		(1)	The right to borrow against, pledge or assign the policy, however, in an amount not to exceed the
Net Premiums.

		(2)	The right to make partial surrenders of the cash surrender value, provided the aggregate amount
of such partial surrenders shall not exceed the amount of the Net Premiums.

		(3)	The right to designate and change the beneficiary for the Employer’s share of the death proceeds.

		(4)	The right to change the planned premium, mode of premium payment and the frequency of premium payment.

 

Unless otherwise state herein, the Co-Owner,
acting alone, may exercise the following rights:

 

		(1)	The right to designate and change the Co-Beneficiary and change a settlement option for the Co-Beneficiary.

		(2)	The right to exercise the Conversion Privilege of any Spouse Term Rider or Children’s Term
Rider which is included in the policy and be the Owner and premium payor of any new policy issued in lieu of such rider.

		(3)	The right to transfer, assign or pledge the Co-Owner’s interest in the policy.

 

Unless otherwise stated herein, the Employer
and Co-Owner must act jointly to exercise the following rights: 

 

		(1)	The right to change the Specified Amount
of the policy and the death benefit option.

		(2)	The right to reinstate the policy.

		(3)	The right to borrow against or make a partial surrender of the Co-Owner’s interest in the
policy.

 

The Employer’s consent to these transactions
shall not be unreasonably withheld.

 

Where the policy is variable universal life
insurance, the Employer and Co-Owner must also act jointly to exercise the following additional rights:

 

		(1)	The right to reallocate premiums among the divisions of the Separate Account and the General Account.

		(2)	The right to transfer accumulation value among the divisions of the Special Account and the General
Account.

 

By signing immediately below, the employer
waives the right of Employer consent and joint action to reallocate premiums among divisions of the Separate Account and the General
Account, and the right to transfer accumulation value among the divisions of the Separate Account and General Account. 

 

	Employer Waiver by:	 	Attest:	 
	 	Title	 	Title

 

The Employer and Co-Owner hereby agree that
Insurer is authorized to recognize the Employer’s claims to its rights hereunder and to rely on the Employer’s determination
of any amount payable to the Employer under this policy prior to the death of the Insured, with no further inquiry of any nature.
The exercise of these rights and determination of these amounts by the Employer shall be binding on the Co-Owner, and the rights
of any other persons or parties having an ownership or beneficiary interest in the policy shall be subject to such exercise and/or
such determination.

 

    	 

    	 

    

Nevertheless, as between the Employer and the
Co-Owner, the Employer covenants that it will not exercise any rights, options and privileges not specifically reserved to the
Employer in a manner which would impair any right or interest of the Co-Owner or Co-Beneficiary. In a like manner, the Co-Owner
covenants that it will not exercise any rights, options or privileges not specifically reserved to the Co-Owner in a manner which
would impair any right or interest of the Employer.

 

This Agreement may be added to a policy previously
owned by the Employer and/or the Co-Owner, including any policy collaterally assigned by the Co-Owner to the Employer. A tax-free
exchange of a previously owned policy for a new policy issued by the insurer may be a necessary preliminary step before this Agreement
can be added to a policy. If there is a tax-free exchange of a previously owned policy, it is expressly agreed that, the exchange
will be requested by the owner(s) (and assignee, if any) of the previously owned policy. Following full and final completion of
the policy exchange, the owner(s) (and assignee, if any) request that this Agreement be added to the new policy, and that the Agreement
become immediately effective.

 

V.Termination

 

		A.	Upon the termination of the Co-Owner’s employment with the Employer for any reason other
than death of the insured or if the Co-Owner shall fail to pay that portion of each premium payment, if any, required in II above,
the Employer shall have the following rights, without the consent of the Co-Owner. 

 

		(1)	If the Surrender Value of the policy is less than the Net Premiums, the Employer shall have the
right to:

 

		(a)	surrender the policy and receive all surrender proceeds tot he exclusion of the Co-Owner, or

 

		(b)	release the Employer’s rights in the policy upon payment by the Co-Owner to the Employer
an amount equal to the Net Premiums. Such release of the Employer’s rights shall be upon such forms as insurer may require.

 

		(2)	If the Surrender Value exceeds the Net Premiums, the following shall apply:

 

		(a)	The Employer may make a partial surrender in an amount equal to the Net Premiums. At the election
of the Employer, the Employer may receive a policy with a Cash Surrender Value equal to the Net Premium and a Death Benefit which
shall not exceed that to which the Employer was entitled under Article III. Following the Employer’s partial surrender and
release of ownership rights, the Co-Owner shall receive a policy with the original policy date and with a Death Benefit not to
exceed the Co-Beneficiary’s Death Proceeds determined under Article III.

 

		(b)	If the Employer elects not to take a policy pursuant to (a) above, the Employer may elect (i) to
make a partial surrender in an amount equal to the Net Premiums, or (ii) release the Employer’s rights in the policy upon
payment by the Co-Owner to the Employer of an amount equal to the Net Premiums. Upon receipt of the amount payable under (i) or
(ii), above, the Employer shall have no further rights to, or any incidents of ownership in, the policy. Provided, however, that
the Death Benefit may be adjusted, if necessary, so that the Death Benefit is no greater than the Co-Beneficiary’s Death
Proceeds as determined in Article III. Such release of the Employer’s rights shall be upon such forms as insurer may require.

 

    	 

    	 

    

The type and insured amount of any
new policy shall conform to Insurer’s policy rules in effect on the date of the issue or reissue of the new policy.

 

Insurer shall have no responsibility
for determining the Net Premiums for the purpose of this Section V but instead shall rely solely upon the statements and representations
of the Employer and shall be fully protected in relying thereon.

 

		B.	If more than one individual is insured under the policy and the insured individual possessing
the employer-employee relationship with the named Employer pre-deceases the other insured individual, then this Agreement will
automatically terminate under the conditions described in paragraph A(1) or A(2) of this Section.

 

		C.	Upon the adjudication of the Employer as an insolvent or as a bankrupt, the Co-Owner may pay
to the Employer an amount equal to the Net Premiums in exchange for the transfer by the Employer of all ownership rights to the
Co-Owner, including the right to change the beneficiary. 

 

		D.	If the employer’s Net Premiums are reduced to zero, this Agreement will automatically
terminate and all rights and ownership will become vested in the Co-Owner, otherwise, this Agreement may be cancelled only upon
the joint request of the Employer and the Co-Owner. 

 

		E.	In the event of a conflict between the terms of this Agreement and the policy to which it is
attached, the terms of the policy shall control. 

 

		F.	It is intended that this Elite LifeComp® Agreement will comply with Treasury decision
9092. The parties agree to amend this Agreement, if necessary, to remain in compliance with the proposed and final regulations.

 

 

Dates         
                       
                       
           this the               day
of                        
                       
        , 20             .

 

	 	 	 
	Witness	 	(Signature of Co-Owner/Applicant)

 

	 
	(Signature of Proposed Instated/Applicant.  If other than Co-Owner/Applicant)

 

	The undersigned officers of 	 	represent that the 
	 	(Name of Employer)	 

Corporation has duly authorized the execution
of this Elite LifeComp® Agreement on behalf of the corporation and that we have the authority to sign this Elite
LifeComp® Agreement on behalf of the Employer.

 

	Attest:	 	By:	 
	 	 	 	 
	Title:	 	Title:	 
	 	 	 	 
	 	 	 	 

 

(To be completed by Home Office)

 

    	 

    	 

    

Insurer acknowledges and has recorded this
Elite LifeComp® Agreement.

 

Signed on behalf of the insurer.

 

 

	 	 	By:	 

(Date Recorded)

 

 

ENDORSEMENTS:

 

 

 

 

 

 

 

Flexible Premium Variable Life Insurance
Policy – Flexible Premiums Payable 

Until The Maturity Date Or Until Prior Death.
Adjustable Death Benefit.

Insurance Payable At Death. Some Benefits
Reflect Investment Results.

Additional Benefits, If Any, As Indicated
On Page 3.

Non-Participating. No Dividends.

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