Document:

Exhibit 4(d)

 EXHIBIT 4(d) 
 FORM OF POLICY RIDER 
 (ADDITIONAL DEATH DISTRIBUTION) 

							
		 	 

	  		  	
	 	  		  	
	 	  		  	
	 	  	Home Office:	  	
	 	  	4333 Edgewood Road N.E.	  	
	 	  	Cedar Rapids, Iowa 52499	  	
	 	  	(319)355-8511	  	
		 	           A Stock Company (Hereafter called the Company, we, our or
us)
	  		  	

 ADDITIONAL DEATH BENEFIT RIDER 

We issued this rider as a part of the policy to which it is attached. All provisions of the policy that do not conflict with this rider
apply to this rider. In the event of any conflict between the provisions of this rider and the provisions of the policy, the provisions of this rider shall prevail over the provisions of the policy. 

This rider will pay an Additional Death Benefit amount equal to a percentage of the gains accumulated in the policy since the rider was
added. This Additional Death Benefit, if any, will be paid whenever death proceeds are payable on the base policy to which this rider is attached. 
 This rider can only be terminated when the policy to which this rider is attached terminates, including when the Policy Value becomes zero, is annuitized, or an Additional Death Benefit is paid or added
to the policy under spousal continuation under the terms of this rider. You may also terminate this benefit at any time by notifying us at our service center. Once terminated, this rider may be re-elected. However, a new rider will be issued and the
Additional Death Benefit amount will be re-determined. 
 Rider Data Specifications 

 

									
		  	Policy Number:	  		  	12345	  	
		  	Rider Date:	  		  	05/01/2013	  	
		  	Additional Death Benefit Factor:	  		  	40%	  	
		  	Rider Fee Percentage:*	  		  	0.25%	  	

 *The Rider Fee applies for the life of the rider. 

DEFINITIONS 
 Rider Anniversary

 The anniversary of the Rider Date for each year the rider remains in force. 
 Rider Date 
 The date that this rider is added to the policy. 

Rider Earnings 
 The
policy gains accrued and not previously withdrawn since the Rider Date. On a given date, this amount is equal to: the current Policy Value of the base policy; minus the Policy Value of the base policy on the Rider Date; minus premiums paid after the
Rider Date; plus amounts withdrawn from the Policy Value after the Rider Date that exceed the Rider Earnings on the date of the withdrawal. 

Rider Fee 
 The Rider Fee
amount is equal to the Rider Fee Percentage above multiplied by the Policy Value on the date the fee is deducted. A Rider Fee is deducted annually on each Rider Anniversary prior to annuitization. We will also deduct this fee upon full Surrender of
the policy or other termination of the rider. However, once terminated the Rider Fee will also terminate. The Rider Fee is deducted pro rata from each Investment Option. The Rider Fee is deducted even during periods when the Additional Death Benefit
rider would not pay any benefit. 
 ADDITIONAL DEATH BENEFIT AMOUNT 

If death proceeds are payable under the terms of the base policy to which this rider is attached, this rider will pay an Additional
Death Benefit equal to the Additional Death Benefit Factor multiplied by the Rider Earnings on the date used to calculate the death proceeds. This amount cannot be withdrawn as a lump sum. 

  

							
	 ICC12 RTP180513
	 	Page 1	  		  	

 SPOUSAL CONTINUATION 

If a death occurs and the base policy gives the surviving spouse the right to continue the policy, the surviving spouse
has two options: 
  

	 	1.)	 Receive the death benefit attributable to this rider as well as the death benefit attributable to the base policy, at which time both rider and base
policy would terminate, or 

  

	 	2.)	 Continue the policy and receive a one-time Policy Value increase equal to the amount of the Additional Death Benefit paid by this rider. At this
time the rider would terminate. 

 If the policy is continued, the spouse would have the
option of immediately re-electing the rider if they meet issue requirements at the time the rider is re-elected. 
 REPORTS
TO OWNER 
 The amount of the Additional Death Benefit will be included in a report sent to You at least once
each year until the Annuity Commencement Date as described in Section 3, Reports to Owner provision, in the policy. 

Additional Death Benefit Example: 
  

					
	  

Additional Death Benefit Example Assumptions:
	 

  

	  
 Policy Value at rider issue
	 	$	    100,000	  
	  
 Premium Payments after rider issue
	 	$	25,000	  
	  
 Policy Value on base policy
	 	$	225,000	  
	  
 Death proceeds on base policy
	 	$	250,000	  
	  
 Additional Death Benefit Factor
	 	 	40%	  
	  
 Withdrawals that exceed Rider Earnings
	 	$	0	  
	  

Additional Death Benefit Calculations:
	 

  

	  
 Rider Earnings = Policy Value - Policy Value on the Rider Date - Premium Payments after the Rider Date + withdrawals that exceed Rider Earnings on date of withdrawal = $225,000 - $100,000 - $25,000 +
$0
	 	$	100,000	  
	  
 Additional Death Benefit amount = Additional Death Benefit Factor * Rider Earnings = 40% * $100,000
	 	$	40,000	  
	  

Total death proceeds = death proceeds on base policy + Additional Death Benefit amount = $250,000 +
$40,000
  
	 	$  
	290,000  
	    

 Signed for us at our Home Office. 

 

							
		 	 

	  	

	 	
		 	 SECRETARY
	  	PRESIDENT	 	

  

							
	 ICC12 RTP180513
	 	Page 2Exhibit 4(e)

 EXHIBIT 4(e) 
 FORM OF POLICY RIDER 
 (ADDITIONAL DEATH DISTRIBUTION+) 

							
		 	 

	  		  	
	 	  	Home Office:	  	
	 	  	4333 Edgewood Road N.E.	  	
	 	  	Cedar Rapids, Iowa 52499	  	
	 	  	(319)355-8511	  	
		 	               A Stock Company (Hereafter called the Company,
we, our or us)
	  		  	

 ADDITIONAL DEATH BENEFIT RIDER 

We issued this rider as a part of the policy to which it is attached. All provisions of the policy that do not conflict with this apply
to this rider. In the event of any conflict between the provisions of this rider and the provisions of the policy, the of this rider shall prevail over the provisions of the policy. 

This rider will pay an Additional Death Benefit amount as described below. This Additional Death Benefit, if any, will be whenever death
proceeds are payable on the base policy to which this rider is attached. 
 This rider can only be terminated when the policy to
which this rider is attached terminates, including when the Policy becomes zero, is annuitized, or an Additional Death Benefit is paid or added to the policy under spousal continuation under terms of this rider. You may also cancel this benefit at
any time by notifying us at our service center. However, if the rider terminated it can not be re-elected within a year after it was last terminated. Once re-elected, a new rider will be issued and Additional Death Benefit amount will be
re-determined. 
 Rider Data Specifications 

 

									
		  	Policy Number:	  		  	12345	  	
		  	Rider Date:	  		  	05/01/2013	  	
		  	Rider Benefit Percentage:	  		  	30%	  	
		  	Rider Fee Percentage:*	  		  	0.55%	  	

 *The Rider Fee applies for the life of the rider. 
 DEFINITIONS 
 Rider Anniversary 

The anniversary of the Rider Date for each year the rider remains in force. 
 Rider Benefit Base 
 This amount is equal to the Policy Value minus premiums paid after the
Rider Date. 
 Rider Date 
 The
date that this rider is added to the policy. 
 Rider Fee 
 The Rider Fee amount is equal to the Rider Fee Percentage above multiplied by the Policy Value on the date the fee is deducted. A Rider Fee is deducted annually on each Rider Anniversary prior to
annuitization. We will also deduct this fee upon full Surrender of the policy or termination of the rider. However, once terminated the Rider Fee will also terminate. The Rider Fee is deducted pro rata from each Investment Option. The Rider Fee is
deducted even during periods when the Additional Death Benefit rider would not pay any benefit. 
 ADDITIONAL DEATH BENEFIT AMOUNT

 If death proceeds are payable under the terms of the base policy to which this rider is attached, this rider will
pay an Additional Death Benefit. If death occurs prior to the fifth Rider Anniversary, the rider will pay an Additional Death Benefit equal to the sum of all Rider Fees paid since the Rider Date. If death occurs on or after the fifth Rider
Anniversary, the rider will pay an Additional Death Benefit equal to the Rider Benefit Percentage multiplied by the Rider Benefit Base on the date used to calculate the death proceeds. This amount cannot be withdrawn as a lump sum.

  

					
	 ICC12 RTP170513
	 	Page 1	  	

 SPOUSAL CONTINUATION 

If a death occurs and the base policy gives the surviving spouse the right to continue the policy, the surviving spouse
has two options: 
  

	 	1.)	 Receive the death benefit attributable to this rider as well as the death benefit attributable to the base policy, at which time both rider and base
policy would terminate, or 

  

	 	2.)	 Continue the policy and receive a one-time Policy Value increase equal to the amount of the Additional Death Benefit paid by this rider. At this
time the rider would terminate. 

 If the policy is continued, the spouse would have the
option of immediately re-electing the rider if they meet issue requirements at the time the rider is re-elected. 
 REPORTS
TO OWNER 
 The amount of the Additional Death Benefit will be included in a report sent to You at least once
each year until the Annuity Commencement Date as described in Section 3, Reports to Owner provision, in the policy. 

Additional Death Benefit Example: 
 The Additional Death Benefit rider is added to a new policy opened with $100,000 initial premium. The Rider Benefit Percentage is 30% and the Rider Fee Percentage is 0.55%. On the first and second Rider
Anniversaries, the Policy Value is $110,000 and $95,000 respectively when the Rider Fees are deducted. The client adds $25,000 premium in the third Rider Year. After five years, the Policy Value has grown to $130,000 and death proceeds have grown to
$150,000. 
  

					
	  

Additional Death Benefit Example Calculations:
	 

  

	  
 Death proceeds on Rider Date (= initial Policy Value)
	 	$	    100,000	  
	  
 Additional Death Benefit during 1st rider year
	 	$	0	  
	  
 Rider Fee on first Rider Anniversary (= Rider Fee Percentage * Policy Value = 0.55% * $110,000)
	 	$	605	  
	  
 Additional Death Benefit during 2nd rider year (= sum of total Rider Fees paid)
	 	$	605	  
	  
 Rider Fee on second Rider Anniversary (= Rider Fee Percentage * Policy Value = 0.55% * $95,000)
	 	$	522.50	  
	  
 Additional Death Benefit during 3rd rider year (= sum of total Rider Fees paid = $605 + $522.40)
	 	$	1,127.50	  
	  

Rider Fees will continue to be deducted each Rider Anniversary.
	 

  

	  
 Rider Benefit Base after 5th rider year (= Policy Value - premiums = $130,000 - $25,000)
	 	$	105,000	  
	  
 Additional Death Benefit after 5th rider year = Rider Benefit Percentage * Rider Benefit Base = 30% * $105,000
	 	$	31,500	  
	  

Total death proceeds (= base policy death proceeds + Additional Death Benefit amount = $150,000 +
$31,500)
	 	$	181,500	  

 Signed for us at our Home Office. 

 

							
		 	

	  	

	 	
		 	 SECRETARY
	  	PRESIDENT	 	

  

					
	 ICC12 RTP170513
	 	Page 2

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