Writing Business:

The Life Insurance Application

General Information

The life application is used for life insurance only. The annuity application is required for the writing of annuity business. You must use the state in which the application is signed in determining which application form to use. If you are uncertain as to which application form number to use, please contact your New Business Department or the Sales Desk.

Licensing Requirements

To solicit an application, you must be licensed in the state where the application is signed and be appointed by Columbus Life. We expect that the majority of applications will be written in the applicant's state of residence. If an application is signed outside of the applicant’s residence state, the non-resident sales certification form, CL 45.945, will be required.

Guidelines

 On those infrequent occasions where the application is written in a state other than the applicant's state of residence, the policy contract must also be delivered in the state where the application was originally solicited and signed.

 Since a copy of the application is included in the policy itself, it must be written in black ink. If written in ordinary pencil, it cannot be accepted.

 Any alteration, erasure, correction or addition to the application must be initialed and dated by the applicant.

 The use of liquid "white out" correction fluid cannot be accepted.

 Highlighted apps will not be accepted.

 Dashes, slashes and ditto marks have no legal meaning and must not be used.

 Applications transmitted by fax or secure e-mail are accepted. All other forms required should be faxed or e-mailed at the same time. The fax copy of an application is the controlling copy. The original does not have to be sent to the Home Office.

We strongly encourage you to provide as much information as possible on the application and if there are any unusual factors, please provide a cover letter or note.

NAIC Illustration Regulation

The National Association of Insurance Commissioners (NAIC) Model Law for Illustrations indicates that applications for policies designated as marketed with an illustration must be accompanied with a signed policy illustration. The purpose of this Model Law is to provide rules for life insurance policy illustrations that will protect the consumer and give them a better understanding of the performance of their life insurance policies.

Signed illustrations must be submitted with applications for Columbus Life Universal Life products before a policy can be issued. If the required illustration is not produced at the time of application, the "Statement Regarding Sales Illustration" or Computer Screen Illustration (if using computer to show illustration to applicant) must be submitted with the application. We will then require a signed illustration upon delivery of the policy.

Forms

NOTE: Refer to iPipeline for an up-to-date listing of required forms. The most current version of iPipeline may be obtained by completing an internet sync or by visiting the Forms Online section on the Extranet.

EF-062-1605 Illustration Certification

CL 45.210-WA Computer Screen Illustration (Washington)

CL 45.210-SD Computer Screen Illustration (South Dakota)

CL 45.210-PA Computer Screen Illustration (Pennsylvania)

States Adopting NAIC Signed Illustration Model

State

Alabama
Alaska
California
Colorado
Connecticut
Delaware
Hawaii
Illinois
Indiana
Iowa
Kansas

Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Mississippi
Montana
Missouri
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Texas
Utah
Vermont
Washington
West Virginia
Wisconsin

Business Purchase Agreements

For policies applied for as a part of business purchase agreements, the Company will necessarily assume that policy ownership, beneficiary designations, and premium payment arrangements are as agreed to in written form between the parties concerned.

 As a general rule, the Company does not require the filing of such agreements as a condition of underwriting a case or issuing a policy, but very often, specific details can be very helpful and can help in servicing a policy after issue.

 The Company reserves the right to ask for copies of plan documents, and in any case where the Company has previously issued policies that differ from newly applied-for insurance in terms of ownership/beneficiary designations, the differences must be resolved before additional policies are issued.

Completing the Life Application

NOTE: Refer to Forms Online for an up-to-date listing of required forms. For the most current version of Forms Online visit the Columbus Life Producer Extranet.

Following are guidelines for completing the life application, based on the standard life application form CL 45.300. The section numbers may vary slightly on state variations of the application.

Most of the information requested on the application is self-explanatory. However, we offer the following suggestions to facilitate rapid handling of your business.

Page 1 & 2 of Application: Proposed Insured and Other Insured

Full legal names should be used. Full first, middle and last names. No initials. Please be certain the names are correctly spelled. With unusual surnames, underline that which is considered the last name. Be sure to include the Social Security Number for all persons proposed for coverage. Also use age last birthday. Home address, employer, occupation, business address, citizenship status and driver’s license numbers are listed here also.

Page 2 of Application: Coverage Applied For

Be certain to use the terminology in the Marketing Manual to assure that we issue the correct plan of insurance. Do not include SCR amount in the area of Base Amount.

If a universal life is being applied for, please include the appropriate death benefit option number as well as plan name.

Page 3 of Application: Optional Benefits and Riders

Complete applicable boxes and show benefit amounts. Plan and rider sections of this library provide details of the supplemental benefits and riders.

When applying for the Children's Term Rider complete Child Supplement form CL45.458. List the rider coverage amount being applied for in the supplement.

Page 3 & 4 of Application: Owner of Policy

Make certain you always include the Social Security Number or Tax I.D. number, date of birth (if applicable) and relationship.

Page 4 & 5 of Application: Beneficiaries

Be sure to include full name(s) and relationship(s). Please use as much detail as necessary. If you need additional space, use a Change of Beneficiary form.

Page 5 & 6 of Application: Premium Amount, Mode of Premium Payment, Payer Name and Address

Indicate modal premium amount that will be paid and the mode (annual, semi-annual, quarterly, monthly).

Complete if the payer name and address are not the same as the residence address listed in Section A and B.

Page 7 & 8 of Application: Insurance in Force Pending or Replacement

This should be fully completed on all cases and is especially important in large amount applications or applications on juveniles. You should be aware of all replacement requirements in your state. Failure to submit requirements with the application will delay processing of the application.

Page 8 & 9 of Application: Lifestyle Information

Includes information about non-medical risk factors. Do not answer question #1, tobacco use, for any proposed Insured under age 18.

If you need additional space, use overflow page.

Page 10 of Application: Physician Information

Page 10 - 12 of Application: Medical Information

Includes information about medical risk factors. All questions must be answered Yes or No, with Yes answers explained in the Details section.

If you need additional space, use overflow page.

If you know a paramedical or medical exam will be done based on age and amount requirements, this section need not be completed. Otherwise, always complete this section.

Financial Information

Complete form CL 70.255, Confidential Financial Supplement, only for amounts applied for exceeding $1,000,000 and California $500,000.00. For producers writing in Washington, there are additional requirements for Key Person/Business Owner Cases.

Signature Page

Applicant signs to indicate the information presented in the application is true and complete. Also signs to authorize Columbus Life to obtain pertinent information, (we include information on both commercial inspection services, i.e. LabOne) to acknowledge understanding about the use and disclosure of such information, verifies Taxpayer Identification Number and that signer is not subject to IRS backup withholding.

Signature

The legal age for contracting for insurance is age 18 in most states. However, the following states have established special legal ages:

Contractual Obligations and Beneficiary Rights of Minors

Please check your state for licensing regulations.

By company practice, we require the signature of all proposed insureds if age 15 or over. We also require the signature of the policyowner if other than the Proposed Insured. If the applicant is a corporation, we require the signature of a company officer authorized to sign on the corporation’s behalf.

Policy Dating

A request for a special policy date should be made in the "Details" box in the application. A policy may not be dated the 29th, 30th, or 31st because of our Home Office administrative billing limitations. Universal Life plans may be backdated. A policy cannot be backdated more than six months except in Ohio. In Ohio, the policy cannot be backdated more than three months from the date of the application or medical exam, whichever is later.

If there is no special date required, the following rules will apply to dating the policy. Policy will be dated current. If delivery requirements are needed, we will date policy current the date the delivery requirements are received.

Annual, Semiannual, Quarterly, or P.A.T. (Monthly) Universal Life/Traditional Life Products

 Cash with Application: The policy date will be the date the delivery requirements are received.

Account Bill: Traditional and UL Products

 Cash with application

 Date the delivery requirements are received.

Producer’s Report (CL 45.459)

Section 1 Purpose of Insurance

Indicate the primary purpose for the insurance application.

Section 2 Exam Detail

Any Inspection report needed will be ordered by the Home Office.

Section 3 Is the Proposed Insured a Relative of the Producer?

Section 4 Future Premium Amount and Mode

Indicate the amount for billing purposes, and indicate the mode as PAT, quarterly, semiannually or annually. See section 4 for special modes. Indicate any premium paid with application.

The following requirements should be fulfilled when requesting a policy loan, surrender, or dividend values from an in-force CL policy should be applied to pay the initial premium on a new policy:

 Complete Service form CL 70.144 (Request for Surrender/Withdrawal, Transfer/Loan) or form CL 45.172 for 1035 Exchanges and attach it to the application, and

 Clearly indicate in Additional Remarks of the Life application the desired instructions.

Columbus Life will follow TEFRA regulations regarding these transactions whenever they apply. Contact Client Services or New Business if you have any questions.

Section 5 Credit Application To

Clearly indicate who is to receive credit for this application, taking special care to ensure that agent code numbers are legible. Be sure to include a phone number, fax number and e-mail address so we can quickly communicate with you should there be any questions on the application.

Pre-Authorized Transfer (CL 35.47)

Carefully complete all sections of this form to have premium payments made via electronic transfer from your client's checking or savings account. Include signatures of all account holders if it is a joint account. Include routing and transit numbers of the financial institution, preferably using an "initial draft" check box to draw first premium.

Accelerated Death Benefit Disclosure For All Products

The completed Accelerated Death Benefit Rider Disclosure form must be sent with the application.

Privacy Policy Disclosure

This disclosure must always be given to the applicant in compliance with MIB rules and the Fair Credit Reporting Act.

Conditional Receipt

The company uses a Conditional Receipt as a receipt for initial premium paid at the time the application is completed. It provides temporary coverage during the underwriting process for a period not to exceed 90 days for an amount not to exceed $500,000. This premium can only be collected (and a Conditional Receipt issued) when a regular Part I application is completed on the same date or prior to the date the TIA is issued. Key features of the Conditional Receipt are outlined below. Rules and features may vary by state.

Maximum Amount of Coverage

The maximum amount of Conditional Receipt coverage is $500,000 for all applications submitted on any life. Only one agreement may be issued and in effect on a proposed insured's life at any time, with the exception of "additional" policies applied for as the following examples show.

As stated in the agreement: "If money has been accepted by the Company as advance payment with an application for life insurance and any person proposed for coverage listed below dies while this temporary insurance is in effect, the Company will pay to the designated beneficiary the lesser of (a) the amount of all death benefits applied for in this application, including any accidental or supplemental death benefits, if applicable, or (b) $500,000. This total benefit limit applies to all insurance applied for under this and any other current applications to the Company and any other Conditional Receipt."

Face Amount Applied For

The Company will accept money on an eligible proposed insured as long as the face amount applied for, together with the amount of insurance already in-force with Columbus Life, does not exceed $1,000,000.

NOTE: On a California resident, the maximum face amount applied for on which we can accept money is $500,000.

Multiple Conditional Receipt—Additionals and Alternates

We will allow multiple applications and requests for additional policies to be submitted with money as long as the cumulative risk does not exceed the face amount limits above.

In cases where an "Alternate" policy is requested, the Conditional Receipt will be in effect for the basic coverage only and money should be collected only for the amount of the "original" application coverage. "Alternates" are not covered under the Conditional Receipt and should be treated strictly as C.O.D.

Who Is Eligible

A Conditional Receipt may be issued to anyone who:

 is at least 15 days old and who is no more than age 70 (last birthday).

 can answer "No" to both health questions in the agreement.

 cannot answer "No" to both health questions in the agreement, but no further treatment or care of any kind has been recommended (and is not contemplated) because of:

1. emergency room or outpatient hospital or clinical care in the past 6 months.

2. in patient hospital or clinical care in the past 6 months for uncomplicated: appendectomy, dental work, hemorrhoids, inguinal hernia repair, sterilization procedure, tonsillectomy, or delivery of a child.

Who Is Not Eligible

A Conditional Receipt may not be issued to anyone who:

 was covered in the past 12 months by a Columbus Life Conditional Receipt unless the policy applied for at that time was actually placed in force.

 has an application pending with Columbus Life that was submitted on a C.O.D. basis more than 90 days ago.

 cannot answer "NO" to both health questions in the agreement, except as described above.

 can answer "NO" to both health questions, but:

1. had a prior application (for new insurance or reinstatement) to any company for life or health insurance postponed or declined;

2. currently has a suspended or revoked driver's license;

3. participates in avocation or aviation activity that requires total (combined) extra premium in excess of $5.00 per $1,000 per year. Please refer to aviation and hazardous sports guidelines elsewhere in this manual.

Special Limitations

 If more than one individual is applying for life insurance (i.e. spouse or children under riders), all persons to be covered under the Conditional Receipt must be listed on the Conditional Receipt. Only those listed will be covered under the agreement. In addition, we would prefer that all proposed insureds age 15 and older who are to be covered sign the agreement along with the applicant.

 The Conditional Receipt does not provide benefits for disability. Fraud or material misrepresentations in the application or in the answers to the health questions of the Conditional Receipt will invalidate the agreement, and the Company's only liability is for refund of any payment made.

 No one is authorized to accept money on proposed insureds under 15 days of age or over age 70 years (last birthday) on the date the agreement is signed, nor will any coverage take effect.

 If any person proposed for insurance dies by suicide, the Company's liability under this agreement is limited to a refund of the payment made. (In Missouri, the Company must prove intent at the time of application.)

 There is no coverage under the agreement if the check submitted as payment is not honored by the bank.

 The minimum advance payment acceptable for this agreement is 1/12 the minimum annual premium for the insurance applied for in the application.

 No one is authorized to waive or modify any of the provisions to this agreement.

Coverage Terms

Temporary coverage begins on the date of the Agreement, but only if a Part I application has been completed no later than the same date.

Coverage under the Agreement will terminate automatically on the earliest of:

 90 days from the date of the Agreement, or

 the date that insurance takes effect under the policy applied for, or

 the date a policy, other than as applied for, is offered to the applicant, or

 the date the Company mails notice of termination of coverage to the premium notice address designated in the application. The Company may terminate coverage at any time.

Premium actually paid is refunded in full directly to the applicant whenever coverage under a Conditional Receipt terminates for any reason before the underwriting is completed. Usually the agent will be given advance notice. After termination, the application will be considered to be C.O.D. and underwriting will continue in a normal manner.

No one may alter a Conditional Receipt. An altered or modified Conditional Receipt is void.

Premium Payment Required

Regardless of the payment frequency desired for the policy, for Conditional Receipt coverage an amount equal to at least one full monthly premium for the policy (and any additional benefits requested) is the minimum payment required.

To activate a case, the remainder of the modal premium will be required.

In return for the required Conditional Receipt prepayment, the second copy of the fully completed and signed Conditional Receipt must be immediately given to the proposed insured (or applicant, if other than the proposed insured).

Source of Initial Premium

The initial premium paid must be made payable to Columbus Life and must be immediately remitted to the Home Office. We will not accept an agent or agency check as premium unless the application is on his or her own life, for a business partner’s application or family member’s application.

Unless the full required minimum payment can be collected, a Conditional Receipt may not be issued. Checks for payment must be currently dated. Postdated checks cannot be accepted.

When a full payment or current dated check cannot be obtained, an application must be submitted on a C.O.D. basis. Later, when full payment or a current dated check can be obtained, a TIA (form CL 45.14) may be issued providing:

 the proposed insured continues to be eligible for a Conditional Receipt; and

 the application has not been pending more than 90 days.

When a proposed insured is ineligible for a Conditional Receipt, no money may be collected. Only a C.O.D. application may be submitted.

Exceptions

No money need accompany cases being paid by Salary Savings if a completed Salary Modification Agreement is submitted with the application. Payment by this method is considered "cash with application" if the proposed insured is eligible for a Conditional Receipt and a Conditional Receipt has been issued by the agent.

Tax Qualified and Other Cases

Guidelines

When the insurance applied for has the purpose of funding certain tax qualified plans, or the funding of business purchase agreements, or other types of key employee coverage (including split dollar), certain additional forms may be required to facilitate handling.

Tax Qualified Plan Questionnaire

This form (CL 5.601) requests additional information required for certain qualified plans. The appropriate section of this form must be completed, either when submitting new applications under a new plan, or when adding new policies to an existing plan to which the company has assigned an ALU number.

The Company does not require submission of a copy of the employer's plan. The purpose of this form is to secure information essential to the proper issue and service of the policies concerned.

Whether or not the employer's plan is (or continues to be) considered qualified by the Internal Revenue Service is the responsibility of the plan administrator, the employer, and/or plan participant.

Additional or Alternate Policies

 These may be requested in the "Details" section of the Life application.

 Additional policies should be requested only when there is a reasonable chance of delivering them. An additional policy may be placed in addition to or in lieu of the original policy.

 An alternate policy may be placed in lieu of the original policy applied for, but cannot be placed in addition to it without permission from the Underwriting Department.

 Be sure to include specific plan names, death benefit option, dividend and APL choice (if applicable) and any rider benefits desired. Also include premium data.

Special Rules

Policies Issued In Conjunction With Keogh And Other 401 Qualified Plans

Both for corporate and non-corporate businesses, pensions, deferred profit sharing, defined contribution, and defined benefit plans are all issued in accordance with the terms and provisions of the employer's plan document. The appropriate section of the Tax Qualified Plan Questionnaire must be submitted with application both for those initially issued to the plan, and for subsequent additions to it.

It should be understood that the Company's principal function when policies are issued to such plans is to fund the benefits concerned, and not to engage in the administration of plans. It is the responsibility of the writing agent and the plan administrator to conform the details of each application and policy issued to both the provisions of the employer's plan and applicable law. Toward that end, assistance will be provided to both parties upon request by the Advanced Markets of the Home Office.

NOTE: Columbus Life does not provide legal or tax advice. The information herein is general and educational in nature and should not be considered legal or tax advice. Tax laws and regulations are complex and subject to change, which can materially impact investment results. Columbus Life cannot guarantee that the information herein is accurate, complete, or timely. Columbus Life makes no warranties with regard to such information or result obtained by its use, and disclaims any liability arising out of your use of, or any tax position taken in reliance on, such information. Please advise your customer to consult an attorney or tax professional regarding their specific situation.

Life Insurance Policies Issued In Connection With Employer-Sponsored Plans

Plans such as non-qualified deferred compensation, split dollar, and other forms of key employee insurance will always have certain characteristics that must generally be adhered to. When, in the judgment of the Home Office, doing what is requested would be clearly detrimental to the beneficiary, or policyholder, or Company, the Home Office may request that legal counsel for the client assume total responsibility in writing for any adverse consequences. Policyowner and beneficiary of these policies must conform to the terms of the individual plan.