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AMENDMENT TO BE ATTACHED TO AND MADE PART OF GROUP POLICY NO.: 000011100388 <br />�UEDSS <br />TO: Florida - Life Specimen <br />The Policy is amended by the addition of the following provisions. <br />PRIOR INSURANCE CREDIT UPON TRANSFER OF <br />LIFE INSURANCE CARRIERS <br />This provision prevents loss of life insurance coverage for an Insured Person, which could otherwise occur solely because of a transfer <br />of insurance carriers. This Policy will provide the following Prior Insurance Credit, when it replaces a prior plan. <br />"Prior Plan" means a prior carrier's group life insurance policy, which this Policy replaced within 1 day of the prior plan's termination <br />date. <br />FAILURE TO SATISFY ACTIVE WORK RULE. Subject to payment of premiums, this Policy will provide life coverage for a <br />Person who: <br />(1) was insured under the prior plan on its termination date; <br />(2) was otherwise eligible under this Policy; but was not Actively -At -Work due to Injury or Sickness on its Effective <br />Date; <br />(3) is not entitled to any extension of life insurance under the prior plan; and <br />(4) is not Totally Disabled (as defined in the Extension of Death Benefit section of this Policy) on the date this Policy <br />takes effect. <br />AMOUNT OF LIFE INSURANCE. Until the Person satisfies this Policy's Active Work rule, the amount of his or her group life <br />insurance under this Policy will not exceed the amount for which the Person was insured under the prior plan on its termination date. <br />This Amendment takes effect on the effective date of coverage under this Policy. In all other respects, this Policy remains the same. <br />• Jefferson Pilot Financial Insurance Company <br />V4VL0_ G"'A <br />Officer of the Company <br />0 <br />GL 1101- AMEND. PC 1 Prior Ins. Cred. - Life <br />21 05/01/01 <br />