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• <br />JEFFERSON PILOT <br />FINANCIAL <br />In Consideration of the application for this Policy made by <br />Jefferson Pilot Financial Insurance Company <br />8801 Indian Hills Drive, Omaha NE 68114 -4066 <br />(402) 361 -7300 A Stock Company <br />Florida - LTD Specimen <br />(herein called the Policyholder) <br />and the payment of all premiums when due, Jefferson Pilot Financial Insurance Company agrees to make <br />the payments provided in this Policy to the person or persons entitled to them. <br />Policy No. XXXXXXXXXXXX Policy Effective Date: January 1, 2001 <br />Monthly Premium: .XX of Total Covered Payroll per Month <br />The above rate is guaranteed until January 1, 2002, unless any of the Policy's terms are changed. <br />Policy Anniversaries will be annually beginning on: January 1, 2002 <br />The first premium is due on the Policy's Effective Date, and subsequent premiums are due on February 1, <br />2001, and on the same day of each month thereafter. <br />The Policy is delivered in the state of Florida and subject to the laws of that jurisdiction. <br />Jefferson Pilot Financial Insurance Company has executed this Policy at its Home Office in Omaha, <br />• Nebraska this 18th day of May, 2001. <br />Chief Executive Officer Secretary <br />• <br />GROUP LONG TERM DISABILITY INSURANCE POLICY <br />GL3001 -LTD -1 Policy Face Page <br />01/01/01 <br />