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<br />You must apply in writing for Contributory Dependents Life Insurance and agree to pay premiums. <br />Subject to the Active Work ProvisioDS, your Dependents Life Insurance becomes effective on: <br /> <br />i The date you become eligible, if you apply on or before that date. <br /> <br />ii. The date you apply, if you apply within 31 days after you become eligible. <br /> <br />ill. The date we approve each Dependent's Evidence Of Insurability, if you apply more than 31 <br />days after you become eligible Qate application). <br /> <br />While your Dependents Life Insurance is in effect, each new Dependent becomes insured immediately. <br /> <br />c. Dependents Life Insurance Subject To Evidence Of Insurability <br /> <br />Insurance subject to Evidence of Insurability becomes effective on the date we approve Evidence Of <br />Insurability. <br /> <br />F. When Dependents Life Insurance Ends <br />Dependents Life Insurance ends automatically on the earliest of: <br /> <br />1. Five months after you die (no premiums will be charged for your Dependents Life Insurance during this <br />time); <br /> <br />2. The date your Life Insurance ends for reasons other than your death; <br /> <br />3. The date the Group Policy terminates, unless: (a) your Dependents Life Insurance continues under 1. <br />. above; or (b) you qualify for Waiver Of Premium; <br /> <br />4. The date the last period ends for which you made a premium contribution, if your Dependents Life <br />Insurance is Contributory; <br /> <br />5. For your Spouse, the date of your divorce; <br /> <br />6. For any Dependent, the date the Dependent ceases to be a Dependent; and <br /> <br />7. For a Disabled Cbild, 90 days after we mail you a request for proof of Disabled Child status, ifproofis not <br />given. <br /> <br />WoOL-01 <br /> <br />ACTIVE WORK PROVISIONS <br /> <br />If you are incapable of Active Work because of Sickness, Injury or Pregnancy on the day before the scheduled <br />effective date of your insurance or an increase in your insurance, your insurance or increase will not become <br />effective until the day after you complete one full day of Active Work as an eligible Member. <br /> <br />Active Work and Actively At Work mean performing the material duties of your own occupation at your Employer's <br />usual place of business. . <br /> <br />Printed 4196 Revised 4196 <br /> <br />-10- <br /> <br />SAMPLE U, AD&D, DU Sup. U <br />