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<br />G. Premium Adjustments <br /> <br />Premium adjustments involving a return of unearned premiums to the Policyowner will be limited to the 12 <br />months just before the date we receive a request for premium adjustment. <br /> <br />H. Dividends <br /> <br />While the Group Policy is in force, it will be credited with its share, if any, of the divisible surplus in the form of <br />dividends we may declare. <br /> <br />If required by state law, the Policyowner will use, for the sole benefit of the insured Members, the amount of <br />such dividends or rate reductions which exceeds the Policyowner's expenditures for the insurance under the <br />Group Policy. <br /> <br />1. Certificates <br /> <br />We will issue certificates to the Policyowner showing the coverage under the Group Policy. The Policyowner <br />will distribute a certificate to each insured Member. <br /> <br />J, Records And Reports <br /> <br />The Policyowner or Employer will fumish on our forms all information reasonably necessary to anm;n;~erthe <br />Group Policy. .We have the right at all reasonable times to inspect the payroll and other records of the <br />Policyowner or Employer which relate to insurance under the Group Policy. <br /> <br />Clerical error by the Policyowner will not: <br /> <br />1. Cause a person to become insured; <br /> <br />2. Invalidate insurance otherwise validly in force; or <br /> <br />3. Continue insurance otherwise validly terminated. <br /> <br />K. Misstatement Of Age <br /> <br />If a person's age has been misstated, we will make an equitable adjustment of premiums, benefits, or both. The <br />adjustment will be based on: <br /> <br />1. The amount of insurance based on the correct age; and <br /> <br />2. The difference between the premiums paid and the premiums which would have been paid if the age had <br />been correctly stated. <br /> <br />L. Entire Contract, Changes <br /> <br />The Group Policy and the application of the Policyowner constitute the entire contract between the parties. A <br />copy of the Policyowner's application is attached to the Group Policy when issued. <br /> <br />The Group Policy may be changed in whole or in part. No change in the Group Policy will be valid unless it is <br />approved in writing by one of our executive officers and given to the Policyowner for attacbment to the Group <br />Policy. No agent has authority to change the Group Policy or to waive any ofits provisions. <br /> <br />M, Effect On Workers' Compensation, State Disability Insurance <br /> <br />The coverage provided under the Group Policy is not a substitute for coverage under a workers' compensation <br />or state disability income benefit law and does not relieve the Employer of any obligation to provide such <br />coverage. <br /> <br />U.PO.01 <br /> <br />Printed 4196 Revised 4'96 <br /> <br />-21- <br /> <br />SAMPLE LIt AD&D, DU. Sup. U <br />