Ins 2.17(6)(b)5. 5. A statement containing in substance the following: “This illustration assumes that the currently illustrated nonguaranteed elements will continue unchanged for all years shown. This is not likely to occur, and actual results may be more or less favorable than those shown.”

Ins 2.17(6)(c) (c) A basic illustration shall include the following numeric summary, following the narrative summary:

Ins 2.17(6)(c)1. 1. A summary of the death benefits and values and the premium outlay and contract premium, as applicable. For a policy that provides for a contract premium, the guaranteed death benefits and values shall be based on the contract premium. This summary shall be shown for at least policy years 5, 10 and 20 and at age 70, if applicable, on the three bases shown below in subds. 2., 3., and 4. For multiple life policies the summary shall show policy years 5, 10, 20 and 30.

Ins 2.17(6)(c)2. 2. Policy guarantees.

Ins 2.17(6)(c)3. 3. Insurer’s illustrated scale.

Ins 2.17(6)(c)4. 4. Insurer’s illustrated scale used but with the non-guaranteed elements reduced as follows:

Ins 2.17(6)(c)4.a. a. Dividends at 50% of the dividends contained in the illustrated scale used.

Ins 2.17(6)(c)4.b. b. Non-guaranteed credited interest at rates that are the average of the guaranteed rates and the rates contained in the illustrated scale used.

Ins 2.17(6)(c)4.c. c. All non-guaranteed charges, including but not limited to, term insurance charges, mortality and expense charges, at rates that are the average of the guaranteed rates and the rates contained in the illustrated scale used.

Ins 2.17(6)(c)5. 5. If coverage would cease prior to policy maturity or age 100, the year in which coverage ceases shall be identified for each of the three bases shown above in subds. 2., 3. and 4.

Ins 2.17(6)(d) (d) Statements substantially similar to the following shall immediately follow the numeric summary and be signed by the applicant, or the policy owner in the case of an illustration provided at time of delivery, as required in this section.

Ins 2.17(6)(d)1. 1. A statement to be signed and dated by the applicant or policy owner reading as follows: “I have received a copy of this illustration and understand that any non-guaranteed elements illustrated are subject to change and could be either higher or lower. The agent has told me they are not guaranteed.”

Ins 2.17(6)(d)2. 2. A statement to be signed and dated by the agent or other authorized representative of the insurer reading as follows: “I certify that this illustration has been presented to the applicant or policy owner and that I have explained that any non-guaranteed elements illustrated are subject to change. I have made no statements that are inconsistent with the illustration.”

Ins 2.17(6)(e) (e) The following elements shall be shown in tabular detail:

Ins 2.17(6)(e)1. 1. A basic illustration shall include the following for at least each policy year from 1 to 10 and for every 5th policy year thereafter ending at age 100, policy maturity or final expiration; and except for term insurance beyond the 20th year, for any year in which the premium outlay and contract premium, if applicable, is to change:

Ins 2.17(6)(e)1.a. a. The premium outlay and mode the applicant plans to pay and the contract premium, as applicable.

Ins 2.17(6)(e)1.b. b. The corresponding guaranteed death benefit, as provided in the policy.

Ins 2.17(6)(e)1.c. c. The corresponding guaranteed value available upon surrender, as provided in the policy.

Ins 2.17(6)(e)2. 2. For a policy that provides for a contract premium, the guaranteed death benefit and value available upon surrender shall correspond to the contract premium.

Ins 2.17(6)(e)3. 3. Non-guaranteed elements may be shown if described in the contract. In the case of an illustration for a policy on which the insurer intends to credit terminal dividends, they may be shown if the insurer’s current practice is to pay terminal dividends. If any non-guaranteed elements are shown they must be shown at the same durations as the corresponding guaranteed elements, if any. If no guaranteed benefit or value is available at any duration for which a non-guaranteed benefit or value is shown, a zero shall be displayed in the guaranteed column.

Ins 2.17(7) (7) Standards for supplemental illustrations.

Ins 2.17(7)(a) (a) A supplemental illustration may be provided so long as it complies with all of the following:

Ins 2.17(7)(a)1. 1. It is appended to, accompanied by or preceded by a basic illustration that complies with this section.

Ins 2.17(7)(a)2. 2. The non-guaranteed elements shown are not more favorable to the policy owner than the corresponding elements based on the scale used in the basic illustration.

Ins 2.17(7)(a)3. 3. It contains the same statement required of a basic illustration that non-guaranteed elements are not guaranteed.

Ins 2.17(7)(a)4. 4. For a policy that has a contract premium, the contract premium underlying the supplemental illustration is equal to the contract premium shown in the basic illustration. For policies that do not require a contract premium, the premium outlay underlying the supplemental illustration shall be equal to the premium outlay shown in the basic illustration.

Ins 2.17(7)(b) (b) The supplemental illustration shall include a statement informing the reader to consult the basic illustration for guaranteed elements and the other important information it contains.

Ins 2.17(8) (8) Delivery of illustration and record retention.

Ins 2.17(8)(a) (a) If a basic illustration is used by an agent or other authorized representative of the insurer in the sale of a life insurance policy and the policy is applied for as illustrated, a copy of that illustration, signed in accordance with this section, shall be submitted to the insurer at the time of policy application. A copy also shall be provided to the applicant. If the policy is issued other than as applied for, a revised basic illustration conforming to the policy as issued shall be sent with the policy. The revised illustration shall conform to the requirements of this section, shall be labeled “Revised Illustration” and shall be signed and dated by the applicant or policy owner and agent or other authorized representative of the insurer no later than the time the policy is delivered. A copy shall be provided to the insurer and the policy owner.