The form discloses the conditions under which the coverage terminates.

1. (1) Benefit provided by rider. The following conditions are disclosed if the benefit is provided by a rider:

   1. (i) Written request from the owner for termination.
   2. (ii) Termination of the policy.
   3. (iii) Nonpayment of premium.
   4. (iv) The benefit is paid. This condition is disclosed if the benefit is built into a policy.
2. (2) Termination condition disclosed. The following termination condition is disclosed if applicable: When a policy nonforfeiture option takes effect. This complies with § 89.42(e) (relating to nonforfeiture value requirements). Alternatively, this termination condition is disclosed in the policy.
3. (3) Termination condition not disclosed. The following termination condition is not disclosed: Attainment of a specific age or contract anniversary, or both, other than at an age or anniversary at which the policy terminates.