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Exhibit 4(iii)
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Exhibit 4(iii)
MEMBERS LIFE INSURANCE COMPANY
2000 Heritage Way, Waverly, Iowa 50677
Telephone: 800.798.6600
CHANGE OF ANNUITANT ENDORSEMENT
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ENDORSEMENT SECTION 1. GENERAL INFORMATION
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1.1 WHAT IS OUR Our agreement with you includes this endorsement as a part of the contract to which it is
AGREEMENT WITH YOU? attached. The provisions of the contract apply to this endorsement unless they conflict
with the endorsement. If there is a conflict, the endorsement provision will apply. The
effective date for this endorsement is the same as the issue date for the contract to
which it is attached.
We promise to provide the benefit described in this endorsement as long as the contract
and this endorsement are in force and all the terms and conditions of this endorsement
are met.
1.2 WHAT IS THE BENEFIT This endorsement allows you to change the annuitant at any time while the annuitant is
PROVIDED BY THIS alive during the accumulation period if:
ENDORSEMENT?
a.) this contract is owned by a business or a trust;
b.) the original annuitant under the contract is a selected manager or a highly
compensated employee (as those terms are defined by Title 1 of the Employee
Retirement Income Security Act, as amended); and
c.) the new annuitant under the contract is also a selected manager or a highly
compensated employee.
1.3 WHEN WILL THIS This endorsement will terminate on the earliest of:
ENDORSEMENT
TERMINATE? a.) the date death proceeds become payable;
b.) the payout date (also referred to as the annuity date); or
c.) the date you surrender your contract.
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ENDORSEMENT SECTION 2. ENDORSEMENT CHARGES
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2.1 IS THERE A CHARGE FOR There is no charge for this benefit. However, if you exercise the right provided by this
THIS BENEFIT? endorsement during the first two contract years, we reserve the right to charge a fee to
offset expenses incurred. Any fee charged will never be greater than $150.00.
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ENDORSEMENT SECTION 3. CHANGE OF ANNUITANT
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3.1 HOW DO YOU REQUEST A Your change of annuitant request must be made in writing on a form acceptable to us and
CHANGE OF ANNUITANT? received at our administrative office. Unless otherwise specified by the owner, the change
will take effect as of the date you signed it. We are not liable for any payment we make
or action we take before receiving any such written request.
2012-ANNCHANGE-MLIC
3.2 WHO CAN BE NAMED You may name any manager or highly compensated employee who meets all requirements
AS ANNUITANT? for issuance of a like contract, as of the contract issue date.
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ENDORSEMENT SECTION 4. EFFECT ON CONTRACT
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4.1 HOW DOES A CHANGE Income payments (also referred to as annuity payments) will be payable under the contract
IN ANNUITANT AFFECT based on the life of the annuitant named at the time of payout.
YOUR CONTRACT?
The death benefit will be determined based on the new annuitant's age as of the contract
issue date. Income payments will be based on the new annuitant's age on the payout date.
Any death benefit riders included under the contract will be terminated automatically as
of the effective date of a change in annuitant.
MEMBERS Life Insurance Company
/s/ Robert N. Trunzo
Presiden