31.09.15.13

.13 Sample Statement of Actuarial Opinion.

The following form is a sample form that may be used for providing the statement of actuarial opinion as described in Regulation .12 of this chapter:

"Statement of Actuarial Opinion for Interest-Indexed Universal Life Insurance Policies

I, {insert name of actuary}, am {insert position or relationship to Insurer} for the XYZ Life Insurance Company (The Insurer) in the state of {Insert State of Domicile of Insurer}. I am a member of the American Academy of Actuaries (or if not, state other qualifications to sign annual statement actuarial opinions). I have examined the interest-indexed universal life insurance policies of the Insurer in force as of December 31, 20XX, encompassing _______ number of policies and $__________ of insurance in force. I have considered the provisions of the policies. I have considered any reinsurance agreements pertaining to such policies, the characteristics of the identified assets, and the investment policy adopted by the Insurer as they affect future insurance and investment cash flows under such policies and related assets. My examination included such tests and calculations as I considered necessary to form an opinion concerning the insurance and investment cash flows arising from the policies and related assets. I relied on the investment policy of the Insurer and on projected investment cash flows as provided by __________________________, Chief Investment Officer of the Insurer. The tests were conducted under various assumptions as to future interest rates, and particular attention was given to those provisions and characteristics that might cause future insurance and investment cash flows to vary with changes in the level of prevailing interest rates. In my opinion, the anticipated insurance and investment cash flows referred to above make good and sufficient provision for the contractual obligations of the Insurer under these insurance policies. __________________________ Signature of Actuary"