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State Farm Life Insurance Company

DISCLOSURE

THIS IS AN ILLUSTRATION ONLY. AN ILLUSTRATION IS NOT INTENDED TO PREDICT


ACTUAL PERFORMANCE. INTEREST RATES, DIVIDENDS, AND VALUES SET FORTH
IN THE ILLUSTRATION ARE NOT GUARANTEED, EXCEPT FOR THOSE ITEMS CLEARLY
LABELED AS GUARANTEED.
Life Insurance Illustration

Plan: Universal Life Date: November 9, 2009


Insured: Joe Sample Prepared by: Jake Stewart
Premium Class: Male, Age 0 Agency: State Farm Insurance
Juvenile 821 Folsom St, Suite 101
Initial Basic Amount: $3,000,000 San Francisco, CA 94107
Death Benefit: Option 1 - Death Benefit Remains Level License No: 0E85157
Phone No: (415)982-9033
Fax No: (415)982-3905
Premium Mode: Special Monthly

This illustration was produced to be used in California.

Summary of Illustrated Coverages and Premium

Benefits and Riders: $3,000,000 Universal Life


Waiver of Monthly Deduction for Disability

The total first year premium outlay illustrated is $6,987.12. The initial premium is $582.26 each month. Please review
this illustration for additional changes in illustrated premiums and coverages in years 2 and later.

Description of Coverage
Plan Universal Life (Form Number 08030 - 05) is a flexible premium adjustable life insurance
policy. A death benefit is payable when the Insured dies. Flexible premiums are
payable to the Insured's age 121.

How This Plan Works You start with a planned premium and death benefit. You may change either in the future
subject to policy provisions. When you pay premiums, we deduct a 5% premium charge.
The remaining premium is added to the account value. From this account value we deduct
each month: (A) the current cost of insurance including the charges for any riders, and
(B) a current monthly expense charge of $8.00. During each of the first 24 months
following issue or an increase, an issue charge will be deducted from the account value.
The issue charge is $0.10 per $1000 of the initial Basic Amount and each increase, each
subject to a maximum of $50.00 per month. The account value earns interest at the
current interest rate, but a different rate may be credited to any account value which
you have borrowed. The current interest rate is increased by 0.50% on the unloaned
account value that exceeds 10% of the Basic Amount. Surrender charges apply.

The current monthly cost of insurance rates and monthly expense charge may be changed by
the company at any time, but will never be more than the maximums given in the policy.
The maximum monthly expense charge is $8.00 in policy years one through five, and $10.00
thereafter. The current interest rate can be changed by the company on a monthly basis,
but will never be less than the guaranteed rate of 4%. This policy is participating, but
no dividends are anticipated.

Important Tax Information This policy complies with the definition of life insurance in Internal Revenue Code
Section 7702. This means that the premium illustrated does not exceed the greater
of the Guideline Single Premium or the cumulative Guideline Annual Premium. Payment
of the guideline annual premium will not provide coverage to age 121 under the contract,
on the guaranteed basis. This illustration should not be relied on for tax advice. The tax
status of this policy should be reviewed with the policyowner's legal and tax advisors.

Guideline Single Premium at issue: $73,131


Guideline Annual Premium at issue: $8,529

State Farm Life Insurance Company


One State Farm Plaza
UL001 (07/2008) Bloomington, IL 61710 Page 1 of 8
Life Insurance Illustration

Plan: Universal Life Initial Basic Amount: $3,000,000


Insured: Joe Sample Death Benefit: Option 1
Premium Class: Male, Age 0 Premium Mode: Special Monthly
Juvenile

Description of Coverage
If at any time during the first 7 years, the total premiums paid exceed the MEC Reference
Premium shown below times the number of years the policy has been in force, the policy
will be considered a Modified Endowment Contract. This means distributions, which include
cash withdrawals, policy loans, and assignments may be subject to Federal Income Tax to the
extent there is a gain in the contract. An additional 10% penalty tax may also apply prior to the
policyowner's age 59 1/2.

Increases in coverages will require a new premium test with a new 7 year test period.
Reductions in coverages during a 7 year test period will generally result in a lower MEC
Reference Premium retroactive to the beginning of the 7 year test period.

Planned premiums after the 1st year shown on this illustration have not been checked
to determine if the MEC Reference Premium limit has been exceeded.

MEC Reference Premium at issue: $31,080

Waiver of Monthly This rider (Form Number 08206 - 05) provides for the waiver of all monthly deductions so
Deduction for Disability long as the Insured is totally disabled as defined in the policy.

Definitions

Juvenile Available for ages 0 through 19. Insurance costs used in this illustration assume that the
Insured qualifies for Non-Tobacco rates beginning with the first renewal date on or after
age 20. To receive these Non-Tobacco rates, the owner must apply and the Insured be
approved for the Non-Tobacco classification.

Basic Amount The Initial Basic Amount plus any increases less any decreases.

Monthly Deductions The sum of the monthly cost of insurance charges, the monthly expense charge, the issue
charge, and charges for any riders.

Guaranteed Values These values are calculated using the illustrated premiums, 5% premium expense charge,
guaranteed interest rate of 4% and the maximum monthly deductions.

Non-Guaranteed Intermediate Values These values are calculated using the illustrated premiums, 5% premium expense charge,
average of the illustrated and guaranteed interest rates, and the average of the current
and maximum monthly deductions. The intermediate values are not guaranteed. They
demonstrate the impact of changes in company experience.

Non-Guaranteed Illustrated Values These values are calculated using the illustrated premiums, 5% premium expense charge,
illustrated interest rates, and current monthly deductions. The illustrated interest rate has
been increased by 0.50% on the unloaned account value that exceeds 10% of the Basic
Amount. These values are not guaranteed.

Annualized Premium Outlay The actual cash outlay each year.

Total Annualized Premium Outlay The sum of each year's annualized premium outlay.

State Farm Life Insurance Company


UL001 (07/2008) One State Farm Plaza, Bloomington, IL 61710 Page 2 of 8
Life Insurance Illustration

Plan: Universal Life Initial Basic Amount: $3,000,000


Insured: Joe Sample Death Benefit: Option 1
Premium Class: Male, Age 0 Premium Mode: Special Monthly
Juvenile

Definitions
Account Value This is the accumulation of premiums shown less a 5% expense charge and monthly
deductions.

Cash Surrender Value This value is the account value less the applicable surrender charge. Surrender charges
apply for 15 policy years following issue or an increase in the Basic Amount of insurance.

Death Benefit This is the amount payable at the death of the Insured. Any increase or decrease must be
approved by the Company, subject to policy provisions. Future increases are illustrated
using the premium class of the base policy, subject to the minimum amount requirements
as of the date of the illustration.

Option 1 Under Option 1, the death benefit is the Basic Amount of insurance. The death benefit
may be increased due to Internal Revenue Code provisions. Changes in the Death Benefit
Option can result in the Basic Amount being lowered below the Policy's Minimum Basic
Amount. In these cases, the Minimum Basic Amount stated in the policy will be amended
to reflect a reduced Minimum Basic Amount.

This illustration assumes that the currently illustrated non-guaranteed 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. The assumptions on which
they are based are subject to change by the Company. Cash values and death benefits shown are end of year values.
Premiums are assumed to be paid when due. This illustration contains a general description of coverage. A complete statement
of coverage is found in the policy.

Interest Adjusted Cost Indices at 5.00%

Guaranteed Illustrated
10 Year 20 Year 10 Year 20 Year

Surrender Cost Index 0.59 0.73 0.49 0.53


Net Payment Index 2.21 2.20 2.21 2.20
Equivalent Level Annual Dividend N/A N/A N/A N/A

These indices are computed by the formulas prescribed by the National Association of
Insurance Commissioners and reflect the time value of money at 5%. These indices
do not include the cost of additional benefits.

Not FDIC - No Bank Guarantee


Insured - May Lose Value

State Farm Life Insurance Company


UL001 (07/2008) One State Farm Plaza, Bloomington, IL 61710 Page 3 of 8
Life Insurance Illustration

Plan: Universal Life Initial Basic Amount: $3,000,000


Insured: Joe Sample Death Benefit: Option 1
Premium Class: Male, Age 0 Premium Mode: Special Monthly
Juvenile

Guaranteed and Non-Guaranteed Values Non-Guaranteed

Guaranteed Values Intermediate Values Illustrated Values

Guaranteed Interest Rate: 4.00% Interest Rate: 4.50% Interest Rate: 5.00%

End Annualized Cash Cash Cash


of Premium Surrender Death Surrender Death Surrender Death
Year Age Outlay Value Benefit Value Benefit Value Benefit

5 5 6,540 26,341 3,000,000 26,799 3,000,000 27,283 3,000,000

10 10 6,540 64,346 3,000,000 66,336 3,000,000 68,430 3,000,000

20 20 6,540 152,642 3,000,000 162,833 3,000,000 173,800 3,000,000

65 65 6,540 815,551 3,000,000 1,366,354 3,000,000 2,115,241 3,000,000

70 70 6,540 769,624 3,000,000 1,601,268 3,000,000 2,741,402 3,180,026

80 80 6,540 0** 0** 2,087,172 3,000,000 4,645,050 4,877,302

85 85 6,540 0 0 2,315,263 3,000,000 6,010,233 6,310,744

**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis.

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.

Applicant Date

I certify that this illustration has been presented to the applicant 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.

Agent Date

State Farm Life Insurance Company


UL001 (07/2008) One State Farm Plaza, Bloomington, IL 61710 Page 4 of 8
Life Insurance Illustration

Plan: Universal Life Initial Basic Amount: $3,000,000


Insured: Joe Sample Death Benefit: Option 1
Premium Class: Male, Age 0 Premium Mode: Special Monthly
Juvenile

Guaranteed and Non-Guaranteed Values


Non-Guaranteed
Guaranteed Values Illustrated Values
Guaranteed Interest 4.00% Illustrated Interest 5.00%
Total
End Annualized Annualized Cash Cash
of Premium Premium Account Surrender Death Account Surrender Death
Year Age Outlay Outlay Value Value Benefit Value Value Benefit

1 1 6,987 6,987 5,420 3,620 3,000,000 5,482 3,682 3,000,000


2 2 6,987 13,974 11,058 7,458 3,000,000 11,239 7,639 3,000,000
3 3 6,540 20,514 17,106 13,506 3,000,000 17,469 13,869 3,000,000
4 4 6,540 27,054 23,397 19,797 3,000,000 24,012 20,412 3,000,000
5 5 6,540 33,594 29,941 26,341 3,000,000 30,883 27,283 3,000,000

6 6 6,540 40,134 36,718 33,118 3,000,000 38,094 34,494 3,000,000


7 7 6,540 46,674 43,738 40,498 3,000,000 45,638 42,398 3,000,000
8 8 6,540 53,214 51,041 48,161 3,000,000 53,561 50,681 3,000,000
9 9 6,540 59,754 58,637 56,117 3,000,000 61,881 59,361 3,000,000
10 10 6,540 66,294 66,506 64,346 3,000,000 70,590 68,430 3,000,000

11 11 6,540 72,834 74,663 72,863 3,000,000 79,707 77,907 3,000,000


12 12 6,540 79,374 83,028 81,588 3,000,000 89,170 87,730 3,000,000
13 13 6,540 85,914 91,551 90,471 3,000,000 98,935 97,855 3,000,000
14 14 6,540 92,454 100,237 99,517 3,000,000 109,022 108,302 3,000,000
15 15 6,540 98,994 108,915 108,555 3,000,000 119,276 118,916 3,000,000

16 16 6,540 105,534 117,527 117,527 3,000,000 129,647 129,647 3,000,000


17 17 6,540 112,074 126,133 126,133 3,000,000 140,204 140,204 3,000,000
18 18 6,540 118,614 134,763 134,763 3,000,000 150,987 150,987 3,000,000
19 19 6,540 125,154 143,567 143,567 3,000,000 162,153 162,153 3,000,000
20 20 6,540 131,694 152,642 152,642 3,000,000 173,800 173,800 3,000,000

21 21 6,540 138,234 162,027 162,027 3,000,000 186,123 186,123 3,000,000


22 22 6,540 144,774 171,765 171,765 3,000,000 199,071 199,071 3,000,000
23 23 6,540 151,314 181,873 181,873 3,000,000 212,677 212,677 3,000,000
24 24 6,540 157,854 192,333 192,333 3,000,000 226,946 226,946 3,000,000
25 25 6,540 164,394 203,161 203,161 3,000,000 241,908 241,908 3,000,000

26 26 6,540 170,934 214,344 214,344 3,000,000 257,551 257,551 3,000,000


27 27 6,540 177,474 225,840 225,840 3,000,000 273,988 273,988 3,000,000
28 28 6,540 184,014 237,721 237,721 3,000,000 291,258 291,258 3,000,000
29 29 6,540 190,554 250,120 250,120 3,000,000 309,414 309,414 3,000,000
30 30 6,540 197,094 263,054 263,054 3,000,000 328,569 328,569 3,000,000

31 31 6,540 203,634 276,545 276,545 3,000,000 348,790 348,790 3,000,000


32 32 6,540 210,174 290,618 290,618 3,000,000 370,131 370,131 3,000,000
33 33 6,540 216,714 305,234 305,234 3,000,000 392,636 392,636 3,000,000
34 34 6,540 223,254 320,390 320,390 3,000,000 416,320 416,320 3,000,000
35 35 6,540 229,794 336,078 336,078 3,000,000 441,273 441,273 3,000,000

**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis.
These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.

State Farm Life Insurance Company


UL001 (07/2008) One State Farm Plaza, Bloomington, IL 61710 Page 5 of 8
Life Insurance Illustration

Plan: Universal Life Initial Basic Amount: $3,000,000


Insured: Joe Sample Death Benefit: Option 1
Premium Class: Male, Age 0 Premium Mode: Special Monthly
Juvenile

Guaranteed and Non-Guaranteed Values


Non-Guaranteed
Guaranteed Values Illustrated Values
Guaranteed Interest 4.00% Illustrated Interest 5.00%
Total
End Annualized Annualized Cash Cash
of Premium Premium Account Surrender Death Account Surrender Death
Year Age Outlay Outlay Value Value Benefit Value Value Benefit

36 36 6,540 236,334 352,261 352,261 3,000,000 467,486 467,486 3,000,000


37 37 6,540 242,874 368,906 368,906 3,000,000 495,032 495,032 3,000,000
38 38 6,540 249,414 386,003 386,003 3,000,000 523,940 523,940 3,000,000
39 39 6,540 255,954 403,516 403,516 3,000,000 554,236 554,236 3,000,000
40 40 6,540 262,494 421,468 421,468 3,000,000 586,032 586,032 3,000,000

41 41 6,540 269,034 439,793 439,793 3,000,000 619,337 619,337 3,000,000


42 42 6,540 275,574 458,457 458,457 3,000,000 654,201 654,201 3,000,000
43 43 6,540 282,114 477,397 477,397 3,000,000 690,641 690,641 3,000,000
44 44 6,540 288,654 496,522 496,522 3,000,000 728,694 728,694 3,000,000
45 45 6,540 295,194 515,756 515,756 3,000,000 768,463 768,463 3,000,000

46 46 6,540 301,734 535,098 535,098 3,000,000 810,116 810,116 3,000,000


47 47 6,540 308,274 554,524 554,524 3,000,000 853,729 853,729 3,000,000
48 48 6,540 314,814 574,122 574,122 3,000,000 899,372 899,372 3,000,000
49 49 6,540 321,354 594,021 594,021 3,000,000 947,171 947,171 3,000,000
50 50 6,540 327,894 614,097 614,097 3,000,000 997,231 997,231 3,000,000

51 51 6,540 334,434 634,232 634,232 3,000,000 1,049,632 1,049,632 3,000,000


52 52 6,540 340,974 654,207 654,207 3,000,000 1,104,481 1,104,481 3,000,000
53 53 6,540 347,514 673,760 673,760 3,000,000 1,161,857 1,161,857 3,000,000
54 54 6,540 354,054 692,631 692,631 3,000,000 1,221,807 1,221,807 3,000,000
55 55 6,540 360,594 710,414 710,414 3,000,000 1,284,449 1,284,449 3,000,000

56 56 6,540 367,134 726,713 726,713 3,000,000 1,349,801 1,349,801 3,000,000


57 57 6,540 373,674 741,333 741,333 3,000,000 1,418,093 1,418,093 3,000,000
58 58 6,540 380,214 754,252 754,252 3,000,000 1,489,529 1,489,529 3,000,000
59 59 6,540 386,754 765,240 765,240 3,000,000 1,564,195 1,564,195 3,000,000
60 60 6,540 393,294 772,838 772,838 3,000,000 1,641,848 1,641,848 3,000,000

61 61 6,540 399,834 786,355 786,355 3,000,000 1,727,031 1,727,031 3,000,000


62 62 6,540 406,374 797,844 797,844 3,000,000 1,816,641 1,816,641 3,000,000
63 63 6,540 412,914 806,767 806,767 3,000,000 1,910,964 1,910,964 3,000,000
64 64 6,540 419,454 812,778 812,778 3,000,000 2,010,351 2,010,351 3,000,000
65 65 6,540 425,994 815,551 815,551 3,000,000 2,115,241 2,115,241 3,000,000

66 66 6,540 432,534 814,810 814,810 3,000,000 2,226,146 2,226,146 3,000,000


67 67 6,540 439,074 810,321 810,321 3,000,000 2,343,630 2,343,630 3,000,000
68 68 6,540 445,614 801,672 801,672 3,000,000 2,468,396 2,468,396 3,000,000
69 69 6,540 452,154 788,359 788,359 3,000,000 2,601,188 2,601,188 3,043,389
70 70 6,540 458,694 769,624 769,624 3,000,000 2,741,402 2,741,402 3,180,026

**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis.
These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.

State Farm Life Insurance Company


UL001 (07/2008) One State Farm Plaza, Bloomington, IL 61710 Page 6 of 8
Life Insurance Illustration

Plan: Universal Life Initial Basic Amount: $3,000,000


Insured: Joe Sample Death Benefit: Option 1
Premium Class: Male, Age 0 Premium Mode: Special Monthly
Juvenile

Guaranteed and Non-Guaranteed Values


Non-Guaranteed
Guaranteed Values Illustrated Values
Guaranteed Interest 4.00% Illustrated Interest 5.00%
Total
End Annualized Annualized Cash Cash
of Premium Premium Account Surrender Death Account Surrender Death
Year Age Outlay Outlay Value Value Benefit Value Value Benefit

71 71 6,540 465,234 744,309 744,309 3,000,000 2,888,635 2,888,635 3,321,930


72 72 6,540 471,774 710,571 710,571 3,000,000 3,043,842 3,043,842 3,439,541
73 73 6,540 478,314 666,448 666,448 3,000,000 3,207,689 3,207,689 3,560,535
74 74 6,540 484,854 610,439 610,439 3,000,000 3,381,054 3,381,054 3,685,348
75 75 6,540 491,394 540,487 540,487 3,000,000 3,564,864 3,564,864 3,814,405

76 76 6,540 497,934 453,885 453,885 3,000,000 3,760,172 3,760,172 3,948,181


77 77 6,540 504,474 346,942 346,942 3,000,000 3,965,439 3,965,439 4,163,710
78 78 6,540 511,014 214,428 214,428 3,000,000 4,181,107 4,181,107 4,390,162
79 79 6,540 517,554 49,558 49,558 3,000,000 4,407,515 4,407,515 4,627,890
80 80 6,540 524,094 0** 0** 0** 4,645,050 4,645,050 4,877,302

81 81 6,540 530,634 0 0 0 4,894,082 4,894,082 5,138,786


82 82 6,540 537,174 0 0 0 5,154,866 5,154,866 5,412,609
83 83 6,540 543,714 0 0 0 5,427,677 5,427,677 5,699,061
84 84 6,540 550,254 0 0 0 5,712,741 5,712,741 5,998,378
85 85 6,540 556,794 0 0 0 6,010,233 6,010,233 6,310,744

86 86 6,540 563,334 0 0 0 6,320,276 6,320,276 6,636,289


87 87 6,540 569,874 0 0 0 6,642,973 6,642,973 6,975,121
88 88 6,540 576,414 0 0 0 6,978,468 6,978,468 7,327,391
89 89 6,540 582,954 0 0 0 7,326,918 7,326,918 7,693,264
90 90 6,540 589,494 0 0 0 7,688,026 7,688,026 8,072,427

91 91 6,540 596,034 0 0 0 8,061,747 8,061,747 8,464,834


92 92 6,540 602,574 0 0 0 8,461,210 8,461,210 8,799,658
93 93 6,540 609,114 0 0 0 8,890,319 8,890,319 9,157,028
94 94 6,540 615,654 0 0 0 9,354,805 9,354,805 9,541,901
95 95 6,540 622,194 0 0 0 9,860,755 9,860,755 9,959,362

96 96 6,540 628,734 0 0 0 10,407,927 10,407,927 10,407,927


97 97 6,540 635,274 0 0 0 10,985,194 10,985,194 10,985,194
98 98 6,540 641,814 0 0 0 11,594,210 11,594,210 11,594,210
99 99 6,540 648,354 0 0 0 12,236,723 12,236,723 12,236,723
100 100 6,540 654,894 0 0 0 12,914,573 12,914,573 12,914,573

101 101 6,540 661,434 0 0 0 13,629,705 13,629,705 13,629,705


102 102 6,540 667,974 0 0 0 14,384,170 14,384,170 14,384,170
103 103 6,540 674,514 0 0 0 15,180,130 15,180,130 15,180,130
104 104 6,540 681,054 0 0 0 16,019,868 16,019,868 16,019,868
105 105 6,540 687,594 0 0 0 16,905,792 16,905,792 16,905,792

**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis.
These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.

State Farm Life Insurance Company


UL001 (07/2008) One State Farm Plaza, Bloomington, IL 61710 Page 7 of 8
Life Insurance Illustration

Plan: Universal Life Initial Basic Amount: $3,000,000


Insured: Joe Sample Death Benefit: Option 1
Premium Class: Male, Age 0 Premium Mode: Special Monthly
Juvenile

Guaranteed and Non-Guaranteed Values


Non-Guaranteed
Guaranteed Values Illustrated Values
Guaranteed Interest 4.00% Illustrated Interest 5.00%
Total
End Annualized Annualized Cash Cash
of Premium Premium Account Surrender Death Account Surrender Death
Year Age Outlay Outlay Value Value Benefit Value Value Benefit

106 106 6,540 694,134 0 0 0 17,840,441 17,840,441 17,840,441


107 107 6,540 700,674 0 0 0 18,826,497 18,826,497 18,826,497
108 108 6,540 707,214 0 0 0 19,866,785 19,866,785 19,866,785
109 109 6,540 713,754 0 0 0 20,964,289 20,964,289 20,964,289
110 110 6,540 720,294 0 0 0 22,122,156 22,122,156 22,122,156

111 111 6,540 726,834 0 0 0 23,343,705 23,343,705 23,343,705


112 112 6,540 733,374 0 0 0 24,632,440 24,632,440 24,632,440
113 113 6,540 739,914 0 0 0 25,992,055 25,992,055 25,992,055
114 114 6,540 746,454 0 0 0 27,426,449 27,426,449 27,426,449
115 115 6,540 752,994 0 0 0 28,939,735 28,939,735 28,939,735

116 116 6,540 759,534 0 0 0 30,536,251 30,536,251 30,536,251


117 117 6,540 766,074 0 0 0 32,220,576 32,220,576 32,220,576
118 118 6,540 772,614 0 0 0 33,997,539 33,997,539 33,997,539
119 119 6,540 779,154 0 0 0 35,872,235 35,872,235 35,872,235
120 120 6,540 785,694 0 0 0 37,850,039 37,850,039 37,850,039

121 121 6,540 792,234 0 0 0 39,936,622 39,936,622 39,936,622

**Beginning in this year, illustrated premiums are insufficient to provide requested benefits on this basis.
These figures do not recognize that, because of interest, a dollar in the future has less value than a dollar today.

State Farm Life Insurance Company


UL001 (07/2008) One State Farm Plaza, Bloomington, IL 61710 Page 8 of 8
TRADITIONAL PRODUCT DISCLOSURE ACKNOWLEDGEMENT

I, , acknowledge that I have been advised of and understand the

disclosures below. I have been encouraged to ask any questions that I have concerning these disclosures.

I have applied to purchase from one of the State Farm Life insurance companies the following

product: Universal Life . I understand that the life companies are affiliated

with State Farm Bank, but that the product offered is not being offered by the Bank.

If anyone asserts that this product is federally insured or guaranteed, or is as safe as an insured deposit, I should

call the Office of Thrift Supervision Regional Director at (404) 888-0771.

I understand that the insurance product I am purchasing:

* IS NOT INSURED BY THE FDIC;

* IS NOT A DEPOSIT OR OTHER OBLIGATION OF ANY BANK AND IS NOT GUARANTEED BY THE BANK OR
BY THE FEDERAL GOVERNMENT;
* INVOLVES INVESTMENT RISKS, INCLUDING POSSIBLE LOSS OF PRINCIPAL INVESTED.

Dated

Signature of Customer Issued By: State Farm Life Insurance Company


(Not licensed in New York or Wisconsin)
State Farm Life and Accident Assurance Company
(Licensed in New York and Wisconsin)
Signature of Agent Home Offices: Bloomington, IL