The Payment Protection Plan

Makes your minimum monthly account payment if you become involuntarily unemployed (loss of job, strike or layoff) for more than 30 consecutive days. In CA unemployment benefits are limited to nine (9) months. Makes your minimum monthly account payment for up to 6 months if you or your co-account holder should take an unpaid leave of absence from full-time employment for more than 30 consecutive days. Family Leave Coverage is not available to residents of Colorado and Oregon. Pays to repair or replace insured property if it is accidentally damaged, destroyed or stolen in a burglary, while in your possession. Coverage continues for 36 months after the purchase of the insured property while this coverage is in effect. Property coverage is not available to residents of Colorado and Idaho. If you are a resident of Nevada and would like to purchase property coverage only at a cost of $.26 per $100, please call Central States toll free at 1-800-445-6500. Makes your minimum monthly account payment if you become totally disabled for more than 30 consecutive days. In CA, benefits are not payable for total disability which is the result of normal pregnancy or childbirth or any intentionally self-inflicted injury. Pays your unpaid account balance up to $10,000 if you or your co-account holder die prior to age 71. Joint coverage is not available to Arizona, New Mexico and Nevada residents. In AZ and CA, life insurance benefits are not payable for death in the event of suicide within 6 months of the effective date of coverage.


Benefits are based on the amount of your account balance at the time of loss or up to a maximum of $10,000 whichever is less. Coverage does not include any amounts added to your account after your loss. During months that you have an account balance, the cost is $.89 per $100 of your average daily balance for residents of Idaho, Nevada and Utah, $.854 for residents of Arizona, $.887 for residents of California, $.485 for residents of Colorado, $.802 for residents of New Mexico, $.843 for residents of Oregon and Wyoming. In Utah, the breakout of the premium is as follows: $.087 for Life, $.148 for Disability, $.307 for Unemployment, $.048 for Family Leave and $.30 for Property. All coverage terminates at age 71. For residents of Arizona, coverage does not terminate at age 71. Rather, the life coverage changes to accidental death coverage, all other coverages remain the same.

To qualify for unemployment benefits, you must register with a recognized employment agency or your state unemployment office within 30 days after the date you become unemployed. To be eligible for unemployment and family leave benefits, you must be gainfully employed on a full-time basis for at least 30 hours a week in a non-seasonal occupation at the time of the loss. Family leave insurance covers unpaid absences from full-time employment while you or your co-account holder are caring for an immediate family member with a serious medical condition; caring for a newborn or adopted child for up to 3 months; on active military duty due to mandatory recall; on jury duty; or residing in a federally declared disaster area. Family Leave Insurance does not cover losses caused by a pre-existing medical condition. A pre-existing condition is one for which your family member saw or was treated by a licensed health care provider both within the 6 months before and the 6 months after the effective date of coverage. Perils for Property Insurance are specified in your Certificate of Insurance; please read your certificate for details. This plan is offered, administered and underwritten by Central States Indemnity Co. of Omaha and is also underwritten by Central States Health & Life Co. of Omaha; both companies of Omaha, Nebraska. Policy Form 10521/11006 Rev./11495/10723 M

Application of account holder (California residents only): You are applying for the credit insurance described in this application and authorizing R.C. Willey to add the charges for insurance to your account each month as they become due. You have the right to stop this authorization. Your signature to enroll means you agree that: 1, You are eligible for involuntary unemployment and family leave coverage only if you are working for wages or profit 30 hours per week or more. If your are not, you will not be insured until you return to work. 2. Your are insured only for your actual credit card balance. Your are not insured for any unused credit which may be available to you. 3. Each month on your statement date, the insurance charge is calculated by multiplying the average daily balance on your credit card account (up to a maximum of $10,000) by .00887. This insurance charge will be shown on your account statement and included in your new balance. We can change the rate later on, but if we do, we will let you know in advance. The new rate will apply only to charges for insurance after the date of the rate change. 4. Your co-account holder is not eligible for the Disability of involuntary Unemployment insurance. 5. Neither you nor your co-account holder are eligible for insurance after you have reached your 71st birthday. Insurance for the co-account holder stops on his or her 71st birthday if the co-account holder reaches age 71 before you do. Otherwise, all insurance stops on the first billing date after you reach age 71.

Disability insurance may not cover conditions for which you have seen a doctor or chiropractor in the last six months. (Refer to "Total Disabilities Not Covered" in your Certificate for details.) Non Std AP10/Non Std I.D. #18