AMERICAN INCOME LIFE INSURANCE COMPANY

Executive Office: P.O. Box 2608 Waco, Texas 76797

BACK & SPINE EXCLUSION RIDER
Attached and made a part of the application taken from
the Applicant.
It is understood and agreed that no payment will be made under my policy on account
of disability or loss resulting from impairment to the back or spine for such person(s)
named below.
Excluded Person:
Excluded Person:
Excluded Person:
I hereby agree that these changes shall be an amendment to and form a part of the
original application and of the policy issued thereunder and that they shall be binding
on any person who shall have or claim any interest under such policy.
X Signature of Applicant
X Signature of Agent

Date

221
AG-2102 (R890) Q21020