UNITED STATES SECURITIES AND EXCHANGE COMMISSIONWashington, D.C. 20549Form N-6EI-1[As last amended in Release No. IC-14234, November 14, 1984, 49 F.R. 47208]FORM N-6EI-1Exact Name of Separate Account Exact Name of Life Insurance Company which Established and Main the Separate Account (223Life Insurer224) h SEC1130 (3-03)Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. American LegalNet, Inc. www.FormsWorkFlow.com 2 substantially in accordance with these instructions.1. Rule as to use of form:Investment Company Act of 1940. (a) Every item is to be answered fully and accurately. If an item is not applicable indicate that fact by giving the answer 223not applicable.224(b) Every item is to be answered as of the date the form is prepared, unless the context clearly indicated the contrary.(c) All answers are to be typewritten or printed. The reply should be centered on the page so that a margin will appear on thereto shall be made under the appropriate item of the form by the words 223See Exhibit No. .224 (d) Names shall be given in full, (e) Signature. shall be signed by the Chairman of the Board of Directors of the separate account claiming exemption, and by a senior (f) Filing. (g) Fee. by Section 8(a). The form will permit the Commission and the staff to monitor the number and types of separate accounts operating pursuant to the exemptions provided by the rule. American LegalNet, Inc. www.FormsWorkFlow.com þ3be maintained and operated in Compliance with Rule under the Investment Company Act of 1940, and submits the following information. þ þ þ þ þ þ þ þ þ 9.þ Exact name of the investment adviser to the separate account. þ þ þ þ þ þ þ 13.þ If the separate account is a unit investment trust, provide the following information with respect to the investment company in þ þ American LegalNet, Inc. www.FormsWorkFlow.com þ4 þ þ þ þ þ 17.þ State the investment objectives of the separate account. þ 19.þ List the types and amounts of any charges to be made on a periodic basis against the assets of the separate account. þ or more of the voting securities of which are owned by the life insurer.en þ en State of þþ þ country underþ voting þþþþþþ þ Company en1 þþþþþ þ submit in the form of an attached exhibit a copy of the life insurers last regular periodic report to its security holders or policyholders.1 Indent to show degree of remoteness from the insurer, for example 226 þ Life Insurer þ þ American LegalNet, Inc. www.FormsWorkFlow.com þSIGNATURE(Name of Separate Account) and (Name of Life Insurer) separate account claiming exemption in the city of , county of , state of on the , 20. Attest þ (Name)þ (Name of Separate Account) þ By (Title)þ (Chairman of the Board of Directors) Attest þ By (Name)þ (Name of Life Insurer) þ By þ American LegalNet, Inc. www.FormsWorkFlow.com