Genworth Life Insurance Company of New York  |

Male Amount / Ages	0 - 17	18 - 39	40 - 44	45 - 49	50 - 59	60 - 70	71 - 99
0 - 99,999	A	C	C	C	C	F1	F1
100,000 - 299,999	A	C	C	C	C	F1	F1
300,000 - 500,000	A	C	C	D	D	F1	F1
500,001 - 1,000,000	B	C	C	D	D	F1	F1
1,000,001 - 2,000,000	B	C	D	D	D	F1	F1
2,000,001 - 3,000,000	E	C	D	D	D	F1	F1
3,000,001 - 5,000,000	E	C	D	D	D	F1	F1
5,000,001 - 10,000,000	E	G	G	G	I3	H2	J1
10,000,001 - 50,000,000	E	G	I3	I3	I3	H2	J1

Female Amount / Ages	0 - 17	18 - 39	40 - 44	45 - 49	50 - 59	60 - 70	71 - 99
0 - 99,999	A	C	C	C	C	F1	F1
100,000 - 299,999	A	C	C	C	C	F1	F1
300,000 - 500,000	A	C	C	D	D	F1	F1
500,001 - 1,000,000	B	C	C	D	D	F1	F1
1,000,001 - 2,000,000	B	C	D	D	D	F1	F1
2,000,001 - 3,000,000	E	C	D	D	D	F1	F1
3,000,001 - 5,000,000	E	C	D	D	D	F1	F1
5,000,001 - 10,000,000	E	G	G	G	I3	H2	J1
10,000,001 - 50,000,000	E	G	I3	I3	I3	H2	J1

Requirements Combination Key
A	Non-Medical
B	Paramed, Urinalysis, Attending Physician Statement
C	Paramed, Urinalysis, Blood Profile
D	Paramed, Urinalysis, Blood Profile, EKG
E	Paramed, Urinalysis, Attending Physician Statement, Dried Blood Spot
F	Paramed, Urinalysis, Attending Physician Statement, Blood Profile, EKG
G	Urinalysis, Blood Profile, EKG, Physician Exam
H	Urinalysis, Attending Physician Statement, Blood Profile, Physician Exam, Treadmill EKG
I	Urinalysis, Blood Profile, Physician Exam, Treadmill EKG
J	Urinalysis, Attending Physician Statement, Blood Profile, EKG, Physician Exam

Footnote Key
1	For ages 65 and over, the APS must include evidence that the proposed insured visited his/her personal care physician in the 18 months immediately before the date of the application Part 1 or 2, whichever is later.
2	For ages 65 and over, the APS must include evidence that the proposed insured visited his/her personal care physician in the 18 months immediately before the date of the application Part 1 or 2, whichever is later. For persons with known coronary artery disease, treadmill stress test is NOT required. For these persons, requirements include a resting EKG, all other age and amount requirements and an APS that includes full cardiac records.
3	For persons with known coronary artery disease, treadmill stress test is NOT required. For these persons, requirements include a resting EKG, all other age and amount requirements and an APS that includes full cardiac records.