(1) A basic illustration shall include the following:

(a) a brief description of the policy being illustrated, including a statement that it is a life insurance policy;

(b) a brief description of the premium outlay or contract premium, as applicable, for the policy.   For a policy that does not require payment of a specific contract premium, the illustration shall show the premium outlay that must be paid to guarantee coverage for the term of the contract, subject to maximum premiums allowable to qualify as a life insurance policy under the applicable provisions of the Internal Revenue Code;

(c) a brief description of any policy features, riders or options, guaranteed or non-guaranteed, shown in the basic illustration and the impact they may have on the benefits and values of the policy;

(d) identification and a brief definition of column headings and key terms used in the illustration; and

(e) a statement containing in substance the following:

(i) "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. "