EXECUTIVE LIFE AND SUPPLEMENTAL
RETIREMENT BENEFIT PLAN
SPLIT DOLLAR LIFE INSURANCE AGREEMENT
THIS SPLIT DOLLAR LIFE INSURANCE AGREEMENT (the "Agreement") is entered into by and between
Certegy Inc. (the "Company"), and _____________________ a key employee and executive of the Company
(the "Participant") effective as of the _____ day of _____________, 2001 (the "Commencement Date").
WHEREAS, the Participant is a participant in the Executive Life and Supplemental Retirement Benefit Plan of the
Company (the "Plan");
WHEREAS, the Company is willing to make contributions to the life insurance policy that is owned by the
Participant as an additional form of compensation to the Participant as its employee; and
WHEREAS, the Participant desires to undertake those steps that are necessary to institute his participation in the
Plan, including executing the Participant Agreements.
NOW, THEREFORE, in consideration of these factors and the mutual covenants contained in this Agreement,
the Company and the Participant mutually agree as follows:
ARTICLE I -- DEFINITIONS
The following terms shall have the meanings ascribed to them below for purposes of this Agreement. Other
capitalized terms used herein and not defined herein shall have the meanings ascribed to them in the Plan:
"COLLATERAL ASSIGNMENT" means the assignment in a form acceptable to the Insurer and the Company,
by and from the Participant to the Company, as the same may be modified, amended, supplemented, restated or
extended from time to time, pursuant to which the Participant assigns the Policy and the Policy Proceeds to the
Company to secure the Participant's obligation to repay the Secured Amount to the Company.
"COMPANY PREMIUMS" means at any point in time the aggregate sum of all premium payments (whether
made pursuant to the terms of the Policy or called for and due under this Agreement) then or theretofore actually
paid by the Company to the Insurer and credite