Preferred Life
Insurance Company of New York
▇▇▇ ▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇ ▇▇▇▇▇
▇▇▇ ▇▇▇▇, ▇▇▇ ▇▇▇▇ ▇▇▇▇▇
This is a legal Contract between the Contract Owner (referred to in this
Contract as you and your) and Preferred Life Insurance Company of New York
(Preferred Life) (herein referred to as we, us and our). We will make Annuity
Payments as set forth in this Contract beginning on the Income Date.
This Contract is issued in consideration of the attached application and payment
of the initial Purchase Payment.
READ YOUR CONTRACT CAREFULLY
RIGHT TO EXAMINE: This Contract may be returned within 10 days after you receive
it. It can be mailed or delivered to either us or the agent who sold it. Return
of this Contract by mail is effective on being postmarked, properly addressed
and postage prepaid. The returned Contract will be treated as if we had never
issued it. We will promptly refund an amount equal to the sum of (i) and (ii),
where (i) is the difference between the Purchase Payment, including any fees or
other charges, and the amounts, if any, allocated to the separate accounts and
the fixed account under the Contract, less any withdrawals, and (ii) the
Contract Value, less any bonus amounts credited.
This is a Variable Annuity Contract with Annuity Payments and Contract Values
increasing or decreasing depending on the experience of the Variable Account
which is set forth in the Contract Schedule.
Signed by the Company:
/s/ ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇ /s/ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇
Senior Vice President, Secretary President
and Chief Legal Officer
INDIVIDUAL FLEXIBLE PAYMENT VARIABLE ANNUITY WITH FIXED OPTION
NONPARTICIPATING
Annuity payments will not decrease as long as the investment return of the
variable account assets equals or exceeds 6.5% (assuming a 4.5% Assumed
Investment Return) on an annual basis. Variable Account expenses consist of a
mortality and expense risk charge, a contract maintenance charge, and transfer
fees. These are shown on the Contract Schedule Page. The variable provisions can
be found on pages 8, 9 and 16 of this Contract.
TABLE OF CONTENTS
RIGHT TO EXAMINE..............................................................1
CONTRACT SCHEDULE...........................................................i-v
DEFINITIONS...................................................................5
PURCHASE PAYMENTS.............................................................7
PURCHASE PAYMENTS....................................................7
CHANGE IN PURCHASE PAYMENTS..........................................7
NO DEFAULT...........................................................7
..........BONUS................................................................7
ALLOCATION OF PURCHASE PAYMENTS AND BONUS AMOUNTS....................7
VARIABLE ACCOUNT..............................................................8
THE VARIABLE ACCOUNT.................................................8
VALUATION OF ASSETS..................................................8
ACCUMULATION UNITS...................................................8
ACCUMULATION UNIT VALUE..............................................8
NET INVESTMENT FACTOR................................................8
MORTALITY AND EXPENSE RISK CHARGE....................................9
MORTALITY AND EXPENSE GUARANTEE......................................9
FIXED ACCOUNT PROVISIONS......................................................9
FIXED ACCOUNT........................................................9
FIXED ACCOUNT VALUE..................................................9
INTEREST TO BE CREDITED..............................................9
CONTRACT VALUE................................................................10
CONTRACT MAINTENANCE CHARGE...................................................10
TRANSFERS.....................................................................10
WITHDRAWAL PROVISIONS.........................................................11
WITHDRAWALS..........................................................11
WITHDRAWAL CHARGE....................................................11
PROCEEDS PAYABLE ON DEATH.....................................................11
DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PERIOD...............11
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD..................11
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD.................11
DEATH OF CONTRACT OWNER DURING THE ANNUITY PERIOD....................12
DEATH OF ANNUITANT...................................................13
PAYMENT OF DEATH BENEFIT.............................................13
BENEFICIARY..........................................................13
CHANGE OF BENEFICIARY................................................13
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION..................................13
CONTRACT OWNER, ANNUITANT, ASSIGNMENT PROVISIONS..............................14
CONTRACT OWNER........................................................14
JOINT OWNER...........................................................14
ANNUITANT.............................................................14
ASSIGNMENT OF A CONTRACT..............................................14
ANNUITY PROVISIONS............................................................15
GENERAL..............................................................15
FIXED ANNUITY........................................................15
VARIABLE ANNUITY..............................................................15
INCOME DATE...................................................................16
SELECTION OF AN ANNUITY OPTION................................................16
DEFAULT ANNUITY OPTION........................................................16
ANNUITY OPTIONS...............................................................16
OPTION 1 - LIFE ANNUITY...........................................17
OPTION 2 - LIFE ANNUITY WITH MONTHLY PAYMENTS OVER 5, 10, 15, OR 20
YEARS GUARANTEED..................................................17
OPTION 3 - JOINT AND LAST SURVIVOR ANNUITY........................17
OPTION 4 - JOINT AND LAST SURVIVOR ANNUITY WITH MONTHLY PAYMENTSOVER
5, 10, 15 OR 20 YEARS GUARANTEED..................................17
OPTION 5 - REFUND LIFE ANNUITY....................................17
OPTION 6 - SPECIFIED PERIOD CERTAIN ANNUITY.......................18
GENERAL PROVISIONS............................................................18
THE CONTRACT.........................................................18
NON-PARTICIPATING IN SURPLUS.........................................18
INCONTESTABILITY.....................................................18
MISSTATEMENT OF AGE OR SEX...........................................18
CONTRACT SETTLEMENT..................................................18
REPORTS..............................................................18
EVIDENCE OF SURVIVAL.................................................19
PROTECTION OF PROCEEDS...............................................19
MODIFICATION OF CONTRACT.............................................19
..........TABLES........................................................... 20-23
CONTRACT SCHEDULE
CONTRACT OWNER: ▇▇▇▇ ▇▇▇ CONTRACT NUMBER: GA687456
JOINT OWNER: ▇▇▇▇ ▇▇▇ ISSUE DATE: 04/15/01
ANNUITANT: ▇▇▇▇ ▇▇▇ INCOME DATE: 04/15/16
PURCHASE PAYMENTS: (Purchase Payments will not be accepted
after the oldest Contract Owner attains
Age 81.)
INITIAL PURCHASE PAYMENT: $35,000.
MINIMUM SUBSEQUENT
PURCHASE PAYMENT: $100 if you have selected the Automatic
Investment Plan.
MAXIMUM TOTAL
PURCHASE PAYMENTS:$1 million; higher amounts may be accepted
with our prior approval.
ALLOCATION GUIDELINES:
1. Currently, you can select up to 10 of the Investment
Options.
2. If allocations are made in percentages, whole numbers must
be used.
3. If the initial Purchase Payment and the forms required to
issue a Contract are in good order, the initial Purchase
Payment will be credited to your Contract within two (2)
business days after receipt at the Service Center.
Additional Purchase Payments will be credited to your
Contract as of the Valuation Period when they are received
in good order.
[INVESTMENT OPTIONS]:
VARIABLE ACCOUNT: [Preferred Life Variable Account C]
Sub-Accounts:
[▇▇▇▇▇ VA FINANCIAL]
[▇▇▇▇▇ VA VALUE]
[DREYFUS SMALL CAP STOCK INDEX]
[DREYFUS STOCK INDEX]
[FRANKLIN GLOBAL COMMUNICATIONS SECURITIES]
[FRANKLIN GROWTH AND INCOME SECURITIES]
[FRANKLIN HIGH INCOME]
[FRANKLIN INCOME SECURITIES]
[FRANKLIN LARGE CAP GROWTH SECURITIES]
[FRANKLIN REAL ESTATE]
[FRANKLIN RISING DIVIDENDS SECURITIES]
[FRANKLIN SMALL CAP]
[FRANKLIN SMALL CAP VALUE SECURITIES]
[FRANKLIN U.S. GOVERNMENT]
[FRANKLIN ZERO COUPON - 2005]
[FRANKLIN ZERO COUPON - 2010]
[▇▇▇▇▇▇▇▇ 20/20 FOCUS]
[MUTUAL DISCOVERY SECURITIES]
[MUTUAL SHARES SECURITIES]
[▇▇▇▇▇▇▇▇▇▇▇ GLOBAL SECURITIES/VA]
[▇▇▇▇▇▇▇▇▇▇▇ HIGH INCOME/VA]
[▇▇▇▇▇▇▇▇▇▇▇ MAIN STREET GROWTH & INCOME/VA]
[PIMCO VIT HIGH YIELD]
[PIMCO VIT STOCKSPLUS GROWTH AND INCOME]
[PIMCO VIT TOTAL RETURN]
[▇▇▇▇▇▇▇▇ SMALL-CAP VALUE]
[▇▇ ▇▇▇▇▇▇▇▇ INTERNATIONAL GROWTH]
[SP STRATEGIC PARTNERS FOCUSED GROWTH]
[▇▇▇▇▇▇▇▇▇ DEVELOPING MARKETS SECURITIES]
[▇▇▇▇▇▇▇▇▇ FOREIGN SECURITIES]
[▇▇▇▇▇▇▇▇▇ GROWTH SECURITIES]
[USAZ AIM BASIC VALUE]
[USAZ AIM BLUE CHIP]
[USAZ AIM DENT DEMOGRAPHIC TRENDS]
[USAZ AIM INTERNATIONAL EQUITY]
[USAZ ALLIANCE CAPITAL GROWTH AND INCOME]
[USAZ ALLIANCE CAPITAL LARGE CAP GROWTH]
[USAZ ALLIANCE CAPITAL TECHNOLOGY]
[USAZ MONEY MARKET]
[USAZ ▇▇▇▇▇▇▇▇▇▇▇ EMERGING GROWTH]
[USAZ PIMCO GROWTH AND INCOME]
[USAZ PIMCO RENAISSANCE]
[USAZ PIMCO VALUE]
[USAZ ▇▇▇▇▇▇▇▇▇ DEVELOPED MARKETS]
[USAZ ▇▇▇ ▇▇▇▇▇▇ AGGRESSIVE GROWTH]
[USAZ ▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇]
[USAZ ▇▇▇ ▇▇▇▇▇▇ EMERGING GROWTH]
[USAZ ▇▇▇ ▇▇▇▇▇▇ GROWTH AND INCOME]
[USAZ ▇▇▇ ▇▇▇▇▇▇ GROWTH]
GENERAL ACCOUNT:
PREFERRED LIFE FIXED ACCOUNT (is part of the General Account)
BONUS RATE:
During the Accumulation Period, a bonus rate of 6% will be credited with each
Purchase Payment made prior to the Contract Owner's attained Age 81. The bonus
will be credited on the date the Purchase Payment is allocated to the Contract.
After a withdrawal of Purchase Payments, a bonus is only applicable to
additional Purchase Payment amounts in excess of any previous Purchase Payments
withdrawn.
MORTALITY AND EXPENSE RISK CHARGE: During the Accumulation Period, the mortality
and expense risk charge is equal on an annual basis to [2.10%] of the average
daily net assets of the Variable Account. During the Annuity Period, the
mortality and expense risk charge is equal on an annual basis to 1.90% of the
average daily net assets of the Variable Account. We may decrease this charge,
but we may not increase it.
PREMIUM TAX: None.
CONTRACT MAINTENANCE CHARGE: The contract maintenance charge is $30.00 each
Contract Year.
During the Accumulation Period, the contract maintenance charge will be deducted
from the Contract Value on the Contract Anniversary while this Contract is in
force. If a full withdrawal is made on other than a Contract Anniversary and
your Contract Value for the Valuation Period during which the full withdrawal is
made is less than $100,000, the full contract maintenance charge will be
deducted at the time of the full withdrawal. The contract maintenance charge
will be deducted from the Investment Options in the same proportion that the
amount of the Contract Value in each Investment Option bears to the total
Contract Value.
During the Annuity Period, the contract maintenance charge will be collected pro
rata from each Annuity Payment.
If the total Contract Value on a Contract Anniversary is at least $100,000, we
will not assess the contract maintenance charge. In the event you own more than
one Contract of this type, we will determine the total Contract Value for all of
the Contracts. If the Contract Owner is not a natural person, we will look to
the Annuitant in determining the foregoing.
TRANSFERS:
NUMBER OF FREE TRANSFERS PERMITTED: You are allowed no fewer than 12
free transfers each Contract Year. In no instance will this be fewer
than 12. This applies to transfers prior to and after the Income Date.
TRANSFER FEE: For each transfer in excess of the Free Transfers
Permitted, the transfer fee is $25. Transfers made at the end of the
Right to Examine period by us and any transfers made pursuant to a
regularly scheduled transfer will not be counted in determining the
application of the transfer fee.
MINIMUM AMOUNT TO BE TRANSFERRED: None.
WITHDRAWALS:
WITHDRAWAL CHARGE: During the Accumulation Period, a withdrawal charge
is assessed against Purchase Payments withdrawn. The withdrawal charge
is calculated at the time of each withdrawal. For partial withdrawals,
the withdrawal charge is deducted from the remaining Purchase Payments
and is deducted from the Investment Options in the same proportion
that the amount of withdrawal from the Investment Options bears to the
total Contract Value. The withdrawal charge is based upon the length
of the time from receipt of the Purchase Payment. Withdrawals are
deemed to have come from the oldest Purchase Payments first. Each
Purchase Payment is tracked as to its date of receipt and the
withdrawal charges are determined in accordance with the following:
WITHDRAWAL CHARGE - DURING THE ACCUMULATION PERIOD:
(as a percentage of Purchase Payments)
Number of Complete Contract
Years since Receipt of Purchase Payments Withdrawal Charge
0 8.5%
1 8.5%
2 8.5%
3 8.0%
4 7.0%
5 6.0%
6 5.0%
7 4.0%
8 3.0%
9 or more 0%
PARTIAL WITHDRAWAL PRIVILEGE: Each Contract Year, on a non-cumulative
basis, you can withdraw Purchase Payments without incurring a
withdrawal charge. The amount not subject to the withdrawal charge is
10% of the Purchase Payments, less any previous withdrawals taken
during that Contract Year. The withdrawal amount that is not subject
to a withdrawal charge cannot exceed the Contract Value.
Upon a full withdrawal, the partial withdrawal privilege is processed
first and withdrawal charges are assessed against remaining Purchase
Payments.
If your Contract Value is $25,000 or more, you can elect the
Systematic Withdrawal Option. Systematic Withdrawals are available on
a monthly or quarterly basis. The total of all partial withdrawals
including Systematic Withdrawals in a Contract Year which can be made
without incurring a withdrawal charge is limited to 10% of the
Purchase Payments determined on the last Valuation Date prior to the
receipt of the Systematic Withdrawal Option request. There is no limit
to the amount or percentage of the Systematic Withdrawals if your
Purchase Payments are no longer subject to a withdrawal charge. If you
have elected the Systematic Withdrawal Option, any withdrawals above
the 10% free amount will be subject to any applicable withdrawal
charge. Systematic Withdrawals cannot be used upon annuitization. We
reserve the right to modify the eligibility rules at any time, without
notice.
If you have a Qualified Contract and you are 70 1/2 or older, you can
elect the Minimum Distribution Program with respect to your Contract.
Such payments will be designed to meet the applicable minimum
distribution requirements imposed by the Internal Revenue Code on
Qualified Contracts. Payments may be made monthly or quarterly unless
your Contract Value is less than $25,000, in which case the payments
shall be made annually. Withdrawals from your Qualified Contract
pursuant to the Minimum Distribution Program are in lieu of the
Partial Withdrawal Privilege described above. If you have elected the
Minimum Distribution Program, any additional withdrawals above the 10%
free amount will be subject to any applicable withdrawal charge.
MINIMUM PARTIAL WITHDRAWAL: None.
FIXED ACCOUNT INITIAL RATE: X%
We guarantee this rate for one year from the Issue Date. The Company guarantees
that the interest to be credited to the Fixed Account will not be less than 3%.
RIDERS:
Traditional Death Benefit Endorsement
Enhanced Death Benefit Endorsement
Unisex Endorsement
Pension Plan Death Benefit Endorsement
Pension Plan and Profit Sharing Plan Endorsement
403 (b) Endorsement Individual Retirement Annuity Endorsement
▇▇▇▇ Individual Retirement Annuity Endorsement
SERVICE OFFICE: [USAllianz] Service Center
[300 Berwyn Park
Berwyn, PA
800-624-0197]
DEFINITIONS
ACCUMULATION PERIOD: The period prior to the Income Date during which you can
make Purchase Payments.
ACCUMULATION UNIT: An accounting unit of measure used to calculate the Contract
Value prior to the Income Date.
ADJUSTED CONTRACT VALUE: The Contract Value less any applicable Premium Tax.
This amount is used to determine the death benefit during the Accumulation
Period or the initial Annuity Payment.
AGE: Age last birthday unless otherwise specified.
ANNUITANT: The natural person upon whose continuation of life any Annuity
Payment involving life contingencies depends. You may change the Annuitant at
any time prior to the Income Date unless the Contract Owner is a non-individual.
On or after the Income Date, any reference to Annuitant shall also include any
Joint Annuitant.
ANNUITY OPTION: An arrangement under which Annuity Payments are made under this
Contract.
ANNUITY PAYMENTS: The series of payments made to you or any named payee after
the Income Date under the Annuity Option selected.
ANNUITY PERIOD: The period of time beginning on the Income Date during which
Annuity Payments are made.
ANNUITY RESERVE: The assets which support the Annuity Option you have selected
during the Annuity Period.
ANNUITY UNIT: An accounting unit of measure used to calculate Annuity Payments
after the Income Date.
ASSUMED INVESTMENT RETURN ("AIR"): The investment return upon which the Variable
Annuity Payments in the Contract are based.
AUTHORIZED REQUEST: A request, in a form satisfactory to the Company, which is
received by the Service Center.
BENEFICIARY: The person(s) or entity(ies) who will receive any death benefit
payable under this Contract.
COMPANY: Preferred Life Insurance Company of New York.
CONTRACT ANNIVERSARY: An anniversary of the Issue Date of this Contract.
CONTRACT OWNER: The person(s) or entity(ies) entitled to the ownership rights
stated in this Contract. If Joint Owners are named, all references to Contract
Owner shall mean the Joint Owners.
CONTRACT VALUE: The dollar value as of any Valuation Date including any bonus
amounts, accumulated under this Contract.
CONTRACT YEAR: Any period of twelve (12) months commencing with the Issue Date
and each Contract Anniversary thereafter.
FIXED ACCOUNT: An Investment Option within the General Account which may be
selected.
GENERAL ACCOUNT: Our general investment account which contains all the assets of
the Company with the exception of the Variable Account and other segregated
asset accounts.
INCOME DATE: The date on which Annuity Payments are to begin.
INVESTMENT OPTION(S): Those investments available under the Contract. Current
Investment Options are shown on the Contract Schedule.
ISSUE DATE: The date shown on the Contract Schedule on which the first Contract
Year begins.
JOINT OWNER: If there is more than one Contract Owner, each Contract Owner shall
be a Joint Owner of the Contract. There can only be 2 Joint Owners. Joint Owners
have equal ownership rights and must both authorize any exercising of those
ownership rights unless otherwise allowed by us.
NET ASSET VALUE: The value per share of the underlying fund, less any investment
management and portfolio administration fees and expenses of the underlying
fund, held by the Sub-Account, as of the close of trading on a Valuation Date.
PREMIUM TAX: Any premium taxes owed to any governmental entity and assessed
against Purchase Payments, Contract Value, or Annuity Payments.
PURCHASE PAYMENT: A payment made toward this Contract.
SERVICE CENTER: The office indicated on the Contract Schedule of this Contract
to which notices, requests and Purchase Payments must be sent.
SUB-ACCOUNT: Variable Account assets are divided into Sub-Accounts. The current
Sub-Accounts available on the Issue Date are shown on the Contract Schedule.
VALUATION DATE: The Variable Account will be valued each day that the New York
Stock Exchange is open for trading.
VALUATION PERIOD: The period commencing at the close of business of the New York
Stock Exchange on each Valuation Date and ending at the close of business for
the next succeeding Valuation Date.
VARIABLE ACCOUNT: A separate account maintained by us in which a portion of our
assets has been allocated for this and certain other contracts. It has been
designated on the Contract Schedule.
PURCHASE PAYMENTS
PURCHASE PAYMENTS: Purchase Payments are payable according to the frequency and
in the amount selected by you. The initial Purchase Payment is due on the Issue
Date. The minimum subsequent Purchase Payment and the maximum total Purchase
Payments allowed are shown on the Contract Schedule. Purchase Payments will not
be accepted after the oldest Contract Owner attains Age 81.
CHANGE IN PURCHASE PAYMENTS: You may elect to increase or decrease or to change
the frequency of Purchase Payments as set forth in the Contract Schedule.
NO DEFAULT: Unless a full withdrawal is made, this Contract remains in force and
will not be in default if no additional Purchase Payments are made.
BONUS: During the Accumulation Period, a bonus will be credited with each
Purchase Payment made prior to the Contract Owner's attained Age 81. The bonus
will be credited on the date the Purchase Payment is allocated to the Contract.
After a withdrawal of Purchase Payments, a bonus is only applicable to
additional Purchase Payment amounts in excess of any previous Purchase Payments
withdrawn.
The bonus rate is specified in the Contract Schedule. The bonus will be credited
to the Contract under the following terms:
1. All bonus amounts and any gains and losses attributable to such amounts
shall be treated as earnings under the Contract.
2. All gains and losses attributable to bonus amounts and the bonus are part
of the Contract Value.
ALLOCATION OF PURCHASE PAYMENTS AND BONUS AMOUNTS: Purchase Payments and bonus
amounts are allocated to one or more of the Investment Options (including the
Fixed Account) in accordance with your selection. The allocation of the initial
Purchase Payment and bonus amount is made in accordance with your selection made
at the Issue Date. Unless you inform us otherwise, subsequent Purchase Payments
and bonus amounts are allocated in the same manner as the initial Purchase
Payment. However, the Company reserves the right to allocate the initial
Purchase Payment and bonus amounts to the Money Market Sub-Account, with the
exception of funds allocated to the Fixed Account, until the expiration of the
Right to Examine period.
During the Right to Examine period, however, bonus amounts will not be included
in the refund amount. All gains and losses attributable to the bonus amounts
will be included in the refund amount.
All allocations of Purchase Payments are subject to the Allocation Guidelines
shown on the Contract Schedule. We guarantee that you will be allowed to select
at least ten Sub-Accounts for allocation of Purchase Payments. The minimum will
never be less than the minimum shown in the Allocation Guidelines section of the
Contract Schedule. You will be allowed to choose the minimum number of
Sub-Accounts from the Investment Options as specified in the application and
Contract Schedule unless Sub-Accounts are eliminated or substituted.
VARIABLE ACCOUNT
THE VARIABLE ACCOUNT: The Variable Account is designated on the Contract
Schedule. It consists of assets we have set aside and have kept separate from
the rest of our assets and those of our other separate accounts. The assets of
the Variable Account, equal to reserves and other liabilities of your Contract
and those of other Contract Owners, will not be charged with liabilities arising
out of any other business we may conduct.
The Variable Account assets are divided into Sub-Accounts as shown on the
Contract Schedule. We may add additional Sub-Accounts to those shown. You may be
permitted to transfer your Contract Value or allocate Purchase Payments to the
additional Sub-Accounts.
Should the shares of any Sub-Account become unavailable for investment by the
Variable Account, or our Board of Directors deems further investment in the
shares inappropriate, we may limit further purchase of such shares or substitute
shares of another Sub-Account for shares already purchased. No such limitations
will be imposed or substitions made unless prior approval is obtained from the
New York State Insurance Department.
VALUATION OF ASSETS: Assets of the underlying fund of each Sub-Account will be
valued at their Net Asset Value on each Valuation Date.
ACCUMULATION UNITS: Accumulation Units shall be used to account for all amounts
allocated to or withdrawn from the Sub-Accounts of the Variable Account as a
result of Purchase Payments, withdrawals, transfers, or fees and charges. We
will determine the number of Accumulation Units of a Sub-Account purchased or
canceled. This will be done by dividing the amount allocated to (or the amount
withdrawn from) the Sub-Account by the dollar value of one Accumulation Unit of
the Sub-Account as of the end of the Valuation Period during which the
transaction is processed at the Service Center. Purchase Payments, withdrawals
and transfers or fees and charges from or to a Sub-Account will result in the
addition of or the cancellation of Accumulation Units in a Sub-Account.
ACCUMULATION UNIT VALUE: The Accumulation Unit value for each Sub-Account was
initially arbitrarily set. Subsequent Accumulation Unit values for each
Sub-Account are determined by multiplying the Accumulation Unit value for the
immediately preceding Valuation Period by the Net Investment Factor for the
Sub-Account for the current period.
The Accumulation Unit value may increase or decrease from Valuation Period to
Valuation Period.
NET INVESTMENT FACTOR: The Net Investment Factor for each Sub-Account is
determined by dividing A by B and multiplying by (1 - C) where:
A is (i) the Net Asset Value per share of the underlying fund held
y the Sub-Account at the end of the current Valuation Period;
plus
(ii) any dividend or capital gains per share declared on
behalf of such underlying fund held by the Sub-Account that
has an ex-dividend date within the current Valuation Period.
B is the Net Asset Value per share of the underlying fund held
by the Sub-Account for the immediately preceding Valuation
Period.
C is (i) the Valuation Period equivalent of the mortality and
expense risk charge, which is shown on the Contract Schedule;
plus
(ii) a charge factor, if any, for any taxes or any tax reserve
we have established as a result of the operation or
maintenance of the Sub-Account.
MORTALITY AND EXPENSE RISK CHARGE: Each Valuation Period, we deduct a mortality
and expense risk charge from the Variable Account which is equal, on an annual
basis, to the amount shown on the Contract Schedule. The mortality and expense
risk charge compensates the Company for assuming the mortality and expense risks
under this Contract.
MORTALITY AND EXPENSE GUARANTEE: We guarantee that the dollar amount of each
Annuity Payment after the first will not be affected by variations in mortality
or expense experience.
FIXED ACCOUNT PROVISIONS
FIXED ACCOUNT: The Contract Owner can elect to have Purchase Payments and bonus
amounts allocated to the Fixed Account. During the Accumulation Period, the
Contract Owner can transfer Contract Values to the Fixed Account from the
Variable Account and from the Fixed Account to the Variable Account.
FIXED ACCOUNT CONTRACT VALUE: The Fixed Account Contract Value of a Contract
within the Fixed Account will be determined as follows:
1. the Purchase Payments and bonus amounts allocated to the Fixed Account;
plus
2. the Contract Value transferred to the Fixed Account; plus
3. interest credited to the Contract Value in the Fixed Account; less
4. any prior withdrawals of the Contract Value from the Fixed Account and
any applicable charges; less
5. any Contract Value transferred from the Fixed Account; less
6. Contract maintenance charges or transfer fees or any applicable
Premium Taxes deducted from the Contract Value held in the Fixed
Account.
INTEREST TO BE CREDITED: The Company guarantees that the interest to be credited
to the Fixed Account will not be less than the amount specified in the Contract
Schedule. The Company may credit additional interest at its sole discretion.
Such additional interest shall be credited at a rate which is set in advance and
effective for at least one year.
CONTRACT VALUE
The Contract Value for any Valuation Period is equal to the total dollar value
accumulated under this Contract in all of the Sub-Accounts. The Contract Value
in a Sub-Account of the Variable Account is determined by multiplying the number
of Accumulation Units by the Accumulation Unit value.
CONTRACT MAINTENANCE CHARGE
We deduct an annual contract maintenance charge shown on the Contract Schedule.
Prior to the Income Date, this will be deducted from the Contract Value. The
number of Accumulation Units to be canceled from each applicable Sub-Account is
in the ratio that the value of each Sub-Account bears to the total Contract
Value. After the Income Date, the contract maintenance charge is deducted from
the Annuity Payments.
TRANSFERS
You may transfer all or a part of your interest in an Investment Option to
another Investment Option. We reserve the right to charge for transfers if there
are more than the number of free transfers shown on the Contract Schedule.
Pre-scheduled transfer programs may be available.
All transfers are subject to the following:
1. The deduction of any transfer fee that may be imposed as shown on the
Contract Schedule. The transfer fee will be deducted from the Investment
Option from which the transfer is made. If the entire amount in the
Investment Option is transferred, then the transfer fee will be deducted
from the amount transferred. If there are multiple source Investment
Options, it will be treated as a single transfer. Any transfer fee will be
deducted proportionally from the source Investment Options if less than the
entire amount in the Investment Option is transferred.
2. We reserve the right to limit transfers until the expiration of the Right
to Examine period.
3. The minimum amount which can be transferred is shown on the Contract
Schedule.
4. During the Accumulation Period, no transfer will be effective within seven
calendar days prior to the date on which the first Annuity Payment is due.
5. Any transfer direction must clearly specify:
a. the amount which is to be transferred; and
b. the Investment Options which are to be affected.
6. After the Income Date, during the Annuity Period, transfers may not be made
from a fixed Annuity Option to a variable Annuity Option.
7. After the Income Date, during the Annuity Period, you can make at least one
transfer from a variable Annuity Option to a fixed Annuity Option. The
number of Annuity Units canceled from the variable Annuity Option will be
equal in value to the amount of the Annuity Reserve transferred out of the
Variable Account. The Annuity Reserve transferred out of the Variable
Account is defined as the present value of the current variable payment
discounted with mortality at the Assumed Investment Return. The amount
transferred will purchase fixed annuity payments at current payout rates
under the Annuity Option in effect and based on the Age and sex (where
allowed) of the Annuitant at the time of the transfer.
8. Restrictions may be applied in any manner reasonably designed to prevent
any use of the transfer right which we consider to be to the disadvantage
of other Contract Owners. A modification could be applied to transfers to
or from one or more of the Investment Options, and could include, but is
not limited to:
a. the requirement of a minimum time period between each transfer;
b. not accepting a transfer request from an agent on behalf of more than one
Contract Owner; or
c. limiting the dollar amount that may be transferred between the Investment
Options by a Contract Owner at any one time;
If you elect to use this transfer privilege, we will not be liable for transfers
made in accordance with your instructions. All amounts and Accumulation Units
will be determined as of the end of the Valuation Period during which the
request for transfer is received at the Service Center.
WITHDRAWAL PROVISIONS
WITHDRAWALS: During the Accumulation Period, you may, upon Authorized Request,
make a full or partial withdrawal of the Contract Value. Withdrawals will result
in the cancellation of Accumulation Units from each Sub-Account in the ratio
that the value of each Sub-Account bears to the total Contract Value. You must
specify, by Authorized Request, which Accumulation Units are to be canceled if
other than the above mentioned method of cancellation is desired.
The Company will pay the amount of any withdrawal from the Variable Account
within seven (7) days of receipt of a request in good order unless the
Suspension or Deferral of Payments Provision is in effect.
The minimum partial withdrawal amount is shown on the Contract Schedule.
WITHDRAWAL CHARGE: Upon a full or partial withdrawal of this Contract, a
Withdrawal Charge as set forth on the Contract Schedule may be assessed. Under
certain circumstances, as set forth in the Contract Schedule, we allow
withdrawals without the Withdrawal Charge.
PROCEEDS PAYABLE ON DEATH
DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PERIOD: Upon the death of the
Contract Owner, or any Joint Owner, during the Accumulation Period, the death
benefit will be paid to the Beneficiary(ies) designated by the Contract Owner.
Upon the death of a Joint Owner, the surviving Joint Owner, if any, will be
treated as the primary Beneficiary. Any other Beneficiary designation on record
at the time of death will be treated as a contingent Beneficiary. If the
Contract is owned by a non-individual, the death benefit will be paid upon the
death of an Annuitant.
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD: The death benefit will be
the Adjusted Contract Value determined as of the end of the Valuation Period
during which the Company receives both due proof of death and an election for
the payment method.
If the Beneficiary is the spouse of the Contract Owner, he or she may elect to
continue the Contract in his or her own name and exercise all the Contract
Owner's rights under the Contract. In this event, the Contract Value for the
Valuation Period during which this election is implemented will be adjusted to
equal the death benefit.
Any part of the death benefit amount that had been invested in the Variable
Account remains in the Variable Account until distribution begins. From the time
the death benefit is determined until complete distribution is made, any amount
in the Variable Account will be subject to investment risk, which is borne by
the Beneficiary.
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD: If the Owner has not
previously designated a death benefit option, a Beneficiary must request that
the death benefit be paid under one of the death benefit options below.
Option A - lump sum payment of the death benefit. The contract
maintenance charge will not be deducted at the time of a full
withdrawal if the distribution is due to death; or
Option B - the payment of the entire death benefit within 5 years of
the date of the death of the Contract Owner or any Joint Owner. The
full contract maintenance charge is assessed each Beneficiary on each
Contract Anniversary; or
Option C - payment of the death benefit under an Annuity Option over
the lifetime of the Beneficiary or over a period not extending beyond
the life expectancy of the Beneficiary with distribution beginning
within one year of the date of death of the Contract Owner or any
Joint Owner. The full contract maintenance charge is assessed to each
Beneficiary.
Any portion of the death benefit not applied under Option C within one year of
the date of the Contract Owner's death, must be distributed within five years of
the date of death.
If a lump sum payment is requested, the amount will be paid within seven (7)
days of receipt of proof of death and the valid election, including any required
governmental forms, unless the Suspension or Deferral of Payments Provision is
in effect.
Payment to the Beneficiary, other than in a lump sum, may only be elected during
the sixty-day period after the day on which such lump sum first became payable
to the Company.
DEATH OF CONTRACT OWNER DURING THE ANNUITY PERIOD: If you, or any Joint Owner,
dies during the Annuity Period, and you are not an Annuitant, any remaining
payments under the Annuity Option elected will continue at least as rapidly as
under the method of distribution in effect at such Contract Owner's death. Upon
your death during the Annuity Period, the Beneficiary becomes the Contract
Owner.
DEATH OF ANNUITANT: Upon the death of an Annuitant, (or death of both Joint
Annuitants), who is not the Contract Owner, during the Accumulation Period, you
will become the Annuitant, unless you designate another Annuitant within 30 days
of the death of the Annuitant. If the Contract Owner is a non-individual, the
death of an Annuitant will be treated as the death of the Contract Owner and a
new Annuitant may not be designated.
Upon the death of the Annuitant during the Annuity Period, the death benefit, if
any, will be as specified in the Annuity Option elected. Death benefits will be
paid at least as rapidly as under the method of distribution in effect at the
Annuitant's death.
PAYMENT OF DEATH BENEFIT: The Company will require due proof of death and
payment election and any required governmental forms before any death benefit is
paid. Due proof of death will be:
1. a certified death certificate; or
2. a certified decree of a court of competent jurisdiction
as to the finding of death; or
3. any other proof satisfactory to the Company.
All death benefits will be paid in accordance with applicable law or regulations
governing death benefit payments.
BENEFICIARY: The Beneficiary designation in effect on the Issue Date will remain
in effect until changed. The Beneficiary is entitled to receive the benefits to
be paid at your death.
Unless you provide otherwise, the death benefit will be paid in equal shares to
the survivor(s) as follows:
1. to the primary Beneficiary(ies) who survive you and/or the Annuitant's
death, as applicable; or if there are none,
2. to the contingent Beneficiary(ies) who survive you and/or the
Annuitant's death, as applicable; or if there are none,
3. to your estate.
CHANGE OF BENEFICIARY: Subject to the rights of any irrevocable
Beneficiary(ies), you may change the primary Beneficiary(ies) or contingent
Beneficiary(ies). A change may be made by Authorized Request. The change will
take effect as of the date the Authorized Request is signed. If the Authorized
Request reaches our Service Center after the Contract Owner dies, but before any
payment is made, the change will be valid. Such changes will be effective on the
date the Authorized Request is signed subject to any actions taken by the
insurer prior to receipt of the Authorized Request.
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION
The Company reserves the right to suspend or postpone payments from the Variable
Account for a withdrawal or transfer for any period when:
1. the New York Stock Exchange is closed (other than customary weekend
and holiday closings);
2. trading on the New York Stock Exchange is restricted;
3. an emergency exists as a result of which disposal of securities held
in the Variable Account is not reasonably practicable or it is not
reasonably practicable to determine the value of the Variable
Account's net assets; or
4. during any other period when the Securities and Exchange Commission,
by order, so permits for the protection of Contract Owners;
provided that applicable rules and regulations of the Securities and Exchange
Commission will govern as to whether the conditions described in (2) and (3)
exist.
The Company reserves the right to postpone payments from the Fixed Account for a
period of up to six months.
CONTRACT OWNER, ANNUITANT, ASSIGNMENT PROVISIONS
CONTRACT OWNER: As the Contract Owner you have all the interests and rights
under this Contract. The Contract Owner is the person designated as such on the
Issue Date, unless changed.
You may change Owners of the Contract at any time by Authorized Request. A
change of Contract Owner will automatically revoke any prior designation of
Contract Owner. The change will become effective as of the date the Authorized
Request is signed. We will not be liable for any payment made or action taken
before the change is recorded. We will not be responsible for any tax
consequences of any such change.
JOINT OWNER: A Contract may be owned by Joint Owners (maximum of two). Upon the
death of either Joint Owner, the surviving Joint Owner, if any, will be the
primary Beneficiary. Any other Beneficiary designation will be treated as a
contingent Beneficiary unless otherwise indicated in an Authorized Request.
ANNUITANT: The Annuitant is the person on whose life Annuity Payments are based.
The Annuitant is the person designated by you subject to our underwriting rules
then in effect. The Annuitant may not be changed in a Contract which is owned by
a non-individual.
ASSIGNMENT OF A CONTRACT: An Authorized Request specifying the terms of an
assignment of a Contract must be provided to the Service Center. We will not be
liable for any payment made or action taken before we record the assignment.
We will not be responsible for the validity or tax consequences of any
assignment. Any assignment made after the death benefit has become payable will
be valid only with our consent.
If the Contract is assigned, your rights may only be exercised with the consent
of the assignee of record.
ANNUITY PROVISIONS
GENERAL: On the Income Date, the amount available for Annuity Payments is based
on the Adjusted Contract Value and will be applied under the Annuity Option you
have selected.
You may elect to have the amount available for Annuity Payments applied to
provide a fixed annuity, a variable annuity or a combination fixed and variable
annuity. Annuity Option 6 is available with fixed annuity payments only.
If a combination is elected, you must specify what part of the amount available
for Annuity Payments is to be applied to the fixed and variable Annuity Options.
If you select a fixed annuity, the amount available for Annuity Payments is
allocated to the General Account and the annuity is paid as a fixed annuity. If
you select a variable annuity, the amount available for Annuity Payments will be
allocated to the Sub-Accounts of the Variable Account in accordance with your
selection, and the annuity will be paid as a variable annuity.
Unless you designate another payee, you will be the payee of the Annuity
Payments. The amount available for Annuity Payments will be applied to the
applicable annuity rate based upon the Annuity Option you have selected. The
Annuity Payments will be at least as favorable as those that would be provided
by the application of an amount to purchase any single premium immediate annuity
contract offered by us at the time for the same class of Annuitants.
We may offer more favorable rates than those guaranteed here at the time your
first Annuity Payment is calculated. Annuity Payments will depend on the Age
and, where permitted, sex of the Annuitant.
If Annuity Payments amount to less than $20, we may change the frequency of the
payments. We will not allow amounts less than $2,000 to be applied under any
Annuity Payment Option.
FIXED ANNUITY: You may elect to have the amount available for Annuity Payments
applied to provide a fixed annuity. The dollar amount of each fixed Annuity
Payment is guaranteed to be at least an amount equal to the amount available for
Annuity Payments, divided first by $1000 and then multiplied by the appropriate
Annuity Payment amount for each $1000 of value for the Annuity Option selected.
The guaranteed rates, as set forth in the tables at the end of the Contract, are
based on an interest rate of 2 1/2% per year and the 1983(a) Individual Annuity
Mortality Table with mortality improvement projected 30 years using Mortality
Projection Scale G.
VARIABLE ANNUITY: You may elect to have the amount available for Annuity
Payments applied to provide a variable annuity. Variable Annuity Payments
reflect the investment performance of the Variable Account in accordance with
the allocation of the amount available for Annuity Payments to the Sub-Accounts
during the Annuity Period. Variable Annuity Payments are not guaranteed as to
dollar amount.
On the Income Date, Annuity Units will be purchased as follows:
The first Annuity Payment is equal to the amount available for Annuity Payments,
divided first by $1000 and then multiplied by the appropriate Annuity Payment
amount for each $1000 of value for the Annuity Option selected as set forth in
the table at the end of the Contract. In each Sub-Account, the number of Annuity
Units is determined by dividing the amount of the initial Annuity Payment
determined for each Sub-Account by the Annuity Unit value on the Income Date.
Thereafter, the number of Annuity Units in each Sub-Account remains unchanged
unless you elect to transfer between Sub-Accounts. All calculations will
appropriately reflect the Annuity Payment frequency selected.
On each subsequent Annuity Payment date, the total Annuity Payment is the sum of
the Annuity Payments for each Sub-Account. The Annuity Payment in each
Sub-Account is determined by multiplying the number of Annuity Units then
allocated to such Sub-Account by the Annuity Unit value for that Sub-Account.
On each subsequent Valuation Date, the value of an Annuity Unit is determined in
the following way:
First: The Net Investment Factor is determined as described under "Variable
Account - Net Investment Factor" above.
Second:The value of an Annuity Unit for a Valuation Period is equal to:
a. the value of the Annuity Unit for the immediately preceding Valuation
Period;
b. multiplied by the Net Investment Factor for the current Valuation
Period;
c. divided by the assumed Net Investment Factor (see below) for the
Valuation Period.
The assumed Net Investment Factor is equal to one plus the Assumed Investment
Return which is used in determining the basis for the purchase of an Annuity,
adjusted to reflect the particular Valuation Period. The Assumed Investment
Return that you can select is either 3% or 4.5%.
INCOME DATE: You select an Income Date at the time of issue. It is the date the
Annuity Payments are to begin. The Income Date must always be the first day of a
calendar month. The earliest Income Date you can select is thirteen months after
the Issue Date. The latest Income Date you can select is the first day of the
first calendar month following the Annuitant's 90th birthday. You may, at any
time prior to the Income Date, change the Income Date by Authorized Request 30
days in advance.
SELECTION OF AN ANNUITY OPTION: You can select an Annuity Option by Authorized
Request. You may, at any time prior to 30 days in advance of the Income Date, by
Authorized Request, select and/or change the Annuity Option.
DEFAULT ANNUITY OPTION: If no Annuity Option is selected, Option 2, which is a
life annuity with period certain, 60 Monthly Payments Guaranteed, will be
automatically applied.
ANNUITY OPTIONS: This Contract provides for Annuity Payments under one of the
Annuity Options described below. Any other Annuity Payment plan that is
acceptable to us may be selected.
OPTION 1 - LIFE ANNUITY. We will make monthly Annuity Payments during the life
of the Annuitant and ceasing with the last Annuity Payment due prior to the
Annuitant's death.
OPTION 2 - LIFE ANNUITY WITH MONTHLY PAYMENTS OVER 5, 10, 15, OR 20 YEARS
GUARANTEED. We will make monthly Annuity Payments during the life of the
Annuitant with a guarantee that if at the Annuitant's death there have been
fewer than 60, 120, 180, or 240 monthly Annuity Payments made as selected,
monthly Annuity Payments will continue for the remainder of the guaranteed
period. Alternatively, the Contract Owner may elect to receive a lump-sum
payment equal to the present value of the guaranteed monthly Annuity Payments
remaining, as of the date proof of the Annuitant's death is received at the
Service Center, commuted at an appropriate rate as defined below. Proof of the
Annuitant's death and return of the Contract are required prior to the payment
of any commuted values. For a fixed Annuity Option, commutation is not
available. For a variable Annuity Option, the commutation rate will be the
Assumed Investment Return.
OPTION 3 - JOINT AND LAST SURVIVOR ANNUITY. We will make monthly Annuity
Payments during the joint lifetime of the Annuitant and the Joint Annuitant.
Upon the death of the Annuitant, if the Joint Annuitant is then living, Annuity
Payments will continue to be paid during the remaining lifetime of the Joint
Annuitant at a level of 100%, 75% or 50% of the previous level, as selected.
Monthly Annuity Payments cease with the final Annuity Payment due prior to the
last survivor's death.
OPTION 4 - JOINT AND LAST SURVIVOR ANNUITY WITH MONTHLY PAYMENTS OVER 5, 10, 15,
0R 20 YEARS GUARANTEED. We will make monthly Annuity Payments during the joint
lifetime of the Annuitant and the Joint Annuitant. Monthly Annuity Payments will
continue to be paid during the remaining lifetime of the Joint Annuitant at 100%
of the previous level. The Company guarantees that if at the last death of the
Annuitant and the Joint Annuitant, there have been fewer than 60, 120, 180, or
240 monthly Annuity Payments made as selected, monthly Annuity Payments will
continue to be made for the remainder of the guaranteed period. Alternatively,
the Contract Owner may elect to receive a lump-sum payment equal to the present
value of the guaranteed monthly Annuity Payments remaining, as of the date proof
of the Annuitant's and Joint Annuitant's death is received at the Service
Center, commuted at an appropriate rate as defined below. Proof of death of the
Annuitant and Joint Annuitant and return of the Contract are required prior to
the payment of any commuted values. For a fixed Annuity Option, commutation is
not available. For a variable Annuity Option, the commutation rate will be the
Assumed Investment Return.
OPTION 5 - REFUND LIFE ANNUITY. We will make monthly Annuity Payments during the
lifetime of the Annuitant ceasing with the last Annuity Payment due prior to the
Annuitant's death with a guarantee that after the Annuitant's death, you may
receive a refund. For a Fixed Annuity the amount of the refund will be any
excess of the amount available for Annuity Payments applied under this Option
over the sum of all Annuity Payments made under this Option. For a Variable
Annuity the amount of the refund will depend on the current Sub-Account
allocation and will be the sum of Refund Amounts attributable to each
Sub-Account. The Refund Amount for a given Sub-Account is calculated using the
following formula:
(1) x {[(2) x (3) x (4)/(5)] - [(4) x (6)]}
where: (1) = Annuity Unit value of that given Sub-Account when claim proofs are
received.
(2) = The amount available for Annuity Payments at the time of
annuitization.
(3) = Allocation percentage in that given Sub-Account (in decimal form)
when claim proofs are received.
(4) = Current number of Annuity Units used in determining each Annuity
Payment attributable to that given Sub-Account.
(5) = Dollar value of first Annuity Payment.
(6) = Number of Annuity Payments made since annuitization.
This calculation will be based upon the allocation of Annuity Units actually
in-force at the time claim proofs are received at the Service Center. There will
be no refund paid if the total refund determined using the above calculations is
less than or equal to zero.
OPTION 6 - SPECIFIED PERIOD CERTAIN ANNUITY. Monthly fixed Annuity Payments are
paid for a specified period of time. The Specified Period Certain is elected by
the Contract Owner and must be specified as a whole number of years from 10 to
30. If at the time of the last death of the Annuitant and any Joint Annuitant,
the Annuity Payments actually made have been for less than the Specified Period
Certain, then Annuity Payments will be continued thereafter to the Contract
Owner for the remainder of the Specified Period Certain. This option is
available on a fixed basis only.
GENERAL PROVISIONS
THE CONTRACT: The entire Contract consists of this Contract, and any attached
application endorsements or riders. This Contract may be changed or altered only
by our President or Secretary. Any change, modification or waiver must be made
in writing.
NON-PARTICIPATING IN SURPLUS: This Contract does not share in any distribution
of our profits or surplus.
INCONTESTABILITY: We will not contest this Contract from its Issue Date.
MISSTATEMENT OF AGE OR SEX: We may require proof of Age of the Annuitant before
making any life contingent Annuity Payment provided for by this Contract. If the
Age or sex of the Annuitant has been misstated, the amount payable will be the
amount the Adjusted Contract Value or the amount available for Annuity Payments
would have provided at the true Age or sex.
Once Annuity Payments have begun, any underpayments will be made up in one sum
with the next Annuity Payment, and overpayments will be deducted from the future
Annuity Payments until the total is repaid. The annual interest rate to be used
in the calculation of the adjustments for underpayments and overpayments is 5%.
CONTRACT SETTLEMENT: This Contract must be returned to us upon any settlement.
Prior to any settlement as a death claim, due proof of death must be submitted
to us. Any paid-up annuity, cash withdrawal or death benefit that may be
available is not less than the minimum benefit required by any statute of the
state in which the contract is delivered.
REPORTS: We will furnish you with a report showing the Contract Value at least
once each calendar year. This report will be sent to your last known address.
EVIDENCE OF SURVIVAL: Where any benefits under this Contract are contingent upon
the recipient being alive on a given date, we may require proof satisfactory to
us that the condition has been met.
PROTECTION OF PROCEEDS: No Beneficiary may commute, encumber, alienate or assign
any payments under this Contract before they are due. To the extent permitted by
law, no payments will be subject to the debts, contracts or engagements of any
Beneficiary or to any judicial process to levy upon or attach the same for
payment thereof.
MODIFICATION OF CONTRACT: This Contract may not be modified by us without your
consent except as may be required by applicable law.
Guaranteed Monthly Payments Per $1,000 of Proceeds
Fixed Payouts
Option 2
Age of Annuitant
Nearest Birthday Option 1 5 Years 10 Years 15 Years 20 Years Option 5
When First Payment Minimum Minimum Minimum Minimum
Is Made M F M F M F M F M F M F
--------------------------------------------------------------------------------------------------------------------------------
30 2.85 2.72 2.85 2.72 2.84 2.72 2.84 2.71 2.84 2.71 2.81 2.70
31 2.87 2.74 2.87 2.74 2.87 2.74 2.87 2.74 2.86 2.73 2.84 2.72
32 2.90 2.76 2.90 2.76 2.90 2.76 2.89 2.76 2.89 2.75 2.86 2.74
33 2.93 2.78 2.93 2.78 2.92 2.78 2.92 2.78 2.91 2.78 2.89 2.76
34 2.96 2.81 2.96 2.81 2.95 2.81 2.95 2.80 2.94 2.80 2.91 2.79
35 2.99 2.83 2.99 2.83 2.98 2.83 2.98 2.83 2.97 2.82 2.94 2.81
36 3.02 2.86 3.02 2.86 3.02 2.86 3.01 2.85 3.00 2.85 2.97 2.83
37 3.05 2.88 3.05 2.88 3.05 2.88 3.04 2.88 3.03 2.88 3.00 2.86
38 3.09 2.91 3.09 2.91 3.09 2.91 3.08 2.91 3.07 2.90 3.03 2.89
39 3.13 2.94 3.13 2.94 3.12 2.94 3.11 2.94 3.10 2.93 3.06 2.91
40 3.17 2.97 3.16 2.97 3.16 2.97 3.15 2.97 3.14 2.96 3.10 2.94
41 3.21 3.01 3.21 3.01 3.20 3.00 3.19 3.00 3.17 2.99 3.13 2.97
42 3.25 3.04 3.25 3.04 3.24 3.04 3.23 3.03 3.21 3.03 3.17 3.00
43 3.29 3.08 3.29 3.08 3.29 3.07 3.27 3.07 3.25 3.06 3.20 3.03
44 3.34 3.11 3.34 3.11 3.33 3.11 3.32 3.10 3.29 3.09 3.24 3.07
45 3.39 3.15 3.39 3.15 3.38 3.15 3.36 3.14 3.34 3.13 3.28 3.10
46 3.44 3.19 3.44 3.19 3.43 3.19 3.41 3.18 3.38 3.17 3.32 3.14
47 3.49 3.23 3.49 3.23 3.48 3.23 3.46 3.22 3.43 3.21 3.37 3.17
48 3.55 3.28 3.55 3.28 3.53 3.27 3.51 3.26 3.48 3.25 3.41 3.21
49 3.61 3.33 3.60 3.32 3.59 3.32 3.57 3.31 3.53 3.29 3.46 3.25
50 3.67 3.38 3.67 3.37 3.65 3.37 3.62 3.36 3.58 3.34 3.51 3.29
51 3.73 3.43 3.73 3.43 3.71 3.42 3.68 3.41 3.63 3.38 3.56 3.34
52 3.80 3.48 3.80 3.48 3.78 3.47 3.74 3.46 3.69 3.43 3.61 3.39
53 3.87 3.54 3.87 3.54 3.84 3.53 3.80 3.51 3.74 3.48 3.67 3.43
54 3.95 3.60 3.94 3.60 3.92 3.59 3.87 3.57 3.80 3.54 3.73 3.48
55 4.03 3.66 4.02 3.66 3.99 3.65 3.94 3.63 3.86 3.59 3.79 3.54
56 4.11 3.73 4.10 3.72 4.07 3.71 4.01 3.69 3.92 3.65 3.85 3.59
57 4.20 3.80 4.19 3.79 4.15 3.78 4.09 3.75 3.99 3.71 3.92 3.65
58 4.29 3.87 4.28 3.87 4.24 3.85 4.17 3.82 4.05 3.77 3.99 3.71
59 4.39 3.95 4.38 3.95 4.33 3.93 4.25 3.89 4.12 3.83 4.06 3.77
60 4.50 4.03 4.48 4.03 4.43 4.01 4.33 3.96 4.18 3.90 4.13 3.84
61 4.61 4.12 4.59 4.12 4.53 4.09 4.42 4.04 4.25 3.96 4.21 3.91
62 4.73 4.22 4.71 4.21 4.64 4.18 4.51 4.12 4.32 4.03 4.29 3.98
63 4.86 4.32 4.83 4.31 4.75 4.27 4.60 4.21 4.39 4.10 4.38 4.06
64 4.99 4.42 4.97 4.41 4.87 4.37 4.70 4.30 4.45 4.18 4.47 4.14
65 5.14 4.54 5.11 4.52 5.00 4.48 4.80 4.39 4.52 4.25 4.56 4.22
66 5.30 4.66 5.26 4.64 5.13 4.59 4.90 4.49 4.59 4.32 4.66 4.31
67 5.46 4.78 5.42 4.77 5.26 4.71 5.00 4.59 4.65 4.40 4.76 4.40
68 5.64 4.92 5.58 4.90 5.40 4.83 5.11 4.69 4.72 4.47 4.87 4.50
69 5.83 5.07 5.76 5.05 5.55 4.96 5.21 4.80 4.78 4.55 4.99 4.60
70 6.03 5.23 5.95 5.20 5.70 5.10 5.31 4.91 4.83 4.62 5.11 4.72
71 6.24 5.40 6.15 5.37 5.86 5.25 5.42 5.02 4.89 4.69 5.23 4.83
72 6.47 5.58 6.36 5.54 6.02 5.40 5.52 5.14 4.94 4.76 5.36 4.95
73 6.71 5.78 6.58 5.73 6.19 5.56 5.62 5.25 4.99 4.83 5.49 5.08
74 6.96 6.00 6.81 5.94 6.36 5.73 5.72 5.37 5.03 4.89 5.64 5.21
75 7.23 6.23 7.05 6.16 6.53 5.91 5.81 5.49 5.07 4.95 5.79 5.35
76 7.53 6.48 7.31 6.39 6.71 6.09 5.91 5.60 5.11 5.00 5.94 5.50
77 7.84 6.75 7.59 6.64 6.89 6.28 5.99 5.71 5.14 5.05 6.11 5.66
78 8.18 7.04 7.87 6.90 7.07 6.48 6.08 5.82 5.17 5.09 6.28 5.83
79 8.54 7.35 8.18 7.18 7.25 6.68 6.16 5.93 5.19 5.13 6.47 6.00
80 8.92 7.68 8.49 7.48 7.43 6.88 6.23 6.02 5.21 5.16 6.66 6.18
81 9.34 8.05 8.83 7.80 7.61 7.09 6.29 6.11 5.23 5.19 6.86 6.37
82 9.78 8.45 9.17 8.14 7.78 7.29 6.35 6.20 5.24 5.22 7.07 6.59
83 10.25 8.88 9.53 8.50 7.95 7.49 6.41 6.28 5.25 5.23 7.30 6.80
84 10.76 9.34 9.91 8.88 8.12 7.69 6.46 6.35 5.26 5.25 7.54 7.04
85 11.30 9.85 10.29 9.29 8.27 7.89 6.50 6.41 5.27 5.26 7.79 7.28
86 11.89 10.40 10.70 9.71 8.42 8.08 6.54 6.47 5.27 5.26 8.07 7.54
87 12.52 11.00 11.11 10.14 8.56 8.26 6.57 6.51 5.27 5.27 8.36 7.83
88 13.21 11.66 11.53 10.60 8.70 8.43 6.59 6.55 5.27 5.27 8.68 8.13
89 13.95 12.36 11.97 11.06 8.83 8.59 6.61 6.58 5.27 5.27 9.02 8.45
90 14.75 13.12 12.41 11.52 8.94 8.74 6.62 6.60 5.27 5.27 9.39 8.81
---------------------------------------------------------------------------------------------------------------------------------
Guaranteed Monthly Payments per $1,000 of Proceeds
Fixed Payout
Option 3
Female Age 30 40 50 60 70 80 90
Male Age
------------------------------------------------------------------
30 2.61 2.71 2.77 2.81 2.83 2.84 2.84
40 2.66 2.82 2.97 3.07 3.12 3.15 3.16
50 2.69 2.90 3.14 3.37 3.53 3.62 3.65
60 2.71 2.94 3.27 3.67 4.05 4.32 4.45
70 2.71 2.96 3.33 3.87 4.59 5.32 5.78
80 2.71 2.97 3.36 3.98 4.97 6.40 7.81
90 2.72 2.97 3.37 4.02 5.15 7.19 10.23
------------------------------------------------------------------
Option 4
5 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
------------------------------------------------------------------
30 2.61 2.71 2.77 2.81 2.83 2.84 2.84
40 2.66 2.82 2.97 3.07 3.12 3.15 3.16
50 2.69 2.90 3.14 3.37 3.53 3.62 3.65
60 2.71 2.94 3.27 3.67 4.05 4.31 4.44
70 2.71 2.96 3.33 3.87 4.59 5.31 5.77
80 2.71 2.97 3.36 3.98 4.97 6.38 7.72
90 2.72 2.97 3.37 4.02 5.14 7.13 9.90
-------------------------------------------------------------------
Option 4
10 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
-------------------------------------------------------------------
30 2.61 2.71 2.77 2.81 2.83 2.84 2.84
40 2.66 2.82 2.96 3.07 3.12 3.15 3.16
50 2.69 2.90 3.14 3.37 3.53 3.61 3.64
60 2.70 2.94 3.27 3.67 4.05 4.16 4.41
70 2.71 2.96 3.33 3.87 4.58 5.26 5.63
80 2.71 2.97 3.36 3.97 4.93 6.21 7.18
90 2.72 2.97 3.37 4.00 5.08 6.77 8.42
-------------------------------------------------------------------
Option 4
15 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
-------------------------------------------------------------------
30 2.61 2.71 2.77 2.81 2.83 2.84 2.84
40 2.66 2.82 2.96 3.07 3.12 3.15 3.15
50 2.69 2.90 3.14 3.37 3.53 3.60 3.62
60 2.70 2.94 3.27 3.66 4.04 4.26 4.33
70 2.71 2.96 3.33 3.86 4.53 5.10 5.30
80 2.71 2.97 3.35 3.94 4.82 5.77 6.20
90 2.71 2.97 3.36 3.96 4.91 6.01 6.58
-------------------------------------------------------------------
Option 4
20 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
-------------------------------------------------------------------
30 2.61 2.71 2.77 2.81 2.83 2.84 2.84
40 2.66 2.82 2.96 3.06 3.12 3.14 3.14
50 2.69 2.90 3.14 3.37 3.51 3.57 3.58
60 2.70 2.94 3.26 3.65 3.99 4.13 4.18
70 2.71 2.96 3.32 3.83 4.41 4.77 4.83
80 2.71 2.96 3.34 3.89 4.60 5.11 5.21
90 2.71 2.96 3.34 3.90 4.62 5.16 5.27
-------------------------------------------------------------------
Guaranteed Initial Monthly Payment Per $1,000 of Proceeds
--------------------------------------------------------------------------------
Variable Payouts Based on 4.50% AIR
--------------------------------------------------------------------------------
Age of Option 2
Annuitant
Nearest Option 1 5 Years 10 Years 15 Years 20 Option 5
Birthday Years
When First Minimum Minimum Minimum Minimum
Payment
Is Made M F M F M F M F M F M F
-----------------------------------------------------------------------------------------------------------------------
30 4.12 4.01 4.12 4.01 4.12 4.01 4.11 4.01 4.11 4.00 4.10 4.00
31 4.14 4.03 4.14 4.03 4.14 4.03 4.13 4.02 4.13 4.02 4.12 4.02
32 4.17 4.04 4.16 4.04 4.16 4.04 4.16 4.04 4.15 4.04 4.14 4.03
33 4.19 4.06 4.19 4.06 4.18 4.06 4.18 4.06 4.17 4.05 4.16 4.05
34 4.21 4.08 4.21 4.08 4.21 4.08 4.20 4.08 4.19 4.07 4.19 4.07
35 4.24 4.10 4.24 4.10 4.24 4.10 4.23 4.10 4.22 4.09 4.21 4.09
36 4.27 4.12 4.27 4.12 4.26 4.12 4.25 4.12 4.24 4.11 4.24 4.11
37 4.30 4.14 4.30 4.14 4.29 4.14 4.28 4.14 4.27 4.13 4.26 4.13
38 4.33 4.17 4.33 4.17 4.32 4.16 4.31 4.16 4.30 4.15 4.29 4.15
39 4.36 4.19 4.36 4.19 4.35 4.19 4.34 4.18 4.33 4.18 4.32 4.17
40 4.40 4.22 4.40 4.22 4.39 4.21 4.38 4.21 4.36 4.20 4.35 4.20
41 4.43 4.25 4.43 4.24 4.42 4.24 4.41 4.24 4.39 4.23 4.38 4.22
42 4.47 4.27 4.47 4.27 4.46 4.27 4.44 4.26 4.42 4.25 4.41 4.25
43 4.51 4.30 4.51 4.30 4.50 4.30 4.48 4.29 4.45 4.28 4.45 4.28
44 4.56 4.34 4.55 4.34 4.54 4.33 4.52 4.32 4.49 4.31 4.48 4.30
45 4.60 4.37 4.60 4.37 4.58 4.36 4.56 4.35 4.53 4.34 4.52 4.34
46 4.65 4.41 4.64 4.40 4.63 4.40 4.60 4.39 4.57 4.37 4.56 4.37
47 4.70 4.44 4.69 4.44 4.68 4.44 4.65 4.42 4.61 4.41 4.60 4.40
48 4.75 4.48 4.74 4.48 4.72 4.47 4.69 4.46 4.65 4.44 4.65 4.44
49 4.81 4.53 4.80 4.52 4.78 4.52 4.74 4.50 4.69 4.48 4.69 4.47
50 4.86 4.57 4.86 4.57 4.83 4.56 4.79 4.54 4.74 4.52 4.74 4.51
51 4.92 4.62 4.91 4.61 4.89 4.60 4.84 4.59 4.78 4.56 4.79 4.56
52 4.99 4.67 4.98 4.66 4.95 4.65 4.90 4.63 4.83 4.60 4.85 4.60
53 5.06 4.72 5.04 4.72 5.01 4.70 4.96 4.68 4.88 4.64 4.90 4.64
54 5.13 4.78 5.12 4.77 5.08 4.76 5.02 4.73 4.94 4.69 4.96 4.69
55 5.20 4.83 5.19 4.83 5.15 4.81 5.08 4.78 4.99 4.74 5.02 4.74
56 5.28 4.90 5.27 4.89 5.22 4.87 5.15 4.84 5.04 4.79 5.09 4.80
57 5.37 4.96 5.35 4.96 5.30 4.93 5.22 4.90 5.10 4.84 5.16 4.85
58 5.46 5.03 5.44 5.03 5.39 5.00 5.29 4.96 5.16 4.90 5.23 4.91
59 5.56 5.11 5.54 5.10 5.47 5.07 5.37 5.02 5.22 4.95 5.31 4.98
60 5.66 5.19 5.64 5.18 5.57 5.15 5.45 5.09 5.28 5.01 5.38 5.05
61 5.77 5.27 5.74 5.26 5.66 5.23 5.53 5.16 5.34 5.07 5.47 5.11
62 5.89 5.36 5.86 5.35 5.77 5.31 5.61 5.24 5.40 5.13 5.56 5.19
63 6.02 5.46 5.98 5.44 5.88 5.40 5.70 5.32 5.46 5.20 5.65 5.27
64 6.15 5.56 6.11 5.55 5.99 5.49 5.79 5.40 5.52 5.26 5.75 5.35
65 6.30 5.67 6.25 5.65 6.11 5.59 5.88 5.49 5.58 5.33 5.85 5.44
66 6.45 5.79 6.40 5.77 6.23 5.70 5.97 5.58 5.64 5.40 5.96 5.53
67 6.62 5.92 6.56 5.89 6.37 5.81 6.07 5.67 5.70 5.46 6.07 5.63
68 6.80 6.05 6.72 6.02 6.50 5.93 6.16 5.77 5.75 5.53 6.19 5.74
69 6.99 6.20 6.90 6.16 6.64 6.06 6.26 5.87 5.81 5.60 6.31 5.85
70 7.19 6.36 7.09 6.32 6.79 6.19 6.35 5.97 5.86 5.66 6.44 5.96
71 7.41 6.53 7.28 6.48 6.94 6.33 6.45 6.07 5.91 5.73 6.58 6.09
72 7.63 6.71 7.49 6.66 7.09 6.48 6.54 6.18 5.95 5.79 6.73 6.22
73 7.88 6.91 7.71 6.85 7.25 6.63 6.64 6.29 6.00 5.85 6.87 6.36
74 8.14 7.13 7.94 7.05 7.42 6.80 6.73 6.40 6.03 5.91 7.04 6.51
75 8.41 7.36 8.18 7.26 7.58 6.97 6.81 6.51 6.07 5.96 7.20 6.67
76 8.71 7.61 8.44 7.50 7.75 7.14 6.90 6.61 6.10 6.00 7.38 6.83
77 9.03 7.88 8.71 7.74 7.92 7.33 6.98 6.72 6.13 6.05 7.56 7.00
78 9.37 8.17 8.99 8.00 8.09 7.51 7.05 6.82 6.16 6.09 7.76 7.19
79 9.73 8.49 9.29 8.28 8.26 7.70 7.13 6.91 6.18 6.12 7.97 7.39
80 10.12 8.83 9.60 8.58 8.43 7.90 7.19 7.00 6.20 6.15 8.18 7.59
81 10.54 9.20 9.93 8.90 8.60 8.09 7.25 7.09 6.21 6.18 8.41 7.82
82 10.98 9.60 10.27 9.23 8.76 8.29 7.31 7.16 6.23 6.20 8.66 8.05
83 11.46 10.04 10.62 9.59 8.92 8.48 7.36 7.24 6.24 6.22 8.91 8.29
84 11.97 10.51 10.99 9.97 9.07 8.67 7.41 7.30 6.24 6.23 9.18 8.56
85 12.52 11.02 11.37 10.36 9.22 8.85 7.45 7.36 6.25 6.24 9.47 8.84
86 13.11 11.58 11.76 10.78 9.36 9.03 7.48 7.41 6.25 6.24 9.77 9.13
87 13.75 12.19 12.16 11.21 9.49 9.20 7.51 7.46 6.25 6.25 10.09 9.44
88 14.45 12.86 12.57 11.65 9.62 9.36 7.53 7.49 6.25 6.25 10.43 9.78
89 15.19 13.57 12.99 12.10 9.74 9.52 7.54 7.52 6.25 6.25 10.81 10.13
90 15.99 14.33 13.41 12.55 9.85 9.66 7.56 7.54 6.25 6.25 11.22 10.52
------------------------------------------------------------------------------------------------------------------------
Guaranteed Initial Monthly Payments per $1,000 of Proceeds
Variable Payout Based on 4.50% AIR
Option 3
Female Age 30 40 50 60 70 80 90
Male Age
-----------------------------------------------------------------
30 3.92 3.99 4.04 4.08 4.10 4.11 4.12
40 3.96 4.07 4.19 4.28 4.34 4.37 4.39
50 3.98 4.14 4.33 4.54 4.69 4.79 4.84
60 4.00 4.18 4.45 4.80 5.16 5.44 5.59
70 4.00 4.20 4.51 5.00 5.67 6.39 6.90
80 4.01 4.21 4.55 5.11 6.06 7.45 8.88
90 4.01 4.22 4.56 5.16 6.26 8.27 11.28
-----------------------------------------------------------------
Option 4
5 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
-----------------------------------------------------------------
30 3.92 3.99 4.04 4.08 4.10 4.11 4.12
40 3.96 4.07 4.19 4.28 4.34 4.37 4.39
50 3.98 4.14 4.33 4.54 4.69 4.79 4.84
60 4.00 4.18 4.45 4.80 5.16 5.44 5.58
70 4.00 4.20 4.51 5.00 5.67 6.39 6.87
80 4.01 4.21 4.55 5.11 6.05 7.43 8.78
90 4.01 4.22 4.56 5.16 6.24 8.20 10.90
-----------------------------------------------------------------
Option 4
10 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
-----------------------------------------------------------------
30 3.92 3.99 4.04 4.08 4.10 4.11 4.12
40 3.96 4.07 4.19 4.28 4.34 4.37 4.39
50 3.98 4.14 4.33 4.53 4.69 4.79 4.82
60 4.00 4.18 4.45 4.80 5.16 5.43 5.54
70 4.00 4.20 4.51 5.00 5.66 6.32 6.71
80 4.01 4.21 4.54 5.10 6.01 7.23 8.18
90 4.01 4.21 4.56 5.14 6.16 7.78 9.35
-----------------------------------------------------------------
Option 4
15 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
-----------------------------------------------------------------
30 3.92 3.99 4.04 4.08 4.10 4.11 4.11
40 3.96 4.07 4.19 4.28 4.34 4.37 4.37
50 3.98 4.14 4.33 4.53 4.69 4.77 4.79
60 4.00 4.18 4.44 4.79 5.14 5.37 5.44
70 4.00 4.20 4.51 4.98 5.60 6.14 6.34
80 4.01 4.21 4.53 5.07 5.88 6.76 7.17
90 4.01 4.21 4.54 5.09 5.97 6.99 7.52
-----------------------------------------------------------------
Option 4
20 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
-----------------------------------------------------------------
30 3.92 3.99 4.04 4.08 4.10 4.11 4.11
40 3.96 4.07 4.19 4.28 4.33 4.35 4.36
50 3.98 4.14 4.33 4.53 4.67 4.73 4.74
60 3.99 4.17 4.44 4.77 5.09 5.25 5.28
70 4.00 4.19 4.50 4.94 5.46 5.86
5.80
80 4.00 4.20 4.52 5.00 5.64 6.37 6.20
90 4.00 4.20 4.52 5.01 5.66 6.15 6.25
------------------------------------------------------------------
INDIVIDUAL FLEXIBLE PAYMENT VARIABLE ANNUITY WITH FIXED OPTION
NON-PARTICIPATING