[LETTERHEAD OF AIGLIFE]
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This is a legal contract issued in consideration of the payment of the Initial
Premium. We will make annuity payments as set forth in this contract beginning
on the Annuity Date.
READ YOUR CONTRACT CAREFULLY
RIGHT TO CANCEL THIS CONTRACT
This contract may be returned within 10 days after You receive it. It can be
mailed or delivered to either Us or Our agent. Return of this contract by mail
is effective as of the date of its postmark, properly addressed and postage
pre-paid. The returned contract will be treated as if We had never issued it. We
will promptly refund the Contract Value and any fees paid as of the date of
return; this may be more or less than the Premium paid.
This is a variable annuity contract. Annuity payments and Contract Value may
increase or decrease depending on the experience of the Variable Account
identified in the Contract Schedule.
Signed by the Company:
/s/ ▇▇▇▇▇▇▇▇▇ ▇. ▇▇▇▇ /s/ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇
Secretary President
INDIVIDUAL VARIABLE ANNUITY
NONPARTICIPATING
TABLE OF CONTENTS
PAGE
CONTRACT SCHEDULE 3
DEFINITIONS 4
GENERAL PROVISIONS 6
OWNERSHIP PROVISIONS 7
BENEFICIARY PROVISIONS 7
PREMIUM PROVISIONS 8
CONTRACT CHARGES 8
VARIABLE ACCOUNT 9
GUARANTEED ACCOUNT 9
TRANSFERS 11
ANNUITY PROVISIONS 12
ANNUITY OPTIONS 12
DEATH BENEFIT 14
SURRENDER PROVISIONS 16
DELAY OF PAYMENTS 16
FIXED ANNUITY OPTION TABLES 17
VARIABLE ANNUITY OPTION TABLES 18
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CONTRACT SCHEDULE
CONTRACT NUMBER: ( ) INITIAL PREMIUM: ($5,000)
OWNER: (▇▇▇▇ ▇▇▇) MINIMUM SUBSEQUENT PREMIUM: ($1,000)
JOINT OWNER (▇▇▇▇ ▇▇▇)
ANNUITANT: (▇▇▇▇ ▇▇▇)
EFFECTIVE DATE: ( )
ANNUITY DATE: ( )
CONTRACT MAINTENANCE CHARGE: [$30.00] each Contract Year. [Before the Annuity
Date, this charge will be waived for each year that the Contract Value exceeds
[$50,000] on the Contract Anniversary.]
ADMINISTRATIVE CHARGE: Equal on an annual basis to [.15%] of the average daily
net assets of the Variable Account.
MORTALITY AND EXPENSE RISK CHARGE: Equal on an annual basis to [1.25%] of the
average daily net assets of the Variable Account.
ACCIDENTAL DEATH BENEFIT CHARGE: Equal on an annual basis to [.10%] of the
average daily net assets of the Variable Account.
TRANSFER FEE: $ 10.00 per transfer. However, we will not make a charge for the
first [12] transfers in any Contract Year.
[ANNUAL RATCHET RIDER CHARGE: Equal on an annual basis to [0.70%] of the net
assets of the Variable Account; this charge will be calculated and deducted
monthly.]
[EQUITY ASSURANCE PLAN RIDER CHARGE: Equal on an annual basis to [0.75%] of the
average daily net assets of the Variable Account up to the contract anniversary
concurrent with or next following the Owner's 60th birthday, and [0.80%]
thereafter; this charge will be calculated and deducted monthly.]
[ENHANCED EQUITY ASSURANCE PLAN RIDER CHARGE: Equal on an annual basis to
[0.80%] of the average daily net assets of the Variable Account up to the
contract anniversary concurrent with or next following the Owner's 60th
birthday, and [0.85%] thereafter; this charge will be calculated and deducted
monthly.]
SEPARATE ACCOUNT: [Variable Account I]
ANNUITY SERVICE OFFICE:
[ AIG Life Insurance Company ]
[ c/o Delaware Valley Financial Services ]
[ 300 Berwyn Park ]
[ P.O. Box 3031 ]
[ Berwyn, PA 19312-0031 ]
[ (▇▇▇) ▇▇▇-▇▇▇▇ ]
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DEFINITIONS
ACCUMULATION UNIT - An accounting unit of measure used to calculate the Contract
Value prior to the Annuity Date.
ADMINISTRATIVE OFFICE - The Annuity Service Office of the Company as designated
on the Contract Schedule.
ANNUITANT - The person designated by the Owner upon whose continuation of life
any annuity payment involving life contingencies depends.
ANNUITY DATE - The date on which annuity payments are to commence.
ANNUITY OPTION - An arrangement under which annuity payments are made under this
contract.
ANNUITY UNIT - An accounting unit of measure used to calculate annuity payments
after the Annuity Date.
BENEFICIARY - The person(s) who is(are) entitled to the Death Benefit of this
contract when there is no surviving Owner or the person(s) who is(are) entitled
to receive the remaining annuity payments, if any, when the Annuitant dies after
the Annuity Date.
CONTRACT ANNIVERSARY - An anniversary of the Effective Date of this contract.
CONTRACT VALUE - The dollar value as of any Valuation Date of all amounts
accumulated under this contract.
CONTRACT YEAR - Each period of twelve (12) months commencing with the Effective
Date.
EFFECTIVE DATE - The date shown on the Contract Schedule on which the first
Contract Year begins.
ELIGIBLE INVESTMENT(S) - Those investments available under the contract.
Eligible Investments, at the time this contract is issued, are shown in the
application for this Contract.
GUARANTEED ACCOUNT - A part of Our General Account which earns a Guaranteed Rate
of interest.
INJURY - Bodily injury caused by an accident which occurs while coverage under
the Accidental Death Benefit is in force, and results, directly and
independently from all other causes, in death.
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JOINT OWNER - The person named as Joint Owner on the application and listed in
the Contract Schedule, unless subsequently changed. The Joint Owner, if any,
possesses an undivided interest in this contract in conjunction with the Owner.
All references within this contract to Owner will apply to both the Owner and
the Joint Owner or to either of them.
OWNER - The person named as Owner on the application and listed in the Contract
Schedule, unless subsequently changed. The Owner has all rights under this
contract.
PREMIUM - Purchase payments are referred to in this contract as Premiums.
SUBACCOUNT - A division of the Variable Account established to invest in a
particular portfolio of Eligible Investments.
YOU, YOUR - The Owner of this contract.
VALUATION DATE - Each day that the New York Stock Exchange is open for trading.
VALUATION PERIOD - The period between the close of business of the New York
Stock Exchange on any Valuation Date and the close of business for the next
succeeding Valuation Date.
VARIABLE ACCOUNT - The Separate Account designated on the Contract Schedule.
WE, OUR, US - AIG Life Insurance Company.
WRITTEN REQUEST - A request made in a form satisfactory to Us and either signed
by You or confirmed by Us in writing to You. A Written Request takes effect when
received and recorded at Our Administrative Office unless specifically noted as
otherwise within this contract.
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GENERAL PROVISIONS
THE CONTRACT - The entire contract consists of this form and any attached
endorsement, rider or application. This contract may be changed or altered only
by Our President or Secretary. Any change, modification or waiver must be made
in writing.
NON-PARTICIPATION IN SURPLUS - This contract does not share in any distribution
of Our profits or surplus.
INCONTESTABILITY - This contract is not contestable.
MISSTATEMENT OF AGE OR SEX - We will require proof of age and sex of the
Annuitant before making any life 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 that the Contract Value would have provided at the correct age or
sex.
Once annuity payments have begun, any underpayments will be made up in one sum
including interest at the annual rate of 3%, unless a higher interest rate is
required by the law of the jurisdiction where this contract is delivered, with
the next annuity payment. Overpayments including interest at the annual rate of
3%, unless a higher interest rate is required by the law of the jurisdiction
where this contract is delivered, will be deducted from the future annuity
payments until the total is repaid.
CONTRACT SETTLEMENT - This contract must be returned to Us upon settlement as a
death claim. Prior to any settlement as a death claim, due proof of death must
be submitted to Us.
FACILITY OF PAYMENT - If any recipient is unable to give a valid receipt for a
payment made under this contract, We may make payments to the person who, in Our
opinion, is caring for that recipient until claim is made by the recipient's
duly appointed guardian or other legal representative.
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.
TAXES - Any taxes, if applicable, paid to any governmental entity will be
charged against the Premiums or the Contract Value, depending upon the Owner's
state of residence. We may, at Our sole discretion, pay taxes when due and
deduct that amount from the Contract Value at a later date. Our payment of such
taxes at an earlier date does not waive any right We may have to deduct amounts
at a later date.
EVIDENCE OF SURVIVAL - Where any benefits under this contract are contingent
upon the recipient being alive on a given date, We will require proof
satisfactory to Us that the condition has been met.
PROTECTION OF PROCEEDS - No payment under this contract may be commuted or
assigned before it is due. To the extent permitted by law, no payments will be
subject to any creditor claim nor to any judicial process for payment of such
claim.
MODIFICATION OF CONTRACT - This contract may not be modified by Us, without Your
consent except as may be required by applicable law. If the state insurance laws
or regulations, the federal securities or tax laws or regulations, or any
regulations under which this contract would qualify as an annuity change, We may
amend this contract to comply with these changes.
MINIMUM BENEFITS - Any paid-up annuity, cash surrender or death benefit that may
be available under this contract is not less than the minimum benefits required
by statute in the jurisdiction in which this contract is delivered.
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OWNERSHIP PROVISIONS
OWNER - The Owner and any applicable Joint Owner are named in the Contract
Schedule.
If there is an Owner and Joint Owner for this contract, then both owners must
agree to any change in this contract. If one Owner dies, the surviving Owner
retains all rights of this contract. All references within this contract to
Owner will apply to both the Owner and Joint Owner or either of them.
The Owner may exercise all the rights of this contract, subject to the rights
of:
1. any assignee under an assignment filed with Our Administrative Office; and
2. any irrevocably named Beneficiary.
CHANGE OF OWNERSHIP - You may change Ownership of this contract by submitting a
Written Request to Our Administrative Office. We may require this contract for
endorsement.
Change of Ownership does not change the Beneficiary. Any change of Ownership is
subject to any payment made by Us before the request is received and recorded at
Our Administrative Office.
ASSIGNMENT - You may assign this contract while the Annuitant is alive and
before the Annuity Date. A copy of any assignment must be filed with Our
Administrative Office. We are not responsible for the validity of any
assignment. If You assign this contract, Your rights and those of any
Beneficiary will be subject to the assignment. An assignment will not affect any
payments We may make or actions We may take before such assignment has been
recorded at Our Administrative Office. The assignment will not be recorded until
We have received sufficient direction from the Owner and assignee as to the
proper allocation of rights under this contract between the Owner and the
assignee.
A change in ownership or an assignment may result in adverse tax consequences.
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BENEFICIARY PROVISIONS
BENEFICIARY - The Beneficiary is as stated on the application, unless later
changed by Your Written Request. One or more beneficiaries can be named in the
application. If more than one Beneficiary is named, each can be classed as
primary or contingent. If two or more persons are named in a class, their shares
in the proceeds can be stated. The stated shares in the proceeds will be paid to
any primary beneficiaries. If no primary beneficiaries survive, payment will be
made to any surviving contingent beneficiaries. If You have not made other
arrangements with Us, Beneficiaries who survive in the same class will share the
proceeds equally.
DEATH OF BENEFICIARY - If no named Beneficiary is living at the time a death
benefit becomes payable, We will pay the death benefit to the Owner, or, if no
Owner is alive, to the last surviving Owner's estate.
CHANGE OF BENEFICIARY - To change a Beneficiary, a Written Request for a change
of Beneficiary must be received at Our Administrative Office. If the request is
received at Our Administrative Office after the death of the Owner, it will be
effective only if no payment has been made. After the change is recorded, it
will take effect as of the date the request was signed.
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PREMIUM PROVISIONS
PREMIUM - The Initial Premium is due on or before the Effective Date.
Thereafter, Premium payments may be made at any time prior to the Annuity Date,
in an amount equal to or greater than the Minimum Subsequent Premium amount,
shown on the Contract Schedule page.
ALLOCATION OF premium PAYMENTS - Premiums may be allocated to one or more of the
Subaccounts of the Variable Account or to the Guaranteed Account. Whole
percentages must be used. The allocation of the Initial Premium is shown on the
application. You may change the allocation at any time. We will send
confirmation of Your changes. Any subsequent Premium received will be allocated
in accordance with the most recently received allocation instructions.
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CONTRACT CHARGES
All charges and fees shown on the Contract Schedule are the maximum amounts
which We may charge. We may, however, charge less than the maximum.
MORTALITY AND EXPENSE RISK CHARGE - We deduct a Mortality And Expense Risk
Charge equal, on an annual basis, to the amount shown on the Contract Schedule.
We guarantee that the dollar amount of each annuity payment after the first will
not be affected by variations in mortality or expense experience.
ADMINISTRATIVE CHARGE - We deduct an Administrative Charge equal, on an annual
basis, to the amount shown on the Contract Schedule. The Administrative Charge
compensates Us for some of the costs associated with the administration of this
contract and the Variable Account.
CONTRACT MAINTENANCE CHARGE - We deduct an annual Contract Maintenance Charge
shown on the Contract Schedule. The Contract Maintenance Charge will be deducted
from the Contract Value on each Contract Anniversary while this contract is in
force. Prior to the Annuity Date, the Contract Maintenance Charge will be
deducted from the Contract Value by canceling Accumulation Units. The number of
Accumulation Units to be canceled from each applicable Subaccount will be in the
ratio that the value of each Subaccount bears to the total Contract Value.
If this contract is surrendered for its full Surrender Value on other than a
Contract Anniversary, the full Contract Maintenance Charge due on the next
Contract Anniversary will be deducted at the time of surrender.
On and after the Annuity Date, the Contract Maintenance Charge will be pro-rated
and collected on a monthly basis. This amount will be subtracted from the
monthly annuity payments.
ACCIDENTAL DEATH BENEFIT CHARGE - If you have elected the Accidental Death
Benefit described in this contract, an Accidental Death Benefit Charge will be
included on the Contract Schedule.
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VARIABLE ACCOUNT
GENERAL DESCRIPTION - The name of the Variable Account is shown in the Contract
Schedule. The assets of the Variable Account and each Subaccount are Our
property but are not chargeable with the liabilities arising out of any other
business We may conduct, except to the extent that Variable Account assets
exceed Variable Account liabilities arising under the contracts supported by the
Variable Account. The Variable Account and each Subaccount is separate from Our
General Account and any other separate account or Subaccount We may have.
INVESTMENT ALLOCATIONS TO THE VARIABLE ACCOUNT - The Variable Account consists
of Subaccounts and each Subaccount may invest its assets in a separate class of
shares of a designated investment company or companies.
We have the right to change, add or delete designated investment companies. We
have the right to add or remove Subaccounts. We also have the right to combine
any two or more Subaccounts.
VALUATION OF ASSETS - Assets within each Subaccount will be valued at their net
asset value on each Valuation Date.
CONTRACT VALUE - Premiums are allocated among the various Subaccounts within the
Variable Account. For each Subaccount, the Premiums are converted into
Accumulation Units. The number of Accumulation Units credited to the contract is
determined by dividing the Premiums allocated to the Subaccount by the value of
the Accumulation Unit for the Subaccount. Surrenders will result in the
cancellation of Accumulation Units. The value of the contract is the sum of the
values for the contract within each Subaccount and the Guaranteed Account. The
value of each Subaccount is determined by multiplying the number of Accumulation
Units attributable to the Subaccount by the Accumulation Unit value for the
Subaccount, independent of the value of any other Subaccount.
ACCUMULATION UNIT VALUES - The value of an Accumulation Unit will vary in
accordance with the investment experience of the underlying portfolio in which
the Subaccount invests. The value of Accumulation Units is expected to increase
or decrease from Valuation Period to Valuation Period. The value of Accumulation
Units in each Subaccount will change daily to reflect the investment experience
of the corresponding underlying portfolio as well as the daily deduction of the
Contract Charges. The number of Accumulation Units credited to the contract will
not change as a result of any fluctuations in the value of an Accumulation Unit.
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GUARANTEED ACCOUNT
GENERAL DESCRIPTION - The Guaranteed Account is a part of Our General Account.
The amount You have in the Guaranteed Account at any time is a result of
Premiums You have allocated to it or any part of Your Contract Value you have
transferred to it.
GUARANTEE PERIODS - The portion of Your Contract Value within the Guaranteed
Account is credited with interest at rates guaranteed by Us for the Guarantee
Period(s) selected. Interest is credited on a daily basis at the then applicable
effective guaranteed interest rate for the applicable Guarantee Period. You may
select from one or more Guarantee Periods which we offer at any particular time.
We reserve the right at any time to add or delete Guarantee Periods. If You have
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allocated any part of Your Initial Premium to a Guarantee Period, the amount
allocated, as well as the duration of the Guarantee Period is shown on the
Application.
The guaranteed interest rate applicable to an allocation of Premium or transfer
of Contract Value to a Guarantee Period is the rate in effect for that Guarantee
Period at the time of the allocation or transfer. If You have allocated or
transferred amounts at different times to the Guaranteed Account, each
allocation or transfer may have a unique effective guaranteed interest rate
associated with that amount. We guarantee that the effective annual rate of
interest for the Guaranteed Account, including any of the Guaranteed Periods,
will not be less than 3%.
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TRANSFERS
During the Accumulation Period, or after the Annuity Date, provided a variable
Annuity Option was selected, You may transfer all or part of Your value, in a
Subaccount, or allocated to a Guarantee Period of the Guaranteed Account, to
another Subaccount or Guarantee Period of the Guaranteed Account. However, after
the Annuity Date no transfers may be made between a Subaccount and the
Guaranteed Account. The Transfer Fee is shown on the Contract Schedule.
All transfers are subject to the following:
1. The deduction of any Transfer Fee that may be imposed will be deducted
from the amount which is transferred. However, no Transfer Fee will be
imposed on transfers resulting from the expiration of a Guarantee Period.
2. If We have not received transfer instructions prior to the end of a
Guarantee Period in which You have Contract Value, We will automatically
transfer it to a new Guarantee Period of the same duration and under the
same restrictions as if You had requested such transfer. However, if a new
Guarantee Period of the same duration is not available, then that portion
of Your Contract Value will be transferred to the Guarantee Period next
shortest in duration.
3. The minimum amount which may be transferred is the lesser of (A) $1,000 or
(B) Your entire value in the Subaccount or in the amount allocated to a
Guarantee Period of the Guaranteed Account.
4. No partial transfer will be made if, as a result of such transfer, Your
remaining Contract Value in the Subaccount or in the amount allocated to
the Guarantee Period of the Guaranteed Account would be less than $1,000.
5. Transfers will be effected during the Valuation Period next following
receipt by Us of a Written Request containing all required information.
However, no transfer may be made effective within seven calendar days of
the date on which any annuity payment is due.
6. Any transfer request must clearly specify:
a. the amount which is to be transferred; and
b. the Subaccounts or Guarantee Periods of the Guaranteed Account which
are to be affected.
7. After the Annuity Date, transfers may not take place between a fixed
Annuity Option and a variable Annuity Option.
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ANNUITY PROVISIONS
ANNUITY PAYMENTS - Beginning on the Annuity Date, We will make annuity payments
to the Annuitant in accordance with the Annuity Option in effect on that date.
Annuity payments will be made on a monthly basis unless such payments would be
less than $100 per month. In that event, we reserve the right to amend the
frequency of annuity payments to be semi-annual or annual to ensure annuity
payments are at least $100 per payment.
CHANGE IN ANNUITY DATE - You may, upon at least thirty (30) days prior Written
Request, at any time prior to the Annuity Date, change the Annuity Date shown on
the Contract Schedule. The Annuity Date must always be the first day of a
calendar month.
Unless We approve otherwise, the new Annuity Date must be at least one year
after the effective Date. The latest Annuity Date is the first day of the first
calendar month following the Annuitant's 90th birthday or such earlier date as
may be set by applicable law.
SELECTION OF ANNUITY OPTION - If the Annuitant is alive on the Annuity Date, We
will apply the Contract Value to provide an income on the basis of a life income
with 10 years guaranteed, unless another Annuity Option has been selected. You
may however, upon at least thirty (30) days prior Written Request, at any time
prior to the Annuity Date, select and/or change the Annuity Option.
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ANNUITY OPTIONS
ANNUITY OPTION - The Annuity Option you select may be on a fixed or variable
basis, or a combination thereof. We may, at the time of election of an Annuity
Option, offer more favorable rates in lieu of those here guaranteed. We may also
make available other income options.
OPTION 1 - LIFE INCOME. Annuity payments are paid during the life of an
Annuitant ceasing with the last Annuity Payment due prior to the Annuitant's
death.
OPTION 2 - LIFE INCOME WITH 10 YEAR GUARANTEE. Annuity payments are paid during
the life of an Annuitant, but at least for a 10 year minimum period.
OPTION 3 - JOINT AND LAST SURVIVOR ANNUITY. Annuity payments are paid during the
joint lifetime of the Annuitant and a designated second person and are paid
thereafter during the remaining lifetime of the survivor ceasing with the last
annuity payment due prior to the survivor's death.
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FIXED ANNUITY OPTION
The fixed dollar amount of each fixed annuity payment is determined by
multiplying the available Contract Value (after the deduction of any premium
taxes, if applicable, not previously deducted) by the factor in the Fixed
Annuity Option Table for the option chosen, using the age and sex of the
Annuitant and Joint Annuitant, if any, divided by 1,000. The tables are
determined from the Annuity 2000 Table projected with Scale G to the year of
annuitization, with interest at the rate of 3.00% per annum. If, when annuity
payments are elected, We are using tables of annuity rates for these contracts
which result in larger annuity payments, We will use those tables instead. The
annuity payments, determined at the time of their election, will not be less
than payments that would be provided by the application of the Contract Value to
an immediate annuity then offered by Us at the time of election, for the same
class of annuitants.
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ANNUITY OPTIONS (Continued)
VARIABLE ANNUITY OPTION
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The amount of the first variable annuity payment depends on the Annuity Option
elected and the age and sex of the Annuitant. This contract contains a Variable
Annuity Options Table indicating the dollar amount of the first monthly payment
under each optional annuity form for each $1,000 of value applied. The tables
are determined from the Annuity 2000 Table projected with Scale G to the year of
annuitization, with interest at the rate of 5.00% per annum. If, when annuity
payments are elected, We are using tables of annuity rates for these contracts
which result in larger annuity payments, We will use those tables instead.
The 5% interest rate assumed in the annuity tables would produce level annuity
payments if the net investment rate remained constant at 5% per year. Subsequent
payments will be less than, equal to, or greater than the first payment
depending upon whether the actual net investment rate is less than, equal to, or
greater than 5%.
The dollar amount of the first variable annuity payment is determined by
applying the available value (after deduction of any premium taxes, if
applicable, not previously deducted) to the table using the age and sex of the
Annuitant and any joint Annuitant. The number of Annuity Units is then
determined by dividing this dollar amount by the then current Annuity Unit
value. Thereafter, the number of Annuity Units remains unchanged during the
period of annuity payments. This determination is made separately for each
Subaccount of the Variable Account. The number of Annuity Units is determined
for each Subaccount and is based upon the available value in each Subaccount as
of the date annuity payments are to begin. The dollar amount determined for each
Subaccount will then be aggregated for purposes of making payments. The dollar
amount of the second and later variable annuity payments is equal to the number
of Annuity Units determined for each Subaccount times the Annuity Unit value for
that Subaccount as of the due date of the payment. This amount may increase or
decrease from month to month. The value of an Annuity Unit for a Subaccount is
determined as shown below, by subtracting item 2. from item 1, dividing that
result by item 3 and multiplying the result by a factor to neutralize the
assumed net investment rate, discussed above, of 5% per annum,
where:
1. is the net result of the assets of the Subaccount attributable to the
Annuity units,
a) plus the cumulative credit; or
b) minus the cumulative charge
for taxes reserved, which credit or charge is determined by Us to have
resulted from the operation of the Subaccount;
2. is the cumulative unpaid amounts for the Mortality and Expense Risk Charge
and for the Administrative Charge, which are shown in the Contract
Schedule; and
3. is the number of Annuity Units outstanding at the end of the Valuation
Period.
The value of an Annuity Unit may increase or decrease from Valuation Period to
Valuation Period.
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DEATH BENEFIT
DEATH OF THE OWNER - If an Owner dies before the Annuity Date and there is a
surviving Joint Owner, a Death Benefit is payable to the surviving Joint Owner.
If an Owner dies prior to the Annuity Date and there is no surviving Joint
Owner, a Death Benefit is payable to the Beneficiary. The value of the Death
Benefit will be determined as of the date We receive proof of death in a form
acceptable to Us. If there has been a change of Owner, the Death Benefit will be
the Contract Value. Otherwise, We will pay the Death Benefit equal to the
greater of:
1. the total of all Premiums paid, with each premium adjusted for surrenders
as described below; or
2. the Contract Value.
Adjustment for Surrenders. In the determination of the Death Benefit, for
each surrender, a proportionate reduction will be made to each Premium
paid prior to the surrender. The proportion is determined by dividing the
amount of the Contract Value surrendered by the Contract Value immediately
prior to each surrender.
The surviving Joint Owner or Beneficiary may elect the Death Benefit to be paid
as follows:
1. payment of the entire Death Benefit within 5 years of the date of the
Owner's death; or
2. payment over the lifetime of the surviving Joint Owner or designated
Beneficiary with distribution beginning within 1 year of the date of death
of the Owner (see Annuity Options section of this contract); or
3. if the surviving Joint Owner or designated Beneficiary is a spouse of the
deceased Owner, he/she can continue the contract in his/her own name.
If no payment option is elected within 60 days of Our receipt of proof of the
Owner's death, a single sum settlement will be made at the end of the sixty (60)
day period following such receipt. Upon payment of the Death Benefit, this
contract will end.
If the Owner is a person other than the Annuitant, and if the Owner's death
occurs on or after the Annuity Date, no Death Benefit will be payable under this
contract. Any guaranteed payments remaining unpaid will continue to be paid to
the Annuitant pursuant to the Annuity Option in force at the date of the Owner's
death.
If the Owner is not an individual, any change of Annuitant or death of Annuitant
before the Annuity Date will be treated as if the Owner had died on the date of
such change or death and the Death Benefit will be the Contract Value.
ACCIDENTAL DEATH BENEFIT - If an Accidental Death Benefit Charge is included on
the Contract Schedule, an Accidental Death Benefit may be payable which is equal
to the lesser of the Contract Value as of the date the death benefit is
determined, or $250,000. The Accidental Death Benefit is payable if the death of
the primary Owner (i.e. the first owner listed on the Contract Schedule) occurs
prior to the Contract Anniversary next following his 75th birthday, and is the
result of an Injury incurred while he was the primary Owner. The death must also
occur before the Annuity Date and within 365 days of the date of the accident
which caused the Injury.
The Accidental Death Benefit will not be paid for any death caused by or
resulting (in whole or in part) from the following:
1. suicide or attempted suicide while ▇▇▇▇ or insane; or intentionally
self-inflicted injuries;
2. sickness, disease or bacterial infection of any kind, except pyogenic
infections which occur as a result of an injury, or bacterial infections
which result from the accidental ingestion of contaminated substances;
3. hernia;
4. injury sustained as a consequence of riding in, including boarding or
alighting from, any vehicle or device used for aerial navigation except if
the primary Owner is a passenger on any aircraft licensed for the
transportation of passengers;
5. declared or undeclared war or any act thereof; or
6. service in the military, naval or air service of any country.
DEATH OF THE ANNUITANT - If the Annuitant is a person other than the Owner and
the Owner is an individual, and if the Annuitant dies before the Annuity Date, a
new Annuitant may be named by the Owner. If no new Annuitant is named within
sixty (60) days of Our receipt of proof of death, the Owner will be the new
Annuitant. If the Annuitant dies after the Annuity Date, the remaining payments,
if any, will be as specified in the Annuity Option elected. We will require
proof of the Annuitant's death. Death benefits, if any, will be paid to the
designated
14
Beneficiary at least as rapidly as under the method of distribution in effect at
the Annuitant's death.
15
================================================================================
SURRENDER PROVISIONS
SURRENDER - While this contract is in force and before the Annuity Date, We
will, upon Written Request, allow the surrender of all or a portion of this
contract for its Surrender Value. Surrenders will result in the cancellation of
Accumulation Units from each applicable Subaccount and the Guaranteed Account in
the ratio that the value of each account bears to the total Contract Value. You
must specify by Written Request, in advance, which units are to be canceled if
other than the above described method of cancellation is desired. We will pay
the amount of any surrender within seven (7) days of receipt of a request unless
the "Delay of Payments" provision is in effect.
The Surrender Value will be the Contract Value, as of the date of Our receipt of
Your Written Request for surrender, reduced by the sum of:
1. any applicable premium taxes not previously deducted; plus
2. any applicable Contract Maintenance Charge.
================================================================================
DELAY OF PAYMENTS
DELAY OF PAYMENTS - We will make any payments under this contract within 7 days
(or any shorter period, if required by law) of a request received in good order.
We reserve the right to suspend or postpone any type of payment from the
Variable Account for any period when:
1. the New York Stock Exchange is closed for other than customary weekend and
holiday closings;
2. trading on the Exchange is restricted;
3. an emergency exists as a result of which it is not reasonably practicable
to dispose of securities held in the Variable Account, or to determine
their value; or
4. the Securities and Exchange Commission so permits delay for the protection
of security holders.
The applicable rules of the Securities and Exchange Commission will govern as
to whether the conditions in 2. or 3. exist.
We reserve the right to delay any type of payment from the General Account for
up to six (6) months from the date we receive the request for payment.
16
Fixed Annuity Option Tables
--------------------------------------------------------------------------------
Option 1: Life Income
--------------------------------------------------------------------------------
Monthly Income per $1,000
--------------------------------------------------------------------------------
Year of
Annuitization 2010 2020 2030 2040
--------------------------------------------------------------------------------
Age Male Female Male Female Male Female Male Female
--------------------------------------------------------------------------------
30 3.16 3.06 3.12 3.03 3.09 3.00 3.06 2.97
--------------------------------------------------------------------------------
35 3.30 3.18 3.25 3.14 3.21 3.10 3.18 3.07
--------------------------------------------------------------------------------
40 3.48 3.32 3.42 3.28 3.37 3.23 3.32 3.20
--------------------------------------------------------------------------------
45 3.70 3.51 3.63 3.45 3.57 3.40 3.51 3.35
--------------------------------------------------------------------------------
50 3.98 3.74 3.89 3.67 3.82 3.60 3.74 3.54
--------------------------------------------------------------------------------
55 4.34 4.05 4.23 3.95 4.13 3.87 4.04 3.79
--------------------------------------------------------------------------------
60 4.82 4.45 4.68 4.33 4.55 4.22 4.43 4.12
--------------------------------------------------------------------------------
65 5.48 4.99 5.29 4.83 5.12 4.68 4.96 4.55
--------------------------------------------------------------------------------
70 6.38 5.75 6.13 5.53 5.89 5.33 5.69 5.16
--------------------------------------------------------------------------------
75 7.62 6.86 7.26 6.54 6.95 6.26 6.66 6.02
--------------------------------------------------------------------------------
80 9.35 8.48 8.85 8.02 8.41 7.61 8.02 7.26
--------------------------------------------------------------------------------
85 11.76 10.89 11.08 10.21 10.48 9.62 9.96 9.11
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Option 2: Life Income with 10 year Guarantee
--------------------------------------------------------------------------------
Monthly Income per $1,000
--------------------------------------------------------------------------------
Year of
Annuitization 2010 2020 2030 2040
--------------------------------------------------------------------------------
Age Male Female Male Female Male Female Male Female
--------------------------------------------------------------------------------
30 3.16 3.06 3.12 3.03 3.09 3.00 3.06 2.97
--------------------------------------------------------------------------------
35 3.30 3.17 3.25 3.14 3.21 3.10 3.17 3.07
--------------------------------------------------------------------------------
40 3.47 3.32 3.42 3.27 3.37 3.23 3.32 3.19
--------------------------------------------------------------------------------
45 3.69 3.50 3.62 3.44 3.56 3.39 3.50 3.35
--------------------------------------------------------------------------------
50 3.96 3.73 3.87 3.66 3.80 3.60 3.73 3.54
--------------------------------------------------------------------------------
55 4.30 4.03 4.20 3.94 4.10 3.86 4.02 3.78
--------------------------------------------------------------------------------
60 4.74 4.41 4.61 4.29 4.50 4.19 4.39 4.10
--------------------------------------------------------------------------------
65 5.31 4.91 5.15 4.76 5.01 4.63 4.87 4.51
--------------------------------------------------------------------------------
70 6.02 5.57 5.83 5.39 5.65 5.22 5.48 5.07
--------------------------------------------------------------------------------
75 6.85 6.42 6.63 6.19 6.42 5.98 6.23 5.79
--------------------------------------------------------------------------------
80 7.73 7.40 7.51 7.16 7.30 6.92 7.10 6.70
--------------------------------------------------------------------------------
85 8.52 8.34 8.35 8.13 8.18 7.93 8.02 7.73
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Option 3: Joint and Last Survivor Annuity (Male and Female)
--------------------------------------------------------------------------------
Monthly Income per $1,000
--------------------------------------------------------------------------------
Year of
Annuitization 2020 2040
--------------------------------------------------------------------------------
Female Age 45 55 65 75 45 55 65 75
--------------------------------------------------------------------------------
Male Age
--------------------------------------------------------------------------------
45 3.25 3.41 3.52 3.59 3.18 3.32 3.42 3.47
--------------------------------------------------------------------------------
55 3.35 3.63 3.90 4.09 3.26 3.52 3.76 3.92
--------------------------------------------------------------------------------
65 3.40 3.80 4.30 4.78 3.31 3.67 4.10 4.52
--------------------------------------------------------------------------------
75 3.43 3.89 4.59 5.54 3.34 3.74 4.36 5.18
--------------------------------------------------------------------------------
The values shown have not been adjusted for the annual contract maintenance
charge described on pages 3 and 9.
Values not shown are available from Our Administrative Office on request.
17
Variable Annuity Option Tables
--------------------------------------------------------------------------------
Option 1: Life Income
--------------------------------------------------------------------------------
Monthly Income per $1,000
--------------------------------------------------------------------------------
Year of
Annuitization 2010 2020 2030 2040
--------------------------------------------------------------------------------
Age Male Female Male Female Male Female Male Female
--------------------------------------------------------------------------------
30 4.47 4.38 4.44 4.36 4.41 4.34 4.39 4.32
--------------------------------------------------------------------------------
35 4.58 4.47 4.55 4.44 4.51 4.41 4.48 4.39
--------------------------------------------------------------------------------
40 4.74 4.60 4.69 4.55 4.64 4.52 4.60 4.49
--------------------------------------------------------------------------------
45 4.94 4.75 4.88 4.70 4.82 4.65 4.76 4.61
--------------------------------------------------------------------------------
50 5.20 4.96 5.12 4.90 5.04 4.83 4.97 4.78
--------------------------------------------------------------------------------
55 5.54 5.24 5.43 5.15 5.34 5.07 5.25 5.00
--------------------------------------------------------------------------------
60 6.00 5.62 5.86 5.50 5.74 5.40 5.62 5.30
--------------------------------------------------------------------------------
65 6.65 6.15 6.46 5.99 6.29 5.84 6.14 5.72
--------------------------------------------------------------------------------
70 7.56 6.90 7.30 6.68 7.07 6.48 6.86 6.30
--------------------------------------------------------------------------------
75 8.81 8.01 8.45 7.69 8.12 7.41 7.83 7.16
--------------------------------------------------------------------------------
80 10.55 9.65 10.05 9.18 9.59 8.76 9.19 8.40
--------------------------------------------------------------------------------
85 12.99 12.09 12.30 11.39 11.68 10.79 11.14 10.26
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Option 2: Life Income with 10 year Guarantee
--------------------------------------------------------------------------------
Monthly Income per $1,000
--------------------------------------------------------------------------------
Year of
Annuitization 2010 2020 2030 2040
--------------------------------------------------------------------------------
Age Male Female Male Female Male Female Male Female
--------------------------------------------------------------------------------
30 4.47 4.38 4.44 4.36 4.41 4.34 4.39 4.32
--------------------------------------------------------------------------------
35 4.58 4.47 4.54 4.44 4.51 4.41 4.48 4.39
--------------------------------------------------------------------------------
40 4.73 4.59 4.68 4.55 4.64 4.51 4.60 4.48
--------------------------------------------------------------------------------
45 4.92 4.74 4.86 4.69 4.80 4.65 4.75 4.61
--------------------------------------------------------------------------------
50 5.16 4.95 5.09 4.88 5.02 4.82 4.95 4.77
--------------------------------------------------------------------------------
55 5.48 5.21 5.38 5.13 5.30 5.05 5.22 4.99
--------------------------------------------------------------------------------
60 5.90 5.57 5.77 5.46 5.66 5.36 5.56 5.27
--------------------------------------------------------------------------------
65 6.44 6.04 6.29 5.90 6.15 5.77 6.02 5.66
--------------------------------------------------------------------------------
70 7.12 6.67 6.93 6.49 6.76 6.33 6.60 6.18
--------------------------------------------------------------------------------
75 7.90 7.49 7.69 7.27 7.49 7.06 7.31 6.88
--------------------------------------------------------------------------------
80 8.73 8.42 8.53 8.18 8.32 7.96 8.13 7.75
--------------------------------------------------------------------------------
85 9.48 9.31 9.32 9.11 9.16 8.91 9.00 8.72
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Option 3: Joint and Last Survivor Annuity (Male and Female)
--------------------------------------------------------------------------------
Monthly Income per $1,000
--------------------------------------------------------------------------------
Year of
Annuitization 2020 2040
--------------------------------------------------------------------------------
Female Age 45 55 65 75 45 55 65 75
--------------------------------------------------------------------------------
Male Age
--------------------------------------------------------------------------------
45 4.50 4.64 4.74 4.81 4.45 4.56 4.66 4.71
--------------------------------------------------------------------------------
55 4.59 4.83 5.07 5.26 4.52 4.73 4.94 5.10
--------------------------------------------------------------------------------
65 4.65 4.98 5.43 5.90 4.57 4.86 5.25 5.65
--------------------------------------------------------------------------------
75 4.68 5.08 5.72 6.62 4.59 4.94 5.49 6.27
--------------------------------------------------------------------------------
The values shown have not been adjusted for the annual contract maintenance
charge described on
pages 3 and 9.
Values not shown are available from Our Administrative Office on request.
18
[LOGO] AIGLIFE
AIG LIFE INSURANCE COMPANY
▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇
▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇
INDIVIDUAL VARIABLE ANNUITY
NONPARTICIPATING
[LETTERHEAD OF AIGLIFE]
--------------------------------------------------------------------------------
This is a legal contract issued in consideration of the payment of the Initial
Premium. We will make annuity payments as set forth in this contract beginning
on the Annuity Date.
READ YOUR CONTRACT CAREFULLY
RIGHT TO CANCEL THIS CONTRACT
This contract may be returned within 10 days after You receive it. It can be
mailed or delivered to either Us or Our agent. Return of this contract by mail
is effective as of the date of its postmark, properly addressed and postage
pre-paid. The returned contract will be treated as if We had never issued it. We
will promptly refund the Premium paid.
This is a variable annuity contract. Annuity payments and Contract Value may
increase or decrease depending on the experience of the Variable Account
identified in the Contract Schedule.
Signed by the Company:
/s/ ▇▇▇▇▇▇▇▇▇ ▇. ▇▇▇▇ /s/ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇
Secretary President
INDIVIDUAL VARIABLE ANNUITY
NONPARTICIPATING
TABLE OF CONTENTS
PAGE
CONTRACT SCHEDULE 3
DEFINITIONS 4
GENERAL PROVISIONS 6
OWNERSHIP PROVISIONS 7
BENEFICIARY PROVISIONS 7
PREMIUM PROVISIONS 8
CONTRACT CHARGES 8
VARIABLE ACCOUNT 9
GUARANTEED ACCOUNT 9
TRANSFERS 11
ANNUITY PROVISIONS 12
ANNUITY OPTIONS 12
DEATH BENEFIT 14
SURRENDER PROVISIONS 16
DELAY OF PAYMENTS 16
FIXED ANNUITY OPTION TABLES 17
VARIABLE ANNUITY OPTION TABLES 18
2
CONTRACT SCHEDULE
CONTRACT NUMBER: ( ) INITIAL PREMIUM: ($5,000)
OWNER: (▇▇▇▇ ▇▇▇) MINIMUM SUBSEQUENT PREMIUM: ($1,000)
JOINT OWNER (▇▇▇▇ ▇▇▇)
ANNUITANT: (▇▇▇▇ ▇▇▇)
EFFECTIVE DATE: ( )
ANNUITY DATE: ( )
CONTRACT MAINTENANCE CHARGE: [$30.00] each Contract Year. [Before the Annuity
Date, this charge will be waived for each year that the Contract Value exceeds
[$50,000] on the Contract Anniversary.]
ADMINISTRATIVE CHARGE: Equal on an annual basis to [.15%] of the average daily
net assets of the Variable Account.
MORTALITY AND EXPENSE RISK CHARGE: Equal on an annual basis to [1.25%] of the
average daily net assets of the Variable Account.
ACCIDENTAL DEATH BENEFIT CHARGE: Equal on an annual basis to [.10%] of the
average daily net assets of the Variable Account .
TRANSFER FEE: $ 10.00 per transfer. However, we will not make a charge for the
first [12] transfers in any Contract Year.
[ANNUAL RATCHET RIDER CHARGE: Equal on an annual basis to [0.70%] of the net
assets of the Variable Account; this charge will be calculated and deducted
monthly.]
[EQUITY ASSURANCE PLAN RIDER CHARGE: Equal on an annual basis to [0.75%] of the
average daily net assets of the Variable Account up to the contract anniversary
concurrent with or next following the Owner's 60th birthday, and [0.80%]
thereafter; this charge will be calculated and deducted monthly.]
[ENHANCED EQUITY ASSURANCE PLAN RIDER CHARGE: Equal on an annual basis to
[0.80%] of the average daily net assets of the Variable Account up to the
contract anniversary concurrent with or next following the Owner's 60th
birthday, and [0.85%] thereafter; this charge will be calculated and deducted
monthly.]
SEPARATE ACCOUNT: [Variable Account I]
ANNUITY SERVICE OFFICE:
[ AIG Life Insurance Company ]
[ c/o Delaware Valley Financial Services ]
[ 300 Berwyn Park ]
[ P.O. Box 3031 ]
[ Berwyn, PA 19312-0031 ]
[ (▇▇▇) ▇▇▇-▇▇▇▇ ]
3
================================================================================
DEFINITIONS
ACCUMULATION UNIT - An accounting unit of measure used to calculate the Contract
Value prior to the Annuity Date.
ADMINISTRATIVE OFFICE - The Annuity Service Office of the Company as designated
on the Contract Schedule.
ANNUITANT - The person designated by the Owner upon whose continuation of life
any annuity payment involving life contingencies depends.
ANNUITY DATE - The date on which annuity payments are to commence.
ANNUITY OPTION - An arrangement under which annuity payments are made under this
contract.
ANNUITY UNIT - An accounting unit of measure used to calculate annuity payments
after the Annuity Date.
BENEFICIARY - The person(s) who is(are) entitled to the Death Benefit of this
contract when there is no surviving Owner or the person(s) who is(are) entitled
to receive the remaining annuity payments, if any, when the Annuitant dies after
the Annuity Date.
CONTRACT ANNIVERSARY - An anniversary of the Effective Date of this contract.
CONTRACT VALUE - The dollar value as of any Valuation Date of all amounts
accumulated under this contract.
CONTRACT YEAR - Each period of twelve (12) months commencing with the Effective
Date.
EFFECTIVE DATE - The date shown on the Contract Schedule on which the first
Contract Year begins.
ELIGIBLE INVESTMENT(S) - Those investments available under the contract.
Eligible Investments, at the time this contract is issued, are shown in the
application for this Contract.
GUARANTEED ACCOUNT - A part of Our General Account which earns a Guaranteed Rate
of interest.
INJURY - Bodily injury caused by an accident which occurs while coverage under
the Accidental Death Benefit is in force, and results, directly and
independently from all other causes, in death.
4
JOINT OWNER - The person named as Joint Owner on the application and listed in
the Contract Schedule, unless subsequently changed. The Joint Owner, if any,
possesses an undivided interest in this contract in conjunction with the Owner.
All references within this contract to Owner will apply to both the Owner and
the Joint Owner or to either of them.
OWNER - The person named as Owner on the application and listed in the Contract
Schedule, unless subsequently changed. The Owner has all rights under this
contract.
PREMIUM - Purchase payments are referred to in this contract as Premiums.
SUBACCOUNT - A division of the Variable Account established to invest in a
particular portfolio of Eligible Investments.
YOU, YOUR - The Owner of this contract.
VALUATION DATE - Each day that the New York Stock Exchange is open for trading.
VALUATION PERIOD - The period between the close of business of the New York
Stock Exchange on any Valuation Date and the close of business for the next
succeeding Valuation Date.
VARIABLE ACCOUNT - The Separate Account designated on the Contract Schedule.
WE, OUR, US - AIG Life Insurance Company.
WRITTEN REQUEST - A request made in a form satisfactory to Us and either signed
by You or confirmed by Us in writing to You. A Written Request takes effect when
received and recorded at Our Administrative Office unless specifically noted as
otherwise within this contract.
5
================================================================================
GENERAL PROVISIONS
THE CONTRACT - The entire contract consists of this form and any attached
endorsement, rider or application. This contract may be changed or altered only
by Our President or Secretary. Any change, modification or waiver must be made
in writing.
NON-PARTICIPATION IN SURPLUS - This contract does not share in any distribution
of Our profits or surplus.
INCONTESTABILITY - This contract is not contestable.
MISSTATEMENT OF AGE OR SEX - We will require proof of age and sex of the
Annuitant before making any life 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 that the Contract Value would have provided at the correct age or
sex.
Once annuity payments have begun, any underpayments will be made up in one sum
including interest at the annual rate of 3%, unless a higher interest rate is
required by the law of the jurisdiction where this contract is delivered, with
the next annuity payment. Overpayments including interest at the annual rate of
3%, unless a higher interest rate is required by the law of the jurisdiction
where this contract is delivered, will be deducted from the future annuity
payments until the total is repaid.
CONTRACT SETTLEMENT - This contract must be returned to Us upon settlement as a
death claim. Prior to any settlement as a death claim, due proof of death must
be submitted to Us.
FACILITY OF PAYMENT - If any recipient is unable to give a valid receipt for a
payment made under this contract, We may make payments to the person who, in Our
opinion, is caring for that recipient until claim is made by the recipient's
duly appointed guardian or other legal representative.
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.
TAXES - Any taxes, if applicable, paid to any governmental entity will be
charged against the Premiums or the Contract Value, depending upon the Owner's
state of residence. We may, at Our sole discretion, pay taxes when due and
deduct that amount from the Contract Value at a later date. Our payment of such
taxes at an earlier date does not waive any right We may have to deduct amounts
at a later date.
EVIDENCE OF SURVIVAL - Where any benefits under this contract are contingent
upon the recipient being alive on a given date, We will require proof
satisfactory to Us that the condition has been met.
PROTECTION OF PROCEEDS - No payment under this contract may be commuted or
assigned before it is due. To the extent permitted by law, no payments will be
subject to any creditor claim nor to any judicial process for payment of such
claim.
MODIFICATION OF CONTRACT - This contract may not be modified by Us, without Your
consent except as may be required by applicable law. If the state insurance laws
or regulations, the federal securities or tax laws or regulations, or any
regulations under which this contract would qualify as an annuity change, We may
amend this contract to comply with these changes.
MINIMUM BENEFITS - Any paid-up annuity, cash surrender or death benefit that may
be available under this contract is not less than the minimum benefits required
by statute in the jurisdiction in which this contract is delivered.
6
================================================================================
OWNERSHIP PROVISIONS
OWNER - The Owner and any applicable Joint Owner are named in the Contract
Schedule.
If there is an Owner and Joint Owner for this contract, then both owners must
agree to any change in this contract. If one Owner dies, the surviving Owner
retains all rights of this contract. All references within this contract to
Owner will apply to both the Owner and Joint Owner or either of them.
The Owner may exercise all the rights of this contract, subject to the rights
of:
1. any assignee under an assignment filed with Our Administrative Office; and
2. any irrevocably named Beneficiary.
CHANGE OF OWNERSHIP - You may change Ownership of this contract by submitting a
Written Request to Our Administrative Office. We may require this contract for
endorsement.
Change of Ownership does not change the Beneficiary. Any change of Ownership is
subject to any payment made by Us before the request is received and recorded at
Our Administrative Office.
ASSIGNMENT - You may assign this contract while the Annuitant is alive and
before the Annuity Date. A copy of any assignment must be filed with Our
Administrative Office. We are not responsible for the validity of any
assignment. If You assign this contract, Your rights and those of any
Beneficiary will be subject to the assignment. An assignment will not affect any
payments We may make or actions We may take before such assignment has been
recorded at Our Administrative Office. The assignment will not be recorded until
We have received sufficient direction from the Owner and assignee as to the
proper allocation of rights under this contract between the Owner and the
assignee.
A change in ownership or an assignment may result in adverse tax consequences.
================================================================================
BENEFICIARY PROVISIONS
BENEFICIARY - The Beneficiary is as stated on the application, unless later
changed by Your Written Request. One or more beneficiaries can be named in the
application. If more than one Beneficiary is named, each can be classed as
primary or contingent. If two or more persons are named in a class, their shares
in the proceeds can be stated. The stated shares in the proceeds will be paid to
any primary beneficiaries. If no primary beneficiaries survive, payment will be
made to any surviving contingent beneficiaries. If You have not made other
arrangements with Us, Beneficiaries who survive in the same class will share the
proceeds equally.
DEATH OF BENEFICIARY - If no named Beneficiary is living at the time a death
benefit becomes payable, We will pay the death benefit to the Owner, or, if no
Owner is alive, to the last surviving Owner's estate.
CHANGE OF BENEFICIARY - To change a Beneficiary, a Written Request for a change
of Beneficiary must be received at Our Administrative Office. If the request is
received at Our Administrative Office after the death of the Owner, it will be
effective only if no payment has been made. After the change is recorded, it
will take effect as of the date the request was signed.
7
================================================================================
PREMIUM PROVISIONS
PREMIUM - The Initial Premium is due on or before the Effective Date.
Thereafter, Premium payments may be made at any time prior to the Annuity Date,
in an amount equal to or greater than the Minimum Subsequent Premium amount,
shown on the Contract Schedule page.
ALLOCATION OF premium PAYMENTS - Premiums may be allocated to one or more of the
Subaccounts of the Variable Account or to the Guaranteed Account. Whole
percentages must be used. The allocation of the Initial Premium is shown on the
application. You may change the allocation at any time. We will send
confirmation of Your changes. Any subsequent Premium received will be allocated
in accordance with the most recently received allocation instructions.
================================================================================
CONTRACT CHARGES
All charges and fees shown on the Contract Schedule are the maximum amounts
which We may charge. We may, however, charge less than the maximum.
MORTALITY AND EXPENSE RISK CHARGE - We deduct a Mortality And Expense Risk
Charge equal, on an annual basis, to the amount shown on the Contract Schedule.
We guarantee that the dollar amount of each annuity payment after the first will
not be affected by variations in mortality or expense experience.
ADMINISTRATIVE CHARGE - We deduct an Administrative Charge equal, on an annual
basis, to the amount shown on the Contract Schedule. The Administrative Charge
compensates Us for some of the costs associated with the administration of this
contract and the Variable Account.
CONTRACT MAINTENANCE CHARGE - We deduct an annual Contract Maintenance Charge
shown on the Contract Schedule. The Contract Maintenance Charge will be deducted
from the Contract Value on each Contract Anniversary while this contract is in
force. Prior to the Annuity Date, the Contract Maintenance Charge will be
deducted from the Contract Value by canceling Accumulation Units. The number of
Accumulation Units to be canceled from each applicable Subaccount will be in the
ratio that the value of each Subaccount bears to the total Contract Value.
If this contract is surrendered for its full Surrender Value on other than a
Contract Anniversary, the full Contract Maintenance Charge due on the next
Contract Anniversary will be deducted at the time of surrender.
On and after the Annuity Date, the Contract Maintenance Charge will be pro-rated
and collected on a monthly basis. This amount will be subtracted from the
monthly annuity payments.
ACCIDENTAL DEATH BENEFIT CHARGE - If you have elected the Accidental Death
Benefit described in this contract, an Accidental Death Benefit Charge will be
included on the Contract Schedule.
8
================================================================================
VARIABLE ACCOUNT
GENERAL DESCRIPTION - The name of the Variable Account is shown in the Contract
Schedule. The assets of the Variable Account and each Subaccount are Our
property but are not chargeable with the liabilities arising out of any other
business We may conduct, except to the extent that Variable Account assets
exceed Variable Account liabilities arising under the contracts supported by the
Variable Account. The Variable Account and each Subaccount is separate from Our
General Account and any other separate account or Subaccount We may have.
INVESTMENT ALLOCATIONS TO THE VARIABLE ACCOUNT - The Variable Account consists
of Subaccounts and each Subaccount may invest its assets in a separate class of
shares of a designated investment company or companies.
We have the right to change, add or delete designated investment companies. We
have the right to add or remove Subaccounts. We also have the right to combine
any two or more Subaccounts.
VALUATION OF ASSETS - Assets within each Subaccount will be valued at their net
asset value on each Valuation Date.
CONTRACT VALUE - Premiums are allocated among the various Subaccounts within the
Variable Account. For each Subaccount, the Premiums are converted into
Accumulation Units. The number of Accumulation Units credited to the contract is
determined by dividing the Premiums allocated to the Subaccount by the value of
the Accumulation Unit for the Subaccount. Surrenders will result in the
cancellation of Accumulation Units. The value of the contract is the sum of the
values for the contract within each Subaccount and the Guaranteed Account. The
value of each Subaccount is determined by multiplying the number of Accumulation
Units attributable to the Subaccount by the Accumulation Unit value for the
Subaccount, independent of the value of any other Subaccount.
ACCUMULATION UNIT VALUES - The value of an Accumulation Unit will vary in
accordance with the investment experience of the underlying portfolio in which
the Subaccount invests. The value of Accumulation Units is expected to increase
or decrease from Valuation Period to Valuation Period. The value of Accumulation
Units in each Subaccount will change daily to reflect the investment experience
of the corresponding underlying portfolio as well as the daily deduction of the
Contract Charges. The number of Accumulation Units credited to the contract will
not change as a result of any fluctuations in the value of an Accumulation Unit.
================================================================================
GUARANTEED ACCOUNT
GENERAL DESCRIPTION - The Guaranteed Account is a part of Our General Account.
The amount You have in the Guaranteed Account at any time is a result of
Premiums You have allocated to it or any part of Your Contract Value you have
transferred to it.
GUARANTEE PERIODS - The portion of Your Contract Value within the Guaranteed
Account is credited with interest at rates guaranteed by Us for the Guarantee
Period(s) selected. Interest is credited on a daily basis at the then applicable
effective guaranteed interest rate for the applicable Guarantee Period. You may
select from one or more Guarantee Periods which we offer at any particular time.
We reserve the right at any time to add or delete Guarantee Periods. If You have
9
allocated any part of Your Initial Premium to a Guarantee Period, the amount
allocated, as well as the duration of the Guarantee Period is shown on the
Application.
The guaranteed interest rate applicable to an allocation of Premium or transfer
of Contract Value to a Guarantee Period is the rate in effect for that Guarantee
Period at the time of the allocation or transfer. If You have allocated or
transferred amounts at different times to the Guaranteed Account, each
allocation or transfer may have a unique effective guaranteed interest rate
associated with that amount. We guarantee that the effective annual rate of
interest for the Guaranteed Account, including any of the Guaranteed Periods,
will not be less than 3%.
10
================================================================================
TRANSFERS
During the Accumulation Period, or after the Annuity Date, provided a variable
Annuity Option was selected, You may transfer all or part of Your value, in a
Subaccount, or allocated to a Guarantee Period of the Guaranteed Account, to
another Subaccount or Guarantee Period of the Guaranteed Account. However, after
the Annuity Date no transfers may be made between a Subaccount and the
Guaranteed Account. The Transfer Fee is shown on the Contract Schedule.
All transfers are subject to the following:
1. The deduction of any Transfer Fee that may be imposed will be deducted
from the amount which is transferred. However, no Transfer Fee will be
imposed on transfers resulting from the expiration of a Guarantee Period.
2. If We have not received transfer instructions prior to the end of a
Guarantee Period in which You have Contract Value, We will automatically
transfer it to a new Guarantee Period of the same duration and under the
same restrictions as if You had requested such transfer. However, if a new
Guarantee Period of the same duration is not available, then that portion
of Your Contract Value will be transferred to the Guarantee Period next
shortest in duration.
3. The minimum amount which may be transferred is the lesser of (A) $1,000 or
(B) Your entire value in the Subaccount or in the amount allocated to a
Guarantee Period of the Guaranteed Account.
4. No partial transfer will be made if, as a result of such transfer, Your
remaining Contract Value in the Subaccount or in the amount allocated to
the Guarantee Period of the Guaranteed Account would be less than $1,000.
5. Transfers will be effected during the Valuation Period next following
receipt by Us of a Written Request containing all required information.
However, no transfer may be made effective within seven calendar days of
the date on which any annuity payment is due.
6. Any transfer request must clearly specify:
a. the amount which is to be transferred; and
b. the Subaccounts or Guarantee Periods of the Guaranteed Account which
are to be affected.
7. After the Annuity Date, transfers may not take place between a fixed
Annuity Option and a variable Annuity Option.
11
================================================================================
ANNUITY PROVISIONS
ANNUITY PAYMENTS - Beginning on the Annuity Date, We will make annuity payments
to the Annuitant in accordance with the Annuity Option in effect on that date.
Annuity payments will be made on a monthly basis unless such payments would be
less than $100 per month. In that event, we reserve the right to amend the
frequency of annuity payments to be semi-annual or annual to ensure annuity
payments are at least $100 per payment.
CHANGE IN ANNUITY DATE - You may, upon at least thirty (30) days prior Written
Request, at any time prior to the Annuity Date, change the Annuity Date shown on
the Contract Schedule. The Annuity Date must always be the first day of a
calendar month.
Unless We approve otherwise, the new Annuity Date must be at least one year
after the effective Date. The latest Annuity Date is the first day of the first
calendar month following the Annuitant's 90th birthday or such earlier date as
may be set by applicable law.
SELECTION OF ANNUITY OPTION - If the Annuitant is alive on the Annuity Date, We
will apply the Contract Value to provide an income on the basis of a life income
with 10 years guaranteed, unless another Annuity Option has been selected. You
may however, upon at least thirty (30) days prior Written Request, at any time
prior to the Annuity Date, select and/or change the Annuity Option.
================================================================================
ANNUITY OPTIONS
ANNUITY OPTION - The Annuity Option you select may be on a fixed or variable
basis, or a combination thereof. We may, at the time of election of an Annuity
Option, offer more favorable rates in lieu of those here guaranteed. We may also
make available other income options.
OPTION 1 - LIFE INCOME. Annuity payments are paid during the life of an
Annuitant ceasing with the last Annuity Payment due prior to the Annuitant's
death.
OPTION 2 - LIFE INCOME WITH 10 YEAR GUARANTEE. Annuity payments are paid during
the life of an Annuitant, but at least for a 10 year minimum period.
OPTION 3 - JOINT AND LAST SURVIVOR ANNUITY. Annuity payments are paid during the
joint lifetime of the Annuitant and a designated second person and are paid
thereafter during the remaining lifetime of the survivor ceasing with the last
annuity payment due prior to the survivor's death.
--------------------------------------------------------------------------------
FIXED ANNUITY OPTION
The fixed dollar amount of each fixed annuity payment is determined by
multiplying the available Contract Value (after the deduction of any premium
taxes, if applicable, not previously deducted) by the factor in the Fixed
Annuity Option Table for the option chosen, using the age and sex of the
Annuitant and Joint Annuitant, if any, divided by 1,000. The tables are
determined from the Annuity 2000 Table projected with Scale G to the year of
annuitization, with interest at the rate of 3.00% per annum. If, when annuity
payments are elected, We are using tables of annuity rates for these contracts
which result in larger annuity payments, We will use those tables instead. The
annuity payments, determined at the time of their election, will not be less
than payments that would be provided by the application of the Contract Value to
an immediate annuity then offered by Us at the time of election, for the same
class of annuitants.
12
================================================================================
ANNUITY OPTIONS (Continued)
VARIABLE ANNUITY OPTION
--------------------------------------------------------------------------------
The amount of the first variable annuity payment depends on the Annuity Option
elected and the age and sex of the Annuitant. This contract contains a Variable
Annuity Options Table indicating the dollar amount of the first monthly payment
under each optional annuity form for each $1,000 of value applied. The tables
are determined from the Annuity 2000 Table projected with Scale G to the year of
annuitization, with interest at the rate of 5.00% per annum. If, when annuity
payments are elected, We are using tables of annuity rates for these contracts
which result in larger annuity payments, We will use those tables instead.
The 5% interest rate assumed in the annuity tables would produce level annuity
payments if the net investment rate remained constant at 5% per year. Subsequent
payments will be less than, equal to, or greater than the first payment
depending upon whether the actual net investment rate is less than, equal to, or
greater than 5%.
The dollar amount of the first variable annuity payment is determined by
applying the available value (after deduction of any premium taxes, if
applicable, not previously deducted) to the table using the age and sex of the
Annuitant and any joint Annuitant. The number of Annuity Units is then
determined by dividing this dollar amount by the then current Annuity Unit
value. Thereafter, the number of Annuity Units remains unchanged during the
period of annuity payments. This determination is made separately for each
Subaccount of the Variable Account. The number of Annuity Units is determined
for each Subaccount and is based upon the available value in each Subaccount as
of the date annuity payments are to begin. The dollar amount determined for each
Subaccount will then be aggregated for purposes of making payments. The dollar
amount of the second and later variable annuity payments is equal to the number
of Annuity Units determined for each Subaccount times the Annuity Unit value for
that Subaccount as of the due date of the payment. This amount may increase or
decrease from month to month. The value of an Annuity Unit for a Subaccount is
determined as shown below, by subtracting item 2. from item 1, dividing that
result by item 3 and multiplying the result by a factor to neutralize the
assumed net investment rate, discussed above, of 5% per annum,
where:
1. is the net result of the assets of the Subaccount attributable to the
Annuity units,
a) plus the cumulative credit; or
b) minus the cumulative charge
for taxes reserved, which credit or charge is determined by Us to have
resulted from the operation of the Subaccount;
2. is the cumulative unpaid amounts for the Mortality and Expense Risk Charge
and for the Administrative Charge, which are shown in the Contract
Schedule; and
3. is the number of Annuity Units outstanding at the end of the Valuation
Period.
The value of an Annuity Unit may increase or decrease from Valuation Period to
Valuation Period.
13
================================================================================
DEATH BENEFIT
DEATH OF THE OWNER - If an Owner dies before the Annuity Date and there is a
surviving Joint Owner, a Death Benefit is payable to the surviving Joint Owner.
If an Owner dies prior to the Annuity Date and there is no surviving Joint
Owner, a Death Benefit is payable to the Beneficiary. The value of the Death
Benefit will be determined as of the date We receive proof of death in a form
acceptable to Us. If there has been a change of Owner, the Death Benefit will be
the Contract Value. Otherwise, We will pay the Death Benefit equal to the
greater of:
1. the total of all Premiums paid, with each premium adjusted for surrenders
as described below; or
2. the Contract Value.
Adjustment for Surrenders. In the determination of the Death Benefit, for
each surrender, a proportionate reduction will be made to each Premium
paid prior to the surrender. The proportion is determined by dividing the
amount of the Contract Value surrendered by the Contract Value immediately
prior to each surrender.
The surviving Joint Owner or Beneficiary may elect the Death Benefit to be paid
as follows:
1. payment of the entire Death Benefit within 5 years of the date of the
Owner's death; or
2. payment over the lifetime of the surviving Joint Owner or designated
Beneficiary with distribution beginning within 1 year of the date of death
of the Owner (see Annuity Options section of this contract); or
3. if the surviving Joint Owner or designated Beneficiary is a spouse of the
deceased Owner, he/she can continue the contract in his/her own name.
If no payment option is elected within 60 days of Our receipt of proof of the
Owner's death, a single sum settlement will be made at the end of the sixty (60)
day period following such receipt. Upon payment of the Death Benefit, this
contract will end.
If the Owner is a person other than the Annuitant, and if the Owner's death
occurs on or after the Annuity Date, no Death Benefit will be payable under this
contract. Any guaranteed payments remaining unpaid will continue to be paid to
the Annuitant pursuant to the Annuity Option in force at the date of the Owner's
death.
If the Owner is not an individual, any change of Annuitant or death of Annuitant
before the Annuity Date will be treated as if the Owner had died on the date of
such change or death and the Death Benefit will be the Contract Value.
ACCIDENTAL DEATH BENEFIT - If an Accidental Death Benefit Charge is included on
the Contract Schedule, an Accidental Death Benefit may be payable which is equal
to the lesser of the Contract Value as of the date the death benefit is
determined, or $250,000. The Accidental Death Benefit is payable if the death of
the primary Owner (i.e. the first owner listed on the Contract Schedule) occurs
prior to the Contract Anniversary next following his 75th birthday, and is the
result of an Injury incurred while he was the primary Owner. The death must also
occur before the Annuity Date and within 365 days of the date of the accident
which caused the Injury.
The Accidental Death Benefit will not be paid for any death caused by or
resulting (in whole or in part) from the following:
1. suicide or attempted suicide while ▇▇▇▇ or insane; or intentionally
self-inflicted injuries;
2. sickness, disease or bacterial infection of any kind, except pyogenic
infections which occur as a result of an injury, or bacterial infections
which result from the accidental ingestion of contaminated substances;
3. hernia;
4. injury sustained as a consequence of riding in, including boarding or
alighting from, any vehicle or device used for aerial navigation except if
the primary Owner is a passenger on any aircraft licensed for the
transportation of passengers;
5. declared or undeclared war or any act thereof; or
6. service in the military, naval or air service of any country.
DEATH OF THE ANNUITANT - If the Annuitant is a person other than the Owner and
the Owner is an individual, and if the Annuitant dies before the Annuity Date, a
new Annuitant may be named by the Owner. If no new Annuitant is named within
sixty (60) days of Our receipt of proof of death, the Owner will be the new
Annuitant. If the Annuitant dies after the Annuity Date, the remaining payments,
if any, will be as specified in the Annuity Option elected. We will require
proof of the Annuitant's death. Death benefits, if any, will be paid to the
designated
14
Beneficiary at least as rapidly as under the method of distribution in effect at
the Annuitant's death.
15
================================================================================
SURRENDER PROVISIONS
SURRENDER - While this contract is in force and before the Annuity Date, We
will, upon Written Request, allow the surrender of all or a portion of this
contract for its Surrender Value. Surrenders will result in the cancellation of
Accumulation Units from each applicable Subaccount and the Guaranteed Account in
the ratio that the value of each account bears to the total Contract Value. You
must specify by Written Request, in advance, which units are to be canceled if
other than the above described method of cancellation is desired. We will pay
the amount of any surrender within seven (7) days of receipt of a request unless
the "Delay of Payments" provision is in effect.
The Surrender Value will be the Contract Value, as of the date of Our receipt of
Your Written Request for surrender, reduced by the sum of:
1. any applicable premium taxes not previously deducted; plus
2. any applicable Contract Maintenance Charge.
================================================================================
DELAY OF PAYMENTS
DELAY OF PAYMENTS - We will make any payments under this contract within 7 days
(or any shorter period, if required by law) of a request received in good order.
We reserve the right to suspend or postpone any type of payment from the
Variable Account for any period when:
1. the New York Stock Exchange is closed for other than customary weekend and
holiday closings;
2. trading on the Exchange is restricted;
3. an emergency exists as a result of which it is not reasonably practicable
to dispose of securities held in the Variable Account, or to determine
their value; or
4. the Securities and Exchange Commission so permits delay for the protection
of security holders.
The applicable rules of the Securities and Exchange Commission will govern as
to whether the conditions in 2. or 3. exist.
We reserve the right to delay any type of payment from the General Account for
up to six (6) months from the date we receive the request for payment.
16
Fixed Annuity Option Tables
--------------------------------------------------------------------------------
Option 1: Life Income
--------------------------------------------------------------------------------
Monthly Income per $1,000
--------------------------------------------------------------------------------
Year of
Annuitization 2010 2020 2030 2040
--------------------------------------------------------------------------------
Age Male Female Male Female Male Female Male Female
--------------------------------------------------------------------------------
30 3.16 3.06 3.12 3.03 3.09 3.00 3.06 2.97
--------------------------------------------------------------------------------
35 3.30 3.18 3.25 3.14 3.21 3.10 3.18 3.07
--------------------------------------------------------------------------------
40 3.48 3.32 3.42 3.28 3.37 3.23 3.32 3.20
--------------------------------------------------------------------------------
45 3.70 3.51 3.63 3.45 3.57 3.40 3.51 3.35
--------------------------------------------------------------------------------
50 3.98 3.74 3.89 3.67 3.82 3.60 3.74 3.54
--------------------------------------------------------------------------------
55 4.34 4.05 4.23 3.95 4.13 3.87 4.04 3.79
--------------------------------------------------------------------------------
60 4.82 4.45 4.68 4.33 4.55 4.22 4.43 4.12
--------------------------------------------------------------------------------
65 5.48 4.99 5.29 4.83 5.12 4.68 4.96 4.55
--------------------------------------------------------------------------------
70 6.38 5.75 6.13 5.53 5.89 5.33 5.69 5.16
--------------------------------------------------------------------------------
75 7.62 6.86 7.26 6.54 6.95 6.26 6.66 6.02
--------------------------------------------------------------------------------
80 9.35 8.48 8.85 8.02 8.41 7.61 8.02 7.26
--------------------------------------------------------------------------------
85 11.76 10.89 11.08 10.21 10.48 9.62 9.96 9.11
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Option 2: Life Income with 10 year Guarantee
--------------------------------------------------------------------------------
Monthly Income per $1,000
--------------------------------------------------------------------------------
Year of
Annuitization 2010 2020 2030 2040
--------------------------------------------------------------------------------
Age Male Female Male Female Male Female Male Female
--------------------------------------------------------------------------------
30 3.16 3.06 3.12 3.03 3.09 3.00 3.06 2.97
--------------------------------------------------------------------------------
35 3.30 3.17 3.25 3.14 3.21 3.10 3.17 3.07
--------------------------------------------------------------------------------
40 3.47 3.32 3.42 3.27 3.37 3.23 3.32 3.19
--------------------------------------------------------------------------------
45 3.69 3.50 3.62 3.44 3.56 3.39 3.50 3.35
--------------------------------------------------------------------------------
50 3.96 3.73 3.87 3.66 3.80 3.60 3.73 3.54
--------------------------------------------------------------------------------
55 4.30 4.03 4.20 3.94 4.10 3.86 4.02 3.78
--------------------------------------------------------------------------------
60 4.74 4.41 4.61 4.29 4.50 4.19 4.39 4.10
--------------------------------------------------------------------------------
65 5.31 4.91 5.15 4.76 5.01 4.63 4.87 4.51
--------------------------------------------------------------------------------
70 6.02 5.57 5.83 5.39 5.65 5.22 5.48 5.07
--------------------------------------------------------------------------------
75 6.85 6.42 6.63 6.19 6.42 5.98 6.23 5.79
--------------------------------------------------------------------------------
80 7.73 7.40 7.51 7.16 7.30 6.92 7.10 6.70
--------------------------------------------------------------------------------
85 8.52 8.34 8.35 8.13 8.18 7.93 8.02 7.73
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Option 3: Joint and Last Survivor Annuity (Male and Female)
--------------------------------------------------------------------------------
Monthly Income per $1,000
--------------------------------------------------------------------------------
Year of
Annuitization 2020 2040
--------------------------------------------------------------------------------
Female Age 45 55 65 75 45 55 65 75
--------------------------------------------------------------------------------
Male Age
--------------------------------------------------------------------------------
45 3.25 3.41 3.52 3.59 3.18 3.32 3.42 3.47
--------------------------------------------------------------------------------
55 3.35 3.63 3.90 4.09 3.26 3.52 3.76 3.92
--------------------------------------------------------------------------------
65 3.40 3.80 4.30 4.78 3.31 3.67 4.10 4.52
--------------------------------------------------------------------------------
75 3.43 3.89 4.59 5.54 3.34 3.74 4.36 5.18
--------------------------------------------------------------------------------
The values shown have not been adjusted for the annual contract maintenance
charge described on pages 3 and 9.
Values not shown are available from Our Administrative Office on request.
17
Variable Annuity Option Tables
--------------------------------------------------------------------------------
Option 1: Life Income
--------------------------------------------------------------------------------
Monthly Income per $1,000
--------------------------------------------------------------------------------
Year of
Annuitization 2010 2020 2030 2040
--------------------------------------------------------------------------------
Age Male Female Male Female Male Female Male Female
--------------------------------------------------------------------------------
30 4.47 4.38 4.44 4.36 4.41 4.34 4.39 4.32
--------------------------------------------------------------------------------
35 4.58 4.47 4.55 4.44 4.51 4.41 4.48 4.39
--------------------------------------------------------------------------------
40 4.74 4.60 4.69 4.55 4.64 4.52 4.60 4.49
--------------------------------------------------------------------------------
45 4.94 4.75 4.88 4.70 4.82 4.65 4.76 4.61
--------------------------------------------------------------------------------
50 5.20 4.96 5.12 4.90 5.04 4.83 4.97 4.78
--------------------------------------------------------------------------------
55 5.54 5.24 5.43 5.15 5.34 5.07 5.25 5.00
--------------------------------------------------------------------------------
60 6.00 5.62 5.86 5.50 5.74 5.40 5.62 5.30
--------------------------------------------------------------------------------
65 6.65 6.15 6.46 5.99 6.29 5.84 6.14 5.72
--------------------------------------------------------------------------------
70 7.56 6.90 7.30 6.68 7.07 6.48 6.86 6.30
--------------------------------------------------------------------------------
75 8.81 8.01 8.45 7.69 8.12 7.41 7.83 7.16
--------------------------------------------------------------------------------
80 10.55 9.65 10.05 9.18 9.59 8.76 9.19 8.40
--------------------------------------------------------------------------------
85 12.99 12.09 12.30 11.39 11.68 10.79 11.14 10.26
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Option 2: Life Income with 10 year Guarantee
--------------------------------------------------------------------------------
Monthly Income per $1,000
--------------------------------------------------------------------------------
Year of
Annuitization 2010 2020 2030 2040
--------------------------------------------------------------------------------
Age Male Female Male Female Male Female Male Female
--------------------------------------------------------------------------------
30 4.47 4.38 4.44 4.36 4.41 4.34 4.39 4.32
--------------------------------------------------------------------------------
35 4.58 4.47 4.54 4.44 4.51 4.41 4.48 4.39
--------------------------------------------------------------------------------
40 4.73 4.59 4.68 4.55 4.64 4.51 4.60 4.48
--------------------------------------------------------------------------------
45 4.92 4.74 4.86 4.69 4.80 4.65 4.75 4.61
--------------------------------------------------------------------------------
50 5.16 4.95 5.09 4.88 5.02 4.82 4.95 4.77
--------------------------------------------------------------------------------
55 5.48 5.21 5.38 5.13 5.30 5.05 5.22 4.99
--------------------------------------------------------------------------------
60 5.90 5.57 5.77 5.46 5.66 5.36 5.56 5.27
--------------------------------------------------------------------------------
65 6.44 6.04 6.29 5.90 6.15 5.77 6.02 5.66
--------------------------------------------------------------------------------
70 7.12 6.67 6.93 6.49 6.76 6.33 6.60 6.18
--------------------------------------------------------------------------------
75 7.90 7.49 7.69 7.27 7.49 7.06 7.31 6.88
--------------------------------------------------------------------------------
80 8.73 8.42 8.53 8.18 8.32 7.96 8.13 7.75
--------------------------------------------------------------------------------
85 9.48 9.31 9.32 9.11 9.16 8.91 9.00 8.72
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Option 3: Joint and Last Survivor Annuity (Male and Female)
--------------------------------------------------------------------------------
Monthly Income per $1,000
--------------------------------------------------------------------------------
Year of
Annuitization 2020 2040
--------------------------------------------------------------------------------
Female Age 45 55 65 75 45 55 65 75
--------------------------------------------------------------------------------
Male Age
--------------------------------------------------------------------------------
45 4.50 4.64 4.74 4.81 4.45 4.56 4.66 4.71
--------------------------------------------------------------------------------
55 4.59 4.83 5.07 5.26 4.52 4.73 4.94 5.10
--------------------------------------------------------------------------------
65 4.65 4.98 5.43 5.90 4.57 4.86 5.25 5.65
--------------------------------------------------------------------------------
75 4.68 5.08 5.72 6.62 4.59 4.94 5.49 6.27
--------------------------------------------------------------------------------
The values shown have not been adjusted for the annual contract maintenance
charge described on pages 3 and 9.
Values not shown are available from Our Administrative Office on request.
18
[LOGO] AIGLIFE
AIG LIFE INSURANCE COMPANY
▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇
▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇
INDIVIDUAL VARIABLE ANNUITY
NONPARTICIPATING
[LETTERHEAD OF AIGLIFE]
--------------------------------------------------------------------------------
This Policy is a contract between AIG Life Insurance Company ("We", "Us" or
"Our") and the Policyholder ("You" or "Your") shown on the Policy Schedule.
Subject to the terms of this Policy and the Certificates We issue to each
Certificate Owner, We will provide the benefits described in this Policy. We do
this in return for the application of the Policyholder, and the required
individual applications for the annuities and for the payment of the premiums.
This Policy becomes effective at 12:01 A.M. Standard Time on the Policy
Effective Date at the address of the Policyholder and will continue in force, in
accordance with the applicable provisions, unless terminated in accordance with
its provisions.
This Policy is non-participating and is not entitled to share in Our surplus
earnings.
/s/ ▇▇▇▇▇▇▇▇▇ ▇. ▇▇▇▇ /s/ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇
Secretary President
GROUP VARIABLE ANNUITY POLICY
Non-Participating
--------------------------------------------------------------------------------
INDEX
--------------------------------------------------------------------------------
Policy Sections Page
Policy Schedule 3
Policy Provisions 4
2
POLICY SCHEDULE
POLICY NUMBER [00001]
POLICYHOLDER [Direct Consumer's Group Trust Dated December 22, 1995]
POLICY EFFECTIVE DATE [December 1, 2000]
ELIGIBLE PERSONS: [Current And Prospective Customers Of American
International Group, Inc. And Its Affiliates]
3
POLICY PROVISIONS
Eligible Persons. Persons eligible to become insured under this Policy are those
described as Eligible Persons on the Policy Schedule.
Certificates. We will issue a Certificate to each certificate Owner describing
the annuity coverage under this Policy. The certificate will describe the
benefits of this Policy, to whom the benefits will be paid, and the limitations
and conditions that apply.
A certificate may be modified by rider or endorsement issued by Us to be
attached to the certificate. The rider or endorsement will set forth the
modifications to the certificate which affect the Insured.
Premiums. All premiums are payable to Us. The initial premium applicable to each
certificate is shown on the certificate Information Page.
Required Data. The Policyholder must give Us all data that We need to administer
this Policy.
Examination Of Records. We have the right to examine all records of the
Policyholder that pertain to the anuities issued under by this Policy.
Continuation Of This Policy. This Policy will continue in force, subject to the
Policy Termination provision.
Entire Contract. The entire contract ("Policy") consists of this Policy, the
certificates, the policyholder's application, each annuity owner's application
for an annuity issued under this Policy, and any attached riders, endorsements
or amendments.
We rely on the Policyholder's application to issue this Policy and the
individual applications, if any, to issue the annuity certificates providing to
each annuity owner. Any certificate issued under this policy is not contestable.
Changing This Policy. This Policy may only be changed, in writing, by one of our
executive officers. No other person, including an agent, has any authority to
change or reinstate this Policy or extend the time for paying a premium.
Conformity With State Statutes. Any provision of this Policy that, on the Policy
Effective Date, conflicts with state laws of the governing jurisdiction is
changed to meet the minimum requirements of those laws.
Policy Termination. This Policy may only be terminated with respect to the
issuance of new certificates. Either We or the Policyholder may terminate this
Policy upon giving at least 31 days written notice to the other. We will not
terminate this Policy prior to the end of the first year following the Policy
Effective Date.
Clerical Error. Clerical error will not void any certificate issued under this
Policy which is otherwise validly in force, nor will it keep in force any
certificate that otherwise would end.
Certificate Provisions Made Part Of This Policy. The remainder of this Policy
consists of provisions that appear in the certificates, riders and endorsements.
A copy of the certificates, riders and endorsements is added to and made a part
of this Policy.
4
[LOGO] AIGLIFE
AIG LIFE INSURANCE COMPANY
▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇
▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇
GROUP VARIABLE ANNUITY POLICY
Non-Participating