4.1
Federal ▇▇▇▇▇▇ Life Assurance Company
A Stock Life Insurance Company
▇▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇
▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇-▇▇▇▇
(▇▇▇) ▇▇▇-▇▇▇▇
RIGHT TO CANCEL - FREE LOOK PROVISION - At any time within 10 days of receiving
this contract You may return it to Us or to the representative through whom it
was purchased. Immediately upon Our receipt, this contract will be voided as if
it had never been in force. All Purchase Payments allocated to the Dollar Cost
Averaging Fixed Account plus the Separate Account Contract Value computed at the
end of the Valuation Period following Our receipt of this contract will then be
refunded within 10 days.
We agree to pay an Annuity to the Owner provided this contract is in force on
the Annuity Date.
We further agree to pay the death benefit prior to the Annuity Date when a death
benefit is payable. Payment will be made upon Our receipt of due proof of death
and the return of this contract.
This contract is issued in consideration of the initial Purchase Payment. The
provisions on this cover and the pages that follow are part of this contract.
Signed for Federal ▇▇▇▇▇▇ Life Assurance Company at its home office in
Schaumburg, Illinois.
/s/ ▇▇▇▇▇▇▇ ▇. ▇▇▇▇ /s/ ▇▇▇ ▇▇▇▇▇▇
▇▇▇ ▇▇▇▇▇▇
Secretary President
FLEXIBLE PREMIUM FIXED AND VARIABLE DEFERRED ANNUITY CONTRACT
NON-PARTICIPATING
THE INITIAL INTEREST RATE IS GUARANTEED FOR ONLY A LIMITED PERIOD OF TIME.
WITHDRAWALS MAY BE SUBJECT TO A WITHDRAWAL CHARGE.
BENEFITS, PAYMENTS AND VALUES PROVIDED BY THE CONTRACT, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF THE SUBACCOUNTS, ARE VARIABLE AND ARE NOT GUARANTEED AS
TO DOLLAR AMOUNT AND MAY INCREASE OR DECREASE. REFER TO THE VARIABLE ACCOUNT AND
ANNUITY PERIOD PROVISIONS FOR A DETERMINATION OF ANY VARIABLE BENEFITS.
This is a legal contract between the Owner and Federal ▇▇▇▇▇▇ Life Assurance
Company.
READ YOUR CONTRACT CAREFULLY.
TABLE OF CONTENTS
Page
CONTRACT SCHEDULE Follows Table of Contents
DEFINITIONS 1-2
GENERAL PROVISIONS 3
The Entire Contract 3
Modification of Contract 3
Incontestability 3
Change of Annuity Date 3
Assignment 3
Due Proof of Death 3
Reserves, Values and Benefits 3
Non-Participating 3
Reports 3
Premium Taxes 3
Creditors 3
OWNER, BENEFICIARY AND ANNUITANT PROVISIONS 4
Owner 4
Change of Ownership 4
Beneficiary Designation and Change of Beneficiary 4
Death of Beneficiary 4
Annuitant 4
PURCHASE PAYMENT PROVISONS 5
Purchase Payment Limitations 5
Place of Payment 5
DOLLAR COST AVERAGING FIXED ACCOUNT PROVISIONS 5
Dollar Cost Averaging Fixed Account Contract Value 5
Interest 5
VARIABLE ACCOUNT PROVISIONS 5-7
Separate Account 5
Liabilities of the Separate Account 5
Subaccounts 5
Fund 6
Rights Reserved by the Company 6
Accumulation Unit Value 6
Investment Experience Factor 6-7
TRANSFER AND WITHDRAWAL PROVISIONS 7-8
Transfers During the Accumulation Period 7
Withdrawals During the Accumulation Period 8
Withdrawal Charges 7
Transfers and Withdrawal Procedures 8
Deferment of Withdrawal or Transfer 8
DEATH BENEFIT PROVISIONS 8-9
Amount Payable Upon Death 8
Payment of Death Benefits During the Accumulation Period 8
Spousal Continuation 9
TABLE OF CONTENTS
Page
ANNUITY PERIOD PROVISIONS 9-14
Annuity Options 9
Option 1 Certain Period Annuity 9
Option 2 Life Annuity 9
Option 3 Life Annuity with Installments Guaranteed 9
Option 4 Joint and Survivor Annuity 9
Option 5 Joint and Survivor Annuity with Installments Guaranteed 10
Other Options 10
Commutability 10
Election of Annuity Option 10-11
Electing a Fixed or Variable Annuity Option 11
Fixed Annuity 11
Variable Annuity 11-12
Annuity Unit Value 12
Basis of Annuity Options 12
Withdrawal Charge Upon Annuitization 12
Transfers Between Subaccounts 12
Conversions from a Fixed Annuity Payment 13
Conversions to a Fixed Annuity Payment 13-14
Payment of Death Benefits During the Annuity Period 14
Disbursement Upon Death of Annuitant: Under Options 1, 3 or 5 14
Supplementary Agreement 14
Date of First Payment 14
Evidence of Age, Sex and Survival 14
Misstatement of Age or Sex 14
ANNUITY OPTION TABLE Follows Page 14
ENDORSEMENTS, if any Follow Annuity Option Table
Contract Schedule
Contract Number: [003255] Issue Date: [October 1, 2003]
Initial Purchase Payment: [$10,000] Type of contract: [Nonqualified]
Owner: [▇▇▇▇ ▇▇▇]
Owner date of birth
or trust inception date: [October 4, 1968]
Annuitant: [▇▇▇▇ ▇▇▇]
Annuitant sex: [Male]
Annuitant date of birth: [October 4, 1968]
Joint Owner: [none]
Joint Owner date of birth: [N/A]
Joint Annuitant: [none]
Joint Annuitant sex: [N/A]
Joint Annuitant date of birth: [N/A]
Annuity Date: [October 1, 2033]
Maximum Annuity Date:
[Later of the Contract Anniversary following
the 90th birthday of the oldest Owner or
Annuitant initially designated or the 10/th/
Contract Anniversary]
Minimum Annuity Date: [The 2/nd/ Contract Anniversary]
[Date of Continuance: N/A]
Riders issued with this contract:
Death Benefit Rider
Qualified Plan Rider
ERISA Loan Rider
▇▇▇▇ ▇▇▇
SIMPLE IRA
457 Deferred Compensation
Agent: [▇▇▇▇ ▇▇▇▇▇]
Contract Schedule
Beneficiary Information
Primary Beneficiary(ies):
[▇▇▇▇ ▇▇▇]
Contingent Beneficiary(ies):
[▇▇▇▇▇ ▇▇▇]
Dollar Cost Averaging Fixed Account
We declare an interest rate and a dollar cost averaging period for each Purchase
Payment made to Dollar Cost Averaging Fixed Account. This interest rate will
never be less than the minimum guaranteed interest rate. This dollar cost
averaging period will not be less than 6 months and not more than 18 months from
the date of the Purchase Payment.
The minimum guaranteed interest rate is:
Contract Years 1-7 1.50%
8+ 1.50%
Purchase Payment and allocation limits
Maximum Total Purchase Payments: [$1,000,000]
Maximum Dollar Cost Averaging Fixed Account Purchase Payments [$1,000,000]
Per Contract Year
Minimum Initial Account Allocation [$500]
Minimum Subsequent Account Allocation [$50]
Minimum Initial Purchase Payment: [$2,000]
Minimum amount of each Purchase Payment after the first: [$500($100 for a Purchase Payment that is part of a
systematic investment program that has been
approved by Us)]
Maximum Age at which a Purchase Payment may be made Age 89 of the oldest Owner or Annuitant
Minimum Contract Value remaining after a partial withdrawal: [$1,000]
Page B
Contract Schedule
Withdrawal Charges:
Years elapsed since date Withdrawal Charge as a Percentage
Purchase Payment was received of Remaining Purchase Payments Withdrawn
Less than one 5.00%
One but less than two 4.00%
Two but less than three 3.00%
Three but less than four 3.00%
Four but less than five 2.00%
Five but less than six 1.00%
Six or more 0.00%
Free withdrawal allowance
The free withdrawal allowance is the amount of Contract Value that may be
withdrawn each Contract Year without the imposition of a withdrawal charge. The
free withdrawal allowance is the greatest of the following:
(a) The sum of earnings and remaining purchase payments that have elapsed
six years or more;
(b) The contract value allowance; or
(c) The purchase payment allowance.
The contract value allowance is 10% of the sum of (i) Contract Value on the date
of the withdrawal, and (ii) partial withdrawals and withdrawal charges during
the current Contract Year. The result is decreased by partial withdrawals made
during the Contract Year that were not subject to withdrawal charges.
The purchase payment allowance is 10% of remaining purchase payments minus
partial withdrawals and withdrawal charges during the current Contract Year.
Charges:
A daily equivalent of the following annual charges will be assessed each
Valuation Date on the Subaccounts:
Mortality and expense risk charge: [1.70%]
Administration charge: [0.15%]
Riders:
[ Death Benefit Rider [0%]]
We reserve the right to charge $10 for each transfer in excess of 12 in a
Contract Year.
Page C
Contract Schedule
Initial Initial Annual Effective Allocation
Allocations Interest Rate(s) Percentage(s)
One Group Investment Trust Mid Cap Growth Portfolio N/A 80%
Dollar Cost Averaging Fixed Account (6 month) 4.00% 20%
Page D
Contract Schedule
General Account options
Dollar Cost Averaging Fixed Account (6 month, 12 month)
[Separate Account: FKLA Variable Annuity Separate Account]
Subaccounts available on the Issue Date:
One Group Investment Trust Mid Cap Growth Portfolio
One Group Investment Trust Diversified Mid Cap Portfolio
One Group Investment Trust Mid Cap Value Portfolio
One Group Investment Trust Diversified Equity Portfolio
One Group Investment Trust Equity Index Portfolio
One Group Investment Trust Large Cap Growth Portfolio
One Group Investment Trust Balanced Portfolio
One Group Investment Trust Bond Portfolio
Dreyfus Money Market Portfolio
One Group Investment Trust Government Bond Portfolio
Page E
DEFINITIONS
ACCUMULATION PERIOD - The period between the Issue Date and the Annuity
Date.
ACCUMULATION UNIT - An accounting unit of measure used to calculate the
value of each Subaccount.
ADMINISTRATION CHARGE - A charge deducted in the calculation of the
Accumulation Unit value and the Annuity Unit value for a portion of Our
administrative costs. This charge is shown in the Contract Schedule.
AGE - The attained age.
ANNIVERSARY VALUE - The Contract Value calculated on each Contract
Anniversary during the Accumulation Period.
ANNUITANT - The person during whose lifetime the Annuity is to be paid.
Joint Annuitants may be named under Nonqualified Plans and any reference to
Annuitant shall include Joint Annuitants.
ANNUITY - A series of payments paid in accordance with this contract which
begin on the Annuity Date.
ANNUITY DATE - The date on which Annuity payments begin. The original
Annuity Date is shown in the Contract Schedule. You may change the Annuity
Date as provided in this contract.
ANNUITY PERIOD - The period that starts on the Annuity Date.
ANNUITY UNIT - An accounting unit of measure used to calculate the amount
of Variable Annuity payments after the first Annuity payment.
CONTRACT ANNIVERSARY - An anniversary of the Issue Date.
CONTRACT OWNER, OR OWNER - See "You, Your, Yours" below.
CONTRACT VALUE - The sum of the Dollar Cost Averaging Fixed Account
Contract Value plus the Separate Account Contract Value.
CONTRACT YEAR - A one-year period starting on the Issue Date and successive
Contract Anniversaries.
DOLLAR COST AVERAGING FIXED ACCOUNT - Our General Account to which an Owner
may allocate all or a portion of Purchase Payments and Contract Value.
DOLLAR COST AVERAGING FIXED ACCOUNT CONTRACT VALUE - The value of amounts
allocated under this contract to the Dollar Cost Averaging Fixed Account.
FIXED ANNUITY - An Annuity payment plan that does not vary as to dollar
amount.
FREE WITHDRAWAL ALLOWANCE - Amount of Contract Value that may be withdrawn
each Contract Year without incurring a withdrawal charge as described in
the Contract Schedule.
FUND - An investment company or separate series thereof, in which the
Subaccounts of the Separate Account invest.
GENERAL ACCOUNT - Our assets other than those allocated to the Separate
Account or any other separate account.
Page 1
Page 2
DEFINITIONS (Continued)
ISSUE DATE - The Issue Date stated in the Contract Schedule.
MORTALITY AND EXPENSE RISK CHARGE - A charge deducted in the calculation of
the Accumulation Unit value and the Annuity Unite value. It is for Our
assumption of mortality risks and expense guarantees. This charge is shown
in the Contract Schedule.
NONQUALIFED PLAN CONTRACT - This contract issued other than as a Qualified
Plan Contract.
PURCHASE PAYMENTS - The dollar amount We receive in U.S. currency to buy
the benefits this contract provides.
QUALIFIED PLAN CONTRACT - A contract issued under a retirement plan which
qualifies for favorable income tax treatment under Section 401, 403, 408,
408A, or 457 of the Internal Revenue Code, as amended.
If this contract is a Qualified Plan Contract, additional provisions may
apply. The rider or endorsement to this contract used to qualify it under
the applicable section of the Internal Revenue Code will indicate the
extent of change in the provisions.
SEPARATE ACCOUNT - A unit investment trust registered with the Securities
and Exchange Commission under the Investment Company Act of 1940 and
identified in the Contract Schedule.
SEPARATE ACCOUNT CONTRACT VALUE - The sum of the Subaccount Values of this
contract on a Valuation Date.
SUBACCOUNTS - The subdivisions of the Separate Account, the assets of which
consist solely of shares of the corresponding Funds.
SUBACCOUNT VALUE - The value of Your interest in each Subaccount.
VALUATION DATE - Each business day that applicable law requires that We
value the assets of the Separate Account. Currently, this is each day that
the New York Stock Exchange is open for trading.
VALUATION PERIOD - The period that starts at the close of a Valuation Date
and ends at the close of the next succeeding Valuation Date.
VARIABLE ANNUITY - An Annuity payment plan which varies as to dollar amount
because of Subaccount investment experience.
WE, OURS, US - Federal ▇▇▇▇▇▇ Life Assurance Company, Schaumburg, Illinois.
YOU, YOUR, YOURS - The party(s) named as Owner, unless later changed as
provided in this contract. Under a Nonqualified Plan Contract, when more
than one person is named as Owner, the terms "You, Your, Yours," mean joint
Owners.
GENERAL PROVISIONS
The Entire Contract This contract (including the Contract Schedule),
any written application attached to this contract,
and any endorsements and riders constitute the
entire contract between the parties. All
statements in any attached application are deemed
representations and not warranties. No statement
will void this contract or be used as a defense of
a claim unless it is contained in an attached
written application.
Modification of Contract Only Our president, secretary and assistant
secretaries have the power to approve a change or
waive any provisions under this contract. Any such
modifications must be in writing. No agent or
person other than those officers named has the
authority to change or waive the provisions of
this contract.
Upon notice to You, this contract may be modified
by Us as is necessary to comply with any law or
regulation issued by a governmental agency to
which We or the Separate Account is subject or as
is necessary to assure continued qualification of
this contract under the Internal Revenue Code or
other laws relating to retirement plans or
annuities or as otherwise may be in Your best
interest. In the event of a modification, We may
make appropriate endorsement to this contract and
We will obtain all required regulatory approvals.
Incontestability We cannot contest this contract after it has been
in force for two years after the Issue Date.
Change of Annuity Date You may write to Us prior to the death of the
Owner and the first Annuity payment date and
request a change of the Annuity Date. The new
Annuity Date must not be earlier than the minimum
annuity date or later than the maximum annuity
date stated in the Contract Schedule.
Assignment No assignment under this contract is binding
unless We receive it in writing. We assume no
responsibility for the validity or sufficiency of
any assignment. The rights of the Owner and
beneficiary are subject to the assignment after We
have recorded it. Any assignments will be subject
to the interest of any previously named
irrevocable beneficiary. Any claim is subject to
proof of the assignee's interest.
Due Proof of Death We must receive written proof of the Owner's or
▇▇▇▇▇▇▇▇▇'s death in the form of a certified death
certificate when a death benefit is payable.
Reserves, Values All reserves are equal to or greater than those
and Benefits required by applicable statute. Any available
contract values and benefits are not less than the
minimum required by the statutes of the state in
which this contract is delivered.
Non-Participating This contract does not pay dividends. It will not
share in Our surplus or earnings.
Reports At least once each Contract Year, We will send You
a statement showing Purchase Payments received,
interest credited, investment experience, and
charges made since the last report, as well as any
other information required by applicable statute.
Premium Taxes We will make a deduction for state premium taxes
in certain situations. On any contract subject to
premium tax, as provided under applicable law, the
tax will be deducted from:
a. the Purchase Payments when We receive them;
b. the Contract Value upon total withdrawal; or
c. from the total Contract Value applied to any
Annuity option at the time Annuity payments start.
In no event will an amount be deducted for premium
taxes before the Company has incurred a tax
liability under applicable state law.
Creditors The proceeds of this contract and any payment
under an Annuity option will be exempt from the
claims of creditors and from legal process to the
extent permitted by law.
Page 3
Page 4
OWNER, BENEFICIARY AND ANNUITANT PROVISIONS
Owner Before the Annuity Date and prior to the death of
an Owner, You may exercise every option and right
conferred by this contract including the right of
assignment. The joint Owners must agree to the
exercise of any option or right if more than one
Owner is named.
Change of Ownership You may change the Owner by written request before
the Annuity Date and prior to the death of an
Owner. You must furnish information sufficient to
clearly identify the new Owner to Us. The new
Owner must be less than 90 years old on the date
the change becomes effective. The change is
subject to any existing assignment of this
contract. After We receive the change, it will
take effect as of the date the written request was
signed. However, any action taken by Us before the
change is recorded by Us remains in effect. Any
change is subject to the payment of any proceeds.
We may require You to return this contract to Us
for endorsement of a change.
Beneficiary Designation The beneficiary initially designated is shown in
and Change of the Contract Schedule. In the case of joint
Beneficiary Owners, the surviving joint Owner is automatically
the primary beneficiary of any death benefit
resulting from the death of a joint Owner. You may
change the beneficiary if You send Us written
notice in a form satisfactory to Us. Beneficiary
designation and changes of Beneficiary are subject
to the following conditions:
1. In the case of joint Owners, the surviving
joint Owner is the primary beneficiary. If
other beneficiaries are designated, they will
be deemed to be contingent beneficiaries;
2. Prior to the Annuity Date, the change must be
filed while You are alive;
3. After the Annuity Date, the change must be
filed while You and the Annuitant(s) are
alive;
4. This contract must be in force at the time
You file a change;
5. Such change must not be prohibited by the
terms of an existing assignment, beneficiary
designation or other restriction;
6. After We receive the change, it will take
effect as of the date the written notice was
signed. However, any action taken by Us
before the change is recorded by Us remains
in effect; and
7. The request for change must provide
information sufficient to clearly identify
the new beneficiary.
We may require You to return this contract to Us
for endorsement of a change.
Death of Beneficiary The interest of a beneficiary who dies before the
distribution of the death benefit will pass to the
other beneficiaries, if any, share and share
alike, unless otherwise provided in the
beneficiary designation. If no beneficiary
survives or is named, the distribution will be
made to Your estate when You die.
Annuitant The initially designated Annuitant is shown in the
Contract Schedule. Prior to the Annuity Date, an
Annuitant may be replaced or added unless the
Owner is a non-natural person. At all times there
must be at least one Annuitant. If the Annuitant
dies, the youngest Owner will become the new
Annuitant unless a new Annuitant is otherwise
named. Upon the death of an Annuitant prior to the
Annuity Date, a death benefit is not paid unless
the Owner is a non-natural person.
PURCHASE PAYMENT PROVISIONS
Purchase Payment Limitations Purchase Payment and allocation limits are shown
in the Contract Schedule.
We reserve the right to waive or modify these
limits and to aggregate multiple contracts with
the same Owner and/or Annuitant in applying these
limits. We reserve the right to refuse to accept
any Purchase Payment.
Place of Payment All Purchase Payments under this contract must be
paid to Us at Our home office or such other
location as We may select. We will notify You and
any other interested parties in writing of such
other locations. Purchase Payments received by an
agent will not be considered received by Us.
DOLLAR COST AVERAGING FIXED ACCOUNT PROVISIONS
Dollar Cost Averaging Fixed Dollar Cost Averaging Fixed Account Contract Value
Account Contract Value includes:
1. Purchase Payments allocated to the
Dollar Cost Averaging Fixed Account;
plus
2. Interest credited; minus
3. Withdrawals, previously assessed
withdrawal charges and transfers from
the Dollar Cost Averaging Fixed
Account.
Interest The initial annual effective interest rate for the
Dollar Cost Averaging Fixed Account and the
minimum guaranteed interest rate are shown in the
Contract Schedule.
We reserve the right to declare interest rates
based upon the Issue Date, the date a Purchase
Payment is received by Us, and the amount of the
Purchase Payment we receive.
We calculate interest credited to the Dollar Cost
Averaging Fixed Account by compounding daily, at
daily interest rates, rates that would produce at
the end of 12 months a result identical to the one
produced by applying an annual interest rate.
VARIABLE ACCOUNT PROVISIONS
Separate Account The variable benefits under this contract are
provided through the Separate Account identified
in the Contract Schedule. The Separate Account is
registered with the Securities and Exchange
Commission as a unit investment trust under the
Investment Company Act of 1940. It is a separate
investment account maintained by Us into which a
portion of Our assets has been allocated for this
contract. We may also allocate to the Separate
Account assets attributable to certain other
contracts and certificates We issue.
Liabilities of the The assets equal to the reserves and other
Separate Account liabilities of the Separate Account will not be
charged with liabilities arising out of any other
business We may conduct. Income, gains and losses,
realized or unrealized, from assets allocated to
the Separate Account will be credited to or
charged against the Separate Account, without
regard to Our other income, gains or losses. We
will value the assets of the Separate Account on
each Valuation Date.
Subaccounts The Separate Account consists of multiple
Subaccounts. We may, from time to time, combine or
remove Subaccounts in the Separate Account and
establish additional Subaccounts of the Separate
Account. In such event, We may permit You to
select other Subaccounts under the contract.
However, the right to select any other Subaccount
is limited by the terms and conditions We may
impose on such transactions.
Page 5
Page 6
VARIABLE ACCOUNT PROVISIONS (continued)
Fund Each Subaccount of the Separate Account will buy
shares of a Fund. Each Fund is registered under
the Investment Company Act of 1940 as an open-end
management investment company. Each series of Fund
represents a separate investment portfolio that
corresponds to one of the Subaccounts of the
Separate Account.
If we establish additional Subaccounts, each new
Subaccount will invest in a new series of a Fund
or in shares of another investment company. We may
also substitute other investment companies.
Rights Reserved by We reserve the right, subject to compliance with
the Company the current law or as it may be changed in the
future:
1. To operate the Separate Account in any form
permitted under the Investment Company Act of
1940 or in any other form permitted by law;
2. To change the name of the Separate Account and
any Subaccounts thereof;
3. To take any action necessary to comply with or
obtain and continue any exemptions from the
Investment Company Act of 1940 or to comply
with any other applicable law;
4. To transfer any assets in any Subaccount to
another Subaccount or to one or more Separate
Accounts, or the General Account, or to add,
combine or remove Subaccounts in the Separate
Account;
5. To delete the shares of any of the portfolios
of a Fund or any other open-end investment
company and to substitute, for the Fund shares
held in any Subaccount, the shares of another
portfolio of a Fund or the shares of another
investment company or any other investment
permitted by law; and
6. To change the way We assess charges, but not
to increase the aggregate amount above that
currently charged to the Separate Account and
the Funds in connection with this contract.
When required by law, We will obtain Your approval
of such changes and the approval of any regulatory
authority.
Accumulation Unit Value Each Subaccount has an Accumulation Unit value for
each combination of charges. When Purchase
Payments or other amounts are allocated to a
Subaccount, a number of units is purchased based
on the relevant Accumulation Unit value of the
Subaccount at the end of the Valuation Period
during which the allocation is made. When amounts
are transferred out of or deducted from a
Subaccount, units are redeemed in a similar
manner. The value of a Subaccount on any Valuation
Date is the number of units held in the Subaccount
times the relevant Accumulation Unit value on that
Valuation Date.
An Accumulation Unit value for each subsequent
Valuation Period is the relevant investment
experience factor for that period multiplied by
the Accumulation Unit value for the Valuation
Period immediately preceding. The Accumulation
Unit value for each Valuation Period is applied to
each day in a Valuation Period. The number of
Accumulation Units will not change as a result of
investment experience; however, adding, deleting
or modifying a rider for this contract may result
in a change in the number of Accumulation Units.
Investment Experience Each Subaccount has an investment experience
Factor factor for each combination of charges. The
investment experience factor of a Subaccount for a
combination of charges for a Valuation Period is
determined by dividing 1. by 2. and subtracting 3.
from the result, where:
1. is the net result of:
a. the net asset value per share of the
investments held in the Subaccount
determined at the end of the current
Valuation Period; plus
VARIABLE ACCOUNT PROVISIONS (continued)
b. the per share amount of any dividend or
capital gain distributions made by the
investments held in the Subaccount, if the
"ex-dividend" date occurs during the
current Valuation Period; plus or minus
c. a credit or charge for any taxes reserved
for the current Valuation Period which We
determine resulted from the investment
operations of the Subaccount;
2. is the net asset value per share of the
investments held in the Subaccount, determined
at the end of the preceding Valuation Period;
and
3. is the factor representing the sum of the
Separate Account charges currently applicable
for the number of days in the Valuation
Period.
TRANSFER AND WITHDRAWAL PROVISIONS
Transfers During the During the Accumulation Period, any transfer
Accumulation Period request must clearly specify:
1. the amount which is to be transferred; and
2. the name of the accounts which are affected.
We reserve the right at any time and without
notice to any party, to terminate, suspend, or
modify the following transfer provision.
Transfers of Separate Account Contract Value are
subject to the following conditions:
1. The minimum amount which may be transferred
out of or into a Subaccount is the minimum
subsequent account allocation stated in the
Contract Schedule or, if smaller, the
remaining value of the Subaccount. No partial
transfer may be made if the remaining value of
the Subaccount will be less than the minimum
initial account allocation shown in the
Contract Schedule.
2. No transfer may be made within seven calendar
days before the date on which the first
Annuity payment is due.
3. We reserve the right to impose a 15 calendar
day waiting period between transfers for any
transfer in excess of 12 in a Contract Year.
4. Transfers to the Dollar Cost Averaging Fixed
Account are not permitted.
Withdrawals During the During the Accumulation Period, You may withdraw
Accumulation Period all or part of the Contract Value reduced by any
withdrawal charge and applicable premium taxes.
Withdrawals are subject to all of the following
conditions:
1. you must return this contract to Us if You
elect a total withdrawal;
2. each withdrawal must be at least $500 or the
value of this contract that remains in the
Dollar Cost Averaging Fixed Account or
Subaccount, if smaller;
3. the minimum subsequent account allocation
stated in the Contract Schedule must remain in
the account after You make a withdrawal unless
the account is eliminated by such withdrawal;
4. we must receive a written request that
indicates the amount of the withdrawal from
the Dollar Cost Averaging Fixed Account and
each Subaccount;
5. withdrawals will reduce each investment option
on a proportional basis unless You direct Us
otherwise; and
6. if a partial withdrawal would reduce the
Contract Value to less than the minimum
contract value remaining after a partial
withdrawal stated in the Contract Schedule,
the partial withdrawal will be processed as a
total withdrawal.
Withdrawal Charges Withdrawal charges are shown in the Contract
Schedule. We calculate withdrawal charges as a
percentage of remaining purchase payments
withdrawn.
Page 7
Page 8
TRANSFER AND WITHDRAWAL PROVISIONS (continued)
On the Issue Date, remaining purchase payments are
equal to Purchase Payments made to the contract.
This amount is increased by subsequent Purchase
Payments.
Earnings are withdrawn first from the Contract
Value and are not subject to withdrawal charges.
Earnings are the positive difference, if any,
between Contract Value at the end of the Valuation
Period prior to any transactions during the
Valuation Period and remaining purchase payments
as of the prior Valuation Period.
Any withdrawal in excess of earnings will reduce
remaining purchase payments. Remaining purchase
payments are reduced in the order received.
Transfer and Withdrawal We will withdraw or transfer from the Dollar Cost
Procedures Averaging Fixed Account as of the Valuation Date
that follows the date We receive in good order the
Owner's written or telephone transfer request. To
process a withdrawal, the request must contain all
required information.
We will redeem the necessary number of
Accumulation Units to achieve the requested dollar
amount when the withdrawal or transfer is made
from a Subaccount. We will reduce the number of
Accumulation Units credited in each Subaccount by
the number of Accumulation Units redeemed. The
reduction in the number of Accumulation Units is
determined based on the Accumulation Unit value at
the end of the Valuation Period when We receive
the request, provided the request contains all
required information. We will pay the withdrawal
amount within seven calendar days after the date
We receive the request, except as provided below.
Deferment of If the withdrawal or transfer is to be made from
Withdrawal or a Subaccount, We may suspend the right of
Transfer withdrawal or transfer or delay payment more than
seven calendar days:
1. during any period when the New York Stock
Exchange is closed other than customary
weekend and holiday closings;
2. when trading in the markets normally utilized
is restricted, or an emergency exists as
determined by the Securities and Exchange
Commission, so that disposal of investments or
determination of the Accumulation Unit value
is not practical; or
3. for such other periods as the Securities and
Exchange Commission by order may permit for
protection of Owners.
We may defer the payment of a withdrawal or
transfer from the Dollar Cost Averaging Fixed
Account for the period permitted by law. This can
never be more than six months after the Owner
sends Us a written request in good order. During
the period of deferral, We will continue to credit
interest, at the then current interest rate(s), to
the Dollar Cost Averaging Fixed Account Contract
Value.
DEATH BENEFIT PROVISIONS
Amount Payable The amount payable upon death is the Contract
Upon Death Value as of the end of the Valuation Period
following Our receipt of due proof of death, the
return of this contract, and such other
information We may require to process the death
benefit.
Payment of Death A death benefit will be paid to the beneficiary
Benefits During upon the death of the Owner. Upon the death of a
Accumulation joint Owner during the accumulation period, a
Period death benefit will be paid to the surviving joint
Owner. If the Contract Owner is a non-natural
person, a death benefit will be paid to the
beneficiary upon the death of an Annuitant prior
to the Annuity Date.
We will pay the death benefit to the beneficiary
after We receive due proof of death, the return of
this contract, and such other information we may
require to process the death benefit. We will then
have no further obligation under this contract.
DEATH BENEFIT PROVISIONS (Continued)
The entire interest in this contract must be
distributed within five years from the date of death
unless it is applied under an Annuity option or the
spouse continues this contract as described below.
The beneficiary may elect to have the death benefit
distributed as stated in the Annuity Period Provisions
Option 1 provided the beneficiary's life expectancy is
not less than 10 years; or Options 2 or 3 as described
in the Annuity Period Provisions of this contract,
based on the life expectancy of the beneficiary as
prescribed by federal regulations unless You have
restricted the right to make such an election. The
beneficiary must make this choice within 60 days of
the time We receive due proof of death, and
distributions must commence within one year of the
death of death.
If the beneficiary is a non-natural person, the
beneficiary must elect that the entire death benefit
be distributed within five years after the date of
death.
Spousal Continuation If this contract was issued as a Nonqualified Plan
Contract or an Individual Retirement Annuity ("IRA")
and Your spouse is the primary beneficiary when You
die before the Annuity Date, Your spouse may elect to
be the successor Owner of this contract. This is known
as a Spousal Continuation. No more than one Spousal
Continuation is available under this contract.
Upon Spousal Continuation, Your surviving spouse
waives claim to the death benefit otherwise payable;
therefore, no death benefit will be payable upon Your
death. Electing to continue this contract under the
Spousal Continuation provision of this contract will
affect how the charges and benefits under this
contract, and applicable riders, are calculated or
determined.
A Spousal Continuation has the following impact on
this contract:
A. The Contract Value will be adjusted to equal the
amount of the death benefit that would otherwise be
payable. If the death benefit otherwise payable
exceeds the Contract Value one day prior to the
date of continuance, such excess will be credited
to the money market Subaccount listed in the
Contract Schedule. The Owner may subsequently
transfer this amount from the money market
Subaccount to other options then available under
this contract.
B. After the Spousal Continuation, the death benefit
payable will be determined as if: (1) this contract
was issued on the date of continuance; and (2) the
Contract Value applied on the date of continuance
resulted from Our receipt of an initial Purchase
Payment.
▇. ▇▇▇▇▇▇▇▇▇▇ charges will not apply to withdrawals
made from the Contract Value credited on the date
of continuance. Withdrawal charges will apply to
Purchase Payments made after the date of
continuance.
We may make certain riders available to the surviving
spouse at the time of continuance.
ANNUITY PERIOD PROVISIONS
Annuity Options You may annuitize this contract under one of the
following Annuity options:
Option 1 We will make monthly payments for a 10 year certain
Certain Period Annuity period.
Option 2 We will make monthly payments while the Annuitant is
Life Annuity alive.
Option 3 We will make monthly payments for a 10 year certain
Life Annuity with period and thereafter while the Annuitant is alive.
Installments Guaranteed
Option 4 We will make full monthly payments while both
Joint and Annuitants are alive. Upon the death of either
Survivor ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇, We will continue to pay a percentage of the
original monthly payment until the death of the
surviving Annuitant. The percentage payable must be
selected at the time this Annuity option is chosen.
The percentages available are 50%, 66 2/3%, 75% and
100%.
Page 9
Page 10
ANNUITY PERIOD PROVISIONS (Continued)
Option 5 We will make full monthly payments for a 10 year
Joint and Survivor certain period and thereafter while both Annuitants
Annuity with are alive. Upon the death of either ▇▇▇▇▇▇▇▇▇, We will
Installments Guaranteed continue to pay a percentage of the original monthly
payment until the death of the surviving Annuitant.
The percentage payable must be selected at the time
this Annuity option is chosen. The percentages
available are 50%, 66 2/3%, 75% and 100%.
Other Options We may make other Annuity options available.
Commutability You may elect to ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇ options having a 10
year certain period. For a ▇▇▇▇▇ ▇▇▇▇▇▇▇, this
election must be made prior to the Annuity Date. If
commutation is elected, partial commutation payments
are available during the 10 year certain period.
Commutation payments are available once per year
following the Annuity Date, but may not be commenced
until 13 months after annuitization has started.
You may elect to receive a partial commutation payment
of the present value of the remaining payments in the
10 year certain period, subject to the restrictions
described below. If a partial commutation payment is
elected, the remaining payments in the certain period
will be reduced based on the ratio of the amount of
the partial commutation to the amount of the present
value of the remaining installments in the certain
period prior to the partial commutation payment. If
the Annuitant is living after the certain period is
over, payments will resume without regard to any
commutation payments made during the 10 year certain
period.
Each time that a partial commutation payment is made,
We will determine the percentage that the payment
represents of the present value of the remaining
installments in the 10 year certain period. The sum of
these percentages over the life of the contract cannot
exceed 75% for Nonqualified Plan Contracts, or 100%
for Qualified Plan Contracts.
In determining the amount of the commutation payment
that is available, the present value of the remaining
installments in the certain period will be calculated
based on the applicable interest rate.
For a Fixed Annuity, the applicable interest rate is
the greater of:
(a) the ten year treasury constant maturity plus 3%,
and
(b) the rated used to determine the initial payment
plus 2%.
For a Variable Annuity, the applicable interest rate
is the assumed investment rate plus 2%.
The amount of each payment for purposes of determining
the present value of any variable installments will be
the annuity value at the end of the Valuation Period
that occurs on or next following the Annuitant's
request.
A supplementary agreement will be issued to reflect
the terms for the commutability of an Annuity option.
Election of Annuity We must receive an election of an Annuity option in
Option writing. You may make an election on or before the
Annuity Date provided the Annuitant is alive.
A subsequent change of beneficiary or an assignment of
this contract will revoke an election unless the
assignment provides otherwise.
Upon election of an Annuity option, We agree to pay
the Owner on the payment due dates as stated in the
specifications page of the supplementary agreement.
The Owner may direct Us, in writing, to make payments
to another person. An option cannot be changed after
the first Annuity payment is made.
ANNUITY PERIOD PROVISIONS (Continued)
If an Annuity option is not elected on or before the
Annuity Date, an Annuity will be paid under Option 3
if there is one Annuitant on the Annuity Date and
Option 5 if there are joint Annuitants on the Annuity
Date.
Electing a Fixed or You may elect a Fixed Annuity, a Variable Annuity or a
Variable Annuity Option combination of both. The portion of the Contract Value
You elect to be paid as a Fixed Annuity, if any, will
be transferred to Our General Account. We must receive
Your Fixed and Variable Annuity allocation election in
writing at least seven days prior to the Annuity Date.
If We do not receive an election from You, the Dollar
Cost Averaging Fixed Account Contract Value, less any
withdrawal charge and charges for other benefits, will
be used to determine the Fixed Annuity monthly
payment, and the Separate Account Contract Value at
the end of the Valuation Period immediately preceding
the Annuity Date, less any withdrawal charge and
charges for other benefits, will be used to determine
the first monthly Annuity payment under a Variable
Annuity.
If your allocation includes a Variable Annuity
payment, payments will reflect the investment
performance of the Subaccounts in accordance with the
allocation on the Annuity Date. Allocations will not
be changed thereafter, except as provided in the
Transfers Between Subaccounts section.
Payments for all Annuity options are derived from the
applicable tables. Current annuity rates will be used
if they produce greater payments than those quoted in
this contract. The age in the tables is the Age of the
Annuitant on the last birthday before the first
payment is due.
The option selected must result in a payment that is
at least equal to Our minimum payment, according to
Our rules, at the time the Annuity option is chosen.
If at any time the payment is less than the minimum
payment, We have the right to increase the period
between payments to quarterly, semi-annual or annual
so that the payment is at least equal to the minimum
payment or to make payment in one lump sum.
Fixed Annuity The portion of the Contract Value You elect to have
paid to you as a Fixed Annuity, less any withdrawal
charge and charges for other benefits, will be used to
determine the Fixed Annuity monthly payment in
accordance with the Annuity option selected.
Variable Annuity The portion of the Contract Value You elect to have
paid to you as a Variable Annuity is first reduced by
any withdrawal charge and charges for other benefits.
The value that remains is used to determine the first
monthly Annuity payment. The first monthly Annuity
payment is based on the guaranteed Annuity option
shown in the Annuity Option Table.
The dollar amount of subsequent payments may increase
or decrease depending on the investment experience of
each Subaccount to which Contract Value is allocated.
You may not have more than three Subaccounts at one
time. The number of Annuity Units per payment will
remain fixed for each Subaccount unless a transfer is
made. If a transfer is made, the number of Annuity
Units per payment will change. Some Annuity options
provide for a reduction in the income level upon the
death of an Annuitant, which will reduce the number of
Annuity Units.
The number of Annuity Units for each Subaccount is
calculated by dividing a. by b. where:
a. is the amount of the monthly payment that can be
attributed to that ▇▇▇▇▇▇▇▇▇▇; and
b. is the Annuity Unit value for that Subaccount at
the end of the Valuation Period. The Valuation
Period includes the date on which the payment is
made.
Monthly Annuity payments, after the first payment, are
calculated by adding, for each Subaccount, the product
of a. multiplied by b. where:
a. is the number of Annuity Units per payment in each
Subaccount; and
Page 11
Page 12
ANNUITY PERIOD PROVISIONS (Continued)
b. is the Annuity Unit value for that Subaccount at
the end of the Valuation Period. The Valuation
Period includes the date on which the payment is
made.
Annuity Unit Value The value of an Annuity Unit for each Subaccount at
the end of any Valuation Period is determined by
multiplying a. times b., with the result multiplied by
c., where:
a. is the Annuity Unit value for the immediately
preceding Valuation Period;
b. is the net investment experience factor for the
Valuation Period for which the Annuity Unit value
is being calculated; and
c. is the interest factor of .99993235 per calendar
day of such subsequent Valuation Period to offset
the effect of the assumed rate of 2.5% per year
used in the Annuity Option Table. A different
interest rate factor will be used if an assumed
rate other than 2.5% is used in the Annuity Option
Table.
Basis of Annuity Options The guaranteed monthly payments are based on an
interest rate of 2.5% per year and, where mortality is
involved, the "Annuity 2000 Table" developed by the
Society of Actuaries projected using Scale G to the
year 2015. We may also make available Variable Annuity
payment options based on assumed investment rates
other than 2.5%, but not greater than 5.00%.
Withdrawal Charge Upon annuitization, a withdrawal charge will be
Upon Annuitization applied as shown in the Contract Schedule. The
withdrawal charge is waived after the second Contract
Anniversary when the Owner elects an Annuity option
which provides either an income benefit period of no
less than 10 years or a benefit under which payment is
contingent on the life of the Annuitant(s).
Transfers Between During the Annuity Period, You may make transfers
Subaccounts between Subaccounts subject to the following:
1. You must send Us written notice in a form
satisfactory to Us.
2. Transfers between Subaccounts are prohibited during
the first year of the Annuity Period; subsequent
transfers are limited to one per year.
3. You may not have more than three Subaccounts at any
time.
4. At least $5,000 of Annuity Unit value must be
transferred from a Subaccount, unless the transfer
will eliminate Your interest in the Subaccount.
5. At least $5,000 of Annuity Unit value must remain
in the Subaccount after a transfer, unless the
transfer will eliminate Your interest in the
Subaccount.
6. If we receive notice of a transfer between
Subaccounts more than seven days before an Annuity
payment date, the transfer is effective during the
Valuation Period after the date We receive the
notice.
7. No transfer may be made within seven days before an
Annuity payment date.
We reserve the right at any time and without notice to
any party to terminate, suspend or modify these
transfer privileges.
When a transfer is made between Subaccounts, the
number of Annuity Units per payment attributable to a
Subaccount to which the transfer is made is equal to
a. multiplied by b. divided by c. where:
a. is the number of Annuity Units per payment in the
Subaccount from which the transfer is being made;
b. is the Annuity Unit value for the Subaccount from
which the transfer is being made; and
c. is the Annuity Unit value for the Subaccount to
which the transfer is being made.
ANNUITY PERIOD PROVISIONS (Continued)
Conversions from a During the Annuity Period, You may convert Fixed
Fixed Annuity Payment Annuity payments to Variable Annuity payments
subject to the following:
1. You must send Us written notice in a form
satisfactory to Us.
2. At least $30,000 of annuity reserve value
must be transferred from Our General Account,
unless the transfer will eliminate the
annuity reserve value.
3. At least $30,000 of annuity reserve value
must remain in Our General Account after a
transfer, unless the transfer will eliminate
the annuity reserve value.
4. Conversions from a Fixed Annuity payment are
available only on an anniversary of the
Annuity Date.
5. We must receive notice at least 30 days prior
to the anniversary.
We reserve the right at any time and without
notice to any party to terminate, suspend or
modify these conversion privileges.
When a conversion is made from a Fixed Annuity
payment to a Variable Annuity payment, the number
of Annuity Units per payment attributable to a
Subaccount to which the conversion is made is
equal to a. divided by b. divided c. where:
a. is the annuity reserve value being
transferred from Our General Account;
b. is the Annuity Unit value for the Subaccount
to which the transfer is being made; and
c. is the present value of $1.00 per payment
period using the Age(s) of the Annuitant(s)
and any remaining payment that may be due at
the time of the transfer.
The annuity reserve value equals the present value
of the remaining Fixed Annuity payments using the
same interest and mortality basis used to
calculate the Fixed Annuity payments.
Money converted to a Variable Annuity payment will
be applied under the same Annuity option as
originally selected.
Conversions to a During the Annuity Period, You may convert
Fixed Annuity Payment Variable Annuity payments to Fixed Annuity
payments subject to the following:
1. You must send Us written notice in a form
satisfactory to Us.
2. At least $30,000 of Annuity Unit value must
be transferred to Our General Account from
the Subaccounts.
3. At least $5,000 of Annuity Unit value must
remain in a Subaccount after a transfer,
unless the transfer will eliminate Your
interest in the Subaccount.
4. Conversions to a Fixed Annuity payment are
available only on an anniversary of the
Annuity Date.
5. We must receive notice at least 30 days prior
to the anniversary.
We reserve the right at any time and without
notice to any party to terminate, suspend or
modify these conversion privileges.
When a conversion is made from a Variable Annuity
payment to a Fixed Annuity payment, the number of
Annuity Units per payment attributable to a
Subaccount from which the conversion is made is
the product of a. multiplied by b. multiplied by
c. where:
a. is the number of Annuity Units representing
Your interest in such Subaccount per Annuity
payment;
Page 13
Page 14
ANNUITY PERIOD PROVISIONS (Continued)
b. is the Annuity Unit value for such
Subaccount; and
c. is the present value of $1.00 per payment
period using the Age(s) of the Annuitant(s)
and any remaining payment that may be due at
the time of the transfer.
Conversions to a Fixed Annuity payment will be
applied under the same Annuity option as
originally selected.
Payment of Death If an Annuitant dies after the Annuity Date, the
Benefits During the death benefit, if any, will depend on the Annuity
Annuity Period option in effect.
If an Owner, who is not also the Annuitant, dies
after the Annuity Date, the following provisions
apply:
1. If the Owner was the sole Owner, the
remaining Annuity payments will be payable to
the beneficiary in accordance with the
Annuity option in effect. The beneficiary
will become the Owner.
2. If the contract has joint Owners, the Annuity
payments will be payable to the surviving
joint Owner in accordance with the terms of
the Annuity option in effect. Upon the death
of the surviving joint Owner, the beneficiary
becomes the Owner.
Disbursement Upon When the Annuitant or surviving joint Annuitant
Death of Annuitant: dies during the 10 year certain period, We will
Under Options 1, 3 or 5 automatically continue to pay the Owner any unpaid
installments for the remainder of the certain
period under Option 1, Option 3 or Option 5.
However, if You elect within 60 days of Our
receipt of due proof of death, We will pay a
commuted value of the remaining payments in the
certain period. In determining the commuted value,
the present value of the remaining payments in the
certain period will be calculated based on the
applicable interest rate.
For a Fixed Annuity, the applicable interest rate
is the greater of:
(a) the ten year treasury constant maturity plus
3%, and
(b) the rate used to determine the initial
payment plus 2%.
For a Variable Annuity, the applicable interest
rate is the assumed investment rate plus 2%.
For purposes of determining the present value of
any variable installments, the amount of each
payment will be determined by applying the Annuity
Unit value next determined following Our receipt
of due proof of death.
Supplementary A supplementary agreement will be issued to
Agreement reflect payments that will be made under an
Annuity option. Interest, under an Annuity option,
will start to accrue on the effective date of the
supplementary agreement.
Date of First Payment The supplementary agreement will provide details
on the payments to be made.
Evidence of Age, Sex We may require satisfactory evidence of the Age,
and Survival sex and the continued survival of any person on
whose life the income is based.
Misstatement of Age If the Age or sex of the Annuitant has been
or Sex misstated, the amount payable under the contract
will be such as the Purchase Payments sent to Us
would have purchased at the correct Age or sex.
Interest not to exceed 6% compounded each year
will be charged to any overpayment or credited to
any underpayment against future payments We may
make under this contract.
ANNUITY OPTION TABLE
AMOUNT OF MONTHLY PAYMENT FOR EACH $1,000 OF VALUE APPLIED
Option 1 - Certain Period Annuity
Number
of years Monthly
selected Payment
10 9.39
Options 2 and 3 - Life Annuity and Life Annuity With Installments Guaranteed
Age of Monthly Payments Guaranteed Age of Monthly Payments Guaranteed
Male Female
Annuitant Annuitant
None 120 None 120
55 4.00 3.96 55 3.71 3.70
56 4.08 4.04 56 3.78 3.76
57 4.17 4.12 57 3.86 3.83
58 4.26 4.21 58 3.93 3.91
59 4.36 4.30 59 4.02 3.99
60 4.46 4.40 60 4.10 4.07
61 4.57 4.50 61 4.20 4.16
62 4.69 4.60 62 4.29 4.25
63 4.81 4.71 63 4.40 4.35
64 4.95 4.83 64 4.51 4.45
65 5.09 4.95 65 4.63 4.56
66 5.24 5.08 66 4.75 4.68
67 5.41 5.22 67 4.89 4.80
68 5.58 5.36 68 5.03 4.93
69 5.76 5.50 69 5.19 5.06
70 5.96 5.65 70 5.36 5.21
71 6.17 5.81 71 5.54 5.36
72 6.39 8.97 72 5.73 5.52
73 6.62 6.13 73 5.94 5.69
74 6.88 6.30 74 6.17 5.86
75 7.14 6.47 75 6.41 6.04
76 7.43 6.65 76 6.68 6.23
77 7.73 6.83 77 6.96 6.42
78 8.06 7.01 78 7.26 6.62
79 8.41 7.18 79 7.59 6.82
80 8.79 7.36 80 7.95 7.02
81 9.19 7.54 81 8.34 7.23
82 9.62 7.71 82 8.76 7.43
83 10.08 7.88 83 9.21 7.62
84 10.57 8.04 84 9.71 7.81
85 11.10 8.20 85 10.24 8.00
Option 4 - Joint and Survivor Annuity
Age of Age of Female Annuitant
Male
Annuitant 55 60 65 70 75 80 85
55 3.38 3.53 3.67 3.77 3.86 3.91 3.95
60 3.48 3.68 3.88 4.06 4.20 4.30 4.37
65 3.56 3.81 4.08 4.35 4.59 4.77 4.91
70 3.62 3.92 4.26 4.63 4.99 5.32 5.57
75 3.65 3.99 4.39 4.87 5.39 5.90 6.34
80 3.68 4.03 4.49 5.05 5.73 6.46 7.18
85 3.69 4.06 4.55 5.18 5.99 6.96 8.01
Option 5 - Joint and Survivor Annuity with Installments Guaranteed
Age of Age of Female Annuitant
Male
Annuitant 55 60 65 70 75 80 85
55 3.38 3.53 3.66 3.77 3.85 3.91 3.94
60 3.48 3.68 3.88 4.05 4.19 4.29 4.35
65 3.56 3.81 4.08 4.34 4.57 4.74 4.86
70 3.61 3.91 4.25 4.61 4.96 5.26 5.46
75 3.65 3.98 4.38 4.84 5.33 5.78 6.13
80 3.67 4.03 4.47 5.01 5.63 6.26 6.78
85 3.69 4.05 4.52 5.12 5.84 6.63 7.34
Page 15
FLEXIBLE PREMIUM FIXED AND VARIABLE DEFERRED ANNUITY CONTRACT
NON-PARTICIPATING
THE INITIAL INTEREST RATE IS GUARANTEED FOR ONLY A LIMITED PERIOD OF TIME.
WITHDRAWALS MAY BE SUBJECT TO A WITHDRAWAL CHARGE.
BENEFITS, PAYMENTS AND VALUES PROVIDED BY THE CONTRACT, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF THE SUBACCOUNTS, ARE VARIABLE AND ARE NOT GUARANTEED AS
TO DOLLAR AMOUNT AND MAY INCREASE OR DECREASE. REFER TO THE VARIABLE ACCOUNT AND
ANNUITY PERIOD PROVISIONS FOR A DETERMINATION OF ANY VARIABLE BENEFITS.
This is a legal contract between the Owner and Federal ▇▇▇▇▇▇ Life Assurance
Company.
READ YOUR CONTRACT CAREFULLY.
Federal ▇▇▇▇▇▇ Life Assurance Company
▇▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇-▇▇▇▇