EXHIBIT 1 A (5)(a)
FLEXIBLE PREMIUM VARIABLE
JOINT AND LAST SURVIVOR
LIFE INSURANCE POLICY
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TO THE OWNER:
PLEASE READ YOUR POLICY CAREFULLY. This Policy is a legal contract between you
and the Company. You, the Owner, have benefits and rights described in this
Policy. We will pay any Account Value less outstanding Policy Debt to you on the
Maturity Date if one Insured is living on that date, subject to policy
provisions. The Insureds are named in the Policy. The Beneficiary is as named in
the attached application, unless later changed. We will pay the Death Proceeds
of this Policy to the Beneficiary, subject to policy provisions. This is a
Flexible Premium Variable Joint and Last Survivor Life Insurance Policy. You may
increase or decrease the Specified Amount. We will allocate Net Premiums to the
Separate Account named on the policy data pages.
THIS POLICY'S ACCOUNT VALUE IN THE SEPARATE ACCOUNT IS BASED ON THE INVESTMENT
EXPERIENCE OF THAT ACCOUNT, AND MAY INCREASE OR DECREASE DAILY. IT IS NOT
GUARANTEED AS TO DOLLAR AMOUNT. SEE ACCOUNT VALUE BENEFITS SECTION. THE AMOUNT
OF THE DEATH BENEFIT OR THE DURATION OF THE DEATH BENEFIT MAY VARY OR BE FIXED
UNDER SPECIFIED CONDITIONS AND MAY INCREASE OR DECREASE. SEE DEATH PROCEEDS
SECTION. THE MAXIMUM LOAN AMOUNT IS NINETY PERCENT OF THE DIFFERENCE BETWEEN THE
ACCOUNT VALUE AND ANY SURRENDER CHARGE ON THE DATE OF THE LOAN.
REFUND PRIVILEGE. You may return this Policy to our Home Office or to your agent
within 10 days after its delivery for a refund. The amount of the refund will
equal the total of all premiums paid.
For GE Capital Life Assurance Company of New York
PRESIDENT SECRETARY
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o Flexible Premium Variable Joint and Last Survivor Life Insurance Policy
o Death Proceeds payable at death of last joint Insured to die prior to Maturity
Date
o No benefit payable at the death of the first Insured to die
o Adjustable Death Benefit
o Flexible premiums payable until death of last joint Insured to die or until
maturity
o Some benefits reflect investment results
o Non-participating
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GE CAPITAL LIFE ASSURANCE
COMPANY OF NEW YORK
▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇ ▇▇▇▇, ▇▇▇ ▇▇▇▇ ▇▇▇▇▇-▇▇▇▇
A Stock Company
POLICY DATA
SCHEDULE OF BENEFITS SCHEDULE OF PREMIUMS
AMOUNT PAYABLE
LIFE INSURANCE
PLANNED PERIODIC PREMIUM [$3,841.98 ANNUALLY]
MINIMUM NET PREMIUM FACTOR: [0.95 (THE MINIMUM NET PREMIUM FACTOR REFLECTS
THE MAXIMUM DEDUCTION OF 5% OF EACH PREMIUM RECEIVED)]
MAXIMUM MONTHLY POLICY CHARGE: [$ 5.00]
MAXIMUM INITIAL MONTHLY EXPENSE CHARGE PER $1,000: [$ 0.XX]
MAXIMUM INCREASE MONTHLY EXPENSE CHARGE PER $1,000: [$ 0.XX]
TRANSFER CHARGE: [$10.00]
MAXIMUM MORTALITY AND EXPENSE RISK CHARGE:[ 0.70% ANNUALLY (.0019246% DAILY)]
PARTIAL SURRENDER CHARGE: [LESSER OF $25.00 AND 2.00% OF AMOUNT OF PARTIAL
SURRENDER]
POLICY LOAN INTEREST RATES:
NON-PREFERRED LOANS: [6.00% PER ANNUM PAYABLE IN ARREARS]
PREFERRED LOANS: [4.00% PER ANNUM PAYABLE IN ARREARS]
MINIMUM POLICY LOAN CREDITING RATE: [4.00% ON ACCOUNT VALUE THAT IS LOANED]
PREFERRED LOAN AVAILABILITY DATE: [May 1, 2010]
MINIMUM SPECIFIED AMOUNT [$250,000]
CONTINUATION PERIOD [5 YEARS]
NOTE: IT IS POSSIBLE THAT COVERAGE WILL EXPIRE PRIOR TO THE MATURITY DATE SHOWN
IF SUFFICIENT PREMIUMS ARE NOT PAID. SEE THE GRACE PERIOD PROVISION. WE HAVE THE
RIGHT TO CHARGE UP TO THE GUARANTEED MAXIMUM COST OF INSURANCE RATES AND OTHER
MAXIMUM EXPENSE CHARGES. THIS MAY RESULT IN YOU HAVING TO PAY MORE PREMIUM THAN
WAS ILLUSTRATED OR THE ACCOUNT VALUE MAY BE LESS THAN THOSE ILLUSTRATED.
OWNER [THE INSUREDS]
INSUREDS [▇▇▇▇ ▇▇▇] [MALE 35] AGE NEAREST BIRTHDAY
[NO NICOTINE USE STANDARD RATING CLASS]
[▇▇▇▇ ▇▇▇] [FEMALE 35] AGE NEAREST BIRTHDAY
[NO NICOTINE USE STANDARD RATING CLASS]
POLICY NUMBER [N00000000]
POLICY DATE [MAY 1, 2000] [MAY 1, 2065] MATURITY DATE
MONTHLY ANNIVERSARY DAY [1]
PLAN FLEXIBLE PREMIUM VARIABLE JOINT AND LAST SURVIVOR LIFE INSURANCE
[$1,000,000] SPECIFIED AMOUNT - DEATH BENEFIT OPTION [B]
POLICY NUMBER: [N00000000]
ADDITIONAL RATING CLASS INFORMATION
[▇▇▇▇ ▇▇▇] [PREFERRED NO NICOTINE USE]
[▇▇▇▇ ▇▇▇] [PREFERRED NO NICOTINE USE]
SEPARATE ACCOUNT III
INVESTMENT SUBDIVISIONS ARE INVESTED IN
[THE ▇▇▇▇▇ AMERICAN FUND
AAF SMALL CAPITALIZATION - A ▇▇▇▇▇ AMERICAN SMALL CAPITALIZATION
PORTFOLIO
AAF GROWTH - A ▇▇▇▇▇ AMERICAN GROWTH PORTFOLIO
FlDELITY VARIABLE INSURANCE PRODUCTS FUND
FID EQUITY-INCOME - A EQUITY-INCOME PORTFOLIO
FID GROWTH - A GROWTH PORTFOLIO
FlD OVERSEAS - A OVERSEAS PORTFOLIO
FlDELITY VARIABLE INSURANCE PRODUCTS FUND II
FID ASSET MANAGER - A ASSET MANAGER PORTFOLIO
FID CONTRAFUND - A CONTRAFUND PORTFOLIO
FIDELITY VARIABLE INSURANCE PRODUCTS FUND III
FID GROWTH AND INCOME - A GROWTH & INCOME PORTFOLIO
FlD GROWTH OPPORTUNITIES - A GROWTH OPPORTUNITIES PORTFOLIO
FEDERATED INSURANCE SERIES
FED UTILITY II - A FEDERATED UTILITY FUND II
FED HIGH INCOME BOND II - A FEDERATED HIGH INCOME BOND FUND II
FED AMERICAN LEADERS II - A FEDERATED AMERICAN LEADERS FUND II
JANUS ASPEN SERIES
JAN BALANCED - A BALANCED PORTFOLIO
JAN FLEXIBLE INCOME - A FLEXIBLE INCOME PORTFOLIO
JAN GROWTH - A GROWTH PORTFOLIO
JAN AGGRESSIVE GROWTH - A AGGRESSIVE GROWTH PORTFOLIO
JAN WORLDWIDE GROWTH - A WORLDWIDE GROWTH PORTFOLIO
JAN INTERNATIONAL GROWTH - A INTERNATIONAL GROWTH PORTFOLIO
JAN CAPITAL APPRECIATION - A CAPITAL APPRECIATION PORTFOLIO
GE INVESTMENTS FUNDS, INC.
GEI MONEY MARKET - A MONEY MARKET FUND
GEI INCOME - A INCOME FUND
GEI S&P 500 INDEX - A * S&P 500 INDEX FUND
GEI TOTAL RETURN - A TOTAL RETURN FUND
GEI INTERNATIONAL EQUITY - A INTERNATIONAL EQUITY FUND
GEI REAL ESTATE SECURITIES - A REAL ESTATE SECURITIES FUND
GEI VALUE EQUITY - A VALUE EQUITY FUND
GEI U.S.EQUITY - A U.S. EQUITY FUND
GEI PREMIER GROWTH EQUITY - A PREMIER GROWTH EQUITY FUND
▇▇▇▇▇▇▇▇▇▇▇ VARIABLE ACCOUNT FUNDS
OPP HIGH INCOME/VA - A OPPENHEIMER HIGH INCOME FUND/VA
OPP BOND/VA - A OPPENHEIMER BOND FUND/VA
OPP AGGRESSIVE GROWTH/VA - A OPPENHEIMER AGGRESSIVE GROWTH FUND/VA
OPP CAPITAL APPRECIATION/VA - A ▇▇▇▇▇▇▇▇▇▇▇ CAPITAL APPRECIATION FUND/VA
OPP MULTI STRATEGIES/VA - A OPPENHEIMER MULTIPLE STRATEGIES FUND/VA
EFFECTIVE [12/01/99]
CONTINUED
INVESTMENT SUBDIVISIONS ARE INVESTED IN
▇▇▇▇▇▇▇ ▇▇▇▇▇ ASSET MANAGEMENT FUND, INC.
GSF GROWTH AND INCOME - A ▇▇▇▇▇▇▇ SACHS GROWTH AND INCOME FUND
GSF MID CAP VALUE - A ▇▇▇▇▇▇▇ ▇▇▇▇▇ MID CAP VALUE FUND
SALOMON BROTHERS VARIABLE SERIES FUNDS INC.
▇▇▇ INVESTORS - A SALOMON BROTHERS VARIABLE INVESTORS FUND
▇▇▇ TOTAL RETURN - A SALOMON BROTHERS VARIABLE TOTAL RETURN FUND
▇▇▇ STRATEGIC BOND - A SALOMON BROTHERS VARIABLE STRATEGIC BOND FUND]
YOU MAY ALLOCATE YOUR NET PREMIUMS AND ACCOUNT VALUE TO AS MANY AS [SEVEN]
INVESTMENT SUBDIVISIONS. YOUR ALLOCATIONS MUST BE IN PERCENTAGES TOTALING 100%.
EACH ALLOCATION PERCENTAGE MUST BE A WHOLE NUMBER AND AT LEAST 1%.
CONSULT YOUR PROSPECTUS FOR INVESTMENT DETAILS.
* "STANDARD & POOR'S," "S&P," "S&P 500," "STANDARD & POOR'S 500," AND "500" ARE
TRADEMARKS OF THE ▇▇▇▇▇▇-▇▇▇▇ COMPANIES, INC. AND HAVE BEEN LICENSED FOR USE BY
GE INVESTMENT MANAGEMENT INCORPORATED. THE S&P 500 INDEX FUND IS NOT SPONSORED,
ENDORSED, SOLD OR PROMOTED BY STANDARD & POOR'S AND STANDARD & POOR'S MAKES NO
REPRESENTATION REGARDING THE ADVISABILITY OF INVESTING IN THE FUND.
POLICY NUMBER: [N00000000]
TABLE OF MAXIMUM PREMIUMS
POLICY MAXIMUM POLICY MAXIMUM
YEAR PREMIUM YEAR PREMIUM
[1 75,881.17 36 276,622.56
2 75,881.17 37 284,306.52
3 75,881.17 38 291,990.48
4 75,881.17 39 299,674.44
5 75,881.17 40 307,358.40
6 75,881.17 41 315,042.36
7 75,881.17 42 322,726.32
8 75,881.17 43 330,410.28
9 75,881.17 44 338,094.24
10 76,839.60 45 345,778.20
11 84,523.56 46 353,462.16
12 92,207.52 47 361,146.12
13 99,891.48 48 368,830.08
14 107,575.44 49 376,514.04
15 115,259.40 50 384,198.00
16 122,943.36 51 391,881.96
17 130,627.32 52 399,565.92
18 138,311.28 53 407,249.88
19 145,995.24 54 414,933.84
20 153,679.20 55 422,617.80
21 161,363.16 56 430,301.76
22 169,047.12 57 437,985.72
23 176,731.08 58 445,669.68
24 184,415.04 59 453,353.64
25 192,099.00 60 461,037.60
26 199,782.96 61 468,721.56
27 207,466.92 62 476,405.52
28 215,150.88 63 484,089.48
29 222,834.84 64 491,773.44
30 230,518.80 65 499,457.40]
31 238,202.76
32 245,886.72
33 253,570.68
34 261,254.64
35 268,938.60
ACCORDING TO OUR UNDERSTANDING OF CURRENT FEDERAL TAX LAW, YOU MAY NOT PAY MORE
THAN THESE AMOUNTS CUMULATIVELY AND MAINTAIN THE TAX STATUS OF THIS POLICY AS
LIFE INSURANCE. THIS TABLE IS SUBJECT TO CHANGE. THIS TABLE DOES NOT RELATE TO
MODIFIED ENDOWMENT CONTRACT STATUS UNDER FEDERAL TAX LAW.
POLICY NUMBER: [N00000000]
TABLE OF CONTINUATION AMOUNTS
POLICY CONTINUATION POLICY CONTINUATION POLICY CONTINUATION
MONTH AMOUNT MONTH AMOUNT MONTH AMOUNT
[1 99.33 41 4,072.53 81 8,045.73
2 198.66 42 4,171.86 82 8,145.06
3 297.99 43 4,271.19 83 8,244.39
4 397.32 44 4,370.52 84 8,343.72
5 496.65 45 4,469.85 85 8,443.05
6 595.98 46 4,569.18 86 8,542.38
7 695.31 47 4,668.51 87 8,641.71
8 794.64 48 4,767.84 88 8,741.04
9 893.97 49 4,867.17 89 8,840.37
10 993.30 50 4,966.50 90 8,939.70
11 1,092.63 51 5,065.83 91 9,039.03
12 1,191.96 52 5,165.16 92 9,138.36
13 1,291.29 53 5,264.49 93 9,237.69
14 1,390.62 54 5,363.82 94 9,337.02
15 1,489.95 55 5,463.15 95 9,436.35
16 1,589.28 56 5,562.48 96 9,535.68
17 1,688.61 57 5,661.81 97 9,635.01
18 1,787.94 58 5,761.14 98 9,734.34
19 1,887.27 59 5,860.47 99 9,833.67
20 1,986.60 60 5,959.80 100 9,933.00
21 2,085.93 61 6,059.13 101 10,032.33
22 2,185.26 62 6,158.46 102 10,131.66
23 2,284.59 63 6,257.79 103 10,230.99
24 2,383.92 64 6,357.12 104 10,330.32
25 2,483.25 65 6,456.45 105 10,429.65
26 2,582.58 66 6,555.78 106 10,528.98
27 2,681.91 67 6,655.11 107 10,628.31
28 2,781.24 68 6,754.44 108 10,727.64
29 2,880.57 69 6,853.77 109 10,826.97
30 2,979.90 70 6,953.10 110 10,926.30
31 3,079.23 71 7,052.43 111 11,025.63
32 3,178.56 72 7,151.76 112 11,124.96
33 3,277.89 73 7,251.09 113 11,224.29
34 3,377.22 74 7,350.42 114 11,323.62
35 3,476.55 75 7,449.75 115 11,422.95
36 3,575.88 76 7,549.08 116 11,522.28
37 3,675.21 77 7,648.41 117 11,621.61
38 3,774.54 78 7,747.74 118 11,720.94
39 3,873.87 79 7,847.07 119 11,820.27
40 3,973.20 80 7,946.40 120 11,919.60
CONTINUED
POLICY NUMBER: [N00000000]
TABLE OF CONTINUATION AMOUNTS
POLICY CONTINUATION POLICY CONTINUATION POLICY CONTINUATION
MONTH AMOUNT MONTH AMOUNT MONTH AMOUNT
121 12,018.93 161 15,992.13 201 19,965.33
122 12,118.26 162 16,091.46 202 20,064.66
123 12,217.59 163 16,190.79 203 20,163.99
124 12,316.92 164 16,290.12 204 20,263.32
125 12,416.25 165 16,389.45 205 20,362.65
126 12,515.58 166 16,488.78 206 20,461.98
127 12,614.91 167 16,588.11 207 20,561.31
128 12,714.24 168 16,687.44 208 20,660.64
129 12,813.57 169 16,786.77 209 20,759.97
130 12,912.90 170 16,886.10 210 20,859.30
131 13,012.23 171 16,985.43 211 20,958.63
132 13,111.56 172 17,084.76 212 21,057.96
133 13,210.89 173 17,184.09 213 21,157.29
134 13,310.22 174 17,283.42 214 21,256.62
135 13,409.55 175 17,382.75 215 21,355.95
136 13,508.88 176 17,482.08 216 21,455.28
137 13,608.21 177 17,581.41 217 21,554.61
138 13,707.54 178 17,680.74 218 21,653.94
139 13,806.87 179 17,780.07 219 21,753.27
140 13,906.20 180 17,879.40 220 21,852.60
141 14,005.53 181 17,978.73 221 21,951.93
142 14,104.86 182 18,078.06 222 22,051.26
143 14,204.19 183 18,177.39 223 22,150.59
144 14,303.52 184 18,276.72 224 22,249.92
145 14,402.85 185 18,376.05 225 22,349.25
146 14,502.18 186 18,475.38 226 22,448.58
147 14,601.51 187 18,574.71 227 22,547.91
148 14,700.84 188 18,674.04 228 22,647.24
149 14,800.17 189 18,773.37 229 22,746.57
150 14,899.50 190 18,872.70 230 22,845.90
151 14,998.83 191 18,972.03 231 22,945.23
152 15,098.16 192 19,071.36 232 23,044.56
153 15,197.49 193 19,170.69 233 23,143.89
154 15,296.82 194 19,270.02 234 23,243.22
155 15,396.15 195 19,369.35 235 23,342.55
156 15,495.48 196 19,468.68 236 23,441.88
157 15,594.81 197 19,568.01 237 23,541.21
158 15,694.14 198 19,667.34 238 23,640.54
159 15,793.47 199 19,766.67 239 23,739.87
160 15,892.80 200 19,866.00 240 23,839.20]
CONTINUATION AMOUNTS ARE DESCRIBED IN THE CONTINUATION AMOUNT AND
CONTINUATION PERIOD PROVISION
POLICY NUMBER: [N00000000]
TABLE OF SURRENDER CHARGES
POLICY SURRENDER POLICY SURRENDER POLICY SURRENDER
MONTH CHARGE MONTH CHARGE MONTH CHARGE
[1 14,000.00 37 14,000.00 73 13,880.00
2 14,000.00 38 14,000.00 74 13,760.00
3 14,000.00 39 14,000.00 75 13,650.00
4 14,000.00 40 14,000.00 76 13,530.00
5 14,000.00 41 14,000.00 77 13,410.00
6 14,000.00 42 14,000.00 78 13,330.00
7 14,000.00 43 14,000.00 79 13,180.00
8 14,000.00 44 14,000.00 80 13,060.00
9 14,000.00 45 14,000.00 81 12,950.00
10 14,000.00 46 14,000.00 82 12,830.00
11 14,000.00 47 14,000.00 83 12,710.00
12 14,000.00 48 14,000.00 84 12,600.00
13 14,000.00 49 14,000.00 85 12,480.00
14 14,000.00 50 14,000.00 86 12,360.00
15 14,000.00 51 14,000.00 87 12,250.00
16 14,000.00 52 14,000.00 88 12,130.00
17 14,000.00 53 14,000.00 89 12,010.00
18 14,000.00 54 14,000.00 90 11,900.00
19 14,000.00 55 14,000.00 91 11,780.00
20 14,000.00 56 14,000.00 92 11,660.00
21 14,000.00 57 14,000.00 93 11,550.00
22 14,000.00 58 14,000.00 94 11,430.00
23 14,000.00 58 14,000.00 95 11,310.00
24 14,000.00 60 14,000.00 96 11,200.00
25 14,000.00 61 14,000.00 97 11,080.00
26 14,000.00 62 14,000.00 98 10,960.00
27 14,000.00 63 14,000.00 99 10,850.00
28 14,000.00 64 14,000.00 100 10,730.00
29 14,000.00 65 14,000.00 101 10,610.00
30 14,000.00 66 14,000.00 102 10,500.00
31 14,000.00 67 14,000.00 103 10,380.00
32 14,000.00 68 14,000.00 104 10,260.00
33 14,000.00 69 14,000.00 105 10,150.00
34 14,000.00 70 14,000.00 106 10,030.00
35 14,000.00 71 14,000.00 107 9,910.00
36 14,000.00 72 14,000.00 108 9,800.00
CONTINUED
POLICY NUMBER: [N00000000]
TABLE OF SURRENDER CHARGES
POLICY SURRENDER POLICY SURRENDER POLICY SURRENDER
MONTH CHARGE MONTH CHARGE MONTH CHARGE
109 9,680.00 145 5,480.00 181 1,280.00
110 9,560.00 146 5,360.00 182 1,160.00
111 9,450.00 147 5,250.00 183 1,050.00
112 9,330.00 148 5,130.00 184 930.00
113 9,210.00 149 5,010.00 185 810.00
114 9,100.00 150 4,900.00 186 700.00
115 8,980.00 151 4,780.00 187 580.00
116 8,886.00 152 4,660.00 188 460.00
117 8,750.00 153 4,550.00 189 350.00
118 8,630.00 154 4,430.00 190 230.00
119 8,510.00 155 4,310.00 191 110.00
120 8,400.00 156 4,200.00 192 0.00]
121 8,280.00 157 4,080.00
122 8,160.00 158 3,960.00
123 8,050.00 159 3,850.00
124 7,930.00 160 3,730.00
125 7,810.00 161 3,610.00
126 7,770.00 162 3,500.00
127 7,580.00 163 3,380.00
128 7,460.00 164 3,260.00
129 7,350.00 165 3,150.00
130 7,230.00 166 3,030.00
131 7,110.00 167 2,910.00
132 7,000.00 168 2,800.00
133 6,880.00 169 2,680.00
134 6,760.00 170 2,560.00
135 6,650.00 171 2,450.00
136 6,530.00 172 2,330.00
137 6,410.00 173 2,210.00
138 6,300.00 174 2,100.00
139 6,180.00 175 1,980.00
140 6,060.00 176 1,860.00
141 5,950.00 177 1,750.00
142 5,830.00 178 1,630.00
143 5,710.00 179 1,510.00
144 5,600.00 180 1,400.00
POLICY NUMBER: [N0000000]
TABLE OF GUARANTEED MAXIMUM INSURANCE RATES
PER $1,000 OF NET AMOUNT AT RISK
AGE LIFE
MONTHLY
RATE
[35 0.00020
36 0.00066
37 0.00121
38 0.00186
39 0.00265
40 0.00359
41 0.00476
42 0.00613
43 0.00775
44 0.00961
45 0.01183
46 0.01443
47 0.01748
48 0.02104
49 0.02522
50 0.03014
51 0.03602
52 0.04311
53 0.05168
54 0.06186
55 0.07389
56 0.08795
57 0.10404
58 0.12230
59 0.14364
60 0.16895
61 0.19907
62 0.23596
63 0.28155
64 0.33722
65 0.40307
66 0.47989
67 0.56783
68 0.66735
69 0.78169
CONTINUED
POLICY NUMBER: [N00000000]
TABLE OF GUARANTEED MAXIMUM INSURANCE RATES
PER $1,000 OF NET AMOUNT AT RISK
AGE LIFE
MONTHLY
RATE
70 0.91701
71 1.08841
72 1.27876
73 1.52262
74 1.81657
75 2.16057
76 2.55596
77 3.00219
78 3.49949
79 4.05866
80 4.69923
81 5.44086
82 6.30715
83 7.31754
84 8.46287
85 9.73940
86 11.12947
87 12.12947
88 14.23436
89 15.95026
90 17.78896
91 19.78598
92 22.00632
93 24.56619
94 27.80324
95 32.43367
96 40.11854
97 55.18811
98 83.33333
99 83.33333]
CONTINUED
TABLE OF CONTENTS
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Policy Data ........................................................ 3
Definitions ........................................................ 4
Introduction ....................................................... 6
The Owner and the Beneficiary ...................................... 7
Premium Payments ................................................... 8
Death Proceeds ..................................................... 10
The Separate Account ............................................... 12
Account Value Benefits ............................................. 15
Loan Benefits ...................................................... 18
General Information ................................................ 20
Optional Payment Plans ............................................. 22
A copy of the application and any riders and endorsements follow page 24.
DEFINITIONS
ACCOUNT VALUE - The total amount under the Policy in each Investment Subdivision
and our General Account.
AGE - An Insured's age on his or her birthday nearest the Policy Date or a
policy anniversary.
ATTAINED AGE - An Insured's age on the Policy Date plus the number of full years
since the Policy Date.
BENEFICIARY - The person or entity designated by the Owner to receive the Death
Proceeds payable at the death of the second Insured to die.
CONTINUATION AMOUNT - A cumulative amount set forth on the policy data pages for
each month of the Continuation Period.
CONTINUATION PERIOD - The period, shown on the policy data pages, during which
the Policy will remain in effect if the Net Total Premium is at least equal to
the Continuation Amount for the number of Policy Months that the Policy has been
in effect.
THE COMPANY - GE Capital Life Assurance Company of New York. "We", "us" or
"our" refers to the Company.
DEATH BENEFIT - The amount determined under the death benefit option in effect
as of the date of death of the second Insured to die.
DEATH PROCEEDS - The total amount payable to the Beneficiary upon the death of
the second Insured to die.
FUND - Any open-end management investment company or unit investment trust in
which an Investment Subdivision invests.
5
GENERAL ACCOUNT - Assets of the Company other than those allocated to the
Separate Account or any other separate account of the Company.
HOME OFFICE - The Company's offices at ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇ ▇▇▇▇,
▇▇▇ ▇▇▇▇ ▇▇▇▇▇-▇▇▇▇.
INSURED(S) - The persons whose lives are insured under this Policy.
INVESTMENT SUBDIVISION - Subdivision of the Separate Account, the assets of
which are invested exclusively in a corresponding portfolio of a Fund.
MATURITY DATE - The date the Policy matures. This date will be the policy
anniversary nearest the younger Insured's 100th birthday. The date is shown on
the policy data pages.
MONTHLY ANNIVERSARY DAY - The same day in each month as the Policy Date. This
day is shown on the policy data pages.
NET PREMIUM - The portion of each premium paid which is used in determining the
Account Value. It is equal to the premium paid times the Net Premium Factor.
NET PREMIUM FACTOR - The factor used in determining the Net Premium which
reflects a deduction from each premium paid.
NET TOTAL PREMIUM - On any date, Net Total Premium means the total of all
premiums paid to that date less (a) divided by (b), where:
(a) is any outstanding Policy Debt, plus the sum of any partial surrenders
to date; and
(b) is the Net Premium Factor.
OPTIONAL PAYMENT PLAN - A plan whereby any part of Death Proceeds, Surrender
Value proceeds, or benefits at maturity can be left with us to provide a series
of periodic payments to an Owner or Beneficiary.
OWNER - The Owner of the Policy as named in this Policy. "You" or "your" refers
to the Owner. Contingent owners may also be named.
PLANNED PERIODIC PREMIUM - A level premium amount scheduled for payment at fixed
intervals over a specified period of time.
POLICY - This Policy with any attached application(s), and any riders and
endorsements.
POLICY DATE - Date as of which the Company issues the Policy and as of which the
Policy becomes effective. Policy years and anniversaries are measured from the
Policy Date. The Policy Date is shown on the policy data pages.
POLICY DEBT - The amount of outstanding loans plus accrued interest. Policy Debt
is deducted from proceeds payable at the death of the second Insured to die, on
maturity, or at the time of surrender.
POLICY MONTH - A one-month period beginning on a Monthly Anniversary Day and
ending on the day immediately preceding the next Monthly Anniversary Day.
SEPARATE ACCOUNT - The segregated asset account of the Company shown on the
policy data pages.
SPECIFIED AMOUNT - An amount used in determining the insurance coverage. The
original Specified Amount is shown on the policy data pages.
SURRENDER VALUE - The amount payable to the Owner upon surrender of the Policy.
UNIT VALUE - Unit of measure used to calculate the Account Value for each
Investment Subdivision.
VALUATION DAY - For each Investment Subdivision, each day on which the New York
Stock Exchange is open for regular trading except for days that the Investment
Subdivision's corresponding portfolio does not value its shares.
VALUATION PERIOD - Period that starts at the close of regular trading on the New
York Stock Exchange on any Valuation Day and ends at the close of regular
trading on the next succeeding Valuation Day.
INTRODUCTION
This is a flexible premium variable joint and last survivor life insurance
policy. The first premium payment is due on the Policy Date. Subsequent premiums
may be paid at any time while this Policy is in effect and before the Maturity
Date, subject to conditions specified in the Premium Payments section. In return
for these premiums and the insurance application, we provide certain benefits.
The Policy provides Death Proceeds. Proceeds can be paid in a lump sum or under
an Optional Payment Plan. No Death Proceeds are payable until the death of the
second Insured to die. (See Death Proceeds section.) At the death of the first
Insured to die, the premiums and benefits provided by the Policy will not
change.
The Policy has an Account Value. The Account Value reflects the investment
experience of the Separate Account. (See THE SEPARATE ACCOUNT section.) This
Account Value is the basis for certain benefits you can use before the death of
the second Insured to die or at maturity.
READ YOUR POLICY CAREFULLY.
PROJECTION OF VALUES
We will provide a projection of illustrative future life insurance and Account
Value proceeds. To receive the illustration, send a written request to our Home
Office. You must pay any service fee in effect at that time. The fee will not be
more than $25 per illustration.
The illustration will assume:
o amounts of insurance;
o coverage options;
o future premium payments you specify; and
o other assumptions specified by you or by us.
WHEN THIS POLICY WILL TERMINATE
All coverage under this Policy will terminate when:
o you request that coverage terminate and you return this Policy;
o at the second death of the two Insureds;
o this Policy matures; or
o the grace period ends without sufficient premium being paid.
This Policy will also terminate as stated in the Suicide provision.
7
THE OWNER AND THE BENEFICIARY
THE OWNER
You have rights in the Policy during either Insured's life. The Policy names the
Insureds. If you are not an Insured, you should name a contingent owner who will
become the Owner if you die before either Insured. If you die before either
Insured and there is no contingent owner, ownership passes to your estate. If
there are multiple Owners, they own the Policy jointly with rights of
survivorship. If the last surviving joint Owner dies before both Insureds,
ownership passes to the estate of that joint Owner.
THE BENEFICIARY
You may name primary and contingent Beneficiaries. Your original Beneficiary
choice is shown in the attached application. Unless an Optional Payment Plan is
chosen, Death Proceeds will be paid in a lump sum to the primary Beneficiary. If
the primary Beneficiary dies before the second Insured to die, Death Proceeds
will be paid to the contingent Beneficiary. If no Beneficiary survives both
Insureds, Death Proceeds will be paid to you or your estate.
You may name more than one primary or contingent Beneficiary. If you do, the
proceeds will be paid in equal shares to the survivors in the appropriate
Beneficiary class who survive both Insureds, unless you have requested
otherwise.
CHANGING THE OWNER OR BENEFICIARY
During either Insured's life, you may change the Owner. You may also change the
Beneficiary during either Insured's life if you reserved this right. An
irrevocable Beneficiary may only be changed with the consent of that irrevocable
Beneficiary.
HOW TO CHANGE THE OWNER OR BENEFICIARY. To make a change, send a written request
to our Home Office. The request must be received by us in a form satisfactory to
us. The change will take effect as of the date you sign the request. The change
will be subject to any payment we make before we record the change.
USING THE POLICY AS COLLATERAL FOR A LOAN
This Policy may be assigned as collateral security. We must be notified in
writing if you assign the Policy. Any payment we make before we record the
assignment at our Home Office will not be affected. We are not responsible for
the validity of an assignment. Your rights and the rights of any revocable
Beneficiary may be affected by an assignment.
TRUSTEE
If a trustee is named as the Owner or Beneficiary of this Policy and exercises
ownership rights or claims benefits, we will have no obligation to verify that a
trust is in effect. We are not obligated to verify that the trustee is acting
within the scope of his/her authority. Payment of policy benefits to the trustee
will release us from all obligations under the Policy to the extent of the
payment. We will have no obligation to ensure that a payment to the trustee is
applied according to the terms of the trust agreement.
PREMIUM PAYMENTS
This Policy's first premium is due on the Policy Date.
PREMIUMS AFTER THE FIRST PREMIUM
Any premium payments after the first premium may be made under a periodic plan
or at any time while this Policy is in effect.
PERIODIC PREMIUM PLAN. You may request that we send reminders of your Planned
Periodic Premium. You may choose to send premiums directly to us either
annually, semi-annually, or quarterly. We can also arrange for pre-authorized
payments from your bank account or similar facility either annually,
semi-annually, quarterly or monthly. Planned Periodic Premiums will be subject
to our rules on minimun amount.
You can change the frequency or amount of your Planned Periodic Premium. We
reserve the right to limit the amount of any increase in Planned Periodic
Premiums.
UNSCHEDULED PAYMENTS. You can make an unscheduled premium payment at any time
while this Policy is in effect. Unscheduled payments are applied first to repay
any Policy Debt, unless you direct us otherwise. We reserve the right to limit
the number and amount of any unscheduled premium payments.
MAXIMUM PREMIUMS. We will limit the total of all premiums paid to date for this
Policy to the amounts shown in the table of maximum premiums in the policy data
pages. We may reject any premium, or any portion of a premium, that would result
in the Policy being disqualified as life insurance under the Internal Revenue
Code. We will refund any rejected premium along with any interest it accrued. We
reserve the right to change the table of maximum premiums when necessary as a
result of changes in coverage or to maintain compliance with the Internal
Revenue Code. If we do, we will send you a new table of maximum premiums
reflecting the adjusted amounts.
WHEN AND WHERE TO PAY PREMIUMS
Each premium is payable in advance. Send each premium to our Home Office. Make
the check payable to GE Capital Life Assurance Company of New York.
ALLOCATION OF NET PREMIUMS
You may allocate the Net Premium to one or more Investment Subdivisions of the
Separate Account. You may not allocate Net Premium to more than the maximum
number of allocations shown in the policy data pages. The minimum percentage of
each Net Premium which may be allocated to any particular Investment Subdivision
is shown on the policy data pages. Net Premiums will initially be allocated in
accordance with the allocations requested by you. You may change the allocation
of Net Premiums at any time without charge. To change your allocations send us a
notice at our Home Office. The notice must be in writing or in any form
acceptable to us. The changed allocation will apply to premiums received after
we record the change.
CONTINUATION AMOUNT AND CONTINUATION PERIOD
On any Monthly Anniversary Day during the Continuation Period, if the Surrender
Value of this Policy is not sufficient to cover the monthly deduction, this
Policy will remain in effect if the Net Total Premium is at least equal to the
Continuation Amount.
At the end of the Continuation Period, you may have to pay an additional premium
to keep the Policy in effect. (See Insufficient Surrender Value provision.)
9
An increase in Specified Amount will increase the Continuation Amounts. A
decrease in Specified Amount will reduce the Continuation Amounts. Any
termination and subsequent reinstatement of the Policy will reduce the
Continuation Amounts. We will send you a supplemental policy data page
reflecting the adjusted amounts. The Continuation Period will be as though the
Policy had been in effect continuously from its original Policy Date.
GRACE PERIOD
On any Monthly Anniversary Day during the Continuation Period, if (1) the
Surrender Value is not sufficient to cover the monthly deduction, and (2) the
Net Total Premium is less than the Continuation Amount, you must pay a premium
sufficient to keep the Policy in effect or coverage will terminate. The amount
of the sufficient premium will equal the lesser of (a) and (b), where:
(a) equals the monthly deduction due minus the Surrender Value, and that result
divided by the Net Premium Factor; and
(b) equals the Continuation Amount minus the Net Total Premium.
All amounts in (a) and (b) above are as of the Monthly Anniversary Day at the
beginning of the grace period. The monthly deduction is described in the ACCOUNT
VALUE BENEFITS section.
On any Monthly Anniversary Day after the Continuation Period, if the Surrender
Value is not sufficient to cover the monthly deduction, you must pay a premium
sufficient to keep the Policy in effect or coverage will terminate. In this
case, the amount of the sufficient premium will equal the monthly deduction due
minus the Surrender Value, and that result divided by the Net Premium Factor. As
used in this paragraph, the monthly deduction due and the Surrender Value are
both as of the Monthly Anniversary Day at the beginning of the grace period.
In either case, we will mail you written notice of the sufficient premium. This
notice will be sent to your last known address. You have a 61-day grace period
from the date we mail the notice to pay the sufficient premium.
Coverage continues during the 61-day grace period. If the death of the second
Insured to die occurs during the grace period, proceeds will be reduced by the
amount of the sufficient premium (as described in this provision) that would
have been required to keep the Policy in effect.
If the sufficient premium is not paid by the end of the grace period, this
Policy will terminate without value.
HOW THIS POLICY CAN BE REINSTATED
You may reinstate this Policy within three years of the end of the grace period
if:
(1) you submit an application for reinstatement;
(2) you provide required evidence of insurability satisfactory to us that each
Insured is insurable at the same rating class used at policy issue to
determine the guaranteed maximum cost of insurance rate scale. This is the
requirement if both Insureds were alive on the date of termination. If only
one Insured was alive on the date of termination, we only require evidence
of insurability for that Insured;
(3) the Policy has not been surrendered for cash; and
(4) you pay the premium as described in this section.
The Policy will be reinstated effective on the date we approve the
reinstatement. The surrender charge and the Continuation Period will be as
though the Policy had been in effect continuously from its original Policy Date.
On the date of reinstatement, the Account Value will be allocated to the
Investment Subdivisions of the Separate Account. Unless you tell us otherwise,
these allocations will be made in the same manner that Net Premiums are
allocated.
IF THIS POLICY TERMINATES AND IS REINSTATED BEFORE THE END OF THE CONTINUATION
PERIOD, you will have to pay a premium equal to (1) minus (2) minus (3) plus
(4), where:
(1) is the Continuation Amount as of the date of reinstatement;
(2) is the sum of the monthly deductions that would have been made during the
period between termination and reinstatement, divided by the Net Premium
Factor;
(3) is the Net Total Premium on the date of termination; and
(4) is an amount sufficient to keep the Policy in effect for two Policy Months
after the date of reinstatement.
On the date of reinstatement, the Account Value will equal (a) plus (b) minus
(c), where:
(a) is the Account Value on the first day of the grace period;
(b) is the premium paid to reinstate multiplied by the Net Premium Factor; and
(c) is the monthly deduction for the month following the date of reinstatement.
IF THIS POLICY TERMINATES BEFORE THE END OF THE CONTINUATION PERIOD, AND IS
REINSTATED AFTER THE END OF THE CONTINUATION PERIOD, you will have to pay a
premium which, after multiplying it by the Net Premium Factor, equals (1) plus
(2) minus (3), where:
(1) is the surrender charge on the date of termination;
(2) is an amount equal to the monthly deductions for two months after the date
of reinstatement; and
(3) is the Account Value on the date of termination.
On the date of reinstatement, the Account Value will equal (a) plus (b) plus
(c), where:
(a) is the surrender charge in effect on the date of reinstatement;
(b) is an amount equal to the monthly deductions for the two months after the
date of reinstatement, minus the monthly deduction for the month following
the date of reinstatement; and
(c) is any premium paid in excess of the required reinstatement premium,
multiplied by the Net Premium Factor.
IF THIS POLICY TERMINATES AFTER THE END OF THE CONTINUATION PERIOD AND IS
REINSTATED, you will have to pay a premium to keep the Policy in effect for at
least two months.
On the date of reinstatement, the Account Value will equal (a) plus (b) minus
(c), where:
(a) is the surrender charge in effect on the date of reinstatement;
(b) is the premium paid to reinstate multiplied by the Net Premium Factor; and
(c) is the monthly deduction for the month following the date of reinstatement.
DEATH PROCEEDS
Death Proceeds are payable at the death of the second Insured to die. No
benefits are payable at the death of the first Insured to die. We will process a
claim for Death Proceeds on this Policy when we receive:
o this Policy;
o due proof that both Insureds died while this Policy was in effect; and
o proof of the interest of the claimant.
Proceeds can be paid in a lump sum or under an Optional Payment Plan. Interest
will be paid on the proceeds from the date of death to the date of payment at
the annual rate of 3%.
11
HOW WE DETERMINE DEATH PROCEEDS
In the application for original coverage, the Owner elected one of two death
benefit options.
Under Option A, the Death Benefit is the greater of (1) and (2), where:
(1) is the Specified Amount plus the Account Value; and
(2) is the Account Value multiplied by the corridor percentage.
Under Option B, the Death Benefit is the greater of (1) and (2), where:
(1) is the Specified Amount; and
(2) is the Account Value multiplied by the corridor percentage.
For both Option A and Option B, references to Specified Amount and Account Value
in items (1) and (2), are amounts in effect on the date of death of the second
Insured to die.
In no event will the Death Benefit be less than the amount required to keep the
Policy qualified as life insurance.
The corridor percentage will depend on the Attained Age of the younger Insured
on the date of death of the second Insured to die. If the younger Insured was
the first to die, the corridor percentage will depend on the Attained Age that
he/she would have been if still living. (See the corridor percentage chart in
this section.)
The actual amount of Death Proceeds will depend on:
o the Death Benefit as determined in this section;
o the use of the Account Value;
o any partial surrenders;
o any Policy Debt;
o any additional insurance provided by rider;
o any increase or decrease in existing coverage;
o either Insured's suicide during the first two policy years or during the
first two policy years following an increase in existing coverage; and
o a misstatement of either Insured's Age or gender.
Younger Younger Younger Younger
Insured's Insured's Insured's Insured's
Attained Corridor Attained Corridor Attained Corridor Attained Corridor
Age Percentage Age Percentage Age Percentage Age Percentage
--- ---------- --- ---------- --- ---------- --- ----------
40 or 50 185% 61 128% 72 111%
younger 250% 51 178 62 126 73 109
41 243 52 171 63 124 74 107
42 236 53 164 64 122 75 105
43 229 54 157 65 120 through
44 222 55 150 66 119 90
45 215 56 146 67 118 91 104
46 209 57 142 68 117 92 103
47 203 58 138 69 116 93 102
48 197 59 134 70 115 94 or older 101
49 191 60 130 71 113
COMPLIANCE AS LIFE INSURANCE
We reserve the right to amend this Policy as necessary to maintain compliance
with the Internal Revenue Code. We will send any such amendments to you. You
have the right to refuse such amendments and accept full responsibility for any
consequences as a result of such refusal.
CHANGE IN EXISTING COVERAGE
After the Policy has been in effect for one year, you can increase or decrease
the Specified Amount. To make a change, send a written request along with the
Policy to our Home Office. The one year limitation will not apply to an increase
or decrease in Specified Amount caused by a change in death benefit options.
DECREASE IN SPECIFIED AMOUNT. Any decrease will become effective on the Monthly
Anniversary Day after the date we receive the request. The decrease will first
apply to coverage provided by the most recent increase. Then the decrease will
apply to the next most recent increases successively. Next the decrease will
apply to the coverage provided under the original application.
During the Continuation Period, we will not allow a decrease unless the Account
Value less any Policy Debt is greater than the surrender charge. A decrease may
not cause the Specified Amount to be less than the minimum Specified Amount
shown on the policy data pages. A decrease may cause a surrender charge to be
assessed and may require us to make a payment to you to keep the Policy
qualified as life insurance. If this event occurs, we will send you revised
policy data pages. (SEE SURRENDER CHARGE ON DECREASE IN SPECIFIED AMOUNT in the
Surrender provision.)
INCREASE IN SPECIFIED AMOUNT. While both Insureds are living, you may apply for
an increase in Specified Amount using a supplemental application. You will have
to submit evidence satisfactory to us that each Insured is insurable at the same
rating class used at policy issue. An increase in Specified Amount will incur
additional surrender charges except for increases in Specified Amount resulting
from a change from death benefit Option A to death benefit Option B. Any
approved increase will become effective on the date shown in the supplemental
policy data page. The approved increase will not become effective if the
Policy's Surrender Value is too low to cover the monthly deduction for the
Policy Month following the increase.
CHANGE IN DEATH BENEFIT OPTIONS
If you elected death benefit Option A, you can request a change to death benefit
Option B. The Specified Amount after the change will equal the sum of (1) plus
(2), where:
(1) is the Specified Amount on the date your request becomes effective; and
(2) is the Account Value on the date your request becomes effective.
If you elected death benefit Option B, you can request a change to death benefit
Option A. This will decrease the Specified Amount by the amount of Account
Value. The decrease will not cause a surrender charge to be assessed.
Any change in death benefit options will become effective on the first Monthly
Anniversary Day after the date we receive the request in our Home Office.
THE SEPARATE ACCOUNT
The Separate Account supports the operation of this Policy and certain other
variable life insurance policies we may offer. We will not allocate assets to
the Separate Account to support the operation of any contracts or policies that
are not variable life insurance.
We own the assets in the Separate Account. These assets are held separately from
our other assets. They are not part of our General Account.
13
The Separate Account is registered with the Securities and Exchange Commission
as a unit investment trust under the Investment Company Act of 1940. The
Separate Account is also subject to laws of the state of New York which regulate
the operations of insurance companies incorporated in New York. The investment
policy of the Separate Account will not be changed without the approval of the
New York Insurance Commissioner. The approval process is on file with the New
York Insurance Commissioner.
INSULATION OF ASSETS
The portion of the assets of the Separate Account which equals the reserves and
other policy liabilities which are supported by the Separate Account will not be
charged with liabilities arising from any other business we conduct. We have the
right to transfer to our General Account any assets of the Separate Account
which are in excess of such reserves and other policy liabilities.
INVESTMENT SUBDIVISIONS
The Separate Account is divided into Investment Subdivisions. The income, gains
and losses, whether or not realized, from the assets allocated to an Investment
Subdivision are credited to or charged against such Investment Subdivision
without regard to other income, gains or losses of the Company.
The Investment Subdivisions available under this Policy are shown in the policy
data pages. Each Investment Subdivision in the Separate Account invests
exclusively in a portfolio. Any amounts of income, dividends and gains
distributed from the shares of a Fund are reinvested in additional shares of
that Fund.
CHANGES TO THE SEPARATE ACCOUNT AND INVESTMENT SUBDIVISIONS
Where permitted by applicable law, the Company may:
o create new separate accounts;
o combine separate accounts, including the Separate Account;
o transfer assets of the Separate Account, which we determine to be
associated with the class of policies to which this Policy belongs, to
another separate account;
o add new Investment Subdivisions to or remove existing Investment
Subdivisions from the Separate Account or combine Investment
Subdivisions;
o make Investment Subdivisions (including new Investment Subdivisions)
available to such classes of policies as we may determine;
o add new Funds or remove existing Funds;
o substitute new Funds for any existing Fund whose shares are no longer
available for investment;
o substitute new Funds for any existing Fund which we determine is no
longer appropriate in light of the purposes of the Separate Account;
o deregister the Separate Account under the Investment Company Act of 1940;
and
o operate the Separate Account under the direction of a committee or in any
other form permitted by law.
In the event of any substitution or change, we may, by appropriate endorsement,
make such changes in this and other policies as may be necessary or appropriate
to reflect the substitution or change.
VALUATION OF SEPARATE ACCOUNT ASSETS
We will value the assets of the Separate Account each Valuation Day at their
fair market value. The valuation will be done in accordance with accepted
accounting practices and applicable laws and regulations.
POLICY EXCHANGE
If you object to a material change in the investment policy of the Separate
Account or any Investment Subdivision, you have the right to exchange this
Policy for a fixed benefit policy. No evidence of insurability will be required.
We will notify you of the options available, and the procedures to follow if you
decide to make an exchange. You must make an exchange within sixty days after
the change in investment policy becomes effective or sixty days after the
receipt of the notice of the options available, whichever is later. There will
always be one policy available for exchange.
UNIT VALUE
Each Investment Subdivision has a Unit Value. When Net Premiums or other amounts
are transferred into an Investment Subdivision, a number of units are purchased
based on that Investment Subdivision's Unit Value as of the end of the Valuation
Period during which the transfer is made. Likewise, when amounts are transferred
out of an Investment Subdivision, units are redeemed in a similar manner.
The Unit Value of each Investment Subdivision was arbitrarily set when the
Investment Subdivision began operations. The Unit Value for each subsequent
Valuation Period is the net investment factor for that period, multiplied by the
Unit Value for the immediately preceding period. The Unit Value for a Valuation
Period applies to each day in the period.
Each Investment Subdivision has its own net investment factor. In the following
definition, "assets" refers to the assets in each Investment Subdivision. "Any
amount charged against the Separate Account" refers to those amounts that are
allocated to each Investment Subdivision.
The net investment factor for a Valuation Period is (a) divided by (b), minus
(c), where:
(a) is the result of:
1. the value of the assets at the end of the preceding Valuation Period;
plus
2. the investment income and capital gains, realized or unrealized,
credited to those assets at the end of the Valuation Period for which
the net investment factor is being determined; minus
3. the capital losses, realized or unrealized, charged against those assets
during the Valuation Period; minus
4. any amount charged against the Separate Account for taxes, or any amount
we set aside during the Valuation Period as a provision for taxes
attributable to the operation or maintenance of the Separate Account;
and
(b) is the value of the assets in the Investment Subdivision at the end of the
preceding Valuation Period; and
(c) is a charge no greater than the maximum mortality and expense risk charge,
as shown on the policy data pages, made for each day in the Valuation
sPeriod.
TRANSFERS
You may transfer Account Value among the Investment Subdivisions of the Separate
Account. The transfer will be effective as of the end of the Valuation Period
during which we receive your request at our Home Office. You must request a
transfer in writing or in any other form acceptable to us. The first transfer in
each calendar month will be made without a transfer charge. A transfer charge
will be imposed for each subsequent transfer in the same calendar month. This
transfer charge is shown on the policy data pages. When we make transfers, the
Account Value on the date of the transfer will not be affected by the transfer
except to the extent of the transfer charge. The transfer charge will be taken
from the amount transferred.
15
We reserve the right to limit, upon written notice, the number of transfers
each calendar year to twelve. Also, we reserve the right to refuse to execute
any transfer:
(1) if any of the Investment Subdivisions that would be affected by the
transfer is unable to purchase or redeem shares of the relevant
portfolio in which the Investment Subdivision invests; or
(2) if the transfer is a result of more than one trade involving the same
Investment Subdivision within a 30 day period; or
(3) if the transfer would adversely affect accumulation unit values (which
may occur if the transfer would affect one percent or more of the
relevant Fund's total assets); or
(4) if the transfer would adversely affect any Fund affected by the
transfer.
Where permitted by law, we may accept your authorization of third party
transfers on your behalf. We may restrict the Investment Subdivisions that will
be available to you for transfers of Account Value and we may restrict the
number of such transfers during any period in which you authorize such third
party to act on your behalf. We will give you prior notice of any such
restrictions. However, we will not enforce such restrictions if you provide us
with satisfactory evidence that (1) such third party has been appointed by a
court of competent jurisdiction to act on your behalf, or (2) such third party
has been appointed by you to act on your behalf for all your financial affairs.
ACCOUNT VALUE BENEFITS
HOW WE DETERMINE ACCOUNT VALUE
At the end of the Valuation Period during which the first premium is applied,
the Account Value in each Investment Subdivision is equal to (a) minus (b),
where:
(a) is the portion of the Net Premium which has been paid and allocated to
that Investment Subdivision; and
(b) is the portion of any due and unpaid monthly deductions allocated to
the Account Value in that Investment Subdivision.
At the end of each Valuation Period after such date, the Account Value allocated
to each Investment Subdivision of the Separate Account is (1) plus (2) plus (3)
minus (4) minus (5) minus (6), where:
(1) is the Account Value allocated to the Investment Subdivision at the end
of the preceding Valuation Period, multiplied by the Investment
Subdivision's net investment factor for the current Valuation Period;
(2) is Net Premiums received during the current Valuation Period and which
are allocated to the Investment Subdivision;
(3) is any other amount transferred into the Investment Subdivision during
the current Valuation Period;
(4) is any partial surrender made from the Investment Subdivision during
the current Valuation Period;
(5) is any Account Value transferred out of the Investment Subdivision
during the current Valuation Period;
(6) any monthly deduction allocated to the Investment Subdivision during
the current Valuation Period.
HOW WE DETERMINE NET PREMIUM
To calculate the Net Premium, we multiply the premium paid times the Net Premium
Factor.
The minimum Net Premium Factor is shown on the policy data pages. We may use a
Net Premium Factor greater than the minimum Net Premium Factor at our sole
discretion.
MONTHLY DEDUCTION
The monthly deduction is a charge made on the Policy Date and each Monthly
Anniversary Day thereafter against the Account Value. It is determined by adding
the cost of insurance, the cost of additional benefits provided by rider, the
initial monthly expense charge, any increase monthly expense charge, and the
monthly policy charge.
MONTHLY POLICY CHARGE. The actual monthly policy charge will never be greater
than the maximum monthly policy charge shown on the policy data pages.
INITIAL MONTHLY EXPENSE CHARGE. The initial monthly expense charge will be
included in the monthly deduction. This charge will be deducted during the first
ten policy years. The maximum amount of the charge per $1,000 of initial
Specified Amount is shown on the policy data pages.
INCREASE MONTHLY EXPENSE CHARGE. The increase monthly expense charge due to an
increase in Specified Amount will be included in the monthly deduction. This
charge will be deducted during the ten year period following the increase. The
maximum amount of the charge per S1,000 of increase is shown on the policy data
pages.
The monthly deduction for a Policy Month will be allocated among the Investment
Subdivisions of the Separate Account in the same proportion that the Policy's
Account Value in each Investment Subdivision bears to the total Account Value in
all Investment Subdivisions at the beginning of the Policy Month.
COST OF INSURANCE
The cost of insurance is calculated on each Monthly Anniversary Day and is based
on the net amount at risk. The net amount at risk is calculated by dividing the
Death Benefit by 1.0032737, and then subtracting the Account Value. To determine
the cost of insurance for a particular Policy Month, we divide the net amount at
risk by 1000 and multiply that result by the applicable cost of insurance rate.
If Option B is in effect, and the Specified Amount has increased, the Account
Value is first considered part of the initial Specified Amount. If the Account
Value is more than the initial Specified Amount, any excess Account Value will
be considered part of the increased Specified Amounts resulting from increases
in the order of the increases. Account Value, as used in this paragraph, means
the Account Value at the beginning of the month, prior to the monthly deduction
for the cost of insurance.
COST OF INSURANCE RATE. The monthly rate is based on each Insured's gender,
issue age, rating class and policy duration. The rates are determined by us
according to our expectations of future experience for mortality, lapse, taxes,
interest, and expenses. We will review our experiences in these categories not
more frequently than once per year or less frequently than every five years. We
can change the rates from time to time. They will never be more than the maximum
rates shown in the table of guaranteed maximum insurance rates. A change in
rates will apply to all persons of the same age, gender and rating class and
whose policies have been in effect for the same length of time. Any change in
the cost of insurance rate will be determined in accordance with the standards
and procedures on file with the New York Insurance Department.
INSUFFICIENT SURRENDER VALUE
On a Monthly Anniversary Day, if the Surrender Value is not enough to cover the
monthly deduction for that Monthly Anniversary Day, the Grace Period provision
will apply.
CONTINUATION OF COVERAGE
This Policy and any riders will remain in effect:
o as long as the Surrender Value covers the monthly deduction; or
o as provided for in the Continuation Amount and Continuation Period
provision under PREMIUM PAYMENTS.
But in any case, the Policy will not continue beyond the Maturity Date. Also, a
rider attached to this Policy will not continue beyond its termination date
under any circumstances.
SURRENDER
You can make a full or partial surrender of this Policy by sending a written
request and the Policy to our Home Office. Unless an Optional Payment Plan is
chosen, any proceeds payable will be paid to you in a lump sum. A surrender must
take place prior to the death of the second Insured to die and before the
Maturity Date.
AMOUNT PAYABLE ON SURRENDER. The Surrender Value of this Policy is the Account
Value on the date we receive your request for surrender in our Home Office less
any Policy Debt and less any surrender charge that applies.
SURRENDER CHARGE. We will charge a surrender charge during any surrender charge
period. Surrender charge amounts are shown in the policy data pages. The
surrender charge period is the period of Policy Months for which a surrender
charge is shown in the policy data pages. The total surrender charge for any
given Policy Month is the sum of:
o the surrender charge that applies to the original Specified Amount,
adjusted for any decrease in Specified Amount; plus,
o the surrender charges that apply to any increases in Specified Amount,
adjusted for any decrease in Specified Amount.
SURRENDER CHARGE ON DECREASE IN SPECIFIED AMOUNT. If the Specified Amount is
decreased during the surrender charge period other than for a partial surrender,
we will charge a surrender charge. The amount of surrender charge will be
deducted from your Account Value. The charge will be allocated among each
Investment Subdivision in the same proportion that the Policy's Account Value in
each Investment Subdivision bears to the Account Value in all Investment
Subdivisions.
The amount of surrender charge will be based:
(1) first on any surrender charge in effect on the most recent increase and
the amount of reduction to this increase caused by the decrease;
(2) then on any surrender charge in effect on the next most recent
increases successively and the amount of any reduction to each of these
increases caused by the decrease; and
(3) finally on the surrender charge in effect on coverage provided under
the original application and any reduction to this amount caused by the
decrease.
Surrender charges in effect before the decrease are adjusted to reflect any
assessments made.
PARTIAL SURRENDER. You can make a partial surrender of this Policy. A partial
surrender cannot be less than $500. A partial surrender cannot exceed the lesser
of:
o the Surrender Value, less $500; or
o the available loan amount.
We will reduce the Account Value and the Death Proceeds by the amount of any
partial surrender. A partial surrender will not be permitted during the first
policy year if death benefit Option B is in effect.
You may tell us how to allocate the partial surrender among the Investment
Subdivisions of the Separate Account. If you do not, the partial surrender will
be allocated among each Investment Subdivision in the same proportion that the
Policy's Account Value in each Investment Subdivision bears to the total Account
Value in all Investment Subdivisions on the date we receive the request in our
Home Office.
We will deduct a charge from the amount of each partial surrender. The charge is
shown on the policy data pages.
RECEIVING THE SURRENDER VALUE
The Surrender Value is payable in one lump sum unless you choose to receive
periodic payments under an Optional Payment Plan.
POSTPONEMENT OF PAYMENTS
We will usually pay any amounts payable as a result of surrender, partial
surrender, or policy loan within seven days after we receive written request in
our Home Office, in a form satisfactory to us. Except to pay premiums, we
reserve the right to defer payment of policy loans for six months. If payment of
a policy loan or surrender is not made within 10 days of receipt of
documentation necessary to complete the transaction, we will pay interest at an
annual rate of 3% on the policy loan or surrender. We will usually pay any Death
Proceeds within seven days after we receive due proof of death.
Payment of any amount for surrender, partial surrender, policy loan or Death
Proceeds may be postponed whenever:
o the New York Stock Exchange is closed other than customary week-end and
holiday closings, or trading on the New York Stock Exchange is restricted
as determined by the Securities and Exchange Commission; or
o the Securities and Exchange Commission by order permits postponement for
the protection of policyowners; or
o an emergency exists, as determined by the Securities and Exchange
Commission, as a result of which disposal of securities is not reasonably
practicable or it is not reasonably practicable to determine the value of
the net assets of the Separate Account.
We have the right to defer payment which is derived from any amount recently
paid to us by check or draft, until we are satisfied the check or draft has been
paid by the bank on which it was drawn.
LOAN BENEFITS
The Policy has loan benefits that are described below.
MAKING A POLICY LOAN
You may obtain a policy loan from us. This Policy is the only security required.
We recommend that you consult a tax advisor before requesting a loan. The
MAXIMUM loan amount is 90% of the difference between (a) the Account Value and
(b) any surrender charge on the date of the loan. The AVAILABLE loan amount is
the maximum loan amount less any outstanding Policy Debt.
When a policy loan is made, an amount of Account Value sufficient to secure the
loan is transferred out of the Separate Account and into our General Account.
You may tell us how to allocate that Account Value among the Investment
Subdivisions of the Separate Account. If you do not, that Account Value will be
allocated among each Investment Subdivision in the same proportion that the
Policy's Account Value in each Investment Subdivision bears to the total Account
Value in all investment Subdivisions on the date we make the loan.
19
Account Value in the General Account will earn interest daily at a minimum
annual rate of 4%. On each policy anniversary day, the interest earned since the
preceding policy anniversary day will be transferred into the Separate Account.
This interest will be allocated to the Investment Subdivisions in the same
manner as Net Premiums.
Account Value in the General Account will earn interest daily at a minimum
annual rate of 4%. On each policy anniversary day, the interest earned since the
preceding policy anniversary day will be transferred into the Separate Account.
This interest will be allocated to the Investment Subdivisions in the same
manner as Net Premiums.
Any loan transaction will permanently affect the values of the Policy.
POLICY LOAN INTEREST
The interest rates charged for non-preferred policy loans and for preferred
policy loans are shown on the policy data pages. Interest accrues daily, and is
due and payable on each policy anniversary. If interest is not paid when due, an
amount equal to the amount owed will be transferred out of the Separate Account
and into our General Account to become part of the Policy Debt and interest will
be charged on that amount. Interest transferred out of the Separate Account will
be transferred from each Investment Subdivision in the same proportion that the
Account Value in that Investment Subdivision bears to the total Account Value in
all Investment Subdivisions at the time of interest transfer.
PREFERRED POLICY DEBT
A portion of policy loans taken and/or existing after the preferred loan
availability date (shown on the policy data pages) will be designated as
preferred policy debt. The amount of preferred policy debt is redetermined each
policy month.
Preferred policy debt will be at least as large as:
(a) the Account Value less any surrender charge that applies, minus
(b) the total premiums paid.
REPAYING POLICY DEBT
You can repay Policy Debt in part or in full any time during either Insured's
life while this Policy is in effect. Loan payments will first be applied to
reduce the portion of Policy Debt that does not correspond to preferred policy
debt.
When a loan repayment is made, Account Value in the General Account related to
that payment will be transferred into the Separate Account. You may tell us how
to allocate this Account Value among each Investment Subdivision of the Separate
Account. If you do not, we will allocate that amount among the Investment
Subdivisions in the same proportion that Net Premiums are being allocated.
If you do not repay Policy Debt, it will be deducted from any proceeds or
benefit payable at the death of the second Insured to die, on maturity, or on
surrender. Any Policy Debt which exists at the end of the 61-day grace period
will be deducted from the Account Value and considered repaid as of the date of
termination.
MINIMUM LOAN PAYMENT
During the Continuation Period, if Policy Debt on any Monthly Anniversary Day
exceeds the Account Value less any surrender charge that applies, and the Net
Total Premium is less than the Continuation Amount, your Policy will enter a
61-day grace period. You will have the 61-day grace period to pay a minimum
loan payment equal to the lesser of (a) and (b), where:
(a) equals the amount by which Policy Debt exceeds the Account Value less
any surrender charge and
(b) equals the Net Premium Factor times the difference between the
Continuation Amount and the Net Total Premium.
All amounts in (a) and (b) above are as of the Monthly Anniversary Day when
excess Policy Debt first occur.
After the Continuation Period, if Policy Debt on any Monthly Anniversary Day
exceeds the Account Value less any surrender charge that applies, your Policy
will enter a 61-day grace period. In this case, you will have the 61-day grace
period to pay a minimum loan payment equal to the amount by which Policy Debt
exceeds the Account Value less any surrender charge. As used in this paragraph,
Policy Debt, Account Value and surrender charge are all as of the Monthly
Anniversary Day when excess Policy Debt first occurs.
We will send written notice of the minimum loan payment to you and any assignee
of record at our Home Office at least 30 days prior to the date of termination.
If you do not pay the minimum loan payment by the end of the grace period, your
Policy will terminate without value.
GENERAL INFORMATION
ANNUAL STATEMENT
On each policy anniversary, we will send you an annual statement that will
describe the current status of your Policy and any other information required by
the New York Insurance Department. The statement will show the Specified Amount,
the Account Value, the Surrender Value and Policy Debt as of the policy
anniversary. The statement will also show premiums paid and charges made during
the policy year.
CALCULATION OF VALUES
Our calculations of guaranteed maximum cost of insurance rates are based on the
Commissioners' 1980 Standard Ordinary Smoker or Nonsmoker Mortality Tables (age
nearest birthday).
The values provided for in this Policy are always at least what is required by
New York law. A detailed statement of how we calculate the values in this Policy
has been filed with the New York Insurance Department.
EXCHANGE PROVISION
During the first 24 policy months, you have the right to exchange this Policy
for a flexible premium adjustable joint and last survivor life policy. We will
not require evidence of insurability. If you decide to make an exchange, we will
notify you of the policies available for exchange and the procedures to follow.
The policy or policies we offer for exchange will be one offered by us or by an
affiliate. You may elect to have the amount of the new policy be either (a) or
(b) where:
(a) is the Death Benefit on the date of exchange, and
(b) is the Death Benefit minus the Account Value on the date of exchange.
The new policy will have the same policy date, genders, issue ages and
equivalent rating classes as this Policy. The new policy will include such
riders and endorsements as were included in this Policy, if such riders and
endorsements are available with the new policy.
The exchange is subject to an equitable adjustment in payments and Account
Values to reflect variances, if any, in the payments and Account Values under
the existing Policy and the new policy.
LIMITS ON CONTESTING THIS POLICY
In deciding to issue this Policy, we relied on statements in the application for
the Policy. If we increase the Specified Amount or reinstate the Policy after it
lapses, we rely on statements in a supplemental application or a reinstatement
application. The statements in all such applications are considered
representations and not warranties.
21
We can contest this Policy, an increase in Specified Amount and/or a
reinstatement of this Policy, if:
o any material misrepresentation of fact was made in the application, a
supplemental application or a reinstatement application; and
o a copy of that application was attached to the Policy when issued or
delivered, or was made a part of the Policy when a change in coverage
or Policy reinstatement went into effect.
With respect to the original Specified Amount, we will not contest this Policy
after it has been in effect during the lifetime of at least one of the Insured's
for two years from its Policy Date. We will not contest an increase in Specified
Amount after that increase has been in effect during the lifetime of at least
one of the Insured's for two years from the effective date of the increase. We
will not contest a reinstatement of this Policy after the reinstated Policy has
been in effect during the lifetime of at least one of the Insured's for two
years from the date of reinstatement.
This provision does not apply to riders that provide disability benefits.
MATURITY DATE
On the Maturity Date, your Policy terminates. We will pay you the Account Value,
less any outstanding Policy Debt, in a lump sum or under an Optional Payment
Plan.
MISSTATEMENT OF AGE OR GENDER
If either Insured's Age or gender was misstated in an application, the Death
Benefit will be adjusted. The Death Benefit after adjustment will be the sum of
(a) and (b), where:
(a) is the Account Value at the time of the death of the second Insured to
die; and
(b) is the unadjusted Death Benefit, reduced by the Account Value at the
time of the death of the second Insured to die, and multiplied by the
ratio of (1) the most recent monthly deduction based on each Age and
gender shown in the application, to (2) the most recent monthly
deduction based on each true Age or gender.
All amounts are those in effect, with respect to each Insured, in the Policy
Month of the death of the second Insured to die.
In no event will the Death Benefit be less than the amount required to keep the
Policy qualified as life insurance.
NONPARTICIPATING
This is not a participating policy. No dividends are payable.
THE POLICY AND ITS PARTS
The Policy with any attached application(s), and any riders and endorsements is
a legal contract. It is the entire contract between you and us. An agent cannot
change this contract. Any change to it must be in writing and approved by us.
Only an authorized officer of the Company can give our approval.
We will not use any statement in the original application to deny a claim unless
a copy of that application was attached to this Policy when issued or delivered.
We will not use any statement in a supplemental application to deny a claim
unless a copy of that application was sent to you when the change in coverage
went into effect. We will not use any statement in a reinstatement application
to deny a claim unless a copy of the reinstatement application was sent to you
when the Policy was reinstated.
SUICIDE
If either Insured commits suicide within two years of the Policy Date, all
coverage under the Policy will end, and we will pay a limited amount of
proceeds. The limited amount of proceeds will equal all premiums paid on the
Policy, less Policy Debt and partial surrenders. We will also provide a single
life policy to the surviving Insured. The single life policy will have the same
Policy Date as this Policy. The rating class of the single life policy will be
the rating class of the surviving Insured under this Policy. We may require
increased premiums under the single life policy. The policy or policies we offer
will be one offered by us or by an affiliate.
If the first Insured to die commits suicide more than two years after the Policy
Date and within two years after an increase in the Specified Amount became
effective, the Specified Amount will be reduced to the amount in effect prior to
the increase. Monthly deductions that were made with respect to the increase
will be refunded in a lump sum to the Owner.
If the second Insured to die commits suicide more than two years after the
Policy Date and within two years after an increase in the Specified Amount
became effective, the Specified Amount will be reduced to the amount in effect
prior to the increase. The amount payable with respect to the increase will
equal the monthly deductions that were made for that increase. The amount
payable will be treated as Death Proceeds and paid to the Beneficiary under the
same conditions as the original Specified Amount.
Any limited amount payable will be treated as Death Proceeds and paid to the
Beneficiary under the same conditions as the original Specified Amount.
WRITTEN NOTICE
Any written notice to us should be sent to our Home Office at ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇,
▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇ ▇▇▇▇, ▇▇▇ ▇▇▇▇ ▇▇▇▇▇-▇▇▇▇. Please include the policy number and
each Insured's full name.
Any notice we send to you will be sent to your address shown in the application.
Notify us of any change of address.
OPTIONAL PAYMENT PLANS
Death Proceeds, Surrender Value proceeds or benefits at maturity will be paid in
one lump sum, unless requested otherwise. Any part of the proceeds can be left
with us and paid under a payment plan. During either Insured's life, you can
choose a plan. A Beneficiary can choose a plan if you have not chosen one at the
death of the second Insured to die.
There are several important payment plan rules:
o The payee under a plan cannot be a corporation, association or fiduciary.
o If you change a Beneficiary, your plan selection will no longer be in
effect unless you request that it continue.
o Any choice or change of a plan must be sent in writing to our Home
Office.
o The amount of each payment under a plan must be at least $50.
o Payments will begin either on the date of death of the second Insured to
die, on surrender, or on the Maturity Date, except for payments under
Plan 4 which begin at the end of the first interest period.
o Payments are backed by assets in our General Account.
o The guaranteed amount payable under Plan 2 and Plan 5 is calculated using
the 1983 Table 'a' with improvement scale G (age nearest birthday), and
will earn interest at 3% compounded yearly.
23
PLAN 1. INCOME FOR A FIXED PERIOD. We will make equal periodic payments for a
fixed period, not longer than 30 years. Payments can be annual, semi-annual,
quarterly or monthly. Payments will be made according to the table in this
section. Guaranteed amounts payable under this plan will earn interest at 3%
compounded yearly. We may increase the interest and the amount of any payment.
If the payee dies, the amount of the remaining guaranteed payments will be
DISCOUNTED to the date of the payee's death at a yearly rate of 3%. DISCOUNTED
means we will deduct the amount of interest each remaining payment would have
included had it not been paid out early. The discounted amount will be paid in
one sum to the payee's estate unless otherwise provided.
PLAN 2. LIFE INCOME. We will make equal monthly payments for a guaranteed
minimum period. If the payee lives longer than the minimum period, payments will
continue for his or her life. The minimum period can be 10, 15 or 20 years.
Payments will be according to the table in this section. Guaranteed amounts
payable under this plan will earn interest at 3% compounded yearly. We may
increase the interest rate and the amount of any payment. If the payee dies
before the end of the guaranteed period, the amount of remaining payments for
the minimum period will be discounted at the same interest rate used to
calculate the monthly income. The discounted amounts will be paid in one sum to
the payee's estate unless otherwise provided.
PLAN 3. INCOME OF A DEFINITE AMOUNT. We will make equal periodic payments of a
definite amount. Payments can be annual, semi-annual, quarterly or monthly. The
amount paid each year must be at least $120 for each $1,000 of proceeds.
Payments will continue until the proceeds are exhausted. The last payment will
equal the amount of any unpaid proceeds. Unpaid proceeds will earn interest at
3% compounded yearly. We may increase the interest rate. If we do, the payment
period will be extended. If the payee dies, the amount of the remaining proceeds
with earned interest will be paid in one sum to his or her estate unless
otherwise provided.
PLAN 4. INTEREST INCOME. We will make periodic payments of interest earned from
the proceeds left with us. Payments can be annual, semi-annual, quarterly or
monthly, and will begin at the end of the first period chosen. Proceeds left
under this plan will earn interest at 3% compounded yearly. We may increase the
interest rate and the amount of any payment. If the payee dies, the amount of
remaining proceeds and any earned but unpaid interest will be paid in one sum to
his or her estate unless otherwise provided.
PLAN 5. JOINT LIFE AND SURVIVOR INCOME. We will make equal monthly payments to
two payees for a guaranteed minimum of 10 years. Each payee must be at least 35
years old when payments begin. The guaranteed amount payable under this plan
will earn interest at 3% compounded yearly. We may increase the interest rate
and the amount of any payment. Payments will continue as long as either payee is
living. If both payees die before the end of the minimum period, the amount of
the remaining payments for the 10 year period will be discounted at the same
interest rate used to calculate the monthly income. The discounted amount will
be paid in one sum to the survivor's estate unless otherwise provided.
PLAN 1 TABLE: Monthly payment rates for each $1,000 of proceeds under Plan 1.
Years
Payable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
------------------------------------------------------------------------------------------------------------------------------------
Monthly
Payment $84.47 $42.86 $28.99 $22.06 $17.91 $15.14 $13.16 $11.68 $10.53 $9.61 $8.86 $8.24 $7.71 $7.26 $6.87
====================================================================================================================================
Years
Payable 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
------------------------------------------------------------------------------------------------------------------------------------
Monthly
Payment $6.53 $6.23 $5.96 $5.73 $5.51 $5.32 $5.15 $4.99 $4.84 $4.71 $4.59 $4.47 $4.37 $4.27 $4.18
------------------------------------------------------------------------------------------------------------------------------------
Annual, semi-annual or quarterly payments are determined by multiplyinq the
monthly payment by 11.838, 5.963 or 2.992, respectively.
PLAN 2 TABLE: Monthly payment rates for each $1,000 of proceeds under Plan 2.
Settlement Settlement
Age Male Payee Female Payee Age Male Payee Female Payee
-------------------- ------------------- --------------------- ----------------------
lO Years 15 Years 20 Years 10 Years 15 Years 20 Years 10 Years 15 Years 20 Years 10 Years 15 Years 20 Years
Certain Certain Certain Certain Certain Certain Certain Certain Certain Certain Certain Certain
------------------------------------------------------------------------------------------------------------------------------------
20 $2.90 $2.89 $2.89 $2.80 $2.80 $2.80 65 $5.44 $5.17 $4.83 $4.85 $4.72 $4.54
25 2.99 2.98 2.98 2.88 2.87 2.87 66 5.58 5.28 4.89 4.97 4.83 4.62
30 3.10 3.10 3.09 2.96 2.96 2.96 67 5.74 5.38 4.96 5.10 4.93 4.69
35 3.24 3.24 3.23 3.08 3.07 3.07 68 5.89 5.49 5.02 5.24 5.04 4.77
40 3.43 3.41 3.39 3.22 3.21 3.20 69 6.05 5.60 5.08 5.39 5.16 4.84
45 3.66 3.64 3.60 3.40 3.39 3.37 70 6.22 5.70 5.13 5.55 5 28 4.92
50 3.95 3.91 3.85 3.63 3.61 3.59 71 6.39 5.81 5.18 5.71 5 39 4.99
51 4 02 3.97 3.91 3.68 3.66 3.63 72 6.57 5.91 5.23 5.88 5.51 5.05
52 4.09 4.04 3.96 3.74 3.72 3.68 73 6.75 6.01 5.27 6.06 5.63 5.12
53 4.16 4.11 4.02 3.80 3.77 3.74 74 6.93 6.10 5.31 6.25 5.75 5.17
54 4.24 4.18 4.08 3.86 3.83 3.79 75 7.12 6.19 5.35 6.44 5.87 5.22
55 4.32 4.25 4.15 3.93 3.90 3.85 76 7.30 6.28 5.38 6.64 5.98 5.27
56 4.41 4.33 4.21 4.00 3.96 3.91 77 7.49 6.35 5.40 6.85 6.09 5.31
57 4.50 4.41 4.28 4.07 4.03 3.97 78 7.67 6.43 5.42 7.06 6.19 5.35
58 4.60 4.49 4.34 4.15 4.10 4.03 79 7.85 6.49 5.44 7.27 6.28 5.38
59 4.70 4.58 4.41 4.23 4.18 4.10 80 8.02 6.55 5.46 7.48 6.37 5.41
60 4.81 4.67 4.48 4.32 4.26 4.17 81 8.18 6.61 5.47 7.68 6.45 5.43
61 4.92 4.77 4.55 4.42 4.35 4.24 82 8.34 6.65 5.48 7.88 6.52 5.45
62 5.04 4.86 4.62 4.52 4.43 4.31 83 8.49 6.69 5.49 8.08 6.58 5.47
63 5.17 4.96 4.69 4.62 4.53 4.39 84 8.63 6.73 5.50 8.26 6.63 5.48
64 5.30 5.06 4.76 4.73 4.62 4.46 85 8.76 6.76 5.50 8.43 6.68 5.49
& over
------------------------------------------------------------------------------------------------------------------------------------
Values for ages not shown wi11 be furnished upon request.
PLAN 5 TABLE: Monthly payment rates for each $1000 of proceeds under Plan 5.
Male Settlement Female Settlement Age
---------------------------------------------------------------------------------------------
Age 35 40 45 50 55 60 65 70 75 80 85&over
--------------------------------------------------------------------------------------------------------------
35 $2.95 $3.00 $3.06 $3.11 $3.15 $3.18 $3.20 $3.22 $3.23 $3.24 $3.24
40 2.98 3.06 3.13 3.20 3.26 3.31 3.35 3.38 3.40 3.41 3.42
45 3.01 3.10 3.20 3.30 3.39 3.46 3.53 3.58 3.61 3.64 3.65
50 3.03 3.14 3.25 3.38 3.51 3.63 3.73 3.81 3.87 3.91 3.93
55 3.04 3.16 3.30 3.45 3.62 3.79 3.94 4.08 4.18 4.25 4.29
60 3.05 3.18 3.33 3.51 3.72 3.94 4.16 4.37 4.55 4.67 4.75
65 3.06 3.19 3.36 3.56 3.79 4.07 4.37 4.68 4.96 5.18 5.32
70 3.07 3.20 3.37 3.59 3.85 4.17 4.55 4.97 5.39 5.75 6.00
75 3.07 3.21 3.38 3.61 3.89 4.24 4.68 5.20 5.78 6.32 6.73
80 3.07 3.21 3.39 3.62 3.91 4.28 4.76 5.37 6.08 6.81 7.40
85&over 3.07 3.22 3.39 3.62 3.92 4.31 4.81 5.47 6.28 7.15 7.91
--------------------------------------------------------------------------------------------------------------
Figures for intermediate ages, for two males or two females will be furnished
upon request.
SETTLEMENT AGE: The settlement age is the payee's age nearest birthday on the
date payments begin, minus an age adjustment from the table below. The age
adjustment cannot exceed the age of the payee.
----------------------------------------------------
Year Payments Begin Age
After Prior To Adjustment
----------------------------------------------------
---- 2001 0
2000 2026 3
2025 2051 7
2050 ---- 10
----------------------------------------------------
FLEXIBLE PREMIUM VARIABLE
JOINT AND LAST SURVIVOR
LIFE INSURANCE POLICY
--------------------------------------------------------------------------------
o Death Proceeds payable at death of last joint Insured to die prior to
Maturity Date
o No benefit payable at the death of the first Insured to die
o Adjustable Death Benefit
o Flexible premiums payable until death of last joint Insured to die or
until maturity
o Some benefits reflect investment results
o Non-participating
--------------------------------------------------------------------------------
GE CAPITAL LIFE ASSURANCE
COMPANY OF NEW YORK