[LOGO]
Little Rock, Arkansas
A stock life insurance company
FIRST VARIABLE LIFE INSURANCE COMPANY (the "Company") will make Annuity Payments
to the Annuitant, unless directed otherwise by the Owner, starting on the
Annuity Date, subject to the terms of this Contract.
This Contract is issued in return for the payment of the initial Purchase
Payment.
TEN DAY FREE LOOK--Within 10 days of the date of receipt of this Contract by the
Owner, it may be returned by delivering or mailing it to the Company at its
Variable Service Center or to the agent through whom it was purchased. When
this Contract is received by the Company, it will be voided as if it had never
been in force. The Company will refund the Contract Value computed at the end
of the Valuation Period during which this Contract is received by the Company at
its Variable Service Center.
/s/ ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ /s/ ▇▇▇▇ ▇. ▇▇▇▇▇▇
▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ ▇▇▇▇ ▇. ▇▇▇▇▇▇
Secretary President
First Variable Life Insurance Company
Little Rock, Arkansas
ANNUITY PAYMENTS, WITHDRAWAL VALUES AND THE DEATH BENEFITS PROVIDED BY THIS
CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, ARE
VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT.
THE VARIABLE PROVISIONS OF THIS CONTRACT CAN BE FOUND ON PAGES 10 AND 14.
INDIVIDUAL DEFERRED VARIABLE ANNUITY CONTRACT WITH
FLEXIBLE PURCHASE PAYMENTS - NON-PARTICIPATING
48
TABLE OF CONTENTS
Page
----
CONTRACT DATA PAGE........................................................CD-1
DEFINITIONS..................................................................1
INVESTMENT OPTIONS...........................................................2
The Separate Account and the Sub-Accounts....................................2
Sub-Account Investment Options...............................................2
Fixed Account Option.........................................................2
TRANSFERS....................................................................2
Transfers Among Investment Options...........................................2
General Requirements for Transfers...........................................3
Automatic Transfer of Small Accounts.........................................3
CHARGES AND DEDUCTIONS.......................................................3
Administrative Charge........................................................3
Annual Contract Maintenance Charge...........................................3
Mortality and Expense Risk Charge............................................3
Separate Account Management Fee..............................................4
Taxes........................................................................4
Transfer Fee.................................................................4
Withdrawal Charge............................................................4
GENERAL PROVISIONS...........................................................4
The Contract.................................................................4
Incontestability.............................................................4
Modification.................................................................5
Ownership....................................................................4
Change of Designations.......................................................4
Non-Participating............................................................5
Protection of Proceeds.......................................................5
Transfer by the Company......................................................5
PURCHASE PAYMENTS............................................................5
General......................................................................5
Conversion to Accumulation Units.............................................5
Delayed Investment Start Date................................................5
CONTRACT VALUE...............................................................6
General......................................................................6
Accumulation Unit Value......................................................6
Fixed Account Value..........................................................6
Minimum Value Required After Partial Withdrawal..............................6
Minimum Value Required If Subsequent Purchase Payments Not Made..............6
Minimum Value Required In Any Investment Option..............................7
Purchase Payment Credits.....................................................7
Reports......................................................................7
DEATH BENEFITS...............................................................7
Death of Annuitant...........................................................8
Death of Owner...............................................................7
Payment of Owner's Death Benefit.............................................7
Owners Other than a Single Person............................................8
Beneficiary Other than a Single Person.......................................8
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TABLE OF CONTENTS (continued)
WITHDRAWALS..................................................................8
General......................................................................8
Withdrawal Charge............................................................9
Partial Withdrawals.........................................................10
Free Withdrawal Amount.......................................................9
Suspension or Deferral of Payments...........................................9
ANNUITY PROVISIONS...........................................................9
Annuity Date.................................................................9
Annuity Payments............................................................10
Variable Annuity Payments...................................................10
Fixed Annuity Payments......................................................12
Annuity Options.............................................................12
Mortality Tables............................................................11
Misstatement of Age or Sex..................................................11
Supplementary Agreement.....................................................13
Evidence of Survival........................................................13
Proof of Age................................................................12
ANNUITY OPTION TABLES.......................................................13
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CONTRACT DATA PAGE
CAPITAL BONUS VA
ANNUITANT: [▇▇▇▇ ▇▇▇] AGE AT ISSUE: [50]
OWNER: [▇▇▇▇ ▇▇▇] AGE AT ISSUE: [50]
BENEFICIARY: [as shown in
application]
CONTRACT NUMBER: 8700-96] ISSUE DATE: [1/1/96]
ANNUITY DATE: 1/1/2015] PURCHASE PAYMENT CREDIT: [3% or more of
Premium Payment]
ANNUITIZATION BONUS: [3% of Contract
Value on Annuity
Date]
SEPARATE ACCOUNT: [First Variable FIXED ACCOUNT:
Annuity Fund E] Minimum Guaranteed Interest Rate: [3.0%]
Current Interest Rate on Issue Date: [5.5%]
Duration of Current Interest Rate: [First Contract Year]
INVESTMENT OPTIONS:
[Pilgrim ▇▇▇▇▇▇ Small Cap Growth] [MFS Growth with Income]
[MFS New Discovery] [SSgA Matrix Equity]
[Bankers Trust Small Cap Index] [Bankers Trust Equity 500 Index]
[▇▇▇▇▇▇▇▇▇ International] [Lord ▇▇▇▇▇▇ Growth & Income]
[Evergreen World Equity] [Warburg Pincus Growth & Income]
[AIM Capital Appreciation] [Value Line Multiple Strategies]
[American Century Value] [Federated High Income Bond]
[MFS Growth] [Strong U.S. Government Bond]
[AIM Growth] [Federated Money Fund]
[Value Line Growth]
DELAYED INVESTMENT START DATE: [Not Applicable]
DELAYED INVESTMENT START SUB-ACCOUNT: [Not Applicable]
PURCHASE PAYMENTS:
INITIAL PURCHASE PAYMENT: [$5,000]
MINIMUM SUBSEQUENT PURCHASE PAYMENT: [$200]
MAXIMUM CUMULATIVE PURCHASE PAYMENTS: [$5 Million]
ADMINISTRATIVE CHARGE:
[Daily charge on net assets in each Sub-Account equal to an annual rate of .15%]
ANNUAL CONTRACT MAINTENANCE CHARGE:
[$30.00 each Contract Year during the Accumulation Period, if Contract Value is less than $100,000]
[No Annual Contract Maintenance Charge during the Annuity Period]
MORTALITY AND EXPENSE RISK CHARGE:
[Daily charge on net assets in each Sub-Account equal to an annual rate of 1.25%]
50
CONTRACT DATA PAGE
CAPITAL BONUS VA
(Continued)
CHARGE FOR RIDERS:
[BEST ANNIVERSARY VALUE DEATH BENEFIT Annual charge of .15% of Contract Value
on each Contract Anniversary prior to
the Annuity Date; on the Annuity Date;
and upon surrender
[EXTRA PROTECTOR DEATH BENEFIT] Annual charge of .20% of Contract Value
on each Contract Anniversary or upon
surrender
SEPARATE ACCOUNT MANAGEMENT FEE: [None]
TRANSFERS:
FREE TRANSFERS:
[12 per year]
TRANSFER FEE: [$10 per transfer if more than 12 transfers in a Contract Year]
MINIMUM CONTRACT VALUE TO BE TRANSFERRED: [$1,000 or the Contract Value in the
selected Investment Option, if less]
RESTRICTIONS ON TRANSFERS FROM THE FIXED ACCOUNT: [Prior to the Annuity Date,
Contract Value to be transferred from the Fixed Account in any Contract
Year may not exceed:
(1) for transfers during the first Contract Year, 25% of Fixed Account Value
on the Issue Date; and
(2) for transfers after the first Contract Year, the greater of: (a) 25% of
Fixed Account Value on the immediately preceding Contract Anniversary; or
(b) 100% of the Fixed Account Value transferred to other Investment Options
during the immediately preceding Contract Year.
No transfers of Contract Value are permitted from the Fixed Account to other
Investment Options during the Annuity Period.]
MINIMUM CONTRACT VALUE TO REMAIN IN INVESTMENT OPTION AFTER TRANSFER: [None]
VARIABLE SERVICE CENTER: [The Variable Service Center on the Issue Date is
located at P.O. Box 1317, Des Moines, IA 50305-1317]
WITHDRAWALS:
WITHDRAWAL CHARGE EVENT: [The Company may impose a Withdrawal Charge:
(1) Upon withdrawal or surrender of Contract Value during the first nine (9)
years a premium is in the Contract; and
(2) On the Annuity Date, if the Annuity Date is within the first two (2)
Contract Years.
No Withdrawal Charge is imposed on Death Benefits payable if an Owner dies
before the Annuity Date.]
DURATION OF WITHDRAWAL CHARGE: [The Withdrawal Charge Duration begins on the
date a purchase payment is placed in the Contract and ends after such premium
payment is in the Contract ten (10) years.]
WITHDRAWAL CHARGE PERCENTAGES:
[(as Percentage of Purchase Payment)]
[Years Since Premium Payment 1 or less 2 3 4 5 6 7 8 9 10+
[Withdrawal Charge Percentage 8.5% 8.5% 8.5% 7.5% 6.5% 5.5% 4.5% 3% 2% 0%
MINIMUM PARTIAL WITHDRAWAL: [$1,000, if less, the Owner's entire Interest ]
FREE WITHDRAWAL AMOUNT ON PARTIAL WITHDRAWALS: [15% of Purchase Payments]
WITHDRAWAL VALUE REQUIRED TO REMAIN IN CONTRACT AFTER PARTIAL WITHDRAWAL:
[$1,000]
51
WAIVER OF WITHDRAWAL CHARGE [As specified in Nursing Home and Terminal Illness -
Waiver Endorsement] ANNUITY UNIT VALUE: Assumed Interest Rate [3% per annum]
52
DEFINITIONS
ACCUMULATION PERIOD: The period during which Purchase Payments may be made
prior to the Annuity Date.
ACCUMULATION UNIT: A unit of measure used to calculate the Contract Value in a
Sub-Account of the Separate Account prior to the Annuity Date.
ACCUMULATION UNIT VALUE: The value of an Accumulation Unit on a Business Day.
AGE: The attained age on the date for which age is being determined for the
Annuitant or Owner, as applicable.
ANNUITANT: The natural person on whose life Annuity Payments are based.
ANNUITY DATE: The date on which Annuity Payments begin. The Annuity Date is
shown on the Contract Data Page.
ANNUITY PAYMENTS: The series of payments made to the Annuitant or other payee
selected by the Owner after the Annuity Date under the Annuity Option selected.
ANNUITY PERIOD: The period after the Annuity Date during which Annuity Payments
are made.
ANNUITY UNIT: A unit of measure used to calculate Variable Annuity Payments
after the Annuity Date.
ANNUITY UNIT VALUE: The value of an Annuity Unit on a Business Day.
BENEFICIARY: The person, persons or entity who will receive the death benefit.
The Beneficiary is stated on the Contract Data Page for this Contract, unless
changed in accordance with the Contract provisions.
BUSINESS DAY: Each day that the New York Stock Exchange is open for trading,
which is Monday through Friday, except for normal business holidays.
COMPANY: First Variable Life Insurance Company.
CONTRACT ANNIVERSARY: An anniversary of the Issue Date.
CONTRACT VALUE: The sum of the Owner's interest in the Sub-Accounts of the
Separate Account and in the Fixed Account.
CONTRACT YEAR: One year from the Issue Date and from each Contract Anniversary.
FIXED ACCOUNT: The Company's general investment account which contains all the
assets of the Company with the exception of the Separate Account and other
segregated asset accounts.
FIXED ACCOUNT VALUE: The Owner's interest in the Fixed Account during the
Accumulation Period.
FIXED ANNUITY PAYMENTS: A series of payments made during the Annuity Period
which are guaranteed as to dollar amount by the Company.
INVESTMENT OPTION: The Fixed Account or any of the Sub-Accounts of the Separate
Account which can be selected under this Contract.
ISSUE DATE: The date on which this Contract became effective. The Issue Date
is shown on the Contract Data Page.
OWNER: The person, persons or entity entitled to all the ownership rights under
this Contract. The Owner is stated on the Contract Data Page for this Contract,
unless changed in accordance with the Contract provisions.
PORTFOLIO: A separate and distinct class of shares that is available as an
underlying investment of a Sub-Account. As of the Issue Date, each Sub-Account
invests exclusively in a Portfolio stated on the Contract Data Pages.
PURCHASE PAYMENT: An amount paid to the Company to provide benefits under this
Contract.
SEPARATE ACCOUNT: A separate investment account of the Company designated on
the Contract Data Page.
SUB-ACCOUNT: A segment of the Separate Account.
VALUATION PERIOD: The period of time between the close of one Business Day and
the close of business for the next succeeding Business Day.
VARIABLE ACCOUNT VALUE: The Owner's interest in the Sub-Accounts of the Separate
Account during the Accumulation Period.
VARIABLE ANNUITY PAYMENTS: A series of payments made during the Annuity Period
which vary in amount with the investment experience of each applicable Sub-
Account.
1
VARIABLE SERVICE CENTER: The Company's administrative service center for this
Contract. The mailing address for the Variable Service Center on the Issue Date
is shown on the Contract Data Pages.
Other terms are defined in the Contract.
INVESTMENT OPTIONS
THE SEPARATE ACCOUNT AND THE SUB-ACCOUNTS
The Separate Account is a separate investment account of the Company. It is
shown on the Contract Data Page. The Company has allocated a part of its assets
for this and certain other contracts to the Separate Account. The assets of the
Separate Account are the property of the Company. The Company guarantees that
the portion of the Separate Account assets equal to the Company's reserves and
other contract liabilities shall not be chargeable with the liabilities arising
out of any other business the Company may conduct.
Assets of the Separate Account are valued at their fair market value in
accordance with procedures of the Company. The Separate Account is segmented
into Sub-Accounts. Each Sub-Account available under this Contract on the Issue
Date invests its assets exclusively in shares of one of the Portfolios shown on
the Contract Data Page.
SUB-ACCOUNT INVESTMENT OPTIONS
The Owner may allocate Purchase Payments to one or more of the Sub-Accounts that
correspond to the Portfolios shown on the Contract Data Page. The Company may,
from time to time, invest Separate Account assets in additional mutual funds,
portfolios of mutual funds, or other investment vehicles. The Owner may be
permitted to transfer Contract Value or allocate Purchase Payments to these
additional Separate Account investments. However, the right to make any
transfer will be limited by the terms and conditions imposed by the Company.
If the shares of any Portfolio, or of any other Separate Account investment,
become unavailable for investment by the Separate Account, or if the Company's
Board of Directors deems further investment in these shares inappropriate, the
Company may limit further purchase of these shares or may substitute shares of
another Portfolio or other investment vehicle for shares already purchased under
this Contract.
FIXED ACCOUNT OPTION
The Owner may allocate Purchase Payments to the Fixed Account. Interest will be
credited to amounts allocated to the Fixed Account as described in the "Contract
Value - Fixed Account Value" provision of this Contract.
TRANSFERS
TRANSFERS AMONG INVESTMENT OPTIONS
During the Accumulation Period, the Owner may transfer Contract Value among
Investment Options without the imposition of any fee or charge if there have
been no more than the number of free transfers shown on the Contract Data Page
for the Contract Year. No transfers are permitted, however, until the end of a
Delayed Investment Start Date, if any, shown on the Contract Data Page. The
amount of Contract Value which may be transferred from the Fixed Account to
other Investment Options will be subject, without limitation, to the specific
restrictions, if any, shown on the Contract Data Page.
During the Annuity Period, the Owner may make a transfer from one or more Sub-
Accounts to other Investment Options only once each Contract Year, and no
transfers of Contract Value are permitted from the Fixed Account to the Separate
Account. The amount transferred to the Fixed Account from a Sub-Account of the
Separate Account will be equal to the annuity reserves for the Owner's interest
in that Sub-Account. The annuity reserve is the product of (a) multiplied by
(b) multiplied by (c), where (a) is the number of Annuity Units representing the
Owner's interest in the Sub-Account per Annuity Payment; (b) is the Annuity
Unit value for the Sub-Account; and (c) is the present value of $1.00 per
payment period as of the Age of the Annuitant at time of transfer for the
Annuity Option, determined using the Mortality Tables used to construct the
Annuity Tables contained in this Contract and the assumed interest rate shown on
the Contract Data Page. Amounts transferred to the Fixed Account will be
applied to the existing Annuity Option, using the Age of the Annuitant at the
time of the transfer.
2
All amounts, Accumulation Unit Values and Annuity Unit Values will be determined
as of the end of the Valuation Period during which a transfer request was
received by the Company of its Variable Service Center.
GENERAL REQUIREMENTS FOR TRANSFERS
If more than the permitted number of free transfers have been made in the
Contract Year, the Company will deduct the Transfer Fee shown on the Contract
Data Page for each subsequent transfer. The Transfer Fee will be deducted from
the Owner's interest in the Investment Option from which the transfer is made.
However, if the Owner's entire interest in an Investment Option is being
transferred, the Transfer Fee will be deducted from the amount which is
transferred.
The minimum amount of Contract Value which can be transferred is shown on the
Contract Data Page. The minimum amount of Contract Value, if any, which must
remain in an Investment Option after a transfer from it is shown on the Contract
Data Page.
Any transfer instruction must be in form satisfactory to the Company, and
received by the Company at its Variable Service Center. Without limitation, any
such instruction must clearly specify the amount which is to be transferred and
the Investment Options which are to be affected. The Company will not be liable
for transfers made in accordance with instructions by, or on behalf of, the
Owner.
The Company reserves the right, at any time and without prior notice to any
party, to terminate, suspend or modify the transfer privileges described above.
AUTOMATIC TRANSFER OF SMALL ACCOUNTS
The Company reserves the right to the extent permitted by law, on any Business
Day to transfer Contract Value then held in any particular Investment Option in
the event that Contract Value in that Investment Option is less than $250, to
the Investment Option with the then highest Contract Value.
CHARGES AND DEDUCTIONS
ADMINISTRATIVE CHARGE
The Company deducts on each Business Day, both prior to and during the Annuity
Period, an Administrative Charge from the Separate Account which is equal, on an
annual basis, to the amount shown on the Contract Data Page. The Administrative
Charge compensates the Company for the costs associated with the administration
of this Contract and the Separate Account.
ANNUAL CONTRACT MAINTENANCE CHARGE
The Company deducts an Annual Contract Maintenance Charge to reimburse it for
its administrative expenses from the Contract Value for the amount, and during
the period, shown on the Contract Data Page. The charge is deducted by the
Company reducing Fixed Account Value and/or Accumulation Unit Value from each
applicable Investment Option in the ratio that the value that Contract Value in
each applicable Investment Option bears to the total Contract Value.
Accumulation Unit Value is reduced by the Company canceling Accumulation Units
credited to this Contract.
The Annual Contract Maintenance Charge will be deducted from the Contract Value
on each Contract Anniversary while this Contract is in force. If a total
withdrawal (surrender) is made on other than a Contract Anniversary, the Annual
Contract Maintenance Charge will be deducted at the time of withdrawal. If the
Annuity Date is not a Contract Anniversary, the Annual Contract Maintenance
Charge will be deducted on the Annuity Date. After the Annuity Date, the Annual
Contract Maintenance Charge, if any, will be collected on a monthly basis and
will result in a reduction of each Annuity Payment.
MORTALITY AND EXPENSE RISK CHARGE
The Company deducts on each Business Day, both prior to and during the Annuity
Period, a Mortality and Expense Risk Charge from the Separate Account which is
equal, on an annual basis, to the amount shown on the Contract Data Page. The
Mortality and Expense Risk Charge compensates the Company for assuming the
mortality and expense risks under this Contract. The Company guarantees that the
dollar amount of each Annuity Payment after the first Annuity Payment will not
be affected by variations in mortality or expense experience.
3
SEPARATE ACCOUNT MANAGEMENT FEE
Any fee deducted by the Company from the Separate Account for investment
management is shown on the Contract Data Page.
TAXES
Any taxes paid to any governmental entity relating to this Contract will be
deducted from the Purchase Payment or Contract Value when incurred. The Company
will, in its sole discretion, determine when taxes have resulted from: the
investment experience of the Separate Account; receipt by the Company of the
Purchase Payments; or commencement of Annuity Payments. The Company may, at its
sole discretion, pay taxes when due and deduct that amount from the Contract
Value at a later date, or may establish reserves or other appropriate provision
for payment of taxes at a later date. Payment at an earlier date does not waive
any right the Company may have to deduct amounts at a later date. The Company
will deduct any withholding taxes required by applicable law.
TRANSFER FEE
The Transfer Fee applicable to a permitted transfer of Contract Value among
Investment Options is shown on the Contract Data Page.
WITHDRAWAL CHARGE
The Withdrawal Charge, if any, shown on the Contract Data Page may be deducted
in the event of a withdrawal of all or a portion of the Contract Value. It is
described in the Withdrawals provisions of this Contract.
GENERAL PROVISIONS
THE CONTRACT
The entire contract consists of this Contract and any riders or endorsements
attached to this Contract.
This Contract may be changed or altered only by the President or Vice President
and the Secretary of the Company. A change or alteration must be made in
writing.
INCONTESTABILITY
The Contract will not be contestable after it has been in force for a period of
two years from the Issue Date.
MODIFICATION
This Contract may be modified in order to maintain compliance with applicable
state and federal law.
OWNERSHIP
The Owner has all rights and may receive all benefits under this Contract. The
Owner is the person shown on the Contract Data Page, unless changed prior to the
Annuity Date. Upon the death of the Owner, the Beneficiary will have all the
rights and may receive all benefits under this Contract.
Assignment: The Owner may, at any time during his or her lifetime, assign his or
her rights under this Contract. The Company will not be bound by any assignment
until written notice is received by the Company at its Variable Service Center.
The Company is not responsible for the validity or tax consequences of any
assignment. The Company will not be liable as to any payment or other settlement
made by the Company before receipt of the assignment.
CHANGE OF DESIGNATIONS
A request to change the designated Owner, Annuitant or Beneficiary must be made
in writing and received by the Company at its Variable Service Center. The
change will become effective as of the date the written request is signed. A new
designation will not apply to any payment made or action taken by the Company
prior to the time it records the change, and the Company shall be released from
any further liability with respect to any such payment made or action taken.
Owner. The Owner may change the Owner at any time prior to the Annuity Date. A
change of Owner will automatically revoke any prior designation of Owner.
4
Annuitant. The Owner may change the Annuitant at any time prior to the Annuity
Date, but not if the Contract is owned by a non-natural person. Any change of
Annuitant is subject to the Company's underwriting rules then in effect. The
Owner may automatically become the Annuitant if a new Annuitant is not
designated within thirty (30) days of the death of the Annuitant prior to the
Annuity Date, as stated in the Death Benefit provisions of this Contract. A
permitted change of Annuitant will automatically revoke any prior designation of
Annuitant.
Beneficiary: Subject to the rights of any irrevocable Beneficiary(ies), the
Owner may change the primary Beneficiary(ies) or contingent Beneficiary(ies). A
permitted change of Beneficiary will automatically revoke any prior designation
of Beneficiary.
NON-PARTICIPATING
This Contract will not share in any distribution of dividends.
PROTECTION OF PROCEEDS
To the extent permitted by law, Death Benefits and Annuity Payments shall be
free from legal process and the claim of any creditor if the person is entitled
to them under this Contract. No payment and no amount under this Contract can be
taken or assigned in advance of its payment date unless the Company receives the
Owner's written consent.
TRANSFER BY THE COMPANY
The Company reserves the right to transfer its obligations hereunder to another
qualified life insurance company under an assumption reinsurance arrangement
without the prior consent of the Owner.
PURCHASE PAYMENTS
GENERAL
The initial Purchase Payment as shown on the Contract Data Page is due on the
Issue Date. The Owner may make subsequent Purchase Payments prior to the Annuity
Date and may increase or decrease or change the frequency of such payments.
Purchase Payments are, however, subject to the Minimum Subsequent Purchase
Payment amount and the Maximum Cumulative Purchase Payment amount shown on the
Contract Data Page (unless otherwise approved by the Company). The Company
reserves the right to reject any Purchase Payment.
CONVERSION TO ACCUMULATION UNITS
Each Purchase Payment is allocated to the Fixed Account and/or one or more Sub-
Accounts of the Separate Account. A Purchase Payment allocated to a Sub-Account
of the Separate Account is converted into Accumulation Units. The number of
Accumulation Units in a Sub-Account credited to this Contract is determined by
dividing the Purchase Payment allocated to that Sub-Account by the dollar value
of the Accumulation Unit Value for that Sub-Account as of the end of the
Valuation Period during which that Purchase Payment is received by the Company
at its Variable Service Center. Except as described in the Delayed Investment
Start Date provision below, the allocation of the initial Purchase Payment is
made in accordance with the selection made by the Owner. Unless otherwise
changed by the Owner, subsequent Purchase Payments are allocated in the same
manner as the initial Purchase Payment. Allocation of the Purchase Payments is
subject to the terms and conditions imposed by the Company.
DELAYED INVESTMENT START DATE
If a Delayed Investment Start Date is shown on the Contract Data Page, the
initial Purchase Payments for this Contract will be allocated to the Delayed
Investment Start Sub-Account shown on the Contract Data Page in lieu of
allocation to any other Sub-Account Investment Option. Contract Value will be
transferred from the Delayed Investment Start Sub-Account on the Business Day
immediately following the Delayed Investment Start Date to any other Sub-Account
Investment Option in accordance with the initial instructions of the Owner.
The allocation of Purchase Payments to the Fixed Account is not affected by a
Delayed Investment Start Date. Purchase Payments received after a Delayed
Investment Start Date will be allocated to any Investment Option then available
under this Contract in accordance with the Owner's direction.
5
CONTRACT VALUE
GENERAL
The Contract Value on any Business Day is the sum of the Owner's interest in the
Sub-Accounts of the Separate Account and in the Fixed Account. The value of the
Owner's interest in a Sub-Account is determined by multiplying the number of
Accumulation Units attributable to that Sub-Account by the Accumulation Unit
Value for that Sub-Account.
ACCUMULATION UNIT VALUE
The number of Accumulation Units in a Sub-Account credited to this Contract is
determined by dividing the amount to be allocated to or deducted from that Sub-
Account by the Accumulation Unit Value for that Sub-Account as of the end of the
Valuation Period during which the request for the transaction was received by
the Company at its Variable Service. The Accumulation Unit Value for each Sub-
Account was arbitrarily set initially at $10. Subsequent Accumulation Unit
Values are determined by subtracting (2) from (1) and dividing the result by (3)
where:
(1) is the net result of:
a. the assets of the Sub-Account attributable to Accumulation Units; plus or
minus
b. the cumulative charge or credit for taxes reserved which is determined by
the Company to have resulted from the operation or maintenance of
that Sub-Account.
(2) is the cumulative unpaid charge for the Mortality and Expense Risk Charge
and for the Administrative Charge, which are shown on the Contract
Data Page; and
(3) is the number of Accumulation Units outstanding at the end of the
Valuation Period.
The Accumulation Unit Value may increase or decrease from Valuation Period to
Valuation Period.
FIXED ACCOUNT VALUE
The Company guarantees that it will credit interest to Contract Value in the
Fixed Account at a rate not less than the Minimum Guaranteed Interest Rate shown
on the Contract Data Page. Additional amounts of interest may be credited by the
Company from time to time in its sole discretion. The Current Interest Rate
credited on the Issue Date, which includes the minimum guaranteed interest rate,
is shown on the Contract Data Page. It is guaranteed for the first Contract Year
by the Company, unless a greater period is shown on the Contract Data Page.
New Purchase Payments allocated to the Fixed Account may be credited with
interest at a different rate than the interest rate credited to Contract Value
transferred from the Separate Account to the Fixed Account. Contract Value
existing in the Fixed Account may be credited with interest at a different rate
than the interest rate(s) applied to new Purchase Payment allocations and
Separate Account transfers. The Company determines interest rates in advance,
and credits interest daily to Fixed Account Value in dollars.
MINIMUM VALUE REQUIRED AFTER PARTIAL WITHDRAWAL
The Company may deem a Contract surrendered if it receives a request to withdraw
Contract Value that would cause the remaining Withdrawal Value to be less than
the amount required to remain in the Contract after a partial withdrawal. The
Withdrawal Value required to remain in the Contract after a partial withdrawal
is shown on the Contract Data Page. The Company reserves the right to terminate
the Contract in such event and pay all Withdrawal Value to the Owner. The
Company will send a notice to the Owner at his or her last known address at
least thirty (30) days in advance of any such termination. This Contract will
remain in force during such thirty (30) day period. The Owner may make
additional Purchase Payments during the thirty (30) day period to increase
Contract Value above such minimum.
MINIMUM VALUE REQUIRED IF SUBSEQUENT PURCHASE PAYMENTS NOT MADE
The Company reserves the right to terminate a Contract if the Contract Value on
any Business Day falls below $1,000 and no Purchase Payments were received by
the Company during the then current Contract Year and the two (2) immediately
preceding Contract Years. The Company will send a notice to the Owner at his or
her last known address at least thirty (30) days in advance of any such
termination. This Contract will remain in force during such thirty (30) day
period. The Owner may make additional Purchase Payments during the thirty (30)
day period to increase Contract Value above such minimum. If such additional
Purchase Payments are received by the Company in good order during the thirty
(30) day
6
period, the Contract will not be in default for failure to make subsequent
Purchase Payments during the then current Contract Year and the two (2)
immediately preceding Contract Years. This Minimum Value requirement, however,
will continue to apply during the next and each subsequent Contract Year.
MINIMUM VALUE REQUIRED IN ANY INVESTMENT OPTION
The Company reserves the right to the extent permitted by law to transfer
Contract Value from any Investment Option if on any Business Day the Contract
Value in the Investment Option is less than $250. In such event, the Contract
Value will be transferred to the Investment Option with the highest Contract
Value.
PURCHASE PAYMENT CREDITS
The Company will credit your Contract with the Purchase Payment Credit as shown
on the Contract Data Page at the time the Purchase Payment is applied to the
Contract.
The Company allocates any Purchase Payment Credit to the investment options in
the same proportion as the allocation of the Purchase Payment you select. You
will not retain any Purchase Payment Credits applied to your Contract: (1) if
you return your Contract within the free look period; (2) for any Purchase
Payment made within one year of death of an Owner, or Annuitant if the Owner is
a non-natural person; (3) for any Purchase Payment made within one year prior to
a partial or full withdrawal or surrender; or (4) for any Purchase Payment made
within three years prior to the Annuity Date. Gains and losses allocable to the
Purchase Payment Credit shall remain in the Contract.
REPORTS
At least once each calendar year, the Company will furnish the Owner with a
report showing the Contract Value and any other information as may be required
by law. Reports will be sent to the last known address of the Owner.
DEATH BENEFITS
DEATH OF ANNUITANT
Upon the death of the Annuitant prior to the Annuity Date, the Owner may
designate a new Annuitant. If no designation is made within 30 days of the death
of the Annuitant, the Owner will become the Annuitant. If the Owner is a non-
natural person, the death of the Annuitant will be treated as the death of the
Owner and a new Annuitant may not be designated.
Upon the death of the Annuitant after the Annuity Date, the Death Benefit, if
any, will be as specified in the Annuity Option elected.
DEATH OF OWNER
Upon the death of an Owner prior to the Annuity Date, the Death Benefit will be
paid to the Beneficiary designated by the Owner. The Death Benefit will be the
greater of:
1. the Purchase Payments, less the sum of any Withdrawal Value previously
taken; or
2. the Contract Value.
For purposes of determining the Death Benefit, "Withdrawal Value previously
taken" is the sum of the reductions in Contract Value attributable to partial
withdrawals during the Owner's lifetime, including applicable charges.
If the Beneficiary is the spouse of the Owner and elects to continue the
Contract, the Contract Value remains unchanged and no determination of the Death
Benefit is made at that time.
Upon the death of an Owner on or after the Annuity Date, any remaining amounts
payable under the Contract will be distributed at least as rapidly as under the
method of distribution being used as of the date of the Owner's death.
PAYMENT OF OWNER'S DEATH BENEFIT
The Death Benefit will be determined by the Company as of the date of an Owner's
death. The Death Benefit will be paid as of the Valuation Period next following
the date of receipt by the Company of both due proof of death and, if no
election of payment method was previously made by the Owner, an election for the
payment method. In the event of the death of an Owner prior to the Annuity Date,
a Beneficiary may elect to have the Death Benefit paid under one of the
7
following options: (a) as a single lump sum payment; (b) payment of the entire
Death Benefit within five years of the date of the Owner's death or (c) payment
of the Death Benefit under an Annuity Option over the lifetime of the
Beneficiary or over a period not extending beyond the life expectancy of the
Beneficiary with payments commencing within one year of the date of the Owner's
death. Any portion of the Death Benefit not applied under option (c) within one
year of the date of the Owner's death, must be distributed within five years of
the date of such death.
A spousal Beneficiary may elect one of the above options or elect to continue
the Contract in his or her name at the then current Contract Value in lieu of
receiving any Death Benefit. Payment to the Beneficiary other than in a lump
sum, may only be elected during the sixty (60) day period beginning with the
date of receipt of proof of death.\If a single sum payment is requested, the
amount will be paid within seven (7) days of receipt of proof of death and the
election, unless the Suspension or Deferral of Payments provision is in effect.
The Company will require due proof of death before payment of a Death Benefit.
For these purposes, "due proof of death" means:
1. a certified death certificate;
2. a certified decree of a court of competent jurisdiction as to the
finding of death; or
3. any other proof satisfactory to the Company.
All Death Benefits will be paid in accordance with applicable law or regulations
governing death benefit payments.
OWNERS OTHER THAN A SINGLE PERSON
If there are Joint Owners, any references to the death of an Owner shall mean
the first death of an Owner. Any Joint Owner must be the spouse of the other
Owner. Upon the death of either Owner, the surviving Joint Owner will be the
primary Beneficiary.
BENEFICIARY OTHER THAN A SINGLE PERSON
Unless the Owner provides otherwise, the Death Benefit will be paid in equal
shares to the survivor(s) as follows:
1. to the primary Beneficiary(ies) who survive the death of the Owner and/or
Annuitant, as applicable; or if there are none,
2. to the contingent Beneficiary(ies) who survive the death of the Owner
and/or Annuitant, as applicable; or if there are none,
3. to the estate of the Owner.
WITHDRAWALS
GENERAL
Prior to the Annuity Date, the Owner may, upon written request received by the
Company at its Variable Service Center, make a total withdrawal (surrender) or
partial withdrawal of the Withdrawal Value. The Withdrawal Value is:
1. the Contract Value at the end of the Valuation Period during which a
written request for a withdrawal is received at the Company; less
2. any applicable taxes not previously deducted; less
3. the Withdrawal Charge, if any; less
4. the Annual Contract Maintenance Charge, if any; less
5. any applicable riders as shown on the riders, if any.
A withdrawal will result in the cancellation of Accumulation Units from each
applicable Sub-Account or a reduction in Fixed Account Value in the ratio that
the Contract Value in each Investment Option bears to the total Contract Value.
The Owner may request in writing in advance if a different method for canceling
Accumulation Units or reducing Fixed Account Value is desired. The Company
reserves the right to approve or disapprove any such request.
The Company will pay the amount of any withdrawal within seven (7) days of
receipt of a request in good order unless he Suspension or Deferral of Payments
provision is in effect.
8
WITHDRAWAL CHARGE
A Withdrawal Charge may be imposed by the Company if a Withdrawal Charge Event
shown on the Contract Data Page occurs during the Withdrawal Charge Duration
shown on the Contract Data Page
The Withdrawal Charge is determined by the Company applying the Withdrawal
Charge Percentages shown on the Contract Data Page to the Contract Value deemed
by the Company to represent Purchase Payments withdrawn, surrendered or applied
to an Annuity Option. The charge will vary depending on the elapsed period shown
on the Contract Data Page for which a Withdrawal Charge applies. Purchase
Payments are deemed withdrawn in the order in which they are received by the
Company. The amount deducted will result in the cancellation of Accumulation
Units from each applicable Sub-Account or a reduction in Fixed Account Value in
the ratio that the Contract Value in each Investment Option bears to the total
Contract Value. The Owner may request in writing in advance if a different
method for assessing the Withdrawal Charge is desired. The Company reserves the
right to approve or disapprove any such request.
PARTIAL WITHDRAWALS
Each partial withdrawal must be for an amount which is not less than the amount
shown on the Contract Data Page. The remaining Withdrawal Value which must
remain in the Contract after a partial withdrawal, if any, is shown on the
Contract Data Page. If a partial withdrawal is requested that would reduce the
remaining Withdrawal Value for the Contract below that shown on the Contract
Data Page, the Company may deem the request to be a total withdrawal (surrender)
from the Contract. In such event, the Company may pay the then current
Withdrawal Value and terminate the Contract in accordance with the "Minimum
Value Required After Partial Withdrawal" provision of this Contract.
FREE WITHDRAWAL AMOUNT
The Free Withdrawal Amount on Partial Withdrawals applicable to this Contract,
if any, is shown on the Contract Data Page. No Withdrawal Charge will be imposed
on a partial withdrawal unless the amount withdrawn during a Contract Year
exceeds the Free Withdrawal Amount on Partial Withdrawals. Amounts taken as a
Free Withdrawal Amount will be subject to a Withdrawal Charge on a Full or
Partial Surrender. The Withdrawal Charge will apply to any amount withdrawn
during a Contract Year in excess of the Free Withdrawal Amount on Partial
Withdrawals. The unused portion of the Free Withdrawal Amount for one Contract
Year will not carry-over to the next Contract Year. The Free Withdrawal Amount
is not available if a withdrawal request would result in remaining Withdrawal
Value that is less than the Withdrawal Value Required to Remain in Contract
After Partial Withdrawal shown on the Contract Data Page.
SUSPENSION OR DEFERRAL OF PAYMENTS
The Company reserves the right to suspend or postpone payments for a withdrawal
or transfer for any period when:
1. the New York Stock Exchange is closed;
2. trading on the New York Stock Exchange is restricted;
3. an emergency exists as a result of which disposal of securities held in the
Separate Account is not reasonably practicable or it is not reasonably
practicable to determine the value of the Separate Account's net assets; or
4. during any other period when the Securities and Exchange Commission, by
order, so permits for the protection of Owners;
5. provided that applicable rules and regulations of the Securities and
Exchange Commission will govern as to whether the conditions described in 2.
and 3. exist.
The Company reserves the right to defer payment for a withdrawal or transfer
from the Fixed Account for the period permitted by law, but not for more than
six months after written election is received by the Company.
ANNUITY PROVISIONS
ANNUITY DATE
The Owner selects the Annuity Date at the time of the application, and may later
change it by written request to the Company's Variable Service Center at least
thirty (30) days prior to the existing Annuity Date. If an Annuity Date is
selected that would cause a Withdrawal Charge Event to occur, a Withdrawal
Charge will be deducted from Contract Value before the first Annuity Payment is
made. The Annuity Date on the Issue Date is shown on the Contract Data Page.
9
ANNUITY PAYMENTS
Annuity Payments are paid in monthly installments in the form of Fixed Annuity
Payments, Variable Annuity Payments or a combination of Fixed Annuity Payments
and Variable Annuity Payments.
The Owner may select the form of Annuity Payments by written request to the
Company at its Variable Service Center at least seven (7) days prior to the
Annuity Date. If all of the Contract Value on the seventh calendar day before
the Annuity Date is allocated to the Fixed Account, Fixed Annuity Payments will
be made. If all of the Contract Value on that date is allocated to the Separate
Account, Variable Annuity Payments will be made. If the Contract Value on that
date is allocated to both the Fixed Account and the Separate Account, a
combination of Fixed Annuity Payments and Variable Annuity Payments will be made
to reflect the allocation between the Fixed Account Value and the Variable
Account Value.
The payments will be made to the Annuitant, unless a different payee is selected
by the Owner by written request to the Company at its Variable Service Center at
least 30 days prior to the Annuity Date.
The Contract Value on the Annuity Date, as adjusted for any applicable taxes and
charges ("Adjusted Contract Value"), will be applied to the applicable Annuity
Table contained in the Contract based upon the Annuity Option selected by the
Owner. The amount of the first payment for each $1,000 of Adjusted Contract
Value is shown in the Annuity Tables. If, as of the Annuity Date, the current
Annuity Option rates applicable to this class of contracts provide an initial
Annuity Payment greater than that guaranteed under the same Annuity Option under
this Contract, the greater payment will be made.
The total dollar amount of each Annuity Payment is the sum of the Variable
Annuity Payment and the Fixed Annuity Payment. The Company reserves the right to
pay Annuity Payments in one sum when the remaining payments are less than
$2,000, or other minimum amount established by the Company from time to time, or
when the Annuity Option elected would result in periodic payments of less than
$100.
VARIABLE ANNUITY PAYMENTS
The amount of a Variable Annuity Payment is dependent upon (a) the Contract
Value, adjusted for any applicable charges, that is applied to an Annuity
Option; (b) the rates for the Annuity Option selected, as stated in the Annuity
Option Tables; and (c) the investment performance of the selected Sub-Accounts
during the Annuity Period. Variable Annuity Payments are not guaranteed as to
dollar amount.
Calculation. The dollar amount of Variable Annuity Payments for each applicable
Sub-Account after the first Variable Annuity Payment is determined as follows:
1. the dollar amount of the first Variable Annuity Payment is divided by the
value of an Annuity Unit for each applicable Sub-Account as of the Annuity
Date. This sets the number of Annuity Units for each monthly payment for the
applicable Sub-Account. The number of Annuity Units for each applicable Sub-
Account remains fixed during the Annuity Period;
2. the fixed number of Annuity Units per payment in each Sub-Account is
multiplied by the Annuity Unit Value for that Sub-Account for the last
Valuation Period of the month preceding the month for which the payment is
due. This result is the dollar amount of the payment for each applicable
Sub-Account.
The total dollar amount of each Variable Annuity Payment is the sum of all Sub-
Account Variable Annuity Payments.
Annuity Unit: The value of any Annuity Unit for each Sub-Account of the
Separate Account was arbitrarily set initially at $10.
The Sub-Account Annuity Unit Value at the end of any subsequent Valuation Period
is determined by subtracting 2. from 1. and dividing the result by 3. and
multiplying the result by a factor which neutralizes the assumed interest rate
shown on the Contract Data Page, where:
1. is the net result of: (a) the assets of the Sub-Account attributable to the
Annuity Units; plus or minus (b) the cumulative charge or credit for taxes
reserved which is determined by the Company to have resulted from the
operation or maintenance of the Sub-Account;
2. is the cumulative unpaid charge for the Mortality and Expense Risk Charge
and for the Administrative Charge, which are shown on the Contract Data
Page; and
3. is the number of Annuity Units outstanding at the end of the Valuation
Period.
The value of an Annuity Unit may increase or decrease from Valuation Period to
Valuation Period.
10
FIXED ANNUITY PAYMENTS
The dollar amount of each Fixed Annuity Payment shall be determined in
accordance with Annuity Tables contained in this Contract which are based on the
minimum guaranteed interest rate of 3.0% per year. After the initial Fixed
Annuity Payment, the payments will not change regardless of investment,
mortality or expense experience.
ANNUITY OPTIONS
An Annuity Option is selected by the Owner at the time of the application and
may be changed by the Owner by written request at least thirty (30) days prior
to the Annuity Date. If no Annuity Option election is in effect at least thirty
(30) days before the Annuity Date, Option B. Life Annuity with a period certain
of 120 months will automatically be applied
The following Annuity Options or any other Annuity Option acceptable to the
Company may be selected:
OPTION A. LIFE ANNUITY: Monthly Annuity Payments during the life of the
Annuitant.
OPTION B. LIFE ANNUITY WITH PERIODS CERTAIN OF 60,120, 180 OR 240 MONTHS:
Monthly Annuity Payments during the lifetime of the Annuitant and in any event
for sixty (60), one hundred twenty (120), one hundred eighty (180) or two
hundred forty (240) months certain as selected.
OPTION C. JOINT AND SURVIVOR ANNUITY: Monthly Annuity Payments payable during
the joint lifetime of the Annuitant and a designated second person and then
during the lifetime of the survivor at the percentage (100%, 75%, 66 2/3% or
50%) selected.
OPTION D. JOINT AND CONTINGENT ANNUITY: Monthly Annuity Payments during the
Annuitant's lifetime and continuing during the lifetime of a designated second
person after the Annuitant's death at the percentage (100%, 75%, 66 2/3% or 50%)
selected.
OPTION E. FIXED PAYMENTS FOR A PERIOD CERTAIN: Fixed monthly Annuity Payments
for any specified period (at least five years but not exceeding thirty years),
as selected.
Annuity Options A, B, C and D are available for Fixed Annuity Payments, Variable
Annuity Payments or a combination of both. Annuity Option E is available for
Fixed Annuity Payments only. If the Annuitant dies during a period certain
(Annuity Options B or E), the remaining Annuity Payments will be made to the
Beneficiary. The Beneficiary may elect to receive the commuted value of the
remaining Annuity Payments in a single sum instead. The Company will determine
the commuted value by discounting the remaining Annuity Payments at its then
current interest rate used for commutation.
MORTALITY TABLES
The mortality tables used in determining the Annuity Purchase Rates for Options
A, B, C, and D is the 1983a Annuity Mortality Table (40% Male, pivotal age 65)
and interest at a rate of 3.0% per year, compounded annually. A detailed
statement of the method of calculation has been filed with the insurance
department of the state in which the Contract was issued. The Company will
compute reserves on this Contract on the Commissioners Annuity Reserve Valuation
Method (CARVM). The reserves and guaranteed values including any paid-up
annuity, Withdrawal Value or Death Benefits will at no time be less than the
minimum required by the laws of the state in which the application was signed.
The dollar amount of an Annuity Payment for any Age or combination of Ages not
shown in the Tables or for any other form of Annuity Option agreed to by the
Company will be provided by the Company upon request.
MISSTATEMENT OF AGE OR SEX
If the Age or sex of the Annuitant, or the Age or sex of any designated second
person, has been misstated, any Annuity Payments will be the Annuity Payments
provided by the correct Age or sex. If the misstatement is discovered after the
Annuity Date: (a) the Company will add interest to any overpayments at the rate
of 6% per year, compounded annually, and deduct the amount from remaining
Annuity Payments until the total is repaid; and (b) the Company will add
interest to any underpayments at the rate of 6% per year, compounded annually,
and pay the amount in a single sum with next Annuity Payment.
SUPPLEMENTARY AGREEMENT
A Supplementary Agreement setting forth the terms of the Annuity Option selected
will be issued at the Annuity Date, at which time this Contract will be
exchanged for the Supplementary Agreement.
EVIDENCE OF SURVIVAL
The Company may require satisfactory evidence of the continued survival of any
person(s) on whose life Annuity Payments are based.
11
PROOF OF AGE
The Company may require evidence of Age of any payee under Annuity Options A, B,
C, and D and of the designated second person under Annuity Options C and D.
12
ANNUITY OPTION TABLES
MINIMUM MONTHLY PAYMENT RATES FOR EACH $1,000 APPLIED
OPTIONS A AND B - LIFETIME PAYMENT OPTION
Age of 10 Year & Age of 10 Year &
Payee Life Payee Life
50 4.07 70 6.30
51 4.13 71 6.47
52 4.20 72 6.65
53 4.28 73 6.83
54 4.35 74 7.01
55 4.44 75 7.20
56 4.52 76 7.39
57 4.61 77 7.58
58 4.71 78 7.76
59 4.81 79 7.95
60 4.91 80 8.12
61 5.02 81 8.29
62 5.14 82 8.45
63 5.26 83 8.60
64 5.39 84 8.74
65 5.53 80 8.87
66 5.67
67 5.82
68 5.97
69 6.13
OPTIONS C AND D - JOINT LIFETIME PAYMENT - PAYMENTS FOR TWO LIVES ONLY
Annuitants' Ages Percentage of Payment Payable to Surviving
Annuitant is:
Primary Joint 50% 662/3% 75% 100%
(A) Payments reduce upon the death of either the Annuitant or the Joint
Annuitant:
50 50 4.10 3.93 3.85 3.63
50 55 4.29 4.09 4.00 3.74
55 55 4.49 4.28 4.18 3.90
55 60 4.74 4.48 4.37 4.05
60 60 5.01 4.74 4.61 4.27
60 65 5.35 5.02 4.87 4.47
65 65 5.73 5.37 5.20 4.76
65 70 6.20 5.75 5.56 5.04
13
(B) Payments reduce only upon the death of the Annuitant (ERISA Joint and
Survivor Annuity Option):
50 50 3.85 3.78 3.73 3.63
50 55 3.91 3.86 3.83 3.74
55 50 4.08 3.97 3.90 3.74
55 55 4.18 4.08 4.03 3.90
55 60 4.26 4.19 4.15 4.05
60 55 4.48 4.33 4.26 4.05
60 60 4.61 4.49 4.43 4.27
60 65 4.72 4.64 4.59 4.47
65 60 5.02 4.83 4.73 4.47
65 65 5.20 5.05 4.97 4.76
65 70 5.36 5.25 5.19 5.04
70 65 5.76 5.51 5.38 5.04
Monthly payment rates for other age combinations will be furnished on request.
For quarterly payments, multiply the monthly payment rate by 2.99. For semi-
annual payments, multiply by 5.96. For annual payment, multiply by 11.84.
OPTION E - FIXED TIME PAYMENT
Years Monthly Payment Years Monthly Payment Years Monthly Payment
1 Not available 11 8.86 21 5.32
2 Not available 12 8.24 22 5.15
3 Not available 13 7.71 23 4.99
4 Not available 14 7.26 24 4.84
5 17.91 15 6.87 25 4.71
6 15.14 16 6.53 26 4.59
7 13.16 17 6.23 27 4.47
8 11.68 18 5.96 28 4.37
9 10.53 19 5.73 29 4.27
10 9.61 20 5.51 30 4.18
For quarterly payments, multiply the monthly payment rate by 2.99. For semi-
annual payments, multiply by 5.96. For annual payment, multiply by 11.84.
14
First Variable Life Insurance Company
0Payments are based on the then current GMIP Value and the applicable GMIP
Annuity Tables.
Guaranteed Minimum Income Payments will be made to the Annuitant, unless a
different payee is selected by the Owner by written request to the Company at
its Variable Service Center. The request must be made at least 30 days prior to
the GMIP Annuity Date.
On the GMIP Annuity Date, any Contract Value in the Separate Account will be
transferred to the Company's general account and no further withdrawals of
Contract Value will be permitted.
GMIP Election Period and GMIP Annuity Date. The Owner may elect to start
Guaranteed Minimum Income Payments only during a GMIP Election Period. The
election must be made in writing to the Company at its Variable Service Center.
The first GMIP Election Period begins on the later of:
. the seventh Contract Anniversary; or
. the Anniversary Date on or immediately following the Annuitant's 60th
birthday. If there are joint Annuitants, this is the Anniversary Date on or
immediately following the older ▇▇▇▇▇▇▇▇▇'s 60th birthday.
Additional GMIP Election Periods begin on each subsequent Anniversary Date until
the earlier of:
. the date the Guaranteed Minimum Income Payment rider ends; or
. the Annuitant's 91st birthday. If there are joint Annuitants, this is the
older Annuitant's 91st birthday.
Each GMIP Election Period ends 30 days after it begins.
Unless otherwise permitted by the Company, the GMIP Annuity Date is the last day
of the GMIP Election Period in which the Owner elects to begin Guaranteed
Minimum Income Payments. Any death benefits under the Contract that end of the
Annuity Date will also end on the GMIP Annuity Date.
GMIP Value. The GMIP Value up to the Age 80 Anniversary Date is the higher of:
. the Best Anniversary Value ("BAV") amount in effect on the GMIP Annuity Date;
or
. the Roll-Up Value ("RUV") amount in effect on the GMIP Annuity Date.
The GMIP Value on the Age 80 Anniversary Date is the higher of:
. the BAV amount then in effect; or
. the RUV amount then in effect.
The GMIP Value after the Age 80 Anniversary Date is:
. the GMIP Value on the Age 80 Anniversary Date; plus
. any Purchase Payments received by the Company after the Age 80 Anniversary
Date; less
. a proportional reduction for any withdrawals of Contract Value after the Age
80 Anniversary Date.
The Company reserves the right to reduce the GMIP Value for any premium taxes
that may apply and for any indebtedness under the Contract. The GMIP Value does
not guarantee performance of any Investment Option. The company uses GMIP Value
only to calculate Guaranteed Minimum Income Payments.
Determination of Best Anniversary Value. The Company determines a Best
Anniversary Value, or "BAV," based on its calculations of Anniversary Value
Amounts and adjustments to previously determined Anniversary Value Amounts.
Anniversary Value Amounts - An Anniversary Value Amount is determined:
. on the Issue Date; and
. on each Contract Anniversary after that up to, and including, the Age 80
Anniversary Date.
The Anniversary Value Amount on the Issue Date is equal to the Contract Value.
The Anniversary Value Amount on each subsequent Anniversary Date (up to the Age
80 Anniversary Date) is the higher of:
. the Contract Value on the Anniversary Date; or
. the most recently determined previous Anniversary Value Amount, adjusted for
Purchase Payments and withdrawals during the immediately preceding Contract
Year. Purchase Payments increase it. Withdrawals of Contract Value cause a
proportional reduction of Anniversary Value Amount.
BAV Amounts - the Best Anniversary Value is:
. the Anniversary Value Amount most recently determined by the Company; plus
. the sum of any Purchase Payments received by the Company after the most recent
Anniversary Date (or, during the first Contract Year, after the Issue Date) to
the GMIP Annuity Date; less
. a proportional reduction for any withdrawals of Contract Value after the last
Anniversary Date to the GMIP Annuity Date.
Determination of Roll-Up Value. The Roll-Up Value, or "RUV" on the Issue Date is
equal to the Contract Value. After the Issue Date until the Age 80 Anniversary
Date, the RUV is an amount equal to:
. Purchase Payments; less
. a proportional reduction for any withdrawals of Contract Value; less
. the amount of any indebtedness under the Contract; plus
. interest accumulated at an annual rate of 5.0%.
Proportional Reductions. Withdrawals of Contract Value cause a proportional
reduction of:
. GMIP Value for withdrawals on and after the Age 80 Anniversary Date; and
. Anniversary Value Amounts for withdrawals before the Age 80 Anniversary Date;
and
. Roll-Up Value for withdrawals before the Age 80 Anniversary Date.
The reduction is made in the ratio that a withdrawal of Contract Value,
including charges on the withdrawal, bears to the total Contract Value before
the withdrawal.
GMIP Annuity Tables. The monthly income factors on the attached tables show the
dollar amount of a Guaranteed Minimum Income Payment for each $1,000 of GMIP
Value applied. If more favorable to the Annuitant, monthly income will be
determined by applying Contract Value to the Company's current fixed annuity
payment rates for the annuity option selected.
The Company computes monthly income factors for GMIP Life Annuity with Period
Certain of 120 or 240 Months based on mortality tables and benchmark rates. The
Company uses the 1983a Annuity Mortality Table projected using projection scale
G (40% Male, pivotal age 65). The benchmark rate is 2.5% per year, compounded
annually. The Owner can request monthly income factors for any Age not shown in
the tables. The Company may provide monthly income factors for other forms of
GMIP Annuity options.
Minimum Monthly Income Factors For Each $1,000 Of GMIP Value
------------------------------------------------------------
. Life Annuity with Period Certain of 120 Months. This form provides monthly
payments based on the lifetime of a single Annuitant or for 120 months,
whichever is longer:
Age of Per Age of Per Age of Per Age of Per Age of ▇▇▇
▇▇▇▇▇▇▇▇▇ $1,000 Annuitant $1,000 Annuitant $1,000 Annuitant $1,000 Annuitant $1,000
----------------------------------------------------------------------------------------------------------
40 2.97 50 3.41 60 4.12 70 5.36 80 7.24
41 3.00 51 3.46 61 4.22 71 5.52 81 7.45
42 3.04 52 3.52 62 4.32 72 5.69 82 7.65
43 3.08 53 3.58 63 4.43 73 5.86 83 7.85
44 3.12 54 3.65 64 4.54 74 6.04 84 8.04
45 3.16 55 3.72 65 4.66 75 6.23 85 8.22
46 3.21 56 3.79 66 4.79 76 6.43 86 8.40
47 3.25 57 3.87 67 4.92 77 6.63 87 8.56
48 3.30 58 3.95 68 5.06 78 6.83 88 8.72
49 3.35 59 4.03 69 5.20 79 7.03 89 8.86
90 8.98
GMIP Annuity Tables (continued).
. Joint and Survivor Life Annuity with Period Certain of 240 Months. This form
provides monthly payments based on the lifetime of two Annuitants or for 240
months, whichever is longer:
Age Per Age Per Age Per
of Annuitants $1,000 of Annuitants $1,000 of Annuitants $1,000
Life 1 Life 2 Life 1 Life 2 Life 1 Life 2
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50 50 3.06 60 60 3.58 70 70 4.38
50 55 3.16 60 65 3.73 70 75 4.57
55 55 3.29 65 65 3.94 75 75 4.82
55 60 3.41 65 70 4.12 75 80 4.97
ELECTION TO TERMINATE RIDER: The Owner may elect to end this Rider after it has
been in effect for at least 7 Contract Years. Once this Rider is ended, it may
not be elected again. The Company must receive a request to end this rider at
its Variable Service Center. If the request is received within 30 days of a
Contract Anniversary, the Rider will remain in force (unless ended for other
reasons) during the next Contract Year.
TERMINATION DATE OF RIDER: The termination date of this Rider is the earliest
of:
. the death of the Owner before the Annuity Date (or GMIP Annuity Date), unless
continued by a spousal beneficiary;
. a change of designation of the Annuitant, unless the Company consents
otherwise;
. the earlier of the Annuity Date or GMIP Annuity Date;
. the Contract Anniversary following the Owner's election to end the Rider
after it has been in effect for at least 7 Contract Years; and
. termination of the Contract.
Signed for the Company.
/s/ ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ /s/ ▇▇▇▇ ▇. ▇▇▇▇▇▇
▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ ▇▇▇▇ ▇. ▇▇▇▇▇▇
Secretary President
First Variable Life Insurance Company
Little Rock, Arkansas