Individual
Annuity
Contract
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This is a deferred annuity contract. It is a legal contract between you, as the
owner, and us, IDS Life Insurance Company. PLEASE READ YOUR CONTRACT
CAREFULLY.
If the annuitant is living on the settlement date, we will begin to pay you
monthly annuity payments. Any payments made by us are subject to the terms of
this contract. The owner and beneficiary are as named in the application unless
they are changed as provided for in this contract.
We issue this contract in consideration of your application and payment of the
single purchase payment.
Signed for and issued by IDS Life Insurance Company, Minneapolis, Minnesota, as
of the contract date shown below.
THIS ANNUITY CONTRACT CONTAINS A MARKET VALUE ADJUSTMENT FORMULA WHICH MAY
RESULT IN BOTH UPWARD AND DOWNWARD ADJUSTMENTS IN CASH SURRENDER BENEFITS.
Surrenders are available without market value adjustment on the last day of each
contract period.
NOTICE OF YOUR RIGHT TO EXAMINE THIS CONTRACT FOR TEN DAYS.
If for any reason you are not satisfied with this contract, return it to us or
our agent within ten days after you receive it. We will then cancel this
contract and refund all purchase payments which you have made. This contract
will then be considered void from the start.
President:
/s/ ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇
▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇
Secretary:
/s/ ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇▇▇▇
▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇▇▇▇
30370C
AMERICAN
EXPRESS
Financial
Advisors
IDS Life Insurance Company
IDS Tower 10
▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇
- Individual Annuity Contract
- Purchase payment is payable in a single sum.
- Annuity payments to begin on the settlement date.
- This contract is nonparticipating. Dividends are not payable.
ANNUITANT: ▇▇▇▇ ▇▇▇
CONTRACT NUMBER: XXX-XXXXXX
CONTRACT DATE: March 18, 1991
CONTRACT SETTLEMENT DATE: March 18, 2021
30370C (3/91)
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Guide to Contract Provisions
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Definitions Important words and meanings/Page 3
The Annuity Contract Entire contract; Modification;
Incontestability; Misstatement of
birthdate/Page 4
Owner Owner's rights; Trust/Custodial ownership;
Change of ownership restricted/Page 4
Beneficiary and Payments to Who is the beneficiary; Change of
Beneficiary beneficiary; Payments to beneficiary/Page
5
Purchase Payment Payment of the purchase payment/Page 5
Accumulation Value, How the accumulation value is
Cash Surrender Value, and determined; How the market adjusted
Market Adjusted Value value is determined; Surrender of the
contract for the cash surrender value; TSA
prohibited distributions; Annual
statement of value/Page 6
Annuity Payment Plans When annuity payments begin; Different
ways to receive annuity payments/Page 8
Table of Settlement Rates Table showing monthly annuity payment
amounts for the various plans/Page 9
30370C
CONTRACT DATA
CONTRACT OWNER: ▇▇▇▇ ▇▇▇
PURCHASE PAYMENT: $5,000.00
INITIAL GUARANTEE RATE: 7%
INITIAL GUARANTEE PERIOD: 5 Years
ACCUMULATION VALUE AT END OF INITIAL GUARANTEE PERIOD: $7,012.76
Surrender Charge Percentage
(Applied to Market Adjusted Value Surrendered)
Guarantee Contract Years as measured from the beginning of a
Period Guarantee Period
1 2 3 4 5 6 7 8
1 Year 1%
2 Years 2% 1%
3 Years 3% 2% 1%
4 Years 4% 3% 2% 1%
5 Years 5% 4% 3% 2% 1%
6 Years 6% 5% 4% 3% 2% 1%
7 Years 7% 6% 5% 4% 3% 2% 1%
8 Years 8% 7% 6% 5% 4% 3% 2% 1%
9 Years 8% 7% 6% 5% 4% 3% 2% 1%
10 Years 8% 7% 6% 5% 4% 3% 2% 1%
For renewal guarantee periods, the surrender charge percentages will be based on
the lesser of:
1. The length of the new guarantee period, or
2. The number of years remaining until the eighth contract
anniversary.
There are no surrender charges on the last day of a guarantee period. There will
never be surrender charges beyond the eighth contract anniversary.
30370C
ANNUITANT: ▇▇▇▇ ▇▇▇
CONTRACT NUMBER: XXXX-XXXXXXX
CONTRACT DATE: March 18, 1991
CONTRACT SETTLEMENT DATE: March 18, 2021
30370C
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Definitions
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The following words are used often in this contract. When we use these words,
this is what we mean:
the annuitant
The person on whose life monthly annuity payments depend.
you, your, owner
The owner of this contract. The owner may be someone other than the annuitant.
The owner is shown in the application unless the owner has been changed as
provided in this contract.
we, our, us
IDS Life Insurance Company.
contract date
It is the date from which contract anniversaries, contract years, and contract
months are determined. Your contract date is shown under contract data.
contract anniversary
The same day and month as the contract date each year that the contract remains
in force.
initial guarantee period
The period during which the initial guarantee rate will be credited. It is shown
under contract data.
initial guarantee rate
The rate of interest credited to the purchase payment as described in the
accumulation value section. It is shown under contract data.
renewal guarantee period
A renewal guarantee period will begin at the end of each guarantee period. It is
determined in accordance with the terms of the contract.
renewal guarantee rate
The rate of interest credited to the renewal value as described in the
accumulation value section.
30370C
renewal date
The first day of a renewal guarantee period. It will always be on a contract
anniversary.
current rate
The applicable interest rate contained in a schedule of rates established by us
from time to time for various guarantee periods.
accumulation value
The value of the purchase payment plus interest credited, adjusted for any
surrenders.
market adjusted value
The accumulation value adjusted by the market adjusted value formula.
market value adjustment
The market adjusted value minus the accumulation value.
renewal value
The accumulation value at the end of the guarantee period.
cash surrender value
The market adjusted value less any applicable surrender charge.
written request
A request in writing signed by you and delivered to us at our home office.
settlement
The application of the market adjusted value of the contract to provide annuity
payments.
settlement date
The date on which annuity payments are to begin under the contract. This date
may be changed as provided in this contract.
Code
The Internal Revenue Code of 1986, as amended, and all related laws and
regulations, which are in effect during the term of this contract.
TSA
A Tax-Sheltered Annuity as described in Section 403(b) of the Code.
30370C
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The Annuity Contract
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What is the entire contract?
This contract form and the copy of the application attached to it are the entire
contract between you and us.
No one except one of our corporate officers (President, Vice President,
Secretary, or Assistant Secretary) can change or waive any of our rights or
requirements under the contract. That person must do so in writing. None of our
agents or other persons has the authority to change or waive any of our rights
or requirements under the contract.
In issuing this contract, we have relied upon the application. The statements
contained in the application are considered representations and not warranties.
No statement made in connection with the application will be used by us to void
the contract or to deny a claim unless that statement is part of the
application.
Can the contract be modified?
We reserve the right to modify the contract to the extent necessary to qualify
the contract, if purchased as part of a qualified plan under Section 401 or 403
of the Code, or if purchased as part of a deferred compensation plan under
Section 457 of the Code, as part of such plan described in Sections 401, 403 or
457 of the Code or under any other applicable section of the Code.
When will this contract become incontestable?
This contract is incontestable from its date of issue.
What if the annuitant's birthdate has been misstated?
If the annuitant's birthdate has been misstated, payments under this contract
will be based on what would have been provided at the correct birthdate. Any
underpayments made by us will be made up immediately. Any overpayments made by
us will be subtracted from the future payments.
30370C
What laws govern the contract?
The contract is governed by the law of the state in which it is delivered. The
values and benefits of this contract are at least equal to those required by
such state.
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Owner
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What are your rights as owner of this contract?
As long as the annuitant is living and unless otherwise provided in this
contract, you may exercise all rights and privileges in this contract or allowed
by us.
What are your rights as owner if you are a trust or custodial account?
If you are a tax-qualified trust or tax-qualified custodial account, then your
trustees or custodians (or their successors), properly named by your trust or
custodial agreement, may exercise all rights and privileges provided in this
contract or allowed by us.
Can you change ownership of this contract?
This contract may not be sold, assigned, transferred, discounted, or pledged as
collateral for a loan or as security for the performance of an obligation or for
any other purpose to any person other than as may be required or permitted under
the applicable Sections 401, 403, 457, or other applicable sections of the Code.
However, if you are the trustee of a tax-qualified trust or the custodian of a
tax-qualified custodial account, you may transfer ownership of this contract to
the annuitant or to a qualified successor trustee or custodian if permitted by
the Code.
Or, if you are a trust or custodian or an employer as part of a qualified plan
under Section 401 or 403 or a deferred compensation plan under Section 457 of
the Code, you may transfer ownership of this contract to the annuitant if
permitted by the Code.
Any permitted transfer must be on a form approved by us. The change must be made
while the annuitant is living. Once the change is recorded by us, it will take
effect subject to any action taken or payment made by us before the recording.
30370C
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Beneficiary and Payments
to Beneficiary
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What death benefits are paid if the annuitant or owner dies before settlement?
If the annuitant or owner dies before settlement while this contract is in
force, we will pay the beneficiary the accumulation value.
The accumulation value will be determined as of the date on which due proof of
death is received at our home office.
The above amount will be payable in a lump sum upon receipt of due proof of
death of the annuitant.
Instead of a lump sum, payment may be made under an annuity payment plan
provided amounts are calculated in accordance with the Code, and:
1. the beneficiary elects the plan within 60 days after we receive due
proof of death; and
2. payments begin no later than one year after the date of death; and
3. the plan provides equal or substantially equal payments over a period
which does not exceed the life of the beneficiary or the life expectancy
of the beneficiary.
In this event, the references to "annuitant" in the annuity payment plans
section will apply to the beneficiary.
To whom are the death benefits payable?
Benefits will be paid equally to all primary beneficiaries surviving the
annuitant. If none survive, proceeds will be paid equally to all contingent
beneficiaries surviving the annuitant. If no beneficiary survives the annuitant,
we will pay the benefits to you, if living, otherwise to your estate.
30370C
Who is the beneficiary?
The beneficiary or beneficiaries are as named in the application unless you have
since changed the beneficiary as provided below. If the beneficiary has been
changed, we will pay any benefits in accordance with your last change of
beneficiary request.
How do you change the beneficiary?
You may change the beneficiary any time while the annuitant is living by
satisfactory written request to us. Once the change is recorded by us, it will
take effect as of the date of your request, subject to any action taken or
payment made by us before the recording.
What is the spouse's option to continue this contract?
If the annuitant's death occurs before the settlement date and before the
annuitant's age 70 1/2, the annuitant's spouse, if designated as sole
beneficiary, may elect in writing to postpone receipt of the death benefit and,
instead, continue this contract in force. The election by the spouse must be
made within 60 days after we receive due proof of death. The contract may be
continued in force only until the date on which the annuitant would have
attained age 70 1/2. Any annuity payment plan later elected by the spouse must
provide amounts calculated in accordance with the Code.
What if the annuitant dies after settlement?
If the annuitant dies after settlement, the amount payable, if any, will be as
provided in the annuity plan then in effect.
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Purchase Payment
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What is the purchase payment for this contract?
The purchase payment for this contract is shown under contract data. It is
payable to us on or before the date we deliver this contract. It must be paid or
mailed to us at our home office or to an authorized agent.
30370C
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Accumulation Value,
Cash Surrender Value,
Market Adjusted Value
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How is the accumulation value determined?
On the contract date, the accumulation value of this contract is the purchase
payment. Thereafter, interest accrues from day to day for the guarantee period
at the rate shown under contract data. This rate represents an effective annual
yield. At no time while the contract is in force shall interest accrue at a rate
less than 3% compounded annually. The accumulation value will be adjusted for
any amounts surrendered.
Are there premium tax charges?
We reserve the right to deduct an amount from the accumulation value of this
contract at the time that any applicable premium taxes not previously deducted
are payable.
If a tax is payable at the time of your purchase payment and we choose to not
deduct it at that time, we further reserve the right to deduct it at a later
date.
How are renewal guarantee periods determined?
At the end of any guarantee period, a renewal guarantee period will begin. We
will notify you in writing 45 days before the renewal guarantee period. Each
renewal guarantee period will be one year unless you elect a different length
from those offered at the time. We must receive your written request at least 15
days before the renewal date. The renewal guarantee period may never extend
beyond the settlement date.
The accumulation value on the renewal date will be equal to the accumulation
value at the end of the guarantee period just ending. This value will earn
interest at the renewal guarantee rate. Upon written request, within 45 days of
the renewal guarantee period, we will notify you of the renewal guarantee rate
then in effect for contracts renewing at that time. The actual renewal guarantee
rate will be determined on the renewal date.
30370C
What is the market adjusted value and how is it determined?
The market adjusted value is the accumulation value on any date before the end
of the current guarantee period adjusted by a formula. The formula adjustment
reflects the relationship between:
1. the interest rate we are then crediting for new contract sales and
renewals (Form 30370) for the time remaining in your contract's current
guarantee period; and
2. the guaranteed interest rate applicable to your contract's current
guarantee period.
The market adjusted value may be more or less than the accumulation value.
The market adjusted value formula is as follows:
market adjusted value = renewal value
(1 + ic + .0025)(N + t)
where: renewal value = the accumulation value at the end of your
current guarantee period.
N = the number of complete contract years to
the end of your guarantee period.
t = the fraction of the contract year
remaining to the end of your contract year
(for example, if 180 days remain in a 365
day contract year, t would be .493)
ic = the current rate offered for new contract
sales and renewals (Form 30370) for the
number of years left in your guarantee
period (straight line interpolation
between whole year rates). If N is
zero, ic is the rate for one year
guarantee periods.
30370C
The market value adjustment is as follows:
market value adjustment = market adjusted value - accumulation value
There will be no market value adjustment made on the last day of a guarantee
period.
Can you request surrender of any amounts under this contract before settlement?
Yes. By written request to us and subject to the rules below you may:
1. surrender this contract for the total cash surrender value;
2. partially surrender this contract for a part of the cash surrender value.
How is the cash surrender value determined?
The cash surrender value is the market adjusted value less a surrender charge.
The surrender charge is based on the amount surrendered and the contract year in
which the surrender is made. The schedule of surrender charges is shown under
contract data.
After the first contract anniversary, surrender charges will not apply to
surrenders of amounts totaling up to 10% of the contract accumulation value as
of the last contract anniversary.
What are the rules for a surrender or partial surrender?
The amount surrendered and any applicable market value adjustment or surrender
charge will be deducted from the accumulation value of the contract on the date
of surrender. You may surrender all or a portion of the cash surrender value.
However, the accumulation value that remains after a partial surrender must be
at least $2,000. Any partial surrender must be at least $250.
The surrender payment will normally be mailed to you within seven days of the
receipt of your written request.
Upon surrender of this contract for the total cash surrender value, this
contract will terminate. We may require that you return this contract to our
home office before we pay the total cash surrender value.
30370C
What distributions are prohibited if your contract is a TSA?
To meet the requirements of Section 403(b) of the Code, unless otherwise
provided in the Code, no amounts may be distributed unless you have:
1. attained age 59 1/2; or
2. separated from service; or
3. died; or
4. become disabled (as defined in Section 72(m)(7) of the Code; or
5. encountered hardship (within the meaning of Section 403(b) of the Code);
and then only such amounts as the Code may provide.
We will require satisfactory written proof of the event(s) in items 1 through 5
above prior to any distribution from the contract.
Can we delay or suspend payment of a partial or full surrender?
We may defer payment of any partial or full surrender for a period not to exceed
6 months from the date we receive your surrender request or the period permitted
by state insurance law, if less. If we defer payment more than 30 days, we will
pay annual interest of at least 3% on the amount deferred.
Will you receive information about your contract values?
Yes. At least once a year we will send you a statement showing both the
accumulation value and the cash surrender value of this contract. The statement
will specify the surrender charge and market value adjustment used to determine
the cash surrender value. This statement will be based on any laws or
regulations that apply.
We will also notify you 45 days before the end of a guarantee period concerning
renewal periods available and your right to surrender without a market value
adjustment on the last day of your guarantee period.
30370C
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Annuity Payment Plans
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When will annuity payments begin?
The first payment will be made as of the settlement date. Before payments begin,
we will require satisfactory proof that the annuitant is alive. We may also
require that you exchange this contract for a supplemental contract which
provides the annuity payments.
Can you change the settlement date?
Yes. Tell us the new date by written request. If you select a new date, it must
be at least 30 days after we receive your written request at our home office.
The settlement date cannot be earlier or later than such date as may be required
or permitted by law or the applicable retirement plan.
Notwithstanding either of the above, the settlement date cannot be later than
the later of:
1. the contract anniversary nearest the annuitant's 85th birthday; or
2. the 10th contract anniversary.
What are the annuity payment plans?
There are different ways to receive annuity payments. We call these plans.
Plan A - This provides monthly annuity payments for the lifetime of the
annuitant. No payments will be made after the annuitant dies.
Plan B - This provides monthly annuity payments for the lifetime of the
annuitant with a guarantee by us that payments will be made for a period of at
least five, ten, or fifteen years. You must select the guaranteed period.
Plan C - This provides monthly annuity payments for the lifetime of the
annuitant with a guarantee by us that payments will be made for a certain number
of months. We determine the number of months by dividing the market adjusted
value applied under this plan by the amount of the monthly annuity payment.
30370C
Plan D - We call this a joint and survivor life annuity. Monthly payments will
be paid for the lifetime of the annuitant and a joint annuitant. When either the
annuitant or joint annuitant dies, we will continue to make monthly payments for
the lifetime of the survivor. No payments will be paid after the death of both
the annuitant and joint annuitant.
Plan E - This provides monthly fixed dollar annuity payments for a period of
years. The period of years may be no less than 10 nor more than 30.
What are the requirements for selecting a plan?
You may elect by written notice to us at any time at least 30 days prior to the
settlement date to have the market adjusted value applied on the settlement date
to provide:
1. a lump-sum payment as a result of a total surrender as provided under
the cash surrender value provision of this contract; or
2. one of the annuity payment plans shown herein. Amounts payable under any
such annuity payment plan will be calculated in accordance with the
Code.
Any such annuity payment plan must be provided:
a. in equal or substantially equal payments over a period no longer
than the life of the annuitant or over the life of the annuitant
and a joint annuitant; or
b. in equal or substantially equal payments over a period which does
not exceed the life expectancy of the annuitant, or the life
expectancy of the annuitant and a joint annuitant.
c. any annuity payment plan selected must also, if selected by a
non-spouse beneficiary, meet the incidental death benefit
requirements under the Code.
If, at least 30 days before the settlement date, we have not received at our
home office your written request to select a plan, we will make payments
according to Plan B with payments guaranteed for 10 years, unless otherwise
required by the Code.
If the amount to be applied to a plan is not at least $2,000, or if payments are
to be made to other than a natural person, we have the right to make a lump-sum
payment of the cash surrender value.
30370C
How will payments be made?
Payments will be made by us by check. The check must be personally endorsed by
the payee or payees as well as the annuitant (or joint annuitant under Plan D).
If the annuitant or joint annuitant does not endorse the check, other evidence
must be furnished to show that the annuitant or joint annuitant is still alive.
30370C
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Table of Settlement Rates
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What will be the amount of the monthly annuity payments?
The amount of each monthly annuity payment for each $1,000 of market adjusted
value applied under any payment plan will be based on our Table of Settlement
Rates in effect at the time of the first payment. The amounts will not be less
than those shown in the table below.
The amount of such payments under plans A, B, and C will depend on the adjusted
age of the annuitant on the settlement date. The amount of such payments under
plan D will depend on the adjusted age of the annuitant and the joint annuitant
on the settlement date. Adjusted age means the age on the annuitant's nearest
birthday minus an "adjustment" based on the calendar year of the birth of the
annuitant as follows:
Calendar Calendar
Year of Year of
Annuitant's Adjust- Annuitant's Adjust-
Birth ment Birth ment
----- ---- ----- ----
Prior to 1920 0 1945 through 1949 6
1920 through 1924 1 1950 through 1959 7
1925 through 1929 2 1960 through 1969 8
1930 through 1934 3 1970 through 1979 9
1935 through 1939 4 1980 through 1989 10
1940 through 1944 5 After 1989 11
30370C
Amount of Each Monthly Annuity Payment Per $1,000 Applied
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Plan A Plan B Plan C Plan D - Joint and Survivor
Adjusted Age of Joint Annuitant
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Adj. Life 5 Years 10 Years 15 Years With Adj. 10 Years 5 Years Same 5 Years 10 Years
Age* Income Certain Certain Certain Refund Age Younger Younger Age Older Older
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55 4.84 4.83 4.80 4.74 4.71 55 4.07 4.20 4.34 4.47 4.58
56 4.92 4.91 4.87 4.81 4.77 56 4.10 4.25 4.40 4.53 4.65
57 5.00 4.99 4.95 4.88 4.85 57 4.15 4.30 4.45 4.60 4.72
58 5.09 5.08 5.03 4.96 4.92 58 4.19 4.35 4.52 4.67 4.80
59 5.19 5.17 5.12 5.04 5.00 59 4.24 4.41 4.58 4.75 4.89
60 5.29 5.27 5.22 5.12 5.09 60 4.28 4.47 4.65 4.83 4.98
61 5.40 5.38 5.32 5.21 5.18 61 4.34 4.53 4.73 4.92 5.07
62 5.52 5.50 5.42 5.30 5.27 62 4.39 4.60 4.81 5.01 5.18
63 5.65 5.62 5.53 5.39 5.37 63 4.45 4.67 4.90 5.11 5.29
64 5.78 5.75 5.65 5.49 5.48 64 4.51 4.75 4.99 5.21 5.41
65 5.92 5.89 5.77 5.58 5.59 65 4.58 4.83 5.09 5.33 5.53
66 6.08 6.03 5.90 5.69 5.71 66 4.65 4.92 5.19 5.45 5.67
67 6.24 6.19 6.04 5.79 5.83 67 4.72 5.01 5.30 5.58 5.81
68 6.42 6.36 6.19 5.90 5.97 68 4.80 5.11 5.42 5.72 5.97
69 6.61 6.54 6.34 6.01 6.11 69 4.89 5.21 5.55 5.88 6.14
70 6.81 6.74 6.50 6.12 6.26 70 4.98 5.33 5.69 6.04 6.33
71 7.04 6.95 6.67 6.22 6.42 71 5.07 5.45 5.85 6.22 6.52
72 7.28 7.17 6.84 6.33 6.59 72 5.18 5.58 6.01 6.41 6.74
73 7.54 7.41 7.02 6.44 6.77 73 5.29 5.72 6.19 6.62 6.97
74 7.83 7.67 7.21 6.54 6.97 74 5.41 5.88 6.38 6.84 7.22
75 8.14 7.95 7.40 6.64 7.17 75 5.53 6.04 6.58 7.09 7.49
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*Adjusted age of annuitant.
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The table above is based on the "1983 Individual Annuitant Mortality Table A"
assuming an interest rate of 4% per year compounded annually. Settlement rates
for any age not shown above will be calculated on the same basis as those rates
shown in the table above. Such rates will be furnished by us upon request.
Amounts shown in the Table below are based on an assumed interest rate of 4% per
year compounded annually.
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Plan E Dollar Amount of Each Monthly Fixed Dollar Annuity Payment Per $1,000
Applied
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Years Monthly Years Monthly Years Monthly
Payable Payment Payable Payment Payable Payment
------- ------- ------- ------- ------- -------
10 $10.06 17 $6.71 24 $5.35
11 9.31 18 6.44 25 5.22
12 8.69 19 6.21 26 5.10
13 8.17 20 6.00 27 5.00
14 7.72 21 5.81 28 4.90
15 7.34 22 5.64 29 4.80
16 7.00 23 5.49 30 4.72
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30370C
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Individual Annuity
Contract
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- Individual Annuity Contract.
- Purchase payment is payable in a single sum.
- Annuity payments to begin on the settlement date.
- This contract is nonparticipating. Dividends are not payable.
AMERICAN
EXPRESS
Financial
Advisors
IDS Life Insurance Company
IDS Tower 10
▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇
30370C