FIDELITY INVESTMENTS LIFE INSURANCE COMPANY
PHILADELPHIA, PENNSYLVANIA
DEFERRED ANNUITY
Flexible Purchase Payments
Optional Variable and Fixed Accumulation Values
Optional Variable and Fixed Annuity Payments
Nonparticipating!
Fidelity Investments Life Insurance Company agrees to pay monthly income to
the Annuitant starting on the Annuity Date and to provide the other rights
and benefits of this Contract
These agreements: are subject to all the provisions of this Contract.
This Contract has; been issued in consideration of the attached application
and the initial purchase payment.
ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT
EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO
DOLLAR AMOUNT. (SEE CONTRACT VALUE, PAGE 10.)
Signed for the Company at its Executive Office, Boston, Massachusetts
~;~ - /~
President Secretary
TEN DAY RIGHT TO RETURN THE CONTRACT
When this Contract is issued, you have 10 days after you receive it from
the Company to examine it. Within those 10 days you can return the Contract
to the Company or its agent for any reason. If you do, the Contract will be
cancelled. Any purchase payment paid will then be refunded and the Contract
will be void from the beginning.
PLEASE READ YOUR CONTRACT CAREFULLY
This is a legal contract between you and the Company.
GUIDE TO CONTRACT PROVISIONS
PAGE
Contract Schedule 4
Definitions 5
General Provisions 7
Entire Contract.
Misstatement of Age
Reports to Owner
Proof of Survival
Protection of Proceeds
Termination
Basis of Values
Nonparticipating
Purchase Payments 9
Purchase Payments
Net Purchase Payments
Additional Purchase Payments
Allocation of Purchase Payments
Contract Value 10
Contract Value
Deductions from the Contract Value
The Fixed Account 11
Fixed Account
Fixed Account Contract Value
Interest on the Fixed Account Contract Value
Transfers of Contract Value Between the Fixed and Variable Accounts
The Variable Account 12
Variable Account
Subaccounts
Accumulation Units
Accumulation Unit Value
Variable Account Contract Value
Net investment Factor
Charges Against the Subaccounts
Transfers Among Subaccounts
Additions, Deletions or Substitutions
Reserved Rights
Valuation Days and Valuation Periods
Proceeds 16
Proceeds
Proceeds on death of Owner During Accumulation Period
Proceeds on Death of Owner During Annuity Period
Interest on Proceeds
Postponement. of Payment
Death Benefit 18
Death Benefit During Accumulation Period
Owner and Beneficiary 19
Owner
Beneficiary
Change of Owner and Beneficiary
Assignments
Designation of Owner and Beneficiary
Surrender Provisions 21
Cash Surrender
Cash Surrender Value
Partial Withdrawals
Free Withdrawal Privilege
Amounts Subject to Surrender Charge
Surrender Charges on Annuity Date
Annuity Provisions 23
Annuity Payments
Deductions from Annuity Payment
Change of Annuity Date
Annuity Payment Options
Fixed Annuity
Variable Annuity
Annuity Unit Value
Determination of First Variable Annuity Payment
Variable Annuity Payments After the First Payment
Exchange of Annuity Units
Age Adjustment
Annuity Tables 27
FIDELITY INVESTMENTS LIFE INSURANCE
COMPANY
VARIABLE PRODUCTS SERVICE CENTER, P.O. BOX 994, PROVIDENCE, R.I.
02901-0994
CONTRACT SCHEDULE
CONTRACT NUMBER Z000000000
CONTRACT DATE August 8, 1988
ANNUITY DATE September 9, 1999
ANNUITANT ▇▇▇▇ ▇. ▇▇▇▇▇▇▇
ISSUE AGE 35
INITIAL :PURCHASE PAYMENT: $5,000.00
VARIABLE A('COUNT SUB-ACCOUNTS
MONEY MARKET EQUITY-INCOME
SHORT TERM GROWTH
HIGH INCOME OVERSEAS
GUARANTEED FIXED ACCOUNT INTEREST RATE: 3.5% per year
compounded annually
MINIMUM ADDITIONAL PURCHASE PAYMENT: $250
DEDUCTIONS FROM THE CONTRACT VALUE:
MAINTENANCE CHARGE: $30.00 per year on the Contact Date
not to exceed 550 per year.
TABLE OF SURRENDER CHARGES
CONTRACT PERCENTAGE OF
YEAR PURCHASE PAYMENTS
1 5%
2 4%
3 3%
4 2%
5 1%
THEREAFTER 0%
DEFINITION'S
ACCUMULATION PERIOD:
The period the Contract is in force prior to the Annuity Date.
ACCUMULATION UNITS:
The measure used to calculate the Variable Account Contract Value prior to
the Annuity Date.
ANNUITANT:
The person on ,whose life monthly annuity payments depend.
ANNUITY DATE:
The date on which annuity payments begin. You may change this date as
provided in this
Contract.
ANNUITY PERIOD:
The period during which the Annuitant receives payments beginning on the
Annuity Date.
ANNUITY UNITS:
The measure used to calculate the amount of variable annuity payments
during the Annuity
Period.
BENEFICIARY:
The person who receives the proceeds in the event of the death of the Owner
or Annuitant.
THE COMPANY:
Fidelity investments Life insurance Company.
CONTRACT ANNIVERSARY:
The same day and month as the Contract Date each year that the Contract
remains in force.
CONTRACT DATE:
The date the Contract becomes effective, from which contract anniversaries,
contract years, and
contract months are determined. Your Contract Date is shown on the Contract
Schedule.
CONTRACT VALUE:
The sum of the Fixed Account Contract Value (which receives a declared
interest rate) and the
Variable Account Contract Value (which varies with the investment
performance of the elected
Subaccounts) for this Contract.
FIXED ANNUITY:
An annuity with fixed payments which are guaranteed during the Annuity
Period. Once
established, the amount of the annuity payment will not vary.
FREE WITHDRAWAL AMOUNT:
The amount that may be withdrawn from the Contract Value without incurring
a surrender
charge.
OWNER:
The person who has the ownership rights and privileges of the Contract.
SUBACCOUNTS:
The portfolios of the V;ariable Account. The Subaccounts available on the
Contract ▇▇▇▇ are
named on the Contract Schedule.
VALUATION DAY:
Each day the blew York: Stock Exchange is open for Trading.
VALUATION PERIOD:
The interval of time beginning at the close of business on each Valuation
Day and ending at the
close of business on the next Valuation Day.
VARIABLE ANNUITY:
An annuity with payments which are not guaranteed as IO dollar amount and
which vary in
amount with the investment experience of elected Subaccounts.
WRITTEN REQUEST:
A request in a form acceptable IO the Company, signed by you and delivered
IO the Company at
the Variable Products Service Center.
YOU, YOUR:
The Owner of this Contract. The owner may be someone other than the
Annuitant. The Owner is
named on the application and may be changed as provided in this Contract.
GENERAL PROVISIONS
ENTIRE CONTRACT
This Contract and the application. a copy of which is attached. arc the
entire contract between you and the Company.
No change in or waiver of the provisions of the Contract is valid unless
the change or waiver is signed by the President or Secretary of the
Company.
MISSTATEMENT OF APE
If the Annuitant's age has been misstated, payments under this Contract
will be adjusted. They will be based or: what would have been provided at
the correct age. Any underpayments by THE Company will 'be paid in a single
sum, with interest at the rate of 6% per year compounded annually. Any
overpayments by the Company must be refunded and to the extent possible
will be subtracted from the future payments, with interest at the rate of
6% per year compounded annually.
REPORTS TO OWNER
At least once once year the Company will send you a report. The report will
show the Contract Value and purchase payments. withdrawals and maintenance
charges made since the last report. The report will also include any other
information that may be required by the insurance department of the state
in which this Contract is delivered.
PROOF OF SURVIVAL
Where any payments under this Contract depend on the Annuitant or other
recipient being alive on a given date, proof of survival may be required by
the Company prior to making the payments.
PROTECTION OF PROCEEDS
Payments under this Contract may not be assigned by any Beneficiary prior
to the time they are due. To the extent allowed by law, payments are not
subject to the claims of creditors or to legal process.
TERMINATION
This Contract WILL terminate on the earliest of:
The death of the Owner prior TO the Annuily Date;
The death of the Annuitant prior to the Annuity Date;
The Surrender of tho Contract; and
The final payment under any payment option.
The Company may at its option, prior TO the Annuity Date, cancel this
Contract if allof the following conditions exist at the same time:
(a) No purchase payments have been paid for a continuous period of 24
months; and
(b) Total purchase payments credited to this Contract are less than
52,000: and
(c) The Contract Value is less than 52,000.
Upon cancellation, the Contract Value will i be paid to you in a single
sum. The Contract Will then terminate.
BASIS OR VALUES
All values are at least as great as those required by the law of the state
in which this Contract is delivered. A statement of the method used to
compute the minimum values has been filed with the insurance department of
the state in which this Contract is delivered.
NONPARTICIPATING
This Contract does not participate in the profits or surplus of the
Company.
PURCHASE PAYMENTS
PURCHASE PAYMENTS
Purchase payments are the payments you make for this Contract.
NET PURCHASE PAYMENTS
A net purchase payment is a purchase payment less any premium tax required
by the state in which this Contract is delivered.
ADDITIONAL PURCHASE PAYMENTS
You may make additional purchase payments during the Accumulation Period.
The minimum additional purchase payment is shown on the Contract Schedule.
The Company reserves the right to limit the amount of additional purchase
payments it will accept. ~
ALLOCATION OF PURCHASE PAYMENTS
You may allocate your net purchase payments to the Fixed Account and among
one or more of the Subaccounts of the Variable Account.
Allocation of purchase payments to the Fixed Account will be permitted in
accordance with the Company's then current rules.
The entire portion of any net purchase payment that you allocate to the
Variable Account will be invested in the Money Market Subaccount until the
estimated end of the Right to Return the Contract period. The contract
value in the Money Market Subaccount will then be transferred to the
Subaccounts you elected on the application. The portion of the initial
purchase payment allocated to any Subaccount is shown on the application.
The entire portion of any net purchase payment that you allocate to the
Fixed Account will be invested in the Fixed Account when received.
Additional net purchase payments received after the Right to Return the
Contract period will be allocated to the Fixed Account and to the
Subaccounts as you elected on the application unless you elect a different
allocation. The portion of any additional net purchase payment allocated to
a Subaccount must be a whole percentage, not less than 10%.
CONTRACT VALUE
CONTRACT VALUE
The Contract Value at any time is:
The Fixed Account Contract Value;
PLUS
The Variable Account Contract Value.
The portion of the Contract Value invested in the Subaccounts of the
Variable Account is not guaranteed and will vary with the performance of
the elected subaccounts.
DEDUCTIONS FROM THE CONTRACT VALUE
The Maintenance Charge is deducted from the Contract Value on each contract
anniversary. A pro rata portion of the charge will be deducted from the
Contract Value on the Annuity Date or when the Contract is surrendered. The
Maintenance Charge is not guaranteed and may be changed by the Company. The
Maintenance Charge as of the Contract Date and the maximum Maintenance
Charge are shown on the Contract Schedule.
Deductions for the Maintenance Charge will be allocated to the Fixed
Account and to the Subaccounts of the Variable Account in the same
proportion as the value in each bears to the Contract Value on the date of
the deduction.
THE FIXED ACCOUNT
FIXED ACCOUNT
The Fixed Account is the Company's general account. The general account
consists of all of the Company's assets other than those in any separate
account.
FIXED ACCOUNT CONTRACT VALUE
The Fixed Account Contract Value at any time will be:
The sum of all amounts credited to the Fixed Account for this Contract;
LESS
Any amounts deducted for charges, transfers or withdrawals.
INTEREST ON THE FIXED ACCOUNT CONTRACT VALUE
The Company will credit interest on the Fixed Account Contract Value.
Interest will accrue from the date a purchase payment is received in the
Variable Products Service Center or an amount is transferred into the Fixed
Account. Different interest rates may apply to different amounts in the
Fixed Account depending on when the amount was initially allocated, and the
interest rate applicable to any particular amount may vary from time to
time. However, the interest rate credited to any amount in the Fixed
Account will never be less than that shown on the Contract Schedule.
When a purchase payment or a transfer from the Variable Account is received
by the Fixed Account, an interest rate will be assigned to that amount.
That rate will be guaranteed for a certain period of time depending on when
that amount was allocated to the Fixed Account. All interest rates assigned
to that amount after the initial guarantee expires will be guaranteed for a
period of at least one year.
TRANSFERS OF CONTRACT VALUE BETWEEN THE FIXED AND VARIABLE ACCOUNTS
During the Accumulation Period and subject to the rules of the Company, you
may transfer values by written request or telephone. if previously
authorized:
Held in one or more of the Subaccounts of the Variable Account into the
Fixed Account; and
Held in the Fixed Account into one or more of the Subaccounts of the
Variable Account.
You may request the transfers in dollar amounts or as a percentage. The
minimum dollar amount you may transfer is $250 per Subaccount or, if less,
the entire amount in a Subaccount. If you transfer a percentage, the
percentage must be a whole number.
THE VARIABLE ACCOUNT
VARIABLE ACCOUNT
The Company established the Fidelity investments Variable Annuity Account I
("the Variable Account") t") support the: operation of this Contract and
other variable annuity contracts the Company may offer.
The Company owns the assets in the Variable Account. Income, gains and
losses. whether or not realized. from assets allocated to the Variable
Account will be credited to or charged against the Variable Account without
regard to the Company's other income, gains or losses.
Assets equal to the reserves and other liabilities of the Variable Account
will not be charged with liabilities that arise from any other business the
Company conducts. The Company has the right IO transfer to its general
account any assets of the Variable Account which are in excess of those
reserves and liabilities.
The Variable Account is registered with the Securities and Exchange
Commission as a unit investment trust under the investment Company Act of
1940. The Variable Account is also subject to the laws of the Commonwealth
of Pennsylvania.
SUBACCOUNTS
On the Contract Date the! Variable Account consists of the Subaccounts
listed on the Contract Schedule. The Company reserves the right to delete
any Subaccount of the Variable Account or to add new Subaccounts. The
Variable Account may invest in a series type of mutual fund, unit
investment trusts and other investment portfolios which the Company
determines to be suitable for this Contract. The assets of the Variable
Account are valued each valuation period. Each Subaccount invests in a
designated investment portfolio. Shares of a portfolio are purchased for a
Subaccount at their net. asset value,
You will share only the income, gains and losses of the Subaccounts to
which the net purchase payments for this Contract have been allocated. The
values and benefits of this Contract depend on the investment performance
of the portfolios in which your elected Sub accounts are invested. The
Company does not guarantee the investment performance of the portfolios.
You bear the full investment risk for amounts allocated to the elected
Subaccounts.
The investment policies of a portfolio may not be changed without all
necessary approvals of the Pennsylvania insurance Department.
ACCUMULATION UNITS
The Company will credit net purchase payments in the form of accumulation
units, The number of units to be credited to each Subaccount will be
determined by dividing the net purchase payment allocated to that
Subaccount by the unit value of the subaccount. In the case of the initial
net purchase payment, units will be credited on the Contract Date. For
additional payments, units will be credited as of the valuation period
during which the purchase payment is received.
The amount of any Maintenance Charge, partial withdrawal or surrender
charge deducted from the Variable Account Contract Value will reduce the
number of units credited to the Contract in the Subaccounts. A transfer out
of a Subaccount will reduce the number of units credited to the Contract in
that Subaccount while a transfer into a Subaccount will increase the number
of units.
ACCUMULATION UNIT VALUE
The accumulation unit value of each Subaccount was set at $10.00 at the
start of the first valuation period of the Subaccount. The unit value for
each subsequent valuation period is the net investment factor for that
period multiplied by the unit value for the immediately preceding valuation
period. The unit value for a valuation period applies to each day in the
period. The unit value may increase or decrease from one valuation period
to the next.
ACCUMULATION UNITS
The Company will credit net purchase payments in the form of accumulation
units, The number of units to be credited to each Subaccount will be
determined by dividing the net purchase payment allocated to that
Subaccount by the unit value of the subaccount. In the case of the initial
net purchase payment, units will be credited on the Contract Date. For
additional payments, units will be credited as of the valuation period
during which the purchase payment is received.
The amount of any Maintenance Charge, partial withdrawal or surrender
charge deducted from the Variable Account Contract Value will reduce the
number of units credited to the Contract in the Subaccounts. A transfer out
of a Subaccount will reduce the number of units credited to the Contract in
that Subaccount while a transfer into a Subaccount will increase the number
of units.
ACCUMULATION UNIT VALUE
The accumulation unit value of each Subaccount was set at $10.00 at the
start of the first valuation period of the Subaccount. The unit value for
each subsequent valuation period is the net investment factor for that
period multiplied by the unit value for the immediately preceding valuation
period. The unit value for a valuation period applies to each day in the
period. The unit value may increase or decrease from one valuation period
to the next.
VARIABLE ACCOUNT CONTRACT VALUE
The Variable Account Contract Value at any time will be the sum of the
values of all accumulation units credited to the Contract.
NET INVESTMENT FACTOR
The net investment factor is an index used to measure the investment
performance of a Subaccount from one valuation period to the next. The net
investment factor can be greater or less than one: therefore, the value of
a Subaccount unit may increase or decrease.
The net investment factor for each Subaccount for a valuation period is
determined by adding (a) and (b), subtracting (c) and then dividing the
result by (a) where:
(a) is the value of the assets at the end of the preceding valuation
period:
(b) is the investment income and capital gains, realized or unrealized,
credited during the current valuation period:
The Variable Account Contract Value at any time will be the sum of the
values of all accumulation units credited to the Contract.
NET INVESTMENT FACTOR
The net investment factor is an index used to measure the investment
performance of a Subaccount from one valuation period to the next. The net
investment factor can be greater or less than one: therefore, the value of
a Subaccount unit may increase or decrease.
The net investment factor for each Subaccount for a valuation period is
determined by adding (a) and (b), subtracting (c) and then dividing the
result by (a) where:
(a) is the value of the assets at the end of the preceding valuation
period:
(b) is the investment income and capital gains, realized or unrealized,
credited during the current valuation period:
(c) is the sum of:
(1) The capital losses, realized or unrealized. charged during the current
valuation
period plus any amount charged or set aside for taxes during the current
valuation
periods;
PLUS
(2) The deduction from the Subaccount during the current valuation period
representing a daily charge equivalent to an effective annual rate of 1%.
CHARGES AGAINST THE SUBACCOUNTS
in determining the unit values for both the accumulation and annuity units,
the Company makes a daily charge equivalent co an effective annual rate of
1* against the assets of each Subaccount.
The earnings of the Variable Account are taxed as part of the operations of
the Company. Al the present time. the Company does not expect IO incur
taxes on earnings of any Subaccount lo the extent that earnings are
credited under the Contract. If the Company incurs taxes due to the
operation of the Variable Account, it may make charges for such taxes
against the Subaccounts
TRANSFERS AMONG SUBACCOUNTS
You may transfer amounts among the Subaccounts without charge either by
written request or telephone, if previously authorized, to the Variable
Products Service Center. You may request the transfers in dollar amounts or
as a percentage. The minimum dollar amount you may transfer is 5250 per
Subaccount or, if less, the entire amount in a Subaccount. If you transfer
a percentage, the percentage must be a whole number. The Company reserves
the right to limit transfers among Subaccounts, but not to fewer than five
transfers per contract year.
ADDITIONS, DELETIONS OR SUBSTITUTIONS
The Company retains the right to make additions to, deletions from or
substitutions for any of the investment portfolios in which the Subaccounts
invest. Such an addition, deletion or substitution would be subject to all
necessary approvals.
RESERVED RIGHTS
The Company reserves the right to:
(a) Combine the Variable Account with other variable accounts.
(b) Deregister the Variable Account under the investment Company Act of
1940 if registration is no longer required.
(c) Operate the Variable Account as a management investment company under
the Investment Company Act of 1940 or in any other form allowed by law.
(d) Make changes required by any change in the investment Company Act of
1940.
VALUATION DAYS AND VALUATION PERIODS
A valuation day is:
(a) Each day the New York Stock Exchange is open for trading; and
(b) Any other day on which the Securities and Exchange Commission requires
mutual funds,or unit investment trusts to be valued.
A valuation period is the interval of time beginning at the close of
business on each valuation day and ending at the close of business on the
next valuation day.
PROCEEDS
PROCEEDS
Proceeds is the amount payable on:
The Annuity Date:
Surrender prior to the Annuity Date:
The death of the Annuitant prior to the Annuity Date;
The death of the Owner prior to the Annuily Date.
Proceeds can be applied to a payment option or paid as a single sum.
It is currently the Company's practice to deduct any applicable tax at the
time proceeds become payable; however. the Company reserves the right to
deduct the tax when due.
On the Annuity Date, the proceeds will be the Contract Value, if any, less
any applicable surrender charge. If you surrender the Contract, the
proceeds will be the cash surrender value.
The proceeds payable on the death of the Annuitant prior to the Annuity
Date will be the Death Benefit.
The Company may require that you return this Contract before the proceeds
are paid.
PROCEEDS ON DEATH OF OWNER DURING THE ACCUMULATION PERIOD
If you die before the Annuity Date, the proceeds are the Contract Value on
the date proof of death is received by the Company. The proceeds must be
distributed to the Beneficiary within five years after the date of death.
unless:
(a) The proceeds are payable over the lifetime of the Beneficiary with
distributions beginning within one year of the date of death: or
(b) Your spouse is the Beneficiary, in which case your spouse may elect to
continue this Contract and become the Owner.
PROCEEDS ON DEATH OF OWNER DURING ANNUITY PERIOD
If you die on or after the Annuity Date, any remaining payments under this
Contract must be distributed at least as rapidly as under the payment
option being used as of the date of death.
Any proceeds will be paid in accordance with the applicable law governing
such payments. To the extent this Contract conflicts with any applicable
provision of the internal Revenue Code with respect to distributions on
death. this Contract will be considered amended to conform to the Code.
INTEREST ON PROCEEDS
If the proceeds are not paid in a single sum or under a payment option
within 30 days after they
become payable. or the time provided by law, whichever is less, the Company
will pay interest on the unpaid proceeds. interest will accrue from the
date the proceeds are payable lo the ▇▇▇▇ of payment al a rate of 3.5% per
year compounded annually or the rate and lime provided by law, whichever is
greater.
POSTPONEMENT OF PAYMENT
The Company will usually pay proceeds payable on surrender or partial
withdrawal within seven days after it receives your written request. The
Company will usually pay proceeds payable as a result of the death of the
Annuitant or Owner within seven days after it receives proof. However, any
payment involving a determination of the Contract Value may be postponed
whenever:
(a) The New York Stock Exchange is closed other than customary weekend and
holiday closings, or trading on the exchange is resiricled as determined by
the Securilies and Exchange Commis'sion: or
(b) The Securities and Exchange Commission by order permits postponemenl
for the protection of conlracl owners; or
(c) A state of emergency exisis, as determined by the Securities and
Exchange Commission. which would make delermination of the value of the net
assets of the Variable Accounl impraclicable.
The Company can postpone the date of any surrender or partial withdrawal
paymenl from the Fixed Accounl for not more than six months. If paymenl is
posiponed for more than 30 days, it will be crediled with interest from the
date of surrender or partial withdrawal. The rate of interest will not be
less than 3.5% per year compounded annually or, if greater, the rate
required by law.
DEATH BENEFIT
DEATH BENEFIT DURING ACCUMULATION PERIOD
If the death of the Annuitant occurs on or before his or her 70th birthday,
the Death Benefit will be the greater of:
(a) The purchase payments paid, less any partial wilhdrawals and any
applicable surrender charges and any incurred taxes; and
(b) The Contract Value on the date that proof of death is received by the
Company.
If the death of the Annuitant occurs after his or her 70th birthday, the
Death benefit will be the Contract Value on the date that proof of death is
received by the Company.
OWNER AND BENEFICIARY
OWNER
The Owner of the Contract is named on the application unless later changed.
The new Owner will succeed to all rights of ownership, including the right
to make a further change of owner. On the Annuity Date the Annuitant
becomes the Owner and all rights of ownership pass to the Annuitant.
BENEFICIARY
The Beneficiary is named on the application unless later changed. The
proceeds will be paid to the Beneficiary upon the death of:
(a) The Owner prior to the Annuity Date: or
(b) The Annuitant prior to the Annuity Date.
The Beneficiary has no rights in the Contract until the death of the Owner
or the Annuitant. If no Beneficiary survives, the proceeds will be paid to
the Owner or to the Owner's estate.
CHANGE OF OWNER AND BENEFICIARY
A change of Owner or Beneficiary must be in written form satisfactory to
the Company, and must be dated and signed by the Owner who is making the
change. The change will be subject to all payments made and actions taken
by the Company under the Contract before the form is received by the
Company at the Variable Products Service Center.
ASSIGNMENTS
An absolute assignment of the Contract by the Owner is a change of owner
and beneficiary to the assignee. A collate:ral assignment of the Contract
by the Owner is not a change of owner or beneficiary; but their rights will
be subject to the terms of the assignment. Assignments will be subject to
all payments made and actions taken by the Company before a signed copy of
the assignment form is received by the Company at the Variable Products
Service Center. The Company will not be responsible for determining whether
or not an assignment is valid.
DESIGNATION OF OWNER AND BENEFICIARY
A numbered sequence can be used to name contingent beneficiaries.
Co~beneficiaries will receive equal shares unless otherwise stated. In
naming owners or beneficiaries, unless otherwise stated:
"Child" includes an adopted or posthumous child:
'Provision for issue' means that if a Beneficiary does not survive the
Owner or Annuitant the share of that Beneficiary will be taken by his or
her living issue by right of representation; and
A family relation such as "wife", "husband. or -child. means the relation
to the Annuitant.
At the time for payment of benefits the Company can rely on an affidavit of
any Owner or other responsible person to determine family relations or
members of a class.
SURRENDER PROVISIONS
CASH SURRENDER
You may surrender this Contract for the cash surrender value at any time
during the Accumulation Period by sending a written request to the Variable
Products Service Center.
CASH SURRENDER VALUE
The cash surrender value is the Contract Value on the date the Company
receives your request for surrender, less any surrender charge.
PARTIAL WITHDRAWALS
You may withdraw part of the cash surrender value at any time during the
Accumulation Period by sending a written request to the Variable Products
Service Center. The partial withdrawal may not be less than 5500.
On the date of withdrawal. the amount withdrawn plus any surrender charge
will be subtracted from the Death BENEFIT AND THE CONTRACT VALUE.
Unless you request otherwise. the Company will allocate partial withdrawals
to the Fixed Account and to the Subaccounts of the Variable Account in the
same proportion as the value in each bears to the' Contract Value on the
date of the partial withdrawal.
The maximum withdrawal allowed will be an amount that, along with the
appropriate surrender charges, will not reduce the Contract Value to less
than $2,500
FREE WITHDRAWAL PRIVILEGE
During each of the first five contract years, you may withdraw up to the
free withdrawal amount without incurring a surrender charge.
The free withdrawal amount equals:
(a) 10% of total purchase payments;
LESS
(b) Any amounts previously withdrawn during the contract year that were not
subject to a surrender charge.
AMOUNTS SUBJECT TO SURRENDER CHARGE
After the fifth contract year there will never be a surrender charge. In
each of the first five contract years, a surrender or partial withdrawal in
excess of the free withdrawal amount will incur a surrender charge. The
amount of the surrender charge deducted from the Contract Value will equal:
(a) The applicable surrender charge percentage;
MULTIPLIED BY
(b) The lesser of:
(1) The amount surrendered or withdrawn in excess of the free withdrawal
amount; and
(2) Total purchase payments.
The surrender charge percentages are shown in the Table of Surrender Charge
Percentages on the Contract Schedule. Total purchase payments equal all
purchase payments made less any amounts previously withdrawn that were
subject to a surrender charge.
Unless you request otherwise. the Company will allocate surrender charges
to the Fixed Account and to the Subaccounts of the Variable Account in the
same proportion as the value in each bears to the Contract Value,
SURRENDER CHARGES ON ANNUITY DATE
The surrender charge will apply if the Annuity Date occurs within the first
three contract years. If the Annuity Date occurs after the third contract
year, there will be no surrender charge.
ANNUITY PROVISIONS
ANNUITY PAYMENTS
On the Annuity Bate the proceeds may be applied to make annuity payments.
All annuity payments will be paid as of the first of the month. The first
payment will be made as of the Annuity Date. this date is shown on the
Contract Schedule unless later changed. Before payments begin the Company
may require proof of the Annuitant's age. The Company may also require that
you exchange this Contract for a supplemental contract which provides the
annuity payments.
Annuity payments under the payment options will be based on the age on the
nearest birthday of the Annuitant. The annuity payable will be the greater
of:
(a) The payment based on the rates shown in the Annuity Table for the
payment option chosen: and
(b) The payment based on the annuity rates in effect on the Annuity Date
for the same payment option.
DEDUCTIONS FROM ANNUITY PAYMENT
During the Annuity Period. the Maintenance Charge will never be higher than
the charge that was in effect immediately before the Annuity Date. The
Maintenance Charge will be deducted on a pro rata basis from each annuity
payment.
CHANGE OF ANNUITY ANNUITY
You may change the Annuity Date shown for this Contract by written request
to the Variable Products Service Center. The Annuity Date must be the first
of a month. Any change must be received by the Company at least 30 days
prior to the Annuity Date being changed. However, the Annuity Date may not
be later than the Annuitant's 80th Birthday or, if later, the fifth
contract anniversary. The new date you select must be at least 30 days
after the Company receives your written request.
ANNUITY PAYMENT OPTIONS
Subject to the terms of this Contract, annuity payments may be made on a
fixed dollar basis, a variable basis, or a combination of both. You can
choose annuity payments according to one of the Options below or another
option agreed to by the Company.
OPTION 1: LIFE ANNUITY
This provides monthly annuity payments during the lifetime of the
Annuitant. No payments will be made after the Annuitant dies.
OPTION 2: JOINT AND SURVIVOR ANNUITY
Monthly payments will be paid during the lifetime of the Annuitant and a
designated second person.
OPTION 3: INCOME FOR A GUARANTEED PERIOD AND LIFE THEREAFTER
The Company will make income payments for a guaranteed period as elected.
If the Annuitant lives beyond the guaranteed period, the payments will
continue until the Annuitant's death.
If the Annuitant dies before the end of the guaranteed period, payments
will be continued to the Beneficiary until the end of the guaranteed
period.
The Beneficiary may elect to have the remaining unpaid guaranteed payments
paid in a single sum. If the Beneficiary dies before the remaining
guaranteed payments have been paid, the remaining unpaid guaranteed
payments will be paid in a single sum to the estate of the Beneficiary. The
remaining unpaid guaranteed payments will be discounted to the date of the
most recent prior annuity payment. Discounted means that the Company will
deduct the amount of interest the remaining payments would have earned.
By written request to the Company at least 30 days before the Annuity Date,
you may select an option and whether payments are to be made on a fixed
dollar basis, or a combination of both. The payment option may not be
changed during the Annuity Period.
If at least 30 days before the Annuity Date the Company has not received at
the Variable Products Service Center your written request:
(a) Payments will be made according to Option 3 with payments guaranteed
for ten years.
(b) The Fixed Account Contract Value, less any surrender charge, will be
applied to purchase a fixed annuity and the Variable Account Contract
Value, less any surrender charge, will be applied to purchase a variable
annuity.
If the amount to be applied to an option would not provide an initial
monthly payment of at least $20, the Company has the right to make a single
sum payment of the proceeds.
FIXED ANNUITY
A fixed annuity is an annuity with payments that are guaranteed by the
Company as to
dollar amount. The payment is determined by applying the Fixed Account
Contract Value, less any surrender charge, to the appropriate Annuity
Table for the option chosen. Income
payments under a fixed annuity Will not vary in dollar amount.
VARIABLE ANNUITY
A variable annuity is an annuity with payments which:
(a) Are not guaranteed as to dollar amount: and
(b) Vary in amount with the investment experience of the elected
Subaccounts.
ANNUITY UNIT VALUE
The value of an annuity unit for each Subaccount was initially set at $1.00
at the start of the first valuation period of the Subaccount. The annuity
unit value for each Subaccount for any subsequent valuation period is equal
to (a) multiplied by (b) multiplied by (c) where:
(a) Is the net investment factor for the valuation period for which the
annuity unit value is being calculated;
(b) Is the,annuity unit value for the preceding valuation period: and
(c) Is the investment result adjustment factor (.99990575 per day) which
recognizes an annual interest rate of 3.5% used in determining the variable
annuity payment amounts
DETERMINATION OF FIRST VARIABLE ANNUITY PAYMENT
The Variable Account Contract Value, less any surrender charge, will be
applied to the appropriate Annuity Table. This will be done for the
valuation period in which the Annuity Date occurs and in accordance with
the payment option chosen. The amount payable for the first payment for
each $ 1,000 so applied is shown in the Annuity Table for the option chosen
based on an assumed interest rate of 3.5%. The Company may make available
variable payments based on other assumed interest rates.
VARIABLE ANNUITY PAYMENTS AFTER THE FIRST PAYMENT
Variable annuity payments after the first vary in amount. The amount
changes with the investment performance of the elected Subaccounts. The
dollar amount of variable annuity payments after the first is not fixed. It
may change from month to month. The dollar amount of such payments is
determined as follows:
(a) The dollar amount of the first annuity payment is divided by the value
of an annuity unit as of the valuation period in which the Annuity Date
occurs. This result establishes the fixed number of annuity units for each
monthly annuity payment after the first. This number of annuity units
remains fixed during the Annuity Period, except for the effect of any
exchange of annuity units.
(b) The fixed number of annuity units is multiplied by the annuity unit
value as of the valuation period in which the payment is due. This result
establishes the dollar amount of the payment.
The dollar amount of each payment after the first will not be affected by
variations in expenses or mortality experience.
EXCHANGE OF ANNUITY UNITS
Annuity units of any Subaccount may be exchanged for units of any other
Subaccount by request to the Variable Products Service Center. The
Exchange, which must be in accordance with the Company's then current
rules, will be effective as of the end of the valuation period in which the
request is received and will affect payments determined after that
valuation period. The exchange will be based on the relative value of the
Subaccount annuity units. Once annuity payments start no exchanges may be
made to or from any fixed annuity.
AGE ADJUSTMENT
Age is based on the adjusted age of the Annuitant &5 of the Annuity Date.
The joint and survivor annuity payment rates are based on the adjusted ages
of both the Annuitant and the designated second person as of the Annuity
Date. The adjusted age is:
(a) The age on the birthday nearest to the Annuity Date;
LESS
(b) The age adjustment shown below which is based on the number of contract
years that have elapsed from the Contract Date to the Annuity Date.
Contract Years Elapsed 1 to 5 6 to 10 11 to 15 16 to 20 21 to 25 25+
Age adjustment 0 1 2 3 4 5
ANNUITY TABLES
DOLLAR AMOUNT OF THE ANNUITY PAYMENT WHICH IS PURCHASED WITH EACH 51,000 OF
PROCEEDS APPLIED
GUARANTEED MONTHLY
PAYMENTS
OPTION 1 OPTION 3
Adjusted Age Life Annuity Life Annuity Life Annuity
10 Years Guaranteed 20 Years Guaranteed
55 4.54 4.51 4.38
56 4.62 4.58 4.44
57 4.71 4.66 4.51
58 4.80 4.75 4.57
59 4.90 4.84 4.64
60 5.00 4.93 4.70
61 5.11 5.03 4 77
62 5.23 5.14 4.84
63 5.36 5.25 4.91
64 5.49 5.37 4.98
65 5.64 5.50 5.05
66 5.79 5.63 5.12
67 5.95 5.77 5.19
68 6.13 5.91 5.25
69 6.32 6.07 5.32
70 6.53 6.23 5.38
71 6.75 6.40 5.43
72 6.99 6.58 5.48
73 7.26 6.76 5.52
74 7.54 6.95 5.57
75 7.85 7.14 5.60
76 8.18 7.34 5.63
77 8.54 7.54 5.66
78 8.94 7.74 5.68
79 9.36 7.94 5.70
80 9.82 8.13 5.71
JOINT AND SURVIVOR LIFE ANNUITY (OPTION 2)
ADJUSTED AGE ADJUSTED AGE SECOND ANNUITANT
FIRST ANNUITANT
Age 55 60 65 70 75 80
55 3.96 4.09 4.19 4.27 4.33 4.37
60 4.09 4.27 4.44 4.58 4.69 4.76
65 4.19 4.44 4.69 4.92 5.11 5.25
70 4.27 4.58 4.92 5.27 5.60 5.86
75 4.33 4.69 5.11 5.60 6.11 6.58
80 4.37 4.76 5.25 5.86 6.58 7.33
Basis =1983a Individual Annuitant Mortality at 3.5% annual interest
The dollar amount of annuity payment for any age or combination of ages not
shown in the Annuity Tables or for any other form of annuity option agreed
toe by us will be furnished on request.
FIDELITY INVESTMENTS LIFE INSURANCE COMPANY
PHILADELPHIA, PENNSYLVANIA
DEFERRED ANNUITY
FLEXIBLE PURCHASE PAYMENTS
OPTIONAL VARIABLE AND FIXED ACCUMULATION VALUES
OPTIONAL VARIABLE AND FIXED ANNUITY PAYMENTS
NONPARTICIPATING
ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT
EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO
DOLLAR AMOUNT. (SEE CONTRACT VALUE, PAGE 10.)