[FORETHOUGHT LOGO]
INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT
FORETHOUGHT LIFE INSURANCE COMPANY
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SUITE 1800
INDIANAPOLIS, IN 46204
1-8XX-XXXX
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In this Contract, "You" or "Your" will refer to the Owner and "We," "Our," or
"Us" will refer to Forethought Life Insurance Company.
We will pay the first of a series of Annuity Payments to the Payee as of the
Annuity Commencement Date, if You are living. The manner in which the dollar
amount of Annuity Payments is determined is described in this Contract. This
Contract is issued in consideration of the payment of the initial Premium
Payment.
The Contract Specifications Page on Page 3 and the conditions and provisions on
this and the following pages are part of the Contract.
RIGHT TO EXAMINE AND RETURN THIS CONTRACT
We want You to be satisfied with the Contract You have purchased. We urge You to
closely examine its provisions. If for any reason You are not satisfied, You may
cancel the Contract by returning it within 10 days after You receive it if this
is not a replacement contract or 30 days, if this is a replacement contract. A
written request for cancellation must accompany the Contract. Mail or deliver
the Contract and written request to Us at the Annuity Service Center address
shown on the Contract Specifications Page or to the agent from whom it was
purchased. If You return the Contract by mail, it will be deemed returned on
being postmarked, properly addressed, and postage prepaid. In such an event, We
will pay You the Contract Value on the date of surrender, plus any fees and
charges deducted from the premiums or imposed under such Contract. For the
Separate Account portion, You bear only the investment risk during the period
prior to Our receipt of request for cancellation.
Signed for the Company
SAMPLE I-SHARE (FR4)
SECRETARY PRESIDENT
PREMIUM PAYMENTS ARE FLEXIBLE AS DESCRIBED HEREIN.
RIGHT TO ADDITIONAL INFORMATION: You may request in writing additional
information regarding the benefits and provisions of your Contract, and we will
respond to your written request, in writing or verbally, within a reasonable
amount of time but in no event not later than ten (10) days from the date on
which we received Your written request.
This Contract is an Individual Flexible Premium Variable Annuity. It is
nonparticipating.
ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT
EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED
DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION
PROVISIONS, PAGES 6 AND 7.
ICC12-FLICVA-NCDSC
1
TABLE OF CONTENTS
PAGE
Annuity Provisions 12
Annuity Tables 15
Contract Control Provisions 8
Contract Specifications Page 3
Death Benefits 11
Definition of Certain Terms 4
General Provisions 8
Premium Payments 6
Surrenders and Partial Withdrawals 10
Transfers Between Accounts 7
Valuation Provisions 6
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CONTRACT SPECIFICATIONS PAGE
CONTRACT NUMBER SPECIMEN ISSUE DATE 07-14-2016
ANNUITANT ▇▇▇▇▇ ▇▇▇▇▇ ANNUITY COMMENCEMENT DATE 01-01-2046
ANNUITANT AGE 35 INITIAL PREMIUM PAYMENT $10,000
ANNUITANT GENDER MALE MINIMUM SUBSEQUENT PAYMENT $500
DESIGNATED BENEFICIARY ▇▇▇ ▇▇▇▇▇ MINIMUM CONTRACT VALUE $2,500
OWNER ▇▇▇▇▇ ▇▇▇▇▇ MINIMUM ANNUITY PAYMENT $100
JOINT OWNER ▇▇▇▇ ▇▇▇▇▇ PREMIUM BASED CHARGE 0.00%
OWNER AGE 35
MINIMUM INITIAL PREMIUM $5,000 for Qualified
Plans,
$10,000 for
Non-Qualified Plans
INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT
SEPARATE ACCOUNT: Separate Account A
MORTALITY AND EXPENSE RISK CHARGE: 1.45% Per annum of the daily Sub-Accounts
value.
ADMINISTRATION CHARGE: 0.20% Per annum of the daily Sub-Accounts value.
ANNUAL MAINTENANCE FEE: $0 If the Contract Value is $50,000 or more on the
Contract Anniversary. $50 If the Contract Value is less than $50,000 on the
Contract Anniversary and when the Contract is fully surrendered.
ADDITIONAL PREMIUMS: Additional payments must be at least equal to the minimum
subsequent Premium Payment shown on the Contract Specifications Page. Our
approval is required for any Premium Payment if the aggregate of all Premium
Payments received from You under all deferred variable annuity contracts issued
by Us or Our affiliates then equals or exceeds $1,000,000. Our approval is also
required for any Premium Payment if the aggregate of all Premium Payments
received from You under this Contract exceeds 150% of the Initial Premium.
ISSUE STATE:
DEPARTMENT OF INSURANCE:
PHONE NUMBER:
ICC12-FLICCSP (I-Share)
3a
ANNUITY SERVICE CENTER: All correspondence concerning this contract should be
sent to:
ADDRESS FOR U. S. P. S. FIRST CLASS MAIL FOR NON-PREMIUM PAYMENT
CORRESPONDENCE: P.O. Box 758507 Topeka, Kansas, 66675-8507
ADDRESS FOR U. S. P. S. FIRST CLASS MAIL FOR PREMIUM PAYMENTS:
P.O. Box 758502, Topeka, Kansas, 66675-8502
ADDRESS FOR OVERNIGHT MAIL: ▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇, ▇▇▇▇▇▇
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RIDERS AND ENDORSEMENTS ATTACHED TO YOUR CONTRACT AS OF THE ISSUE DATE:
NAME MAXIMUM CHARGE/FEE
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SAMPLE RIDERS SAMPLE FEES
3b
DEFINITION OF CERTAIN TERMS
ACCOUNT - Any of the Sub-Accounts.
ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of
a Sub-Account before Annuity Payments begin.
ANNUAL MAINTENANCE FEE - An amount which, depending on the amount of the
Contract Value, may be deducted from the value of the Contract on each Contract
Anniversary and upon full surrender of this Contract. The Annual Maintenance Fee
is shown on the Contract Specifications Page.
ANNUITANT - The person upon whose life the Annuity Payments may be based. The
Annuitant may not be changed at any time if the Owner is a non-natural person.
The Annuitant may not be changed after the Annuity Commencement Date.
ANNUITY CALCULATION DATE - The date on which the first Annuity Payment will be
calculated. It will be no more than five Valuation Days prior to the Annuity
Commencement Date.
ANNUITY COMMENCEMENT DATE - The date on which Annuity Payments begin as
described under Settlement Provisions in this Contract.
ANNUITY PAYMENTS - The payments made to the Owner or other named Payee after the
Annuity Commencement Date under the Annuity Option elected.
ANNUITY PAYMENT FREQUENCY - The frequencies at which Annuity Payments may be
made. The frequencies are monthly, quarterly, semi-annually, and annually,
subject to availability.
ANNUITY SERVICE CENTER - All correspondence concerning this Contract should be
sent to Our Annuity Service Center shown on the Contract Specifications Page.
BENEFICIARY - The person You name to receive a Death Benefit payable under this
Contract.
COMMUTED VALUE - The present value of the remaining guaranteed Annuity Payments.
CONTRACT ANNIVERSARY - An anniversary of the Issue Date.
CONTRACT VALUE - The aggregate value of the Accounts on any Valuation Day.
CONTRACT MATURITY DATE - The later of (i) the tenth Contract Anniversary or (ii)
the Valuation Day immediately following the oldest Owner's 90th birthday; or, in
the case of a non-natural Owner, the Valuation Day immediately following the
Annuitant's 90th birthday.
CONTRACT YEAR - A period of 12 months commencing with the Issue Date or each
anniversary thereafter.
DEATH BENEFIT - The amount that We will pay upon the death of the Owner or the
Annuitant, as applicable. If there are joint Owners, the Death Benefit will pay
upon the first death of an Owner.
DUE PROOF OF DEATH - A certified copy of a death certificate, an order of a
court of competent jurisdiction, or any other proof, acceptable to Us.
FUNDS - The securities which underlie Your Sub-Accounts.
GENERAL ACCOUNT - All of Our assets other than those allocated to the Separate
Account.
GUARANTEED PAYMENT PERIOD - The period of time during which Annuity Payments are
certain and guaranteed.
ICC12-FLICVA-NCDSC
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INITIAL PREMIUM - Premium Payments made within 90 days of the Issue Date.
INTERNAL REVENUE CODE - The United States Internal Revenue Code of 1986, as
amended or any successor law.
INTERNAL REVENUE SERVICE - The United States Internal Revenue Service or any
successor agency.
ISSUE DATE - The date as of which the Contract is established for You by Us. The
Issue Date is shown on the Contract Specifications Page.
JOINT ANNUITANT - Upon annuitization, a person other than the Annuitant on whose
continuation of life Annuity Payments may be made. The Contract will have a
Joint Annuitant only if the Annuity Option selected provides for a survivor. The
Joint Annuitant may not be changed.
OWNER(S) - The owner(s) or holder of the Contract.
PAYEE - The person, designated by You, to whom Annuity Payments will be made.
PARTIAL WITHDRAWAL - A withdrawal of a portion of the Contract Value, which may
be subject to charges if applicable.
PREMIUM BASED CHARGE - A charge based on total RGP. The Premium Based Charge is
shown on the Contract Specifications Page.
PREMIUM TAX - The amount of tax, if any, charged by a federal, state, or other
governmental entity on Premium Payments or Contract Values. If this Contract is
subject to a Premium Tax, We may deduct the tax at the time We pay the tax, the
Contract is surrendered or paid as a Death Benefit or on the Annuity
Commencement Date. If We deduct the tax after Your Premium Payments have been
applied to the Accounts, the tax will be deducted from the Accounts on a
pro-rata basis.
QUARTERLY CONTRACT ANNIVERSARY - Each successive three-month anniversary of the
Issue Date of the Contract.
SEPARATE ACCOUNT - An account that We established to separate the assets funding
the variable benefits for this type of contract from Our other assets. The
assets in the Separate Account are not chargeable with liabilities arising out
of any other business We may conduct. The name of the Separate Account is shown
on the Contract Specifications Page. Income gains, and losses, whether or not
realized, from assets allocated to the Separate Account will be credited to or
charged against the Separate Account without regard to other income, gains or
losses of the Company.
SUB-ACCOUNT - The subdivisions of the Separate Account which are used to
allocate Your Contract Value allocated to the Separate Account among the
corresponding Funds.
SURRENDER VALUE - The Contract Value prior to the Annuity Commencement Date,
less any applicable Premium Taxes, applicable rider fee, applicable Premium
Based Charge, and/or Annual Maintenance Fee.
VALUATION DAY - Every day the New York Stock Exchange is open for trading. The
value of the Separate Account is determined at the close of the New York Stock
Exchange (generally 4:00 p.m. Eastern Time) on such days.
VALUATION PERIOD - The period of time between the close of business on
successive Valuation Days.
WE, US, OUR - The company referred to on the first page of this Contract.
YOU, YOUR - The Owner(s).
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PREMIUM PAYMENTS
PREMIUM PAYMENTS
Premium Payments are payable at the Annuity Service Center. Payments may be made
by check or by any other method that We deem acceptable.
The initial Premium Payment is shown on the Contract Specifications Page. This
is a flexible premium annuity. We may accept additional payments. Restrictions
on additional payments are shown on the Contract Specifications Page.
If You are exchanging from one of Our existing contracts, You may be eligible
for certain credits applied to the amount exchanged. Eligibility for such
credits will be extended to all members of any class of business We designate.
ALLOCATION OF PREMIUM PAYMENTS
Premium Payments will be allocated to each Account according to Your
instructions subject to Our minimum amount(s) then in effect. Any subsequent
Premium Payments will be allocated to Accounts in accordance with the most
recent Premium Payment allocation instructions that We received.
VALUATION PROVISIONS
NET PREMIUM PAYMENTS
A Net Premium is the Premium Payment, less Premium Taxes, if applicable, that is
applied to purchase or Sub-Account Accumulation Units with respect to the
Sub-Account(s) that You have selected.
The number of Accumulation Units credited to each Sub-Account is determined by
dividing the net Premium Payment allocated to a Sub-Account by the dollar value
of one Accumulation Unit for such Sub-Account. This is computed in compliance
with Securities and Exchange Commission regulations. The number of Accumulation
Units will not be affected by any subsequent change in the value of such
Accumulation Units. The Accumulation Unit value in any Sub-Account may increase
or decrease from day to day as described below.
NET INVESTMENT FACTOR
The net investment factor for each of the Sub-Accounts is equal to:
a) the net asset value per share plus applicable distributions per share of
the corresponding Fund at the end of the Valuation Period; divided by
b) the net asset value per share of the corresponding Fund at the beginning of
the Valuation Period; multiplied by
c) the daily expense factor for mortality and expense risk charge, any
applicable administration charge shown on the Contract Specifications Page,
and the asset based charge for elected optional riders, if any, adjusted
for the number of days in the Valuation Period.
ACCUMULATION UNIT VALUE
The value of an Accumulation Unit for each Sub-Account of the Separate Account
will vary to reflect the investment experience of the applicable Funds. It will
be determined by multiplying:
a) the value of the Accumulation Unit for that Sub-Account as of the preceding
Valuation Day by
b) the net investment factor for that Sub-Account for the Valuation Day for
which the Accumulation Unit value is being calculated.
The value of the Sub-Account as of each Valuation Day is then determined by
multiplying:
a) the number of Accumulation Units in that Sub-Account by
b) the Accumulation Unit value as of that Valuation Day.
6
ANNUAL MAINTENANCE FEE
During each year that this contract is in force prior to the Annuity
Commencement Date, the Annual Maintenance Fee, if applicable, will be deducted
on the Contract Anniversary and upon full surrender of the Contract. The fee
will be charged against the Contract Value by reducing the number of
Accumulation Units held as of that date. The fee will be charged on a pro-rata
basis with respect to each active Account. The number of Accumulation Units
deducted from each Sub-Account is determined by dividing the pro-rata portion of
the Annual Maintenance Fee by the value of an Accumulation Unit for the
applicable Sub-Account.
PREMIUM BASED CHARGE
The Premium Based Charge is designed to compensate Us for a portion of Our
acquisition expenses, including promotion and distribution of the Contract. We
will apply an annual Premium Based Charge against each Premium Payment made to
this Contract. This charge will be deducted from the Contract Value on the
Quarterly Contract Anniversary. The amount of the Premium Based Charge assessed
on any Quarterly Contract Anniversary will equal the Premium Based Charge
multiplied by total RGP, divided by four. The entire Premium Based Charge will
be deducted only from Contract Value invested in Sub-Accounts on a pro-rata
basis with respect to each active Sub-Account. The number of Accumulation Units
deducted from each Sub-Account is determined by dividing the pro-rata portion of
the Premium Based Charge by the value of an Accumulation Unit for the applicable
Sub-Account.
TRANSFERS BETWEEN ACCOUNTS
TRANSFERS BETWEEN ACCOUNTS
You may transfer Contract Values held in the Accounts into other Accounts before
the Annuity Commencement Date. We may, according to Our then current policies
and procedures, restrict or terminate Your transfer privileges if We determine,
in Our sole discretion, that You have engaged in a pattern of transfers that is
disadvantageous or potentially harmful to other Owners.
We may upon 30 days advance written notice to You establish restrictions,
policies, and procedures, which may restrict or terminate Your ability to
transfer Contract Values between any Accounts that We determine are competing
investment choices.
The right to make transfers between Sub-Accounts is subject to modification if
We determine, in Our opinion, that exercising that right by one or more Owners
is, or would be, to the disadvantage of other Owners. Any modification could be
applied to transfers to or from some or all of the Sub-Accounts and could
include, but not be limited to:
a) the requirement of a minimum time period between each transfer;
b) not accepting transfer requests of an agent acting under a power of
attorney or on behalf of more than one Owner, or
c) limiting the dollar amount that may be transferred between the Sub-Accounts
by an Owner at any one time.
Such restrictions may be applied in any manner reasonably designed to prevent
any use of the transfer right which is considered by Us to be to the
disadvantage of other Owners.
No transfers may be made after the Annuity Commencement Date.
DOLLAR COST AVERAGING AND OTHER PROGRAMS
From time to time, We may offer various programs, including, but not limited to,
systematic transfer or dollar cost averaging programs, enhanced interest rate
dollar cost averaging programs, interest averaging programs, and various other
programs ("Program").
You may obtain the applicable rules, restrictions, credited rate (if applicable)
and the duration for a Program when You enroll in the Program. You may terminate
participation in a Program at any time by calling or writing Us.
We may discontinue, modify or amend any Program that We establish. Any change to
a Program will not affect Owners currently enrolled in the Program during the
term of their existing enrollment.
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CONTRACT CONTROL PROVISIONS
ANNUITANT, OWNER
The designations of Owner and Annuitant will remain in effect until You change
them. The designation of the Owner may be changed at any time by written notice
to Us. Unless specified by You, the change of Owner will be effective as of the
date signed by You, subject to any payments or actions taken by Us prior to Our
receipt of notice. The designation of the Annuitant may be changed at any time
prior to the Annuity Commencement Date by written notice to Us; however, the
Annuitant may not be changed in a Contract which is owned by a non-natural
person.
ASSIGNMENT
You may assign Your rights under this Contract at any time by written notice to
Us. Unless specified by You, the assignment will be effective as of the date
signed by You, subject to any payments or actions taken by Us prior to Our
receipt of notice.
OWNERSHIP
You have the sole power to exercise all the rights, options, and privileges
granted by this Contract or permitted by Us and to agree with Us to any change
in or amendment to the Contract. Your rights will be subject to the rights of
any assignee of record with Us and of any irrevocably designated Beneficiary. In
the case of joint Owners, each Owner alone may exercise all rights, options, and
privileges, except with respect to the surrender, Partial Withdrawal, selection
of an Annuity Option, change of Beneficiary and change of ownership.
BENEFICIARY
The designated Beneficiary will remain in effect until You change it. The
designated Beneficiary may be changed by written notice to Us at the Annuity
Service Center. If the designated Beneficiary has been designated irrevocably,
the designation cannot be changed or revoked without such Beneficiary's written
consent. Upon receipt of written notice and consent, if required by Us, the new
designation will take effect as of the date the notice is signed, unless
otherwise specified by the Owner and whether or not the Owner is alive at the
time of receipt. Any payments made or other action taken by Us before the
receipt of the notice will not be subject to the requested change.
Subject to any tax qualification requirements under the Internal Revenue Code,
Our then policies and procedures, and subject to the paragraph entitled
"Distribution Requirements" of this Contract, a Beneficiary may designate
another individual or entity to receive, upon the death of the Beneficiary, any
remaining interest of the Beneficiary in the Contract.
GENERAL PROVISIONS
THE CONTRACT
This Contract and the endorsements or riders, if any, constitute the entire
contract.
CONTRACT MODIFICATION
This Contract may be modified by Us to maintain compliance with federal laws.
This Contract may be changed only in writing signed by Our President or
Secretary.
FUND MODIFICATION
We reserve the right, subject to any applicable law, to make certain changes,
including the right to add, eliminate, or substitute any investment options
offered under the Contract.
MINIMUM VALUE STATEMENT
Any Surrender Values, Death Benefits, or settlement provisions available under
this Contract are not less than the minimum benefits required by Section 7B of
the Model Variable Annuity Regulation, model #250.
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NON-PARTICIPATING
This Contract does not share in Our surplus earnings. That portion of the
Separate Account assets equal to the reserves and other Contract liabilities
will not be chargeable with liabilities arising out of any other business We may
conduct.
MISSTATEMENT OF AGE AND GENDER
If the age or gender of an Annuitant has been misstated, the amount of the
annuity payable by Us will be adjusted based on the correct information without
changing the date of the first payment. Any underpayments by Us will be made up
immediately and any overpayments will be charged against future amounts becoming
payable. The calculation of the overpayment or underpayment will be based on an
interest rate of 1%.
If the age of an Annuitant or Owner has been misstated, the amount of any Death
Benefit payable will be determined based upon the correct age of an Annuitant or
Owner.
INCONTESTABILITY
We will not contest this Contract as of the Issue Date.
REPORTS TO THE OWNER
You will be sent copies of any shareholder reports of the Funds and of any other
notices, reports or documents required by law to be delivered to You. At least
annually, a statement of the Contract Value will be sent to You.
VOTING RIGHTS
We will notify You of any Fund shareholder's meetings at which the shares held
for Your account may be voted. We will send proxy materials and instructions for
You to vote the shares held for Your account. We will arrange for the handling
and tallying of proxies received from Owners. We will vote the Fund shares held
by Us in accordance with the instructions received from Owners. You may attend
any meeting, where shares held for Your benefit, will be voted.
In the event that You give no instructions or leave the manner of voting
discretionary, We will vote such shares of the appropriate Fund in the same
proportion as shares of that Fund for which instructions have been received.
Also, We will vote the Fund shares in this proportionate manner which are held
by Us for Our own account.
CHANGE IN THE OPERATION OF THE SEPARATE ACCOUNT
At Our election and subject to any necessary vote by persons having the right to
give instructions on the voting of the Fund shares held by the Sub-Accounts, the
Separate Account may be operated as a management company under the Investment
Company Act of 1940 or any other form permitted by law, may be deregistered
under the Investment Company Act of 1940 in the event registration is no longer
required, or may be combined with one or more Separate Accounts.
EVIDENCE OF SURVIVAL
We may require satisfactory evidence of the continued survival of any person(s)
on whose life Annuity Payments are based. We reserve the right to discontinue
Annuity Payments until satisfactory proof of continued survival is received by
Us.
TAX QUALIFICATION
This Contract is intended to qualify as an annuity contract for federal income
tax purposes. To that end, the provisions of this Contract are to be interpreted
to ensure and maintain such tax qualification, notwithstanding any other
provisions to the contrary. We reserve the right to amend this Contract to
conform to any changes in the tax qualification requirements under the
applicable provisions of the Internal Revenue Code.
CONFORMITY WITH INTERSTATE INSURANCE PRODUCT REGULATION COMMISSION STANDARDS
This Contract was approved under the authority of the Interstate Insurance
Product Regulation Commission and is issued under the Commission standards. If
any provision of the Contract is in conflict with the applicable Interstate
Insurance Product Regulation Commission standards on the date such provision is
effective, the provision will automatically be amended to conform to the
applicable Interstate Insurance Product Regulation Commission standards as of
the provision's effective date.
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REPORTS
At least annually, and without charge, We will provide you with a report that
contains the following information:
a) the beginning and end dates of the report;
b) the Contract Value, if any, at the beginning of the current report period
and at the end of the current report period;
c) the amounts that have been credited or debited to the Contract Value during
the current report period, identified by type; and
d) the cash surrender value, if any, at the end of the current report period.
The information in the report will be current as of a date that in no more than
four months prior to the date of mailing. Additional reports are available upon
request. There will be a maximum $10 charge for additional reports You request.
SURRENDERS AND WITHDRAWALS
FULL SURRENDER PRIOR TO THE ANNUITY COMMENCEMENT DATE
At any time prior to the Annuity Commencement Date, You have the right to
terminate the Contract by submitting a written request to Us at the Annuity
Service Center. In such event, the Surrender Value of the Contract may be taken
in the form of a cash settlement.
The Surrender Value of the Contract is equal to the Contract Value less:
a) any applicable Premium Taxes not previously deducted;
b) the Annual Maintenance Fee shown the Contract Specifications Page; and
c) any applicable Premium Based Charge shown on the Contract Specifications
Page
PARTIAL WITHDRAWALS PRIOR TO THE ANNUITY COMMENCEMENT DATE
You may request, in writing or other means acceptable to Us, a Partial
Withdrawal of Contract Values at any time prior to the Annuity Commencement Date
provided the Contract Value remaining after the withdrawal is at least equal to
the Minimum Contract Value shown on the Contract Specifications Page. If the
remaining Contract Value following such withdrawal is less than Our Minimum
Contract Value, We may terminate the Contract and pay the Surrender Value.
SURRENDERS AFTER THE ANNUITY COMMENCEMENT DATE
You may surrender all or portions of Your Contract attributable to Guaranteed
Payment Period payments if You selected an annuity under Option 3 (Life Annuity
with Payments for Guaranteed Payment Period), Option 5 (Joint and Last Survivor
Life Annuity with Payments for Guaranteed Payment Period), or Option 6
(Guaranteed Payment Period).
We pay You the Commuted Value of the amounts surrendered that We would have paid
during the Guaranteed Payment Period. Your surrender must occur during the
Guaranteed Payment Period.
For Options 3, and 5, on the date the Guaranteed Payment Period would have
expired had it not been surrendered and if the Annuitant is living, Annuity
Payments will resume and will cease with the last payment due prior to the death
of the Annuitant.
To calculate the Commuted Value We will use an interest rate We determine at Our
discretion.
PAYMENT ON SURRENDER - DEFERRAL OF PAYMENT
Payment on any request for Partial Withdrawal or Surrender will be made as soon
as possible and with respect to Contract Values in the Sub-Accounts, within
seven days after the written request is received by Us in good order. However,
such payment may be subject to postponement:
a) for any period during which the New York Stock Exchange is closed or during
which trading on the New York Stock Exchange is restricted;
10
b) for any period during which an emergency exists as a result of which (i)
disposal of the securities held in the Sub-Accounts is not reasonably
practicable, or (ii) it is not reasonably practicable for the value of the
net assets of the Separate Account to be fairly determined;
c) for such other periods as the Securities and Exchange Commission ("SEC")
may, by order, permit for the protection of the Owners. The conditions
under which trading will be deemed to be restricted or any emergency will
be deemed to exist will be determined by rules and regulations of the SEC.
d) with respect to a money market Sub-Account, if the board of directors of
the underlying money market Fund suspends redemptions from the Fund in
connection with the Fund's plan of liquidation, in compliance with rules of
the SEC or an order of the SEC.
DEATH BENEFITS
DEATH OF OWNER BEFORE THE ANNUITY COMMENCEMENT DATE
We pay a Death Benefit before the Annuity Commencement Date if the Owner dies.
If
a) the joint Owner is living, the joint Owner will become the Beneficiary. In
this case, the rights of the designated Beneficiary are voided;
b) there is no surviving joint Owner, the designated Beneficiary will be the
Beneficiary; or
c) no Beneficiary designation is in effect or the designated Beneficiary has
predeceased the Owner, the Owner's estate shall be the Beneficiary.
DEATH OF OWNER ON OR AFTER THE ANNUITY COMMENCEMENT DATE
If the Owner dies after the Annuity Commencement Date, the Beneficiary will
become the Owner.
DEATH OF ANNUITANT BEFORE, ON OR AFTER THE ANNUITY COMMENCEMENT DATE
If an Annuitant who is not an Owner dies before the Annuity Commencement Date,
the Owner becomes the Annuitant. The Owner may select a different Annuitant. Any
new Annuitant designation will be subject to the Company's underwriting rules
then in effect. If the Owner is a non-natural person, the death of the Annuitant
will be treated as the death of the Owner.
Upon the death of the Annuitant on or after the Annuity Commencement Date, the
death benefit will be paid as specified in the Annuity Option elected. Death
benefits will be paid at least as rapidly as under the method of distribution in
effect at the time of the Annuitant's death.
CALCULATION OF THE DEATH BENEFIT
If a Death Benefit is payable before the Annuity Commencement Date, the Death
Benefit payable will be calculated as of the date We receive written
notification of Due Proof of Death at the Annuity Service Center.
If the calculated Death Benefit exceeds the Contract Value, the difference will
be allocated to the Sub-Account(s) in accordance with the last Sub-Account
allocation instructions received from the Owner. During the time period between
Our receipt of written notification of Due Proof of Death and Our receipt of
complete settlement instructions from each Beneficiary, the calculated Death
Benefit amount will be subject to market fluctuations.
If a Death Benefit is payable after the Annuity Commencement Date, the Death
Benefit will be calculated as of the date We receive both written notification
of Due Proof of Death and written instructions as in the manner described in the
annuity payout option then in effect.
DEATH BENEFIT BEFORE THE ANNUITY COMMENCEMENT DATE
The Death Benefit payable is equal to the greater of:
a) Contract Value, or
b) the greatest Death Benefit payable under any rider or endorsement made part
of this Contract.
SETTLEMENT OF THE DEATH BENEFIT
The Death Benefit may be taken in one sum or under any of the settlement options
then being offered by Us subject, however, to the Distribution Requirements
below. The Beneficiary may elect any available settlement option, unless the
Owner has designated the settlement option for that Beneficiary. The available
settlement options include any of the Annuity Options under this Contract or any
other options then being offered by Us.
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As of the date of receipt of complete disbursement instructions from the
Beneficiary, the amount to be paid or applied to a selected settlement option
will be computed. When there is more than one Beneficiary, the amount will be
calculated for each Beneficiary's share of the proceeds and paid or applied to a
selected settlement option according to and upon each Beneficiary's
instructions. If the date of receipt of complete instructions falls on a
non-Valuation Day, the amount will be computed on the next Valuation Day.
When payment is taken in one sum, payment from the Sub-Accounts will be made
within 7 days of Our receipt of complete instructions, except when We are
permitted to defer such payment under the Investment Company Act of 1940 or any
other applicable state or federal law.
DISTRIBUTION REQUIREMENTS
Subject to the Alternative Election or Spouse Beneficiary provisions below,
a) If any Owner dies before the Annuity Commencement Date, the entire interest
in the Contract will be distributed within five years after such death; and
b) If any Owner dies on or after the Annuity Commencement Date, and before the
entire interest in the Contract has been distributed, the remaining portion
of such interest will be distributed at least as rapidly as under the
method of distribution being used as of the date of such death.
If the Owner is a non-natural person, then for purposes of the preceding
paragraph a) or b), the Annuitant will be treated as the Owner.
If the Owner dies before the Annuity Commencement Date, proceeds from the Death
Benefit can be left with Us for a period not to exceed five years from the date
of the Owner's death. The proceeds will remain in the Sub-Account(s) to which
they were allocated at the time of death unless the Beneficiary elects to
reallocate them. Partial Withdrawals or Surrenders may be made at any time. In
the event of withdrawals, the remaining value will equal the Contract Value of
the proceeds left with Us, minus any withdrawals.
ALTERNATIVE ELECTION TO SATISFY DISTRIBUTION REQUIREMENTS
If any portion of the interest of an Owner described above is payable to or for
the benefit of a designated Beneficiary, and the Beneficiary elects after the
Owner's death to have the benefit distributed over a period that:
a) does not extend beyond such Beneficiary's life (or life expectancy); and
b) does commence within one year of the Owner's date of death, then for
purposes of satisfying the Distribution Requirements above, the benefit
will be treated as distributed entirely on the date such periodic
distributions begin.
SPOUSE BENEFICIARY
If the Owner's spouse becomes the Beneficiary by reason of the Owner's death
that portion of the Contract for which the spouse is the Beneficiary will
continue with the spouse as the Owner, unless the spouse elects to be paid a
Death Benefit option. This provision will apply only once with respect to this
Contract.
If the Contract continues with the spouse as the Owner, the Death Benefit will
be calculated on receipt of Due Proof of Death. If the Contract Value is less
than the calculated Death Benefit amount, the Contract Value will be increased
to equal the Death Benefit.
ANNUITY PROVISIONS
ANNUITY COMMENCEMENT DATE
The Annuity Commencement Date is shown on the Contract Specifications Page. You
may change the date by notifying Us prior to the Annuity Commencement Date. The
date cannot be deferred beyond the Contract Maturity Date, except in annual
increments, and not to a date later than (i) the Valuation Day immediately
following the oldest Owner's 100th birthday; or, in the case of a non-natural
Owner, the Valuation Day immediately following the Annuitant's 100th birthday.
Any extensions of the Annuity Commencement Date beyond the Contract Maturity
Date must be approved by Us to be effective.
ELECTION OF ANNUITY OPTION
After the first Contract Anniversary You may elect, in writing any one of the
Annuity Options described below or any annuity option then being offered by Us.
The Annuity Option cannot be changed on or after the Annuity Commencement Date.
Upon annuitization, Your Contract Value will be moved to the General Account.
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If You do not make an election, Annuity Payments will be made under Option 3
(Life Annuity with 10 Years of Annuity Payments Guaranteed).
Some of the Annuity Options may not be available if this Contract is issued to
qualify under Section 401, 403, or 408 of the Internal Revenue Code. Annuity
Option 3 (Life Annuity with 10 Years of Annuity Payments Guaranteed), Option 5
(Joint and Last Survivor Annuity with 10 Years of Annuity Payments Guaranteed)
and Option 6 (Guaranteed Payment Period) will be available only if the
guaranteed payment period is not greater than the life expectancy of the
Annuitant at the time the option becomes effective. Such life expectancy will be
computed under applicable Internal Revenue Service tables.
Annuity Payments, as of the Annuity Commencement Date, will not be less than
those that would be provided by the application of the cash surrender value to
purchase a single premium immediate annuity contract at purchase rates offered
by Us at Annuity Commencement Date to similarly situated individuals.
Your Annuity Payouts will not be affected by the actual mortality experience of
Our Annuitants, or Our actual expenses.
ELECTION OF ANNUITY PAYMENT FREQUENCY
Annuity Payments will be made according to the Annuity Payment Frequency that
You select. If You do not select a payment frequency, then Annuity Payments will
be made quarterly.
ANNUITY CALCULATION DATE
The Annuity Calculation Date will be no more than five Valuation Days prior to
the Commencement.
On the Annuity Calculation Date, Contract Values, net of any Premium Taxes, if
applicable, will be applied to the General Account. The payment amount will be
based on the greater of current rates or the guaranteed rates shown in the
Annuity Tables section below.
FIXED DOLLAR ANNUITY PAYMENTS
Under a fixed dollar annuity, annuity payments remain level as to dollar amount
throughout the payment period.
MINIMUM ANNUITY PAYMENT
The Annuity Payments must be at least equal to the Minimum Annuity Payment
Amount shown on the Contract Specifications Page. If at any time, payments are
less than the Minimum Annuity Payment Amount, We have the right to change the
Annuity Payment Frequency to meet the minimum annuity payment requirements or to
may make an alternative arrangement with You.
ANNUITY OPTIONS
You may elect any one of the Annuity Options described below or any other
Annuity Option We offer at the time of annuitization.
OPTION 1 - LIFE ANNUITY WITH CASH REFUND - We will make Annuity Payments during
the lifetime of the Annuitant. If the sum of such Annuity Payments at the time
of the Annuitant's death does not equal or exceed the Contract Value, net of
Premium Taxes, if applicable, as of the Annuity Commencement Date, We will pay
Your Beneficiary the difference between the sum of those Annuity Payments and
the Contract Value, net of Premium Taxes on the Annuity Commencement Date.
OPTION 2 - LIFE ANNUITY - We will make Annuity Payments during the lifetime of
the annuitant. Annuity Payments will cease with the last payment due prior to
the Annuitant's death.
OPTION 3 - LIFE ANNUITY WITH 10 YEARS OF ANNUITY PAYMENTS GUARANTEED - We will
make Annuity Payments during the lifetime of the Annuitant with a guarantee that
if at the time of the Annuitant's death We have made Annuity Payments for less
than 10 years, We will continue Annuity Payments for the remainder of the
guaranteed period.
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OPTION 4 - JOINT AND LAST SURVIVOR ANNUITY - We will make Annuity Payments
during the lifetime of the Annuitant and the Joint Annuitant. Upon the death of
either the Annuitant or Joint Annuitant, Annuity Payments will continue to be
paid during the remaining lifetime of the survivor. Annuity Payments will cease
with the final Annuity Payment due prior to the last survivor's death.
OPTION 5 - JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEARS OF ANNUITY PAYMENTS
GUARANTEED - We will make Annuity Payments as long as either the Annuitant or
the Joint Annuitant is living. Annuity Payments will continue to be paid during
the remaining lifetime of the survivor. If at the last death of the Annuitant
and the Joint Annuitant, We have made less than 10 years of Annuity Payments, We
will continue to make Annuity Payments for the remainder of the guaranteed
period.
OPTION 6 - GUARANTEED PAYMENT PERIOD ANNUITY- We will make Annuity Payments for
a guaranteed payment period of 10 to 30 years. The payments do not depend on the
Annuitant's lifespan.
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ANNUITY TABLES
DESCRIPTION OF TABLES
The Annuity Tables show the minimum dollar amount of monthly Annuity Payments
for each $1,000 applied under each of the Annuity Options. The Annuity Tables
for all of the Annuity Options, excluding the Guaranteed Payment Period Annuity
option, vary based on the modified age of the Annuitant(s) in accordance with
the Modified Age Table. The modified age will equal the Annuitant's attained age
as of the Annuity Commencement Date less a specified number of years, if any, as
shown in the Modified Age Table as follows:
MODIFIED AGE TABLE
DATE OF FIRST PAYMENT AGE MODIFICATION
--------------------- ------------------
Prior to 2025 0 years
2025 - 2034 1 years
2035 - 2044 2 years
2045 - 2054 3 years
2055 or later Company Discretion
The mortality assumption for all of the Annuity Options, excluding the
Guaranteed Payment Period Annuity option, is based on the Annuity 2000 Mortality
Table projected forward using Improvement Table G, an annuitization year of 2020
and generational mortality improvement based on Improvement Table G for every
projection year thereafter. The interest rate basis for all of the Annuity
Options is 0.5%.
For modified ages, combinations of genders, Guaranteed Payment Periods, Annuity
Payment Frequencies, and interest rates not shown in these tables, Annuity
Payments will be calculated in a manner consistent with the values in these
Annuity Tables.
LIFE ANNUITY WITH CASH REFUND, LIFE ANNUITY AND LIFE ANNUITY WITH 10 YEARS OF
ANNUITY PAYMENTS GUARANTEED
Life Annuity with 10
Life Annuity with Cash Years of Annuity
Refund Life Annuity Payments Guaranteed
Modified ---------------------- -------------------- --------------------
Age Male Female Male Female Male Female
--------- --------- ----------- --------- --------- --------- ---------
65 $ 2.84 $ 2.71 $ 3.69 $ 3.28 $ 3.61 $ 3.25
66 $ 2.91 $ 2.78 $ 3.83 $ 3.40 $ 3.74 $ 3.36
67 $ 2.98 $ 2.85 $ 3.98 $ 3.52 $ 3.87 $ 3.47
68 $ 3.06 $ 2.93 $ 4.13 $ 3.65 $ 4.01 $ 3.60
69 $ 3.14 $ 3.00 $ 4.30 $ 3.79 $ 4.15 $ 3.73
70 $ 3.23 $ 3.09 $ 4.48 $ 3.95 $ 4.30 $ 3.86
71 $ 3.31 $ 3.17 $ 4.67 $ 4.11 $ 4.45 $ 4.01
72 $ 3.41 $ 3.26 $ 4.87 $ 4.29 $ 4.62 $ 4.17
73 $ 3.50 $ 3.36 $ 5.09 $ 4.48 $ 4.78 $ 4.33
74 $ 3.61 $ 3.46 $ 5.32 $ 4.69 $ 4.96 $ 4.50
75 $ 3.72 $ 3.56 $ 5.57 $ 4.91 $ 5.14 $ 4.68
76 $ 3.83 $ 3.68 $ 5.83 $ 5.15 $ 5.32 $ 4.87
77 $ 3.95 $ 3.79 $ 6.12 $ 5.41 $ 5.51 $ 5.07
78 $ 4.08 $ 3.92 $ 6.42 $ 5.69 $ 5.71 $ 5.28
79 $ 4.21 $ 4.05 $ 6.75 $ 5.99 $ 5.90 $ 5.49
80 $ 4.35 $ 4.19 $ 7.10 $ 6.32 $ 6.10 $ 5.70
FL-FPVATA-12
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JOINT AND LAST SURVIVOR ANNUITY AND JOINT AND LAST SURVIVOR ANNUITY
WITH 10 YEARS OF ANNUITY PAYMENTS
JOINT AND LAST SURVIVOR ANNUITY
FEMALE MODIFIED AGE
------------------------------
60 65 70 75
------ ------ ------ ------
MALE 60 $ 2.47 $ 2.47 $ 2.81 $ 2.93
MODIFIED 65 $ 2.59 $ 2.85 $ 3.10 $ 3.31
AGE 70 $ 2.67 $ 3.01 $ 3.36 $ 3.36
75 $ 2.73 $ 3.12 $ 3.57 $ 4.07
JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEARS OF ANNUITY PAYMENTS
FEMALE MODIFIED AGE
------------------------------
60 65 70 75
------ ------ ------ ------
MALE
MODIFIED 60 $ 2.47 $ 2.66 $ 2.81 $ 2.93
AGE 65 $ 2.59 $ 2.85 $ 3.09 $ 3.30
70 $ 2.67 $ 3.00 $ 3.35 $ 3.69
75 $ 2.73 $ 3.11 $ 3.56 $ 4.04
GUARANTEED PAYMENT PERIOD ANNUITY
Guaranteed Payment Period Annuity
10 Year $ 8.54
11 Year $ 7.78
12 Year $ 7.15
13 Year $ 6.61
14 Year $ 6.16
15 Year $ 5.76
16 Year $ 5.41
17 Year $ 5.11
18 Year $ 4.83
19 Year $ 4.59
20 Year $ 4.37
21 Year $ 4.17
22 Year $ 3.99
23 Year $ 3.83
24 Year $ 3.68
25 Year $ 3.54
26 Year $ 3.41
27 Year $ 3.29
28 Year $ 3.18
29 Year $ 3.08
30 Year $ 2.99
We may make unilateral changes for guaranteed annuity purchase rates for any new
premiums received. We will provide You with notice of any change to the annuity
purchase rates
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[FORETHOUGHT LOGO] PRINTED IN U.S.A.
FORETHOUGHT LIFE INSURANCE COMPANY
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INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT
ICC12-FLICVA-NCDSC
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