EXHIBIT NO. (4)
SPECIMEN CONTRACT
-------------------------------------------------------------------------------
THE PERSONS INVOLVED
-------------------------------------------------------------------------------
OWNER. The person named at the time of application is the owner of this
Certificate unless subsequently changed. As owner, you will receive any
periodic income payments, unless you have directed us to pay them to someone
else.
You may exercise all rights stated in this Certificate, subject to the rights of
any irrevocable beneficiary.
You may change the owner or beneficiary at any time. If the owner is a natural
person, you may change the annuitant prior to the Payout Start Date. Once we
have received a satisfactory written request for an owner, beneficiary or
annuitant change, the change will take effect as of the date you signed it. We
are not liable for any payment we make or other action we take before receiving
any written request for a change from you.
You may not assign an interest in this Certificate as collateral or security for
a loan. However, you may assign periodic income payments under this Certificate
prior to the Payout Start Date. We are bound by an assignment only if it is
signed by the assignor and filed with us. We are not responsible for the
validity of an assignment.
If the sole surviving owner dies prior to the Payout Start Date, the beneficiary
becomes the new owner. If the sole surviving owner dies after the Payout Start
Date, the beneficiary becomes the new owner and will receive any subsequent
guaranteed income payments.
If more than one person is designated as owner:
- owner as used in this certificate refers to all people named as
owners, unless otherwise indicated;
- any request to exercise ownership rights must be signed by all owners;
and
- on the death of any person who is an owner, the surviving person(s)
named as owner will continue as owner.
ANNUITANT. The annuitant is the person named on the Annuity Data Page, but may
be changed by the owner, as described above. The annuitant must be a natural
person. If the annuitant dies prior to the Payout Start Date, the new annuitant
will be:
- the youngest owner; otherwise,
- the youngest beneficiary.
BENEFICIARY. The beneficiary is the person(s) named on the Annuity
Data Page, but may be changed by the owner, as described above. We will
determine the beneficiary from the most recent written request we have
received from you. If you do not name a beneficiary or if the beneficiary named
is no longer living, the beneficiary will be:
- your spouse if living; otherwise
- your children equally if living; otherwise
- your estate.
The beneficiary may become the owner under the circumstances described above.
The beneficiary may assign benefits under the Certificate, as described above,
once they are payable to the beneficiary. We are bound by an assignment only if
it is signed by the assignor and filed with us. We are not responsible for the
validity of an assignment.
Page 4
-------------------------------------------------------------------------------
ACCUMULATION PHASE
-------------------------------------------------------------------------------
ACCUMULATION PHASE DEFINED. The "Accumulation Phase" is the first of two phases
during your Certificate. The Accumulation Phase begins on the issue date
stated on the Annuity Data Page. This phase will continue until the Payout
Start Date unless the Certificate is terminated before that date.
CERTIFICATE YEAR. The one year period beginning on the issue date and on
each anniversary of the
issue date.
PURCHASE PAYMENTS. You may make subsequent purchase payments during the
Accumulation Phase. The number of purchase payments is unlimited. The minimum
subsequent purchase payment amount is $500. We reserve the right to reduce the
minimum purchase payment. We may limit the maximum amount of purchase payments
we will accept.
We will invest the purchase payments in the Investment Alternatives you select.
You may allocate any portion of your purchase payment in whole percents from 0%
to 100% or in exact dollar amounts to any of the Investment Alternatives. The
total allocation must equal 100%. For each purchase payment, the minimum
amount that may be allocated to the Fixed Account is $500.
The allocation of the initial purchase payment is shown on the Annuity Data
Page. Allocation of each subsequent purchase payment will be the same as for
the most recent purchase payment unless you change the allocation. You may
change the allocation of subsequent purchase payments at any time, without
charge, simply by giving us written notice. Any change will be effective at the
time we receive the notice.
INVESTMENT ALTERNATIVES. Investment Alternatives are the Sub-accounts of the
Variable Account and the Sub-accounts of the Fixed Account shown on the Annuity
Data Page.
VARIABLE ACCOUNT. The "Variable Account" for this Certificate is the Glenbrook
Life and Annuity Company Separate Account A. This account is a separate
investment account to which we allocate assets contributed under this and
certain other certificates. These assets will not be
charged with liabilities arising from any other business we may have.
VARIABLE SUB-ACCOUNTS. The Variable Account is divided into Sub-accounts.
Each Sub-account invests solely in the shares of the mutual fund underlying
that Sub-account.
FIXED ACCOUNT. The Fixed Account is divided into Sub-accounts. A Sub-account
is identified by the Guarantee Period and the date the Guarantee Period begins.
You create a Sub-account when:
- you make a purchase payment; or
- you select a new Guarantee Period after the prior Sub-account expires; or
- you transfer an amount from an existing Sub-account of the Variable
Account or the Fixed Account.
A Sub-account continues until the end of the Guarantee Period.
You must select the Guarantee Period for all purchase payments and transfers
allocated to the Fixed Account. If you do not select a Guarantee Period for a
purchase payment or transfer, we will assign the same period(s) as used for the
most recent purchase payment. Guarantee Periods are offered at our discretion
and may range from on to ten years. We may change the Guarantee Periods
available for future purchase payments or transfers allocated to the Fixed
Account.
Page 5
We will mail you a notice prior to the expiration of each Sub-account outlining
the options available at the end of a Guarantee Period. During the 30 day
period after a Guarantee Period expires you may:
- take no action and we will automatically renew the Sub-account value to a
Guarantee Period of the same duration to be established on the day the
previous Guarantee Period expired; or
- notify us to apply the Sub-account value to a new Guarantee Period(s) to be
established on the day the previous Guarantee Period expired; or
- notify us to apply the Sub-account value to any Sub-account of the Variable
Account on the day we receive the notification; or
- receive a portion of the Sub-account value or the entire Sub-account value
through a partial or full withdrawal that is not subject to a Market Value
Adjustment. In this case, the amount withdrawn will be deemed to have been
withdrawn on the day the Guarantee Period expired.
The minimum amount that can be allocated to a new Sub-account is $500.
CREDITING INTEREST. We credit interest daily to money allocated to the Fixed
Account at a rate which compounds over one year to the interest rate we
guaranteed when the money was allocated. We will credit interest to the initial
purchase payment from the issue date. We will credit interest to subsequent
purchase payments from the date we receive them. We will credit interest to
transfers from the date the transfer is made. The interest rates will never be
less than the minimum guaranteed rate shown on the Annuity Data Page.
TRANSFERS. Prior to the Payout Start Date, you may transfer amounts between
Investment Alternatives. You may make 12 transfers per Certificate Year without
charge. Each transfer after the 12th transfer in any Certificate Year may be
assessed a $10 transfer fee. Transfers are subject to the following
restrictions.
- The minimum amount that may be transferred into a Sub-account of the Fixed
Account is $500.
- Any transfer from a Sub-account of the Fixed Account at a time other than
during the 30 day period after a Guarantee Period expires will be subject
to a Market Value Adjustment.
- If any transfer reduces the value of a Sub-account of the Fixed Account to
less than $500, we will treat the request as a transfer of the entire Sub-
account value.
We reserve the right to waive the transfer fees and restrictions contained in
this Certificate.
CERTIFICATE VALUE. Your "Certificate Value" is equal to the sum of:
- the number of Accumulation Units you hold in each Sub-account of the
Variable Account multiplied by the Accumulation Unit Value for that Sub-
account on the most recent Valuation Date; plus
- the sum of Sub-account values in the Fixed Account.
ACCUMULATION UNITS AND ACCUMULATION UNIT VALUE. Amounts which you allocate to a
Sub-account of the Variable Account are used to purchase Accumulation
Units in that Sub-account. The Accumulation Unit Value for each Sub-account
at the end of any Valuation Period is calculated by multiplying the Accumulation
Unit Value at the end of the immediately preceding Valuation Period by the Sub-
account's Net Investment Factor for the Valuation Period. The Accumulation
Unit Values may go up or down. Additions or transfers to a Sub-account of the
Variable Account will increase the number of Accumulation Units for that Sub-
account. Withdrawals or transfers from a Sub-account of the Variable Account
will decrease the number of Accumulation Units for that Sub-account.
Page 6
VALUATION PERIOD AND VALUATION DATE. A "Valuation Period" is the time interval
between the closing of the New York Stock Exchange on consecutive Valuation
Dates. A "Valuation Date" is any date the New York Stock Exchange is open for
trading.
NET INVESTMENT FACTOR. For each Sub-account of the Variable Account, the "Net
Investment Factor" for a Valuation Period is (A) divided by (B), minus (C)
where:
(A) is the sum of:
(1) the net asset value per share of the mutual fund underlying the
Sub-account determined at the end of the current Valuation
Period, plus
(2) the per share amount of any dividend or capital gain
distributions made by the mutual fund underlying the Sub-account
during the current Valuation Period.
(B) is the net asset value per share of the mutual fund underlying the Sub-
account determined as of the end of the immediately preceding Valuation
Period.
(C) is the sum of the annualized Administrative Expense Charge and the
annualized Mortality and Expense Risk Charge divided by 365 and then
multiplied by the number of calendar days in the current Valuation Period.
CHARGES. The charges for this Certificate include Administrative Expense
Charges, Mortality and Expense Risk Charges, Certificate Maintenance Charges,
transfer charges, and taxes. If withdrawals are made, the Certificate may also
be subject to Withdrawal Charges and Market Value Adjustments.
ADMINISTRATIVE EXPENSE CHARGE. The annualized Administrative Expense Charge
will never be greater than 0.10%. (See Net Investment Factor for a description
of how this charge is applied.)
MORTALITY AND EXPENSE RISK CHARGE. The annualized Mortality and Expense Risk
Charge will never be greater than 1.35%. (See Net Investment Factor for a
description of how this charge is applied.)
Our actual mortality and expense experience will not adversely affect the dollar
amount of variable benefits or other contractual payments or values under this
Certificate.
CERTIFICATE MAINTENANCE CHARGE. Prior to the Payout Start Date, a Certificate
Maintenance Charge will be deducted from your Certificate Value on each
certificate anniversary. The charge will be deducted on a pro-rata basis from
each Sub-account of the Variable Account in the proportion that your value in
each bears to your total value in all Sub-accounts of the Variable Account. A
full Certificate Maintenance Charge will be deducted if the Certificate is
terminated on any date other than a certificate anniversary. After the Payout
Start Date the Certificate Maintenance Charge will be deducted in equal parts
from each income payment. The annualized charge will never be greater than $35
per certificate year. The Certificate Maintenance Charge will be waived if
total purchase payments are $50,000 or more or if all money is allocated to the
Fixed Account on the certificate anniversary.
TAXES. Any premium tax or income tax withholding relating to this Certificate
may be deducted from purchase payments or the Certificate Value when the tax is
incurred or at a later time.
WITHDRAWAL. You have the right to withdraw part or all of your Certificate
Value at any time during the Accumulation Phase. A withdrawal must be at least
$50. If any withdrawal reduces the value of any Sub-account of the Fixed
Account to less than $500, we will treat the request as a withdrawal of the
entire Sub-account value. If any withdrawal reduces the Certificate Value to
less than $1,000, we will treat the request as a withdrawal of the entire
Certificate Value. If you withdraw the entire Certificate Value, the
Certificate will terminate.
You must specify the Investment Alternative(s) from which you wish to make a
withdrawal. When you make a withdrawal, your Certificate Value will be reduced
by the amount paid to you and any applicable Withdrawal Charge, Market Value
Adjustment, and taxes. Any Withdrawal Charge will be waived on withdrawals
taken to satisfy IRS minimum distribution rules.
Page 7
PREFERRED WITHDRAWAL AMOUNT. Each Certificate Year the Preferred Withdrawal
Amount is equal to 10% of the amount of purchase payments. Each Certificate
Year you may withdraw the Preferred Withdrawal Amount without any Withdrawal
Charge or Market Value Adjustment. Each Certificate Year begins on the
anniversary of the date the Certificate was established. Any Preferred
Withdrawal Amount which is not withdrawn in a year may not be carried over to
increase the Preferred Withdrawal Amount in a subsequent year.
WITHDRAWAL CHARGE. Withdrawals in excess of the Preferred Withdrawal Amount
will be subject to a Withdrawal Charge as follows:
Payment Year: 1 2 3 4 5 6 7 8 and Later
Percentage: 6% 6% 5% 5% 4% 4% 3% 0%
To determine the Withdrawal Charge, we assume that purchase payments are
withdrawn first, beginning with the oldest payment. When all purchase payments
have been withdrawn, additional withdrawals will not be assessed a Withdrawal
Charge.
For each purchase payment withdrawal, the "Payment Year" in the table is
measured from the date we received the purchase payment. The Withdrawal Charge
is determined by:
- multiplying the percentage corresponding to the Payment Year, times
- that part of each purchase payment withdrawal that is in excess of the
Preferred Withdrawal Amount, adjusted by a Market Value Adjustment.
MARKET VALUE ADJUSTMENT. Withdrawals in excess of the Preferred Withdrawal
Amount, transfers, death benefits, and amounts applied to an income plan from a
Sub-account of the Fixed Account other than during the 30 day period after a
Guarantee Period expires are subject to a Market Value Adjustment. A Market
Value Adjustment is an increase or decrease in the amount reflecting changes in
the level of interest rates since the Sub-account was established. As used in
this provision, "Treasury Rate" means the U. S. Treasury Note Constant Maturity
yield as reported in Federal Reserve Bulletin Release H.15. The Market Value
Adjustment is based on the following:
I = the Treasury Rate for a maturity equal to the Sub-account's
Guarantee Period for the week preceding the establishment of
the Sub-account;
N = the number of whole and partial years from the date we
receive the withdrawal, transfer, or death benefit request,
or from the Payout Start Date, to the end of the Sub-
account's Guarantee Period;
J = the Treasury Rate for a maturity of N years for the week
preceding the receipt of the withdrawal request, transfer
request, death benefit request, or Income Payment request.
If a Note with a maturity of N years is not available, a
weighted average will be used. If N is one year or less, J
will be the 1-year Treasury Rate.
An adjustment factor is determined from the following formula:
.9 x (I - J) x N
The amount subject to a Market Value Adjustment that is deducted from a Sub-
account of the Fixed Account is multiplied by the adjustment factor to determine
the amount of the Market Value Adjustment. The amount deducted from the Sub-
account includes the transfer amount or the amount we pay you, income tax we
withhold for you, the Withdrawal Charge, any applicable premium tax charge, and
the Market Value Adjustment.
Page 8
DEATH OF OWNER OR ANNUITANT. A benefit may be paid to the owner determined
immediately after the death if, prior to the Payout Start Date:
- any owner dies; or
- the annuitant dies and the owner is not a natural person.
If the owner eligible to receive a benefit is not a natural person, the
owner may elect to receive the benefit in one or more distributions. Otherwise,
if the owner is a natural person, the owner may elect to receive a benefit
either in one or more distributions or by periodic payments through an Income
Plan.
A Death Benefit will be paid: 1) if the owner elects to receive the Death
Benefit distributed in a single payment within 180 days of the date of death,
and 2) if the Death Benefit is paid as of the day the value of the Death Benefit
is determined. Otherwise, the Settlement Value will be paid. In any event, the
entire value of the certificate must be distributed within five (5) years after
the date of death unless an Income Plan is elected or a surviving spouse
continues the certificate in accordance with the following provisions.
Payments from the Income Plan must begin within one year of the date of death
and must be payable throughout:
- the life of the owner; or
- a period not to exceed the life expectancy of the owner; or
- the life of the owner with payments guaranteed for a period not to exceed
the life expectancy of the owner.
If the surviving spouse of the deceased owner is the new owner, then the spouse
may elect one of the options listed above or may continue the Certificate in the
Accumulation Phase as if the death had not occurred. If the Certificate is
continued in the Accumulation Phase, the surviving spouse may make a single
withdrawal of any amount within one year of the date of death without incurring
a Withdrawal Charge. However, any applicable Market Value Adjustment,
determined as of the date of the withdrawal, will apply. Death of Owner or
Annuitant. A death benefit may be paid to the owner determined immediately
after the death if, prior to the Payout Start Date:
DEATH BENEFIT. Prior to the Payout Start Date, the death benefit is equal to
the greatest of:
- Certificate Value on the date we determine the death benefit; or
- the amount that would have been payable in the event of a full
withdrawal of the Certificate Value on the date we determine the death
benefit; or
- the Certificate Value on the Death Benefit Anniversary immediately
preceding the date we determine the death benefit adjusted by any purchase
payments, withdrawals and charges made between such Death Benefit
Anniversary and the date we determine the death benefit.
The first Death Benefit Anniversary is the issue date. Subsequent Death
Benefit Anniversaries are those certificate anniversaries that are
multiples of 7 Certificate Years, beginning with the 7th certificate
anniversary. For example, the issue date, 7th, and 14th certificate
anniversaries are the first three Death Benefit Anniversaries.
- the greatest of the Anniversary Values as of the date we determine the
death benefit. The Anniversary Value is equal to the Certificate
Value on a Certificate Anniversary, increased by purchase payments
made since that anniversary and reduced by the amount of any partial
withdrawals since that anniversary. Anniversary values will be
calculated for each Certificate anniversary prior to the earlier of:
a. the date we determine the death benefit, or
b. the oldest owner's or the annuitant's, if the owner is not a natural
person, attained age 75 or 5 years after the date the Certificate was
established, if later.
Page 9
We will determine the value of the death benefit as of the end of the Valuation
Period during which we receive a complete request for payment of the death
benefit. A complete request includes due proof of death.
The Death Benefit will never be greater than the maximum death benefit allowed
by any non-forfeiture laws which govern the Certificate.
SETTLEMENT VALUE. The Settlement Value is the same amount that would be paid in
the event of withdrawal of the Certificate Value. We will calculate the
Settlement Value at the end of the Valuation Period coinciding with the
requested distribution date for payment or on the mandatory distribution date of
5 years after the date of death.
Page 10
-------------------------------------------------------------------------------
PAYOUT PHASE
-------------------------------------------------------------------------------
PAYOUT PHASE DEFINED. The "Payout Phase" is the second of the two phases during
your Certificate. During this phase the Certificate Value adjusted by any
Market Value Adjustment and less any applicable taxes is applied to the Income
Plan you choose and is paid out as provided in that plan.
The Payout Phase begins on the Payout Start Date. It continues until we make
the last payment as provided by the Income Plan chosen.
PAYOUT START DATE. The "Payout Start Date" is the date the Certificate Value
adjusted by any Market Value Adjustment and less any applicable taxes is applied
to an Income Plan. The anticipated Payout Start Date is shown on the Annuity
Data Page. You may change the Payout Start Date by writing to us at least 30
days prior to this date.
The Payout Start Date must be on or before the annuitant's 85th birthday.
INCOME PLANS. An "Income Plan" is a series of payments on a scheduled basis to
you or to another person designated by you. The Certificate Value on the
Payout Start Date adjusted by any Market Value Adjustment and less any
applicable taxes, will be applied to your Income Plan choice from the following
list:
1. LIFE INCOME WITH GUARANTEED PAYMENTS. We will make payments for as long
as the annuitant lives. If the annuitant dies before the selected number
of guaranteed payments have been made, we will continue to pay the
remainder of the guaranteed payments.
2. JOINT AND SURVIVOR LIFE INCOME WITH GUARANTEED PAYMENTS. We will
make payments for as long as either the annuitant or joint
annuitant, named at the time of Income Plan selection, lives. If
both the annuitant and the joint annuitant die before the selected
number of guaranteed payments have been made, we will continue to pay
the remainder of the guaranteed payments.
3. GUARANTEED NUMBER OF PAYMENTS. We will make payments for a specified
number of months beginning on the Payout Start Date. These payments do not
depend on the annuitant's life. The number of months guaranteed may be
from 60 to 360.
We reserve the right to make available other Income Plans.
INCOME PAYMENTS. Income payment amounts may vary based on any Sub-account of
the Variable Account and/or may be fixed for the duration of the Income Plan.
The method of calculating the initial payment is different for the two accounts.
The Certificate Maintenance Charge will be deducted in equal payments from each
income payment. The Certificate Maintenance Charge will be waived if total
Purchase Payments are $50,000 or more.
VARIABLE AMOUNT INCOME PAYMENTS. The initial income payment based upon the
Variable Account is calculated by applying the portion of the Certificate Value
in the Variable Account on the Payout Start Date, less any applicable premium
tax, to the appropriate value from the Income Payment Table selected.
Subsequent income payments will vary depending upon the changes in the Annuity
Unit Values for the Sub-accounts upon which the income payments are based.
The portion of the initial income payment based upon a particular Variable Sub-
account is determined by applying the amount of the Certificate Value in that
Sub-account on the Payout Start Date, less any applicable premium tax, to the
appropriate value from the Income Payment Table. This portion of the initial
income payment is divided by the Annuity Unit Value on the Payout Start Date for
that Variable Sub-account to determine the number of Annuity Units from that
Sub-account which will be used to determine subsequent income payments. Unless
Annuity Transfers are made between Sub-accounts, each subsequent income payment
from that Sub-account will be that number of Annuity Units times the Annuity
Unit Value for the Sub-account for the Valuation Date on which the income
payment is made.
Page 11
ANNUITY UNIT VALUE. The Annuity Unit Value for each Sub-account of the Variable
Account at the end of any Valuation Period is calculated by:
- multiplying the Annuity Unit Value at the end of the immediately
preceding Valuation Period by the Sub-account's Net Investment Factor
during the period; and then
- dividing the result by 1.000 plus the assumed investment rate for the
period. The assumed investment rate is an effective annual rate of 3%.
FIXED AMOUNT INCOME PAYMENTS. The income payment amount derived from any monies
allocated to Sub-accounts of the Fixed Account during the Accumulation Phase are
fixed for the duration of the Income Plan. The Fixed Amount Income Payment is
calculated by applying the portion of the Certificate Value in the Fixed Account
on the Payout Start Date, adjusted by any Market Value Adjustment and less any
applicable premium tax, to the greater of the appropriate value from the Income
Payment Table selected or such other value as we are offering at that time.
ANNUITY TRANSFERS. After the Payout Start Date, no transfers may be made from
the Fixed Amount Income Payment. Transfers between Sub-accounts of the Variable
Account, or from the Variable Amount Income Payment to the Fixed Amount Income
Payment may not be made for six months after the Payout Start Date. Annuity
Transfers may be made once every six months thereafter.
PAYOUT TERMS AND CONDITIONS. The income payments are subject to the following
terms and conditions:
- If the Certificate Value is less than $2,000, or not enough to
provide an initial payment of at least $20, we reserve the right to:
- change the payment frequency to make the payment at least $20; or
- terminate the Certificate and pay you the Certificate Value
adjusted by any Market Value Adjustment and less any
applicable taxes in a lump sum.
- If we do not receive a written choice of an Income Plan from you at
least 30 days before the Payout Start Date, the Income Plan will be
life income with guaranteed payments for 120 months.
- If you choose an Income Plan which depends on any person's life, we
may require:
- proof of age and sex before income payments begin; and
- proof that the annuitant or joint annuitant is still alive before we
make each payment.
- After the Payout Start Date, the Income Plan cannot be changed and
withdrawals cannot be made unless income payments are being made from
the Variable Account under Income Plan 3. You may terminate the
income payments being made from the Variable Account under Income Plan
3 at any time and withdraw their value, subject to Withdrawal Charges.
- If any owner dies during the Payout Phase, the remaining income
payments will be paid to the successor owner as scheduled.
Page 12
-------------------------------------------------------------------------------
INCOME PAYMENT TABLES
-------------------------------------------------------------------------------
The initial income payment will be at least the amount based on the
adjusted age of the annuitant(s) and the tables below, less any federal income
taxes which are withheld. The adjusted age is the actual age on the Payout
Start Date reduced by one year for each six full years between January 1, 1983
and the Payout Start Date. Income payments for ages and guaranteed payment
periods not shown below will be determined on a basis consistent with that used
to determine those that are shown. The Income Payment Tables are based on 3.0%
interest and the 1983a Annuity Mortality Tables.
INCOME PLAN 1 - LIFE INCOME WITH GUARANTEED PAYMENTS FOR 120 MONTHS
----------------------------------------------------------------------------------
----------------------------------------------------------------------------------
Monthly Income Payment for each $1,000 Applied to this Income Plan
----------------------------------------------------------------------------------
Annuitant's Annuitant's Annuitant's
Age Male Female Age Male Female Age Male Female
----------------------------------------------------------------------------------
35 $3.43 $3.25 49 $4.15 $3.82 63 $5.52 $4.97
36 3.47 3.28 50 4.22 3.88 64 5.66 5.09
37 3.51 3.31 51 4.29 3.94 65 5.80 5.22
38 3.55 3.34 52 4.37 4.01 66 5.95 5.35
39 3.60 3.38 53 4.45 4.07 67 6.11 5.49
40 3.64 3.41 54 4.53 4.14 68 6.27 5.64
41 3.69 3.45 55 4.62 4.22 69 6.44 5.80
42 3.74 3.49 56 4.71 4.29 70 6.61 5.96
43 3.79 3.53 57 4.81 4.38 71 6.78 6.13
44 3.84 3.58 58 4.92 4.46 72 6.96 6.31
45 3.90 3.62 59 5.02 4.55 73 7.13 6.50
46 3.96 3.67 60 5.14 4.65 74 7.31 6.69
47 4.02 3.72 61 5.26 4.75 75 7.49 6.88
48 4.08 3.77 62 5.39 4.86
INCOME PLAN 2 - JOINT AND SURVIVOR LIFE INCOME WITH GUARANTEED PAYMENTS FOR 120
MONTHS
-----------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------
Monthly Income Payment for each $1,000 Applied to this Income Plan
-----------------------------------------------------------------------------------------------------------
Female Annuitant's Age
Male -----------------------------------------------------------------------------------------
Annuitant's 35 40 45 50 55 60 65 70 75
Age
-----------------------------------------------------------------------------------------------------------
35 $3.09 $3.16 $3.23 $3.28 $3.32 $3.36 $3.39 $3.40 $3.42
40 3.13 3.22 3.31 3.39 3.46 3.51 3.56 3.59 3.61
45 3.17 3.28 3.39 3.50 3.60 3.69 3.76 3.81 3.85
50 3.19 3.32 3.45 3.60 3.74 3.87 3.98 4.07 4.14
55 3.21 3.35 3.51 3.68 3.87 4.06 4.23 4.37 4.48
60 3.23 3.37 3.55 3.75 3.98 4.23 4.47 4.70 4.88
65 3.24 3.39 3.57 3.80 4.07 4.37 4.71 5.04 5.34
70 3.24 3.40 3.59 3.83 4.13 4.48 4.90 5.36 5.81
75 3.25 3.41 3.61 3.86 4.17 4.56 5.04 5.61 6.22
-----------------------------------------------------------------------------------------------------------
INCOME PLAN 3 - GUARANTEED NUMBER OF PAYMENTS
---------------------------------------------------------------
---------------------------------------------------------------
Monthly Income Payment for each
Specified Period $1,000 Applied to this Income Plan
---------------------------------------------------------------
10 Years $9.61
11 Years 8.86
12 Years 8.24
13 Years 7.71
14 Years 7.26
15 Years 6.87
16 Years 6.53
17 Years 6.23
18 Years 5.96
19 Years 5.73
20 Years 5.51
Page 13
-------------------------------------------------------------------------------
GENERAL PROVISIONS
-------------------------------------------------------------------------------
THE ENTIRE CONTRACT. The entire contract consists of the Master Policy,
the Master Policy application, and any written enrollments, any endorsements,
and any riders.
All statements made in written enrollments are representations and not
warranties. No statement will be used by us in defense of a claim or to void
the Certificate unless it is included in a written enrollment.
Only our officers may, in order to conform to any state or federal law, change
the Master Policy or Certificate or waive a right or requirement. No other
individual may do this.
MASTER POLICYHOLDER The Master Policyholder may be amended by us, terminated by
us, or terminated by the Master Policyholder without the consent of any other
person. No termination completed after the issue date of this Certificate will
adversely affect your rights under this Certificate.
We may not modify this Certificate without your consent, except to
make it comply with any changes in the Internal Revenue Code or as required
by any other applicable law.
INCONTESTABILITY. We will not contest the validity of this Certificate after
the issue date.
MISSTATEMENT OF AGE OR SEX. If any age or sex has been misstated,
we will pay the amounts which would have been paid at the correct age and sex.
If we find the misstatement of age or sex after the income payments begin, we
will:
- pay all amounts underpaid including interest; or
- stop payments until the total payments are equal to the corrected amount.
For purposes of the Misstatement of Age or Sex provision, interest will be
calculated at an effective annual rate of 6%.
ANNUAL STATEMENT. At least once a year, prior to the Payout Start Date, we will
send you a statement containing Certificate Value information. We will provide
you with Certificate Value information at any time upon request. The
information presented will comply with any applicable law.
SETTLEMENTS. We may require that this Certificate be returned to us prior to
any settlement. We must receive due proof of death of the owner or annuitant
prior to settlement of a death claim. Due proof of death is one of the
following:
- a certified copy of a death certificate; or
- a certified copy of a decree of a court of competent jurisdiction as to a
finding of death; or
- any other proof acceptable to us.
Any full withdrawal or death benefit under this Certificate will not be less
than the minimum benefits required by any statute of the state in which the
Certificate is delivered.
DEFERMENT OF PAYMENTS. We will pay any amounts due from the Variable Account
under this Certificate within seven days, unless:
- the New York Stock Exchange is closed for other than usual weekends or
holidays, or trading on such Exchange is restricted;
- an emergency exists as defined by the Securities and Exchange Commission;
or
- the Securities and Exchange Commission permits delay for the protection of
Certificate holders.
Page 14
We reserve the right to postpone payments or transfers from the Fixed Account
for up to six months. If we elect to postpone payments or transfers from the
Fixed Account for 30 days or more, we will pay interest as required by
applicable law. Any interest would be payable from the date the withdrawal
request is received by us to the date the payment or transfer is made.
VARIABLE ACCOUNT MODIFICATIONS. We reserve the right, subject to applicable
law, to make additions to, deletions from, or substitutions for the mutual fund
shares underlying the Sub-accounts of the Variable Account. We will not
substitute any shares attributable to your interest in a Sub-account of the
Variable Account without notice to you and prior approval of the Securities and
Exchange Commission, to the extent required by the Investment Company Act of
1940.
We reserve the right to establish additional Sub-accounts of the Variable
Account, each of which would invest in shares of another mutual fund. You may
then instruct us to allocate purchase payments or transfers to such Sub-
accounts, subject to any terms set by us or the mutual fund.
In the event of any such substitution or change, we may by endorsement, make
such changes as may be necessary or appropriate to reflect such substitution or
change.
If we deem it to be in the best interests of persons having voting rights under
the certificates, the Variable Account may be operated as a management company
under the Investment Company Act of 1940 or it may be deregistered under such
Act in the event such registration is no longer required.
Page 15