Exhibit 4
Variable Annuity Contract
--------------------------------------------------------------
71
Great-West Life & Annuity Insurance Company A Stock Company
▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇
Signed for Great-West Life & Annuity Insurance Company on
the issuance of this Contract.
[GRAPHIC OMITTED]
1
[GRAPHIC OMITTED]
▇.▇. ▇▇▇▇▇▇, ▇.▇. ▇▇▇▇▇▇▇▇, Secretary President and Chief
Executive Officer
PLEASE READ THIS CONTRACT CAREFULLY. It is a Contract which
may provide for payments or values which are not guaranteed
as to Fixed-Dollar Amount and which increase or decrease
according to the investment experience of a Variable Annuity
Account.
20 DAY RIGHT TO EXAMINE: IF NOT SATISFIED WITH THE CONTRACT,
RETURN IT TO THE COMPANY OR AN AUTHORIZED AGENT WITHIN 20
DAYS OF RECEIVING IT. THE CONTRACT WILL BE VOID FROM THE
START AND ALL CONTRIBUTIONS PAID LESS ANNUITY PAYMENTS WILL
BE REFUNDED. ANY INVESTMENT GAINS OR LOSSES ARISING DURING
THIS PERIOD SHALL ACCRUE TO OR BE BORNE BY THE COMPANY.
FIXED AND VARIABLE DEFERRED ANNUITY
FLEXIBLE CONTRIBUTION INDIVIDUAL RETIREMENT ANNUITY. The
Variable Account Value, Guaranteed Account Value, expenses
and charges provisions of this Contract are stated in
Article V (Pages 8-9), Article VIII (Pages 12-13), and the
attached Guaranteed Sub-Account Riders, if any.
Contract No. 12345GP Form No. FCIRA/RO-10/97
Table
Of
Contents
ARTICLE
I:
DEFINITIONS
3
ARTICLE
II:
OWNERSHIP
PROVISIONS
2.1...............................................Ownership
of
Series
Account4
2.2...............................................Ownership
of
the
Contract4
2.3...........................................Nonforfeitable
4
2.4...............................................Exclusive
Benefit4
2.5................................................Transfer
and
Assignment4
2.6...................................................Loans
Prohibited4
ARTICLE
III:
GENERAL
PROVISIONS
3.1..................................................Entire
Contract5
3.2........................................Non-Participating
5
3.3..............................................Beneficiary
5
3.4................................................Currency
and
Payment
Contributions5
3.5Age
5
3.6..................................................Voting
Rights5
3.7..................................................Reports
6
3.8................................................Contract
Maintenance
Charge6
3.9..................................................Notice
and
Proof6
3.10....................................................Tax
Consequences
of
Payments6
ARTICLE
IV:
CONTRIBUTIONS
PROVISIONS
4.1............................................Contributions
6
4.2.................................................Initial
Contribution6
4.3.................................................Regular
▇▇▇
Contributions6
4.4.............................................Commingling
of
Contributions7
4.5.............................................Designation
of
Regular
▇▇▇
Contributions7
4.6..................................................Excess
Contributions7
4.7..............................................Allocation
of
Contributions7
4.8.....................................................SEP
Contributions
Not
Accepted7
ARTICLE
V:
ACCOUNT
VALUE
PROVISIONS
5.1................................................Variable
Account
Value8
5.2............................................Accumulation
Unit8
5.3............................................Accumulation
Unit
Value8
5.4.....................................................Net
Investment
Factor8
5.5....................................................Risk
Charge8
5.6..............................................Guaranteed
Account
Value9
5.7..............................................Guaranteed
Sub-Account
Riders9
ARTICLE
VI:
TRANSFERS
6.1................................................Transfers
9
6.2................................................Transfer
Terms9
6.3...........................................Intra-Company
Transfers9
Table
Of
Contents
(continued)
6.4.............................................Non-Taxable
Distribution9
6.5................................................Transfer
Outside
the
Contract9
ARTICLE
VII:
DISTRIBUTIONS
7.1...........................................Distributions
Prior
to
Age
59 1/210
7.2...........................................Distributions
Before
Death10
7.3
Distribution
▇▇▇▇
▇▇▇▇▇▇▇
7.4.................................................Minimum
Distributions11
7.5.....................................................▇▇▇
to
▇▇▇
Transfer11
7.6................................................Election
of
Payment
Option11
7.7..................................................Amount
Payable
on
Death
of
the
Owner11
ARTICLE
VIII:
SURRENDER
AND
PARTIAL
WITHDRAWALS
8.1...............................................Surrender
Benefit12
8.2...............................................Surrender
Value12
8.3...............................................Surrender
Charge12
8.4.................................................Partial
Withdrawal12
8.5
Loss
of
Interest
Charge13
8.6..................................................Waiver
of Loss of Interest Charge13
ARTICLE IX: PERIODIC PAYMENT OPTIONS
9.1.....................................................How
to Elect Periodic Payment Options13
9.2...............................................Selection
of
Periodic
Payment
Options13
9.3..................................................Estate
Maximizer
Option
("EMO")13
9.4................................................Flexible
Payment
Option
("FPO")13
9.5............................................Modification
of
Periodic
Payment
Options14
9.6..........................................Administration
Fee14
ARTICLE X: PAYMENT OPTIONS (OTHER THAN PERIODIC PAYMENTS)
10.1 How to Elect Payment Options15
10.2 Selection of Payment Options15
10.3 Variable Dollar Payment Options15
10.4 Fixed Dollar Payment Options16
ARTICLE XI: MODIFICATIONS
11.1 Contract Modification...................................17
11.2 Modification of Guaranteed Sub-Account Riders, If Any...17
11.3 Modification of Variable Sub-Accounts...................17
FCIRA/RO-10/97 Page
4
Article
I:
Definitions
Accumulation Period- the period between the Effective Date and
the Annuity Commencement Date.
Accumulation
Unit
-
an accounting unit used to determine the variable contract value before the
Annuity Commencement Date.
Annuitant - the person upon whose life the payment of an annuity
is based. The Annuitant will at all times be the Owner of the
Contract.
Annuity Account - a record that reflects the total value of the
Owner's Variable and Guaranteed Sub-Accounts.
Annuity Account Value - the sum of the Variable and Guaranteed
Sub-Accounts credited to the Owner under the Annuity Account.
Annuity Commencement Date - The date on which a one sum payment
is to be made, or the date on which payments commence under a
payment option.
Annuity Payment Period - the period beginning on the Annuity
Commencement Date and continuing until all annuity payments have
been made under the Contract.
Annuity Unit - an accounting unit used to determine the dollar
value of any variable dollar annuity payment after the first
annuity payment is made.
Beneficiary - the person(s) designated by the Owner to receive
distributions, if any, payable upon the death of the Owner.
Certificate - represents the amount deposited into the Guaranteed
Certificate Fund, if offered, under each Interest Guarantee
Period. Each Certificate has its own interest rate and term.
Code - the Internal Revenue Code of 1986, as amended.
Company - Great-West Life & Annuity Insurance Company.
Contribution - amounts allocated to a Guaranteed or Variable
Sub-Account prior to any Premium Tax, if applicable, or other
deductions.
Contract - this Flexible Contribution Individual Retirement
Annuity which is a binding agreement between the Owner and the
Company.
Effective Date - the date on which the first Contribution is
credited to the Annuity Account.
Eligible Fund - a registered management investment company in
which the assets of the Series Account may be invested.
Guaranteed Account - the portion of this individual annuity
contract providing Guaranteed Sub-Accounts, each of which
guarantees principal.
Guaranteed Account Value - the sum of the values of the
Guaranteed Sub-Accounts credited to the Owner under the Annuity
Account.
Guaranteed Interest Rate - a minimum interest rate applicable to
Guaranteed Sub-Accounts equal to an annual effective rate of 3%.
Guaranteed Sub-Account - a sub-division of the Guaranteed
Account. Such subdivision(s) is described in greater detail in
the attached Guaranteed Sub-Account Riders, if any.
Home Office - the Company's Home Office located at ▇▇▇▇ ▇▇▇▇
▇▇▇▇▇▇▇ ▇▇▇▇, ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇.
Intra-Company Transfer - amounts moved within and between any of
the Variable and Guaranteed Sub-Accounts.
Investment Division - there is within the Series Account an
Investment Division for each Variable Sub-Account. Each
Investment Division invests in one or more Eligible Funds. The
Company may change the Eligible Funds within an Investment
Division at its sole discretion subject to compliance with
applicable law.
Individual Retirement Annuity (▇▇▇) - an annuity contract used
for a retirement savings program that is intended to satisfy the
requirements of Section 408 of the Internal Revenue Code of 1986,
as amended.
Article I: Definitions (continued)
Loss of Interest Charge - a charge which may be applied whenever
amounts deposited into the Guaranteed Certificate Fund are
transferred as described in Section 6.1 prior to Certificate
Maturity Date. The Loss of Interest Charge is calculated by
reducing the credited interest rates declared by the Company to
the Guaranteed Interest Rate credited on the affected
certificates. Thus, the charge equals the difference between the
amount of interest which would have been credited using the
credited interest rate declared by the Company and the amount of
interest credited using the Guaranteed Interest Rate on each
affected Certificate from the initial deposit date up to the time
of transfer.
Owner - the person who is entitled to all rights and benefits
under the Contract. The Annuitant will at all times be the Owner
of the Contract.
Partial
Withdrawal
-
a withdrawal of some of the Annuity Account Values prior to the Annuity
Commencement Date which is not an ▇▇▇ to ▇▇▇ transfer and not a distribution.
Payee - any person receiving distributions or annuity payments
under the Individual Retirement Annuity Contract, as designated
by the Owner.
Premium Tax - the amount of premium tax, if any, charged by a
state or other government authority.
Request - any request in a form, either written, telephoned or
computerized, satisfactory to the Company and received by the
Company at its Home Office, from the Owner, or the Owner's
designee as required by any provision of this Contract, or as
required by the Company.
Series Account - The Retirement Plan Series Account, a separate
investment account established by Great-West Life & Annuity
Insurance Company under Colorado law and registered as a unit
investment trust under the Investment Company Act of 1940, as
amended. The Series Account is separate from the general assets
of the Company.
Surrender - a withdrawal of all Annuity Account Values prior to
the Annuity Commencement Date which is not an ▇▇▇ to ▇▇▇ transfer
and not a distribution.
Transfer - the moving of money from one sub-account to another
sub-account or outside the Contract.
Valuation Date - the date on which the new asset value of each
Eligible Fund is determined.
Valuation Period - the period between the ending of two
successive Valuation Dates.
Variable Account - the portion of the Series Account to which Contributions
under the Contracts may be allocated. The Variable Account consists of Variable
Sub-Accounts, each having its own Accumulation Unit and Annuity Unit Value.
Variable Account Value - the sum of the values of the Variable Sub-Accounts
credited to the Owner under the Annuity Account.
Variable Sub-Account - a sub-division of the Variable Account. Each
Variable Sub-Account has its own Accumulation Unit and Annuity Unit
Value containing the value credited to the Owner from an Investment
Division.
Article II: Ownership Provisions
2.1 OWNERSHIP OF SERIES ACCOUNT
The Company has absolute ownership of the assets of the Series Account. All
monies invested in the Series Account, however, are held separate and apart
from the Company's general assets. The assets of such separate account
which are equal to the reserves and other Contract
liabilities with respect to such account shall not be chargeable with
liabilities arising out of any other Company business.
2.2
OWNERSHIP
OF
THE
CONTRACT
The Annuitant will at all times be the Owner of the Contract.
2.3
NONFORFEITABLE
The entire interest of the Owner is nonforfeitable.
2.4
EXCLUSIVE
BENEFIT
The Contract is established for the exclusive benefit of the Owner and
the Beneficiary.
2.5
TRANSFER
AND
ASSIGNMENT
The Contract is not transferable. The Owner may not sell or transfer
the Contract and may not name a secondary Owner. No benefits under the
Contract may be assigned; except the Contract may be transferred to a
former spouse of the Owner under a divorce decree or written
instrument incident to such divorce. In the event of such transfer,
the transferee shall for all purposes be treated as the Owner of the
Contract.
2.6
LOANS
PROHIBITED
The Owner may not borrow any money under the Contract or pledge the Annuity
Account Value or any portion thereof as security for a loan.
Article
III:
General
Provisions
3.1
ENTIRE
CONTRACT
The Contract, application, tables, Guaranteed Sub-Account Riders, if
any, and any other rider issued in conjunction with the Contract
constitute the entire contract between the Owner and the Company, as
well as any Beneficiary. A copy of the application is attached to the
Contract when issued to the Owner.
The Contract supersedes all prior representations, statements,
warranties, promises and agreements of any kind, whether oral or
written, relating to the subject matter of the Contract.
All statements in the application, in the absence of fraud,
as determined by a court of competent jurisdiction have been
accepted as representations and not as warranties.
3.2
NON-PARTICIPATING
The Contract is non-participating. It is not eligible to
share in the Company's divisible surplus.
3.3
BENEFICIARY
The Owner may, by Request, designate or change a Beneficiary from time to time.
When recorded by the Company, a change of Beneficiary will take effect as of the
date the Request was submitted by the Owner. If the Owner dies before the date
the Request was recorded, the change will take effect as of the date of the
Request except to the extent that the Company has made a payment or has
otherwise taken action on a designation or change before receipt or recording of
the designation or change of Beneficiary.
Unless otherwise provided in the Beneficiary designation, the following
provisions will apply:
(A) upon the death of the Owner, the Annuity Account Value shall pass to
any
surviving primary Beneficiary and if more than one, the Annuity Account
Value shall be shared equally among them.
(B)
if
a
primary Beneficiary dies before the Owner, that Beneficiary's intended
share will be shared equally among the surviving primary beneficiaries.
(C) if there is no surviving primary Beneficiary, the Annuity Account
Value shall pass to any surviving contingent Beneficiary, and if more
than one, shall be shared equally among them.
(D) if no Beneficiary has been designated, or no Beneficiary survives
the Owner, the Annuity Account Value will pass to the Owner's estate.
3.4
CURRENCY
AND
PAYMENT
CONTRIBUTIONS
All amounts to be paid to or by the Company must be in the currency of the
United States of America. All Contributions to the Contract must be made payable
to the Company or its designated agent.
3.5
AGE
The maximum issue age is 90. If the age of the Annuitant has been
misstated, the payments established will be made on the basis of the
correct age. If payments were too large because of misstatement, the
difference with interest may be deducted by the Company from the next
payment or payments. If payments were too small, the difference with
interest may be added by the Company to the next payment. This interest
will result in an annual effective rate which will not be less than the
Guaranteed Interest Rate per year of 3%, as determined by the Company.
Regular
▇▇▇ Contributions may not be made for any tax year during or after which
the Owner has attained age 70 1/2.
3.6
VOTING
RIGHTS
The Company will vote the shares of an Eligible Fund. To the extent
required by law, the Company will vote according to the instructions of the
Owner in proportion to the interest in the Variable Sub-Account. In such
event, the Company will send proxy materials and form(s) to the Owner for a
reply. If no reply is received by the date specified in the proxy
materials, the Company will vote shares of the appropriate Eligible Fund in
the same proportion as shares of the Eligible Fund for which replies have
been received.
During the Annuity Payment Period, the number of votes will decrease as the
assets held to fund annuity payments decrease. The Payee will be entitled
to receive the proxy materials and form(s) otherwise provided to the Owner,
and all other
provisions concerning voting rights will apply to the Payee of a Variable
Dollar Payment Option.
3.7
REPORTS
The Company will furnish the Owner, not less frequently than annually on a
calendar year basis, a statement of the Annuity Account Value. The Company
will furnish the Owner copies of any
shareholder reports of the Eligible Funds and of any other notices, reports
or documents required by law.
Article III: General Provisions (continued)
3.8
CONTRACT
MAINTENANCE
CHARGE
The Company may assess a contract maintenance charge each calendar year.
The contract maintenance charge will not be more than $30 per Annuity
Account per year if the Contract value is not at least $5,000 on December
31st of the prior year. The annual amount will be deducted from each
Owner's Annuity Account in existence during the second quarter of the
current year. If an Annuity Account is established for an Owner after the
date of assessment, the contract maintenance charge will be deducted on the
first day of the next quarter and will be pro-rated for the remaining
portion of the year. No refund of this charge will be made.
The deduction will be pro-rated among the Owner's Variable and Guaranteed
Sub-Accounts based upon their Variable and Guaranteed Account Values on the
date of deduction. Whenever a deduction for a contract maintenance charge
is to be made from a Variable Sub-Account, the Company will cancel
Accumulation Units having a total value equal to the amount of the
deduction.
3.9 NOTICE AND PROOF
The Company reserves the right to require satisfactory proof to establish
the age, continued life or death of any person, or the
designation of any Beneficiary before making any payment. Any notice or
demand by the Company to or upon the Owner, or any other person may be
given by mailing it to that person's last known address as stated in the
Company's file.
Any application, report, Request, election, direction, notice or demand by
the Owner, or any other person must be made in a form satisfactory to the
Company.
3.10
TAX
CONSEQUENCES
OF
PAYMENTS
The Owner or Beneficiary, as the case may be, must determine the timing and
amount of any benefit payable. Nothing contained herein shall be construed to be
tax or legal advice and the Company assumes no responsibility or liability for
any damages or costs, including but not limited to taxes, penalties, interest or
attorney's fees incurred by the Owner, the Annuitant, the Payee, the
Beneficiary, or any other person arising out of any such determination.
3.11
POSTPONEMENT
If
the
Company receives a request for surrender or partial withdrawal, the Company
may postpone any cash payment for no more than 6 months (30 days in West
Virginia) other than for payment of any premium to the Company.
Article IV: Contribution Provisions
FCIRA/RO-10/97
Page
7
4.1
CONTRIBUTIONS
Contributions under the Contract are not fixed. Except in the case of a
rollover Contribution (as permitted by Code Sections 402(c), 403(a)(4),
403(b)(8), or 408(d)(3)), no Contributions will be accepted unless they are
by check, money order, or wire transfer, and the total of such
Contributions shall not exceed $2,000, or such other maximum as the Code
may allow, for any taxable year.
No Contribution will be accepted unless the Company has also received the
appropriate Request forms for establishment of the ▇▇▇, designation of
Contribution and direction to allocate to the sub-account(s).
4.2
INITIAL
CONTRIBUTION
The initial Contribution to the Contract may be an eligible rollover
distribution (defined by the Code) from a plan qualified under Code Section
401(a), a rollover from a Tax Sheltered Annuity as defined in Code Section
403, a rollover from a deductible existing ▇▇▇, or an initial contribution
made from earned income derived from non-retirement plan sources.
4.3
REGULAR
▇▇▇
CONTRIBUTIONS
Provided the Owner has made a rollover Contribution as provided under
Article 4.2 of the Contract, the Company will accept ▇▇▇ Contributions
throughout the Owner's tax year. Such
Contributions must be made by check, money order, or wire transfer on
behalf of the Owner. The appropriate Request forms must accompany the
Contributions to accurately designate and allocate the Contributions. The
minimum amount of such Contribution must be at least $250 and must not
include any amount contributed on behalf of the Owner's spouse. The Company
reserves the right to modify the minimum ▇▇▇ Contribution.
If the Owner wishes to ensure that the initial Contribution will be
eligible to be rolled back into a qualified plan at some future date, no
regular ▇▇▇ Contributions should be made to the Contract containing the
initial Contribution.
If the Owner wishes to make regular ▇▇▇ Contributions, the Owner must
complete and submit an application to the Company at its Home Office for an
additional Contract to accept regular ▇▇▇ Contributions. It shall be the
Owner's sole responsibility to determine whether to make annual regular ▇▇▇
Contributions and to determine whether such Contributions should be made to
the Contract containing the initial Contribution or to a separate Contract
issued specifically to accept such regular Contributions.
Any refund of premiums (other than those attributable to excess
Contributions) will be applied before the close of the calendar year
following the year of the refund toward the payment of additional premiums
or the purchase of additional benefits.
4.4
COMMINGLING
OF
CONTRIBUTIONS
Consult your tax advisor about the consequences of contributing rollover
proceeds from a qualified plan under 401(a), rollover proceeds from other
eligible sources (as defined by the Code) and non-retirement plan earned
income into the same ▇▇▇ account.
4.5
DESIGNATION
OF
REGULAR
▇▇▇
CONTRIBUTIONS
Regular
▇▇▇ Contributions for a tax year of the Owner may be made on or before the
due date of the Owner's federal income tax return for that year, not
including any extensions for filing that return. Such Contributions made
after December 31 for the preceding tax year must be designated as such by
the Owner.
The Owner must designate each regular ▇▇▇ Contribution or portion thereof
made, to be:
(a) a regular Contribution for the current year; or
(b) a regular Contribution for the prior year.
The Company will rely exclusively upon information provided by
the Owner in determining the appropriate designation of each
regular ▇▇▇ Contribution.
4.6
EXCESS
CONTRIBUTIONS
The Company will not knowingly accept a regular ▇▇▇ Contribution
in excess of $2,000 made by the Owner or spouse for a tax year.
Should the Company discover that it has received a Contribution
which would bring the Owner's or spouse's regular ▇▇▇
Contribution for a tax year to over $2,000, the Company is not
obligated to return the excess to the Owner except upon the
Owner's written authorization. The Owner is solely responsible
for the determination of any excess Contributions and timely
withdrawal thereof.
Article
IV:
Contribution
Provisions
(continued)
4.7
ALLOCATION
OF
CONTRIBUTIONS
Contributions, less Premium Tax, if any, will be allocated in the
Annuity Account among any number of currently offered Variable
and Guaranteed Sub-Accounts in accordance with the latest
recorded Request of the Owner. Allocations shall be effective
upon the Company's receipt of the Contribution. Contributions
received after 4:00 p.m. EST/EDT shall be deemed to have been
received on the next business day.
The allocation of Contributions may be changed at any time upon the
Company's receipt at its Home Office of the Request of the Owner.
A
change
of
allocation will be effective for Contributions which are received after the
Company's receipt and recording of such Request.
4.8
SEP
CONTRIBUTIONS
NOT
ACCEPTED
The Company will not accept SEP (simplified employee pension)
Contributions, as defined under Code Section 408(k), to the
Contract.
Article V: Account Value Provisions
5.1
VARIABLE
ACCOUNT
VALUE
The Variable Account Value for the Owner on any date during the
Accumulation Period will be the sum of the values of the Variable
Sub-Accounts.
The value of the Owner's interest in a Variable Sub-Account
will be determined by multiplying the number of the Owner's
Accumulation Units by the accumulation unit value for that
Variable Sub-Account.
5.2
ACCUMULATION
UNIT
For each Contribution, the number of Accumulation Units
credited for the Owner to a Variable Sub-Account will be
determined by dividing the amount of such Contribution by
the accumulation unit value for that Variable Sub-Account on
the next Valuation Date on which such Contribution was
allocated.
Contributions received at the Home Office of the Company
before 4:00 p.m. EST/EDT of a Valuation Date will be
allocated as requested and shall be applied as of that date.
All Contributions received after 4:00 p.m. EST/EDT shall be
applied as of the following Valuation Date.
5.3
ACCUMULATION
UNIT
VALUE
The accumulation unit value of a Variable Sub-Account on any Valuation Date
is equal to the accumulation unit value of that Variable Sub-Account as of
the immediately preceding Valuation Date multiplied by the net investment
factor as described in Section 5.4, for the Valuation Period ending on the
Valuation Date on which the accumulation unit value is being determined.
The accumulation unit value may increase, decrease, or remain unchanged as
a result of the investment experience of the Eligible Fund.
The established dollar value for the initial accumulation unit value of
each Variable Sub-Account is $10.
5.4
NET
INVESTMENT
FACTOR
The
net
investment factor for any Variable Sub-Account for any Valuation period is
determined by dividing (a) by (b), and subtracting (c) from the result
where:
(a) is the net result of:
(i) the net asset value per share of the Eligible Fund shares held in the
Variable Sub-Account determined as of the end of the current Valuation Period;
plus
(ii) the per share amount of any dividend (or, if applicable, capital gain
distributions) made by the Eligible Fund on shares held in the Variable
Sub-Account if the "ex-dividend" date occurs during the current valuation
period; minus or plus
(iii)a per unit charge or credit for any taxes incurred by or reserved for in
the Variable Sub-Account, which is determined by the Company to have resulted
from the investment operations of the Variable Sub-Account.
(b) is the net result of:
(i) the net asset value per share of the Eligible Fund shares held in the
Variable Sub-Account determined as of the end of the immediately preceding
Valuation Period; minus or plus
(ii) the per unit charge or credit for any taxes incurred by or reserved for in
the Variable Sub-Account for the immediately preceding Valuation Period.
(c) is an amount representing the risk charge deducted from each Variable
Sub-Account on a daily basis. The risk charge is equal to an annual rate applied
to the daily net asset value of each Variable Sub-Account where the annual rate
is determined from the Risk Charge Schedule attached to this Contract.
The net investment factor may be greater than, less than, or equal to one.
Therefore, the accumulation unit value may increase, decrease, or remain
unchanged.
5.5
RISK
CHARGE
The risk charge compensates the Company for its assumption of certain mortality
and expense risks. This charge is described above in Section 5.4 (c). The
Company's current schedule at the time of issue of the Contract is shown in the
attached Risk Charge Schedule. The Company has the right to prospectively adjust
the schedule subject to compliance with applicable law.
Article V: Account Value Provisions (continued)
5.6
GUARANTEED
ACCOUNT
VALUE
The Guaranteed Account Value on any date during the Accumulation Period
will be the sum of the values of the Guaranteed Sub-Accounts credited to
the Owner under the Annuity Account.
5.7
GUARANTEED
SUB-ACCOUNT
RIDERS
The computation of the value of a Guaranteed Sub-Account is described in
the attached Guaranteed Sub-Account Rider(s), if any.
Article
VI:
Transfers
6.1
TRANSFERS
The Owner may make transfers by Request. Transfers will be accepted after the
appropriate administrative forms and other procedures are executed.
Beneficiaries may make Transfers in limited circumstances as discussed below.
6.2
TRANSFER
TERMS
The following provisions apply:
a.
A Transfer will take effect on the later of the date elected or the date
the Request is received at the Home Office. For Transfers from or into a
Variable Sub-Account, a unit value is calculated by the Company. If such
Request is received after 4:00 p.m. EST/EDT, the Transfer will take
effect based on the unit value on the later of the date elected or the
date following the date the Request is received.
b. When required by the Company, the Owner, or Beneficiary will execute forms
provided by the Company.
c. No Transfers are permitted after the Annuity Commencement Date.
d.
A Transfer from a Guaranteed Sub-Accounts shall be subject to the terms
of the attached Guaranteed Sub-Accounts Rider(s), if any.
e. If a Transfer is made within 30 days of the Annuity Commencement Date, the
Company may delay the annuity commencement by 30 days.
f. If the Owner dies prior to the Annuity Commencement Date, one Transfer
may be made after the death of the Owner by the Beneficiary to effect the
election of a payment option.
6.3
INTRA-COMPANY
TRANSFERS
The following provisions will apply:
a. Monies in the Guaranteed Certificate Fund cannot be transferred prior to
Certificate Maturity Date, except in the following situations:
(1) the Annuitant dies; or
(2)
the Annuitant elects a payment option with a life contingency or an
annuity payment period of at least (36) thirty-six months.
b. Subject to the provisions of Section 6.3.a., at any time prior to the
Annuity Commencement Date, the Owner, by Request, may Transfer all or a
portion of the Annuity Account Value within and between the Variable and
Guaranteed Sub-Accounts currently offered by the Company.
c. No surrender charge will apply to Intra-Company Transfers.
6.4
NON-TAXABLE
DISTRIBUTION
No amount transferred pursuant to these provisions will be treated as a
taxable distribution to the Owner.
6.5 TRANSFER OUTSIDE THE CONTRACT
A Transfer outside the Contract to another investment vehicle qualified
under Code Sections 401(a) or 408 will be considered a Surrender or Partial
Withdrawal in accordance with the provisions of Article VIII of this
Contract.
Article VII: Distributions
7.1 DISTRIBUTIONS PRIOR TO AGE 59 1/2
Distributions from the Contract made prior to age 59 1/2 and not
rolled-over or transferred as provided in the Code, are subject to tax
penalties except if made on account of the disability of the Owner (as
evidenced to the Internal Revenue Service by the approval of the
Owner's application for disability benefits under the Social Security
Act or by certification made by a licensed physician), the death of
the Owner or as part of a series of substantially equal annual or more
frequent periodic payments as described in Section 7.2 of the
Contract.
7.2
DISTRIBUTIONS
BEFORE
DEATH
The Owner's entire interest in the policy must be distributed, or
begin to be distributed, by the Owner's required beginning date, which
is the April 1 following the calendar year in which the Owner reaches
age 70.
For each succeeding year, a distribution must be made on or before
December 31. By the required beginning date, the Owner may elect to
have the balance in the policy distributed in one of the following
forms:
(a) a single sum payment;
(b) equal or substantially equal payments over the life of the Owner;
(c) equal or substantially equal payments over the lives of the Owner
and his or her designated beneficiary;
(d) equal or substantially equal payments over a specified period that
may not be longer than the Owner's life expectancy;
(e)
equal
or
substantially equal payments over a specified period that may not be
longer than the joint life and last survivor expectancy of the Owner and
his or her designated beneficiary.
All distributions made hereunder shall be made in accordance with
section 408(a)(6) or section 408(b)(3) of the Code and the regulations
thereunder, including the incidental death benefit requirements of
section 401(a)(9) of the Code, the minimum distribution incidental
benefit requirement of Prop. Treas. Reg. ss.1.401(a)(9)-2, and the
regulations thereunder. Payments must be either non-increasing or may
increase only in accordance with Prop. Treas. Reg. ss.1.401(a)(9)-1,
Q&A F-3.
Life expectancy is computed by use of the expected return multiples in
Tables V and VI of section 1.72-9 of the Income Tax Regulations. Unless
otherwise elected by the Owner by the time distributions are required to
begin, life expectancies shall be recalculated annually. Such election
shall be irrevocable by the individual and shall apply to all subsequent
years. The life expectancy of a non-spouse beneficiary may not be
recalculated. Instead, life expectancy will be calculated using the
attained age of such Beneficiary during the calendar year in which the
Beneficiary attains age 70 1/2, and payments for subsequent years shall be
calculated based on such life expectancy reduced by one for each calendar
year which has elapsed since the calendar year life expectancy was first
calculated.
7.3
DISTRIBUTION
UPON
DEATH
(a) Distributions beginning before death. If the Owner dies while
receiving distributions, but before the entire interest has been
distributed, the remainder will continue to be distributed at least as
rapidly as under the method of distribution being used prior to the
individual's death
(b) Distributions beginning after death. If the Owner dies before
distribution of his or her interest begins, distribution of the
individual's entire interest shall be completed by December 31 of the
calendar year containing the fifth anniversary of the individual's
death, except to the extent that an election is made to receive
distribution in accordance with (1) or (2) below:
(1) If the Owner's interest is payable to a designated beneficiary,
then the entire interest of the individual may be distributed in equal
or substantially equal payments over the life or over a period certain
not greater than the life expectancy of the designated beneficiary
commencing on or before December 31 of the calendar year immediately
following the calendar year in which the Owner died.
(2) If the Owner's spouse is not the named beneficiary, the method of
distribution selected will assure that at least 50% of the present
value of the amount available for distribution is paid within the
Owner's life expectancy and that such method of distribution complies
with the requirements of Code section 408(b)(3) and the regulations
thereunder.
Article
VII:
Distributions
(continued)
(3)
If
the
designated beneficiary is the Owner's surviving spouse, the date
distributions are required to begin in accordance with (1) above
shall not be earlier than the later of (A) December 31 of the
calendar year immediately following the calendar year in which the
individual died or (B) December 31 of the calendar year in which the
individual would have attained age 70 1/2.
(4) If the designated beneficiary is the Owner's surviving spouse, the
spouse may treat the contract as his or her own ▇▇▇. This election
will be deemed to have been made if such surviving spouse makes a
regular ▇▇▇ contribution to the contract, makes a rollover to or from
such contract, or fails to elect any of the above provisions.
(c) Life expectancy is computed by use of the expected return
multiples in Tables V and VI of section 1.72-9 of the Income Tax
Regulations. For purposes of distributions beginning after the Owner's
death, unless otherwise elected by the surviving spouse by the time
distributions are required to begin, life expectancies shall be
recalculated annually. Such election shall be irrevocable by the
surviving spouse and shall apply to all subsequent years. In the case
of any other designated beneficiary, life expectancies shall be
calculated using the attained age of such Beneficiary during the
calendar year in which distributions are required to begin pursuant to
this section, and payments for any subsequent calendar year shall be
calculated based on such life expectancy reduced by one for each
calendar year which has elapsed since the calendar year life
expectancy was first calculated.
(d) Distributions under this section are considered to have begun if
distributions are made on account of the Owner reaching his or her
required beginning date or if prior to the required beginning date
distributions irrevocably commence to an individual over a period
permitted and in an annuity form acceptable under section 1.401(a)(9) of
the Regulations.
7.4
MINIMUM
DISTRIBUTIONS
An individual may satisfy the minimum distribution requirements under
sections 408(a)(6) and 408(b)(3) of the Code by receiving a distribution
from one ▇▇▇ that is equal to the amount required to satisfy the minimum
distribution requirements for two or more IRAs. For this purpose, the Owner
of two or more IRAs may use the alternative method described in Notice
88-38, 1988-1 C.B. 524, to satisfy the minimum distribution requirements.
7.5
▇▇▇
TO
▇▇▇
TRANSFER
A Transfer of funds from the Contract directly to another ▇▇▇ either at the
Owner's Request or at the Request of the trustee of such ▇▇▇, is not a
rollover. Because there is no distribution to the Owner, the Transfer is
tax-free. Since it is not a rollover, it is not affected by the one-year
waiting period that is required between rollovers.
7.6 ELECTION OF PAYMENT OPTION
If the Owner dies the designated Beneficiary may, subject to the other
provisions of the Contract, elect that payment be made under one or a
combination of the payment options.
7.7 AMOUNT PAYABLE ON DEATH OF THE
OWNER
(A) If the Owner dies before the Annuity Commencement Date, the amount
payable will be the Annuity Account Value as of the date of death,
less Premium Tax, if any.
(B) If the Owner dies after the Annuity Commencement Date, the amount
payable will be the amount remaining to be paid under the method of
distribution in effect on the date of the Owner's death.
(C)
No surrender charge or Loss of Interest Charge will apply to the Amount
Payable on Death of the Owner, described above.
Article VIII: Surrender and Partial Withdrawals
8.1 SURRENDER BENEFIT
Subject to the provisions of the Contract, the Owner may Surrender the
Contract for the Surrender Value. In no event shall any cash surrender
benefit be less than the minimum nonforfeiture amount at that time,
that is required by law. The Company shall make the distribution as
soon as practicable after receipt of the Request.
8.2
SURRENDER
VALUE
The Surrender Value is:
(A) the value of all monies held in the Variable Sub-Accounts; plus
(B) the value of all monies held in the Guaranteed Certificate Fund
relating to the Contract, less
(C) the Loss of Interest Charge on all monies held in the Guaranteed
Certificate Fund relating to the Contract, less
(D) the surrender charge, if any, less
(E) Premium Tax, if any.
The Surrender will take effect on the later of the date elected or the date
the Request is received at the Home Office. If such request is received
after 4:00 p.m. EST/EDT, the Surrender will take effect based on the unit
value on the later of the date elected or the date following the date the
Request is received.
8.3 SURRENDER CHARGE
A surrender charge of $50 will apply if the Owner surrenders the
Contract at any time during the 12 month period commencing on the
Effective Date, provided however that no surrender charge will apply
if the Contract is returned for refund in connection with the "20 Day
Free Look" provisions described on the face page of the Contract. The
Company has the right to change the surrender charge subject to
compliance with applicable law.
8.4
PARTIAL
WITHDRAWAL
A charge of $25 will apply on any Partial Withdrawal Request during
the 12 month period commencing on the Effective Date. The Company has
the right to change this charge subject to compliance with applicable
law.
The Owner may make a Partial Withdrawal at any time while this
Contract is in force, subject to the terms of the Contract. After any
Partial Withdrawal, the Annuity Account Value must be at least equal
to the minimum initial Contribution as described in Section 4.3 of the
Contract. Therefore, the maximum Partial Withdrawal will be:
o the Surrender Value described in Section 8.2; less
o the minimum initial Contribution.
By Request, the Owner must elect the Variable or Guaranteed
Sub-Account(s), or a combination of them, from which a Partial
Withdrawal is to be made and the amount to be withdrawn from each
sub-account. If an adequate election is not made, the Request
will be denied and no Partial Withdrawal will be processed.
Partial Withdrawals will be paid in a single sum only. The
Annuity Account Value will be reduced by the Partial Withdrawal
amount and the surrender charge, if any.
The following terms apply:
A. A Partial Withdrawal will take effect on the later of the date
elected or the date the Request is received at the Home Office.
If such Request is received after 4:00 p.m. EST/EDT, the Partial
Withdrawal will take effect based on the unit value on the later
of the date elected or the date following the date the Request is
received.
B.
When required by the Company, the Owner, or Beneficiary will execute
forms provided by the Company.
C. No Partial Withdrawals are permitted after the Annuity
Commencement Date.
D.
A
Partial Withdrawal from a Guaranteed Sub-Accounts shall be subject to
the terms of the attached Guaranteed Sub-Accounts Riders, if any.
E. If a Partial Withdrawal is made within 30 days of the Annuity
Commencement Date, the Company may delay the Annuity Commencement
Date by 30 days provided such delay does not violate the Code or
regulations pertaining thereto.
F. If the Owner dies prior to the Annuity Commencement Date, the
Beneficiary will be accorded the same rights as the Owner was
with respect to a Partial Withdrawal.
Article VIII: Surrender and Partial Withdrawals (continued)
8.5 LOSS OF INTEREST CHARGE
On any total or partial Transfer, distribution, or payment
from the Annuity Account, the Loss of Interest Charge will
be deducted from amounts distributed from any Guaranteed
Certificate Fund prior to the Certificate Maturity Date.
8.6 WAIVER OF LOSS OF INTEREST CHARGE
The Loss of Interest Charge will be waived in the event the
Owner selects a payment option of substantially level
payments over a period of at least five years, on account of
death or disability of the Owner (as evidenced by the
Owner's approval for disability benefits under the Social
Security Act or by certification by a licensed physician),
for qualified first time homebuyer distributions or for
qualifying educational expenses (as defined by the Code).
Article IX: Periodic Payment Options
9.1 HOW TO ELECT PERIODIC PAYMENT
OPTIONS
The Owner may Request that all or part of the Annuity
Account be applied to a periodic payment option. While
periodic payments are being received, the Owner may continue
to exercise all contractual rights that are available prior
to electing one of the periodic payment options. Once
elected, the applicable option(s) may be revoked by the
Owner at any time, by submitting a Request to the Company's
Home Office. Any revocation will apply only to the amounts
not yet paid. Once an option is revoked, it may not be
elected again.
9.2 SELECTION OF PERIODIC PAYMENT
OPTIONS
The Flexible Payment Option is available for any Owner. The Estate
Maximizer Option is available only for Owners who are at least 70 1/2 years
of age.
An Owner electing a periodic payment option at or after age
59 1/2 will be subject to no penalties and no Loss of
Interest Charge for payments from unmatured guaranteed
certificates as long as payments are substantially level and
are to be paid over a period of not less than five year.
An Owner electing a periodic payment option prior to age 59 1/2 will be
subject to a Loss of Interest Charge to any payment made from an
unmatured guaranteed certificate. As well, an early withdrawal penalty
imposed by the Code may apply. All payments made to an Owner upon the
Owner's attainment of age 70 1/2 from any periodic payment option must
comply with the minimum distribution rules prescribed by the Code.
If
any
payment to be made under the elected periodic payment option will be less
than $100, the Company may make the periodic payments in the most frequent
interval which produces a payment of at least $100.
9.3
ESTATE
MAXIMIZER
OPTION
("EMO")
The Company will calculate and distribute an annual amount
using the method contained in the Code's minimum
distribution regulations. The Owner must specify the initial
distribution date. Subsequent distributions will be made on
the 15th day of any month or such other date as the Company
may designate or allow. The annual distribution is
determined by dividing the current value of the Annuity
Account by a life expectancy factor from tables designated
by the Internal Revenue Service ("IRS"). The factor will be
based on either the Owner's life expectancy or the joint
life expectancy of the Owner and the Owner's spouse and will
be redetermined for each calendar year's distribution. The
current value to be used in this calculation is the Annuity
Account Value on December 31 prior to the year in which the
EMO payment is being made. This calculation will be changed
if necessary to conform to changes in the Code or applicable
regulations.
9.4
FLEXIBLE
PAYMENT
OPTION
("FPO")
FPO payments are available on a monthly, quarterly, semi-annual or annual basis.
The Owner must specify the initial distribution date. Subsequent distributions
will be made on the 15th day of any month or such other dates the Company may
designate or allow.
Article
IX:
Periodic
Payment
Options
(continued)
Under each of the methods of distribution described below, the annual
distribution amount must be greater than or equal to the minimum distribution
amount required by the Code and applicable regulations.
One of three following methods of distribution may be elected:
a. Specified Payment - payments of a designated dollar amount. The current value
to be used in this calculation is the Annuity Account Value on the December 31st
prior to the year for which the payment is being made. Payments will cease on
the earlier of the date the amount elected to be paid under the option selected
has been reduced to zero; or the Annuity Account Value is zero.
b. Specified Period - payments for a designated time period. Each annual
distribution is determined by dividing the Annuity Account Value by the
number of years remaining in the elected period. The current value used in
this calculation is the Annuity Account Value on the December 31st prior to
the year for which the payment is being made. For payments made more often
than annually, the annual payment result (calculated above) is divided by
the number of payments due each year. The specified period must be at least
three years, but not greater than the Annuitant's life expectancy factor.
Payments will cease on the earlier of the date the amount elected to be
paid under the option selected has been reduced to zero; or the Annuity
Account Value is zero.
c. Interest Earnings only - payments equal to the interest earnings portion
only on guaranteed certificates. This method of distribution is only
available to Owners who have all monies invested in the guaranteed
certificates. Payments will cease on the earlier of the date the amount
elected to be paid under the option selected has been reduced to zero; or
the Annuity Account Value is zero.
For purposes of determination of amounts to be distributed under each of
the referenced distribution methods, life expectancy will be recalculated
annually based on Internal Revenue Code ss.401(a)(9) or applicable
regulations.
The withdrawals from the Annuity Account for purposes of any of the
periodic payment options will be prorated over all Variable and/or
Guaranteed Sub-Accounts.
9.5
MODIFICATION
OF
PERIODIC
PAYMENT
OPTIONS
The Company may offer new or cease offering existing periodic payment
options. No such modification shall affect the terms, provisions or
conditions which are or may be applicable to periodic payment options
elected prior to such modifications.
9.6
ADMINISTRATION
FEE
The Company's current administration fee, if any, will apply to each
periodic payment. The fee is intended to cover costs associated with the
administration of periodic payments and is subject to change by the
Company.
Article X: Payment Options (Other Than Periodic Payments)
10.1 HOW TO ELECT PAYMENT OPTIONS
The Request of the Owner is required to elect, or change the election of, a
payment option and must be received by the Company at least 30 days prior
to the Annuity Commencement Date. If a Partial Withdrawal is made within 30
days of the Annuity Commencement Date, the Company may delay the Annuity
Commencement Date by 30 days.
10.2
SELECTION
OF
PAYMENT
OPTIONS
(a) A total or partial single sum payment or one of the variable or fixed
dollar payment options or a combination of them may be elected.
(b) If the Owner elects to apply any or all of the Guaranteed Account Value
to a variable dollar method of payment option, or any or all of the
Variable Account Value to a fixed dollar method of payment option, a
Transfer must be made prior to the Annuity Commencement Date. Procedures
for Transfers are described in Article VI of the contract.
(c) If a single sum payment is elected, the amount to be paid is the
Surrender Value and will be subject to any applicable surrender charge.
(d) If a variable dollar payment option is elected, the amount to be
applied is the Variable Account Value, as of the date the amount of the
first monthly payment is determined, less Premium Tax, if any.
(e) If a fixed dollar method of payment option is elected, the amount to be
applied is the Guaranteed Account Value, as of the Annuity Commencement
Date, less Premium Tax, if any.
(f) The minimum amount that may be applied under the elected payment
option is equal to the minimum initial Contribution as described in
Section 4.3 of the Contract. If the amount is less than the minimum
initial Contribution, the Company may pay it in a single sum. If any
payment to be made under the elected payment option will be less than
$50, the Company may make the payments in the most frequent interval
which produces a payment of at least $50. The maximum amount that may
be applied under any elected payment option is $1,000,000. For the
application of any greater amount, the Company's consent is required.
10.3
VARIABLE
DOLLAR
PAYMENT
OPTIONS
The guaranteed annuity tables are based on mortality from the 1983 Table
(a) for Individual Annuity Valuation (blended 60% male and 40% female) and
a guaranteed interest rate of 3% per year. The Company may offer a better
rate than the guaranteed rate shown.
The following variable dollar payment options are available:
(a) Option 1: Variable Life Annuity with
Guaranteed
Period
Monthly payments for the guaranteed Annuity Payment Period elected or
the lifetime of the Annuitant whichever is longer. The guaranteed
Annuity Payment Period elected may be 5, 10, 15, or 20 years. Upon death
of the Annuitant, the Beneficiary will begin to receive the remaining
payments at the same monthly interval elected by the Owner. See Table A.
(b) Option 2: Variable Life Annuity
Monthly payments for Annuitant's lifetime, without a guaranteed
period. See Table A.
(c) Option 3: Any Other Form
Any other form of variable annuity which is acceptable to the
Company.
These variable dollar payment options are subject to the following
provisions:
(a) Amount of First Monthly Payment
The first monthly payment under a variable dollar payment option will be
based on the value of each Variable Account on the 5th
Valuation Date preceding the Annuity Commencement Date. It will be
determined by applying the appropriate rate from the applicable Table to
the amount applied under the payment option. The first monthly payment
will be the sum of the variable dollar annuity payments for each
Variable Sub-Account.
(b)
Annuity
Units
The number of Annuity Units paid to the Annuitant for each
variable sub-account is determined by dividing the amount of the
first monthly payment by the sub-account's annuity unit value on
the 5th Valuation Date preceding the date the first payment is
due. The number of Annuity Units used to calculate each payment
for a Variable Sub-Account remains fixed during the Annuity
Payment Period.
Article X: Payment Options (Other Than Periodic Payments)
(continued)
(c) Amount of Monthly Payments after the first monthly payment will vary
depending upon the investment experience of the Variable
Sub-Accounts. The subsequent dollar amount paid from each sub-account is
determined by multiplying (a) by (b) where (a) is the number of
sub-account Annuity Units to be paid and (b) is the sub-account annuity
unit value on the 5th Valuation Date preceding the date the annuity
payment is due. The total dollar amount of each variable dollar annuity
payment will be the sum of the variable dollar annuity payments for each
Variable Sub-Account. The Company guarantees that the dollar amount of
each payment after the first will not be affected by variations in
expenses or mortality experience.
10.4
FIXED
DOLLAR
PAYMENT
OPTIONS
The guaranteed annuity tables are based on mortality from the 1983 Table
(a) for Individual Annuity Valuation (blended 60% male and 40% female) and
a guaranteed interest rate of 3% per year. The Company may offer a better
rate than the guaranteed rate shown.
The following fixed dollar payment options are available:
(a)
Option
1:
Specified
Amount
Annuity payments at 12-, 6-, 3-, or 1- month intervals, of an
amount elected by the Owner for an Annuity Payment Period of not
more than 240 months. Upon death of the Annuitant, the
Beneficiary will begin to receive the remaining payments at the
same monthly interval elected by the Owner. See Table B.
(b) Option 2: Specified Period
Annuity payments at 12-, 6-, 3-, or 1- month intervals, for the
number of months elected for an Annuity Payment Period of not
more than 240 months. Upon death of the Annuitant, the
Beneficiary will begin to receive the remaining payments at the
same monthly interval elected by the Owner. See Table B.
(c) Option 3: Fixed Life Annuity with
Guaranteed
Period
Monthly payments for the guaranteed Annuity Payment Period elected which
may be 5, 10, 15, or 20 years or the lifetime of the Annuitant whichever
is longer. Upon death of the Annuitant, the Beneficiary will begin to
receive the remaining payments at the same monthly interval elected by
the Owner. See Table C.
(d) Option 4: Fixed Life Annuity with
Installment Refund Period
Monthly payments for the life of the Annuitant or until the
sum of the payments made equals the amount applied,
whichever is longer. See Table E.
(e) Option 5: Fixed Life Annuity
Monthly payments for the Annuitant's lifetime, without a
guaranteed period. See Table C.
(f) Option 6: Joint and One-Half Survivor Fixed Annuity
Fixed monthly payments to an Annuitant for life, with
one-half of the fixed payment amount continuing to the
survivor for life. See Table D for the minimum monthly
amount.
(g) Option 7: Any Other Form
Any other form of fixed annuity which is acceptable to the
Company. Upon death of the Annuitant, the Beneficiary will
begin to receive the remaining payments at the same monthly
interval elected by the Owner. Payments under these fixed
dollar payment options are guaranteed by the Company as to
dollar amount throughout the Annuity Payment Period.
Article X: Payment Options (Other Than Periodic Payments)
(continued)
(c) Amount of Monthly Payments after the first monthly payment will vary
depending upon the investment experience of the Variable
Sub-Accounts. The subsequent dollar amount paid from each sub-account is
determined by multiplying (a) by (b) where (a) is the number of
sub-account Annuity Units to be paid and (b) is the sub-account annuity
unit value on the 5th Valuation Date preceding the date the annuity
payment is due. The total dollar amount of each variable dollar annuity
payment will be the sum of the variable dollar annuity payments for each
Variable Sub-Account. The Company guarantees that the dollar amount of
each payment after the first will not be affected by variations in
expenses or mortality experience.
10.4
FIXED
DOLLAR
PAYMENT
OPTIONS
The guaranteed annuity tables are based on mortality from the 1983 Table
(a) for Individual Annuity Valuation (blended 60% male and 40% female) and
a guaranteed interest rate of 3% per year. The Company may offer a better
rate than the guaranteed rate shown.
The following fixed dollar payment options are available:
(a) Option 1: Specified Amount
Annuity payments at 12-, 6-, 3-, or 1- month intervals, of an amount elected by
the Owner for an Annuity Payment Period of not more than 240 months. Upon death
of the Annuitant, the Beneficiary will begin to receive the remaining payments
at the same monthly interval elected by the Owner. See Table B.
(b) Option 2: Specified Period
Annuity payments at 12-, 6-, 3-, or 1- month intervals, for the number of months
elected for an Annuity Payment Period of not more than 240 months. Upon death of
the Annuitant, the Beneficiary will begin to receive the remaining payments at
the same monthly interval elected by the Owner. See Table B.
(c) Option 3: Fixed Life Annuity with
Guaranteed Period
Monthly payments for the guaranteed Annuity Payment Period elected which
may be 5, 10, 15, or 20 years or the lifetime of the Annuitant whichever
is longer. Upon death of the Annuitant, the Beneficiary will begin to
receive the remaining payments at the same monthly interval elected by
the Owner. See Table C.
(d) Option 4: Fixed Life Annuity with
Installment Refund Period
Monthly payments for the life of the Annuitant or until the sum
of the payments made equals the amount applied, whichever is
longer. See Table E.
(e) Option 5: Fixed Life Annuity
Monthly payments for the Annuitant's lifetime, without a
guaranteed period. See Table C.
(f) Option 6: Joint and One-Half Survivor Fixed Annuity
Fixed monthly payments to an Annuitant for life, with one-half of the fixed
payment amount continuing to the survivor for life. See Table D for the minimum
monthly amount.
(g) Option 7: Any Other Form
Any other form of fixed annuity which is acceptable to the Company. Upon
death of the Annuitant, the Beneficiary will begin to receive the remaining
payments at the same monthly interval elected by the Owner. Payments under
these fixed dollar payment options are guaranteed by the Company as to
dollar amount throughout the Annuity Payment Period.
Article
XI:
Modifications
11.1
CONTRACT
MODIFICATION
The Contract may be modified at any time by written agreement between the
Company and the Owner. However, the Company reserves the right to amend the
Contract at any time without the consent of the Owner, in order to comply
with future changes in the Code and any regulations or rulings thereunder
as required to maintain conformity with state law. The Company will provide
the Owner with a copy of such amendment.
The Company may also, at any time and without the consent of the Owner or
other person, but upon 30 days written notice to the Owner, modify the
Contract in any respect to conform it to changes in tax or other law,
including applicable regulations or rulings.
After issue, modifications to the Contract under the Contract Modification
provisions become part of the Contract.
Only the President, a Vice-President or the Secretary of the Company can
modify or waive any provision of this Contract.
11.2 MODIFICATION OF GUARANTEED
SUB-ACCOUNT RIDER(S), IF ANY
Any Guaranteed Sub-Account Rider may be modified at any time by written
agreement between the Company and the Owner. No such modification will,
without the written consent of the Owner, affect the terms, provisions, or
conditions of the rider(s) which are or may be applicable to Contributions
prior to the date of such modification.
Provided however, if the Company ceases to offer the Guaranteed Certificate
Fund, 30 days written notice will be given to the Owner, no new
Contributions will be allocated and no new Certificates will be issued
after the cessation date. Amounts allocated to Certificates prior to such
date will continue to receive the credited interest rate until the
Certificate Maturity Date.
11.3 MODIFICATION OF VARIABLE
SUB-ACCOUNTS
Notwithstanding the other Contract Modification provisions, the Company may
offer new or cease offering existing Variable Sub-Accounts. No such
modification shall affect the terms, provisions or conditions which are or
may be applicable to Contributions previously paid to any Variable
Sub-Account which is no longer offered by the Company provided, however, if
the Company ceases to offer a Variable Sub-Account 30 days notice will be
given to the Owner. The Owner must then Transfer the value of the Variable
Sub-Account to another Variable Sub-Account then offered by the Company. If
the Owner fails to make such Transfer then the Company upon notification to
the Owner may make an automatic allocation on behalf of the Owner to any
Variable or Guaranteed Sub-Account which allows for immediate Transfers
subject to applicable law. Such allocation will become effective until such
time as a Request for a different allocation is received. The Company will
periodically notify the Owner of the current offering of Variable or
Guaranteed Sub-Accounts.
===
..
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TABLE A - Variable Life Annuity
Monthly Payment for Each $1,000
of Annuity Account Value
Age of Without Guaranteed With Guaranteed Period
Payee Period
5 Years 10 Years 15 Years 20 Years
50 4.05 4.04 4.02 3.98 3.93
55 4.43 4.42 4.38 4.32 4.22
60 4.94 4.92 4.85 4.73 4.55
65 5.65 5.60 5.46 5.22 4.89
70 6.63 6.53 6.23 5.75 5.18
75 8.05 7.81 7.14 6.24 5.38
If payments commence on any other date than the exact age of the Annuitant as
shown above, the amount of the monthly payment shall be determined by the
Company on the actuarial basis used by it in determining the above amounts.
FCIRA/RO-10/97 Page 20
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TABLE B - Income of Specified Amount
Income for a Specified Period
Monthly Payment for Each $1,000
of Annuity Account Value
Years Payment
3 28.99
4 22.06
5 17.91
6 15.14
7 13.16
8 11.68
9 10.53
10 9.61
11 8.86
12 8.24
13 7.71
14 7.26
15 6.87
16 6.53
17 6.23
18 5.96
19 5.73
20 5.51
To determine the payment for other frequencies of payment, multiply the above
monthly payment by the following factors:
Factor
Quarterly payment 2.99
Semi-annual payment 5.97
Annual payment 11.87
If payments are for an amount or duration different than that outlined above,
the Company will determine the proper amount or duration using the actuarial
basis used to determine the above Table.
FCIRA/RO-10/97 Page 21
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TABLE C - Fixed Life Annuity
Monthly Payment for Each $1,000
of Annuity Account Value
Age of Payee Without Guaranteed With Guaranteed Period
Period
5 Years 10 Years 15 Years 20 Years
50 4.05 4.04 4.02 3.98 3.93
55 4.43 4.42 4.38 4.32 4.22
60 4.94 4.92 4.85 4.73 4.55
65 5.65 5.60 5.46 5.22 4.89
70 6.63 6.53 6.23 5.75 5.18
75 8.05 7.81 7.14 6.24 5.38
If payments commence on any other date than the exact age of the Annuitant as
shown above, the amount of the monthly payment shall be determined by the
Company on the actuarial basis used by it in determining the above amounts.
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TABLE D - Joint and One-Half Survivor Fixed Annuity
Monthly Payment for Each $1,000
of Annuity Account Value
If Designated Payee Is Age
Age of Annuitant 50 55 60 65 70 75
50 3.81 4.04 4.30 4.60 4.94 5.33
55 3.87 4.13 4.43 4.78 5.17 5.62
60 3.92 4.21 4.56 4.96 5.42 5.95
65 3.96 4.28 4.67 4.14 5.69 6.32
70 3.99 4.33 4.76 5.29 5.94 6.72
75 4.01 4.37 4.83 5.42 6.17 7.10
If payments commence on any other date than the exact age of the Annuitant as
shown above, the amount of the monthly payment shall be determined by the
Company on the actuarial basis used by it in determining the above amounts.
FCIRA/RO-10/97(OR) Page 22
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TABLE E - Joint and One-Fixed Life Annuity with Installment Refund Period
Monthly Payment for Each $1,000
of Annuity Account Value
Age of Annuitant Payment
50 4.42
55 4.67
60 4.97
65 5.30
70 5.83
75 6.72
If payments commence on any other date than the exact age of the Annuitant as
shown above, the amount of the monthly payment shall be determined by the
Company on the actuarial basis used by it in determining the above amounts.
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RISK CHARGE SCHEDULE
Annuity Account Values Risk Charge
[$0.00 - $ 9,999.99] [.75%]
[$10,000.00 - $24,999.99] [.50%]
[$25,000.00 - $49,999.99] [.25%]
[$50,000.00 and greater] [.00%]
Guaranteed Certificate Fund
GUARANTEED SUB-ACCOUNT RIDER ATTACHED TO AND FORMING PART OF CONTRACT
THE GUARANTEED CERTIFICATE FUND IS A GUARANTEED SUB-ACCOUNT, WHEREBY CREDITED
INTEREST RATES ARE CREDITED TO CONTRIBUTIONS HELD FOR VARYING INTEREST GUARANTEE
PERIODS. THE COMPANY MAY OFFER CERTIFICATES TO THE OWNER WHO MAY, BY REQUEST,
ALLOCATE ANY CONTRIBUTION TO ANY ONE CERTIFICATE. THE OWNER MAY ALLOCATE HIS
CONTRIBUTIONS ONLY TO THOSE CERTIFICATES CURRENTLY BEING OFFERED BY THE COMPANY.
IF THE OWNER ALLOCATES CONTRIBUTIONS TO CERTIFICATES NOT CURRENTLY OFFERED BY
THE COMPANY, THE COMPANY WILL ALLOCATE SUCH CONTRIBUTIONS TO THE SUB-ACCOUNT
INDICATED ON THE APPLICATION ATTACHED TO THE CONTRACT.
DEFINITIONS
Certificate - represents the amount deposited into the Guaranteed Certificate
Fund under each Interest Guarantee Period, Term and credited interest rate. Each
Certificate has its own credited interest rate and Term.
Term - the duration of the Certificate expressed in months, which will consist
of two periods:
(a)an initial window period during which Contributions are received. The
duration of the window period will be specified by the Company.
(b)a holding period which begins on the day after the end of the window
period and ends on the Certificate Maturity Date.
The Terms available may be limited by the Company.
Certificate Maturity Date - the last day of the Term.
Interest Guarantee Period - the period from the date of the Contribution to the
Certificate Maturity Date.
INTEREST CREDITING AND SELECTION OF
METHOD OF PAYMENT
The credited interest rate on an annual effective basis will be compounded daily
and will equal the annual effective rate declared by the Company. The credited
interest rate will never be less than 3%. A Contribution to the Guaranteed
Certificate Fund, until the Certificate Maturity Date, will earn a credited
interest rate for the Certificate's Interest Guarantee Period.
If the Owner dies, is disabled as defined by the Code or has attained age 59
1/2, then upon Request from the Owner amounts deposited into the Guaranteed
Certificate Fund may be paid in a single sum or applied to a payment option
pursuant to Article IX of this Contract prior to the Certificate Maturity Date.
Such amounts will receive the credited interest rate from the date of
Contribution to the date the amount is paid or applied to the elected payment
option. No Transfers from the Guaranteed Certificate Fund may be made prior to
the Certificate Maturity Date.
If the Owner does not meet the requirements described in the previous paragraph,
amounts contributed into the Guaranteed Certificate Fund must remain in the
Certificate until the Certificate Maturity Date. Thus, no payment option may be
elected, and no distributions or Intra-Company Transfers will be permitted prior
to the Maturity Date of each respective Certificate.
In the event of Surrender under Article VIII of the Contract, the provisions of
such Article will apply.
CERTIFICATE MATURITY
Prior to the Certificate Maturity Date, the Company will offer a Guaranteed or
Variable Sub-Account into which the value of the Certificate may be contributed
on its Maturity Date. The sub-account so offered may be either the Guaranteed
Certificate Fund or another sub-account. The Owner may elect, by Request, to
Transfer the value of the Certificate on its Maturity Date. If the Owner fails
to make such Request, then the Company at its sole
Guaranteed Certificate Fund (continued)
discretion will make an allocation to the Guaranteed Sub-account indicated in
the application to the Contract. Such allocation will become effective until
such time as a Request, for a different allocation is received.
If the Guaranteed Certificate Fund is offered, the value of the Certificate on
its Maturity Date may, upon Request, be contributed to a new Certificate which
has its own interest rate and Term. The credited interest rate of this new
Certificate may be higher or lower than the credited interest rate of any other
Certificate or Contribution.
If another sub-account is offered, the value of the Certificate on its Maturity
Date may, upon Request, be contributed to that sub-account. The credited
interest rate of this Contribution may be higher or lower than the credited
interest rate of any other Contribution. If the value of the Certificate on its
Maturity Date is transferred to a Variable Sub-Account there will be no credited
interest rate.
TRANSFERS
The terms of Article VI of the Contract will apply to any
Transfer to or from the Guaranteed Certificate Fund.
VALUE OF GUARANTEED CERTIFICATE FUND
The value of the Guaranteed Certificate Fund of the Owner will be determined by
adding the Guaranteed Certificate Fund sub-account Contributions and credited
interest, and subtracting any Partial Withdrawals, Surrenders, amounts payable
on death, amounts applied under a payment option, Transfers, and Premium Tax, if
any.
LOSS OF INTEREST CHARGE
The Transfer, distribution or application to a payment option prior to the
Certificate Maturity Date of funds in a Certificate shall be known as breaking a
Certificate. If a Certificate is broken, a Loss of Interest Charge may be
assessed, as defined in Article I and in Section 8.5 of this Contract. However,
the Loss of Interest Charge may be waived as described in Section 8.6.
Signed for Great-West Life & Annuity Insurance Company on the issuance of the
contract (unless a different date is shown here).
[GRAPHIC OMITTED]
▇.▇. ▇▇▇▇▇▇▇▇,
President and Chief Executive Officer
