Exhibit 99.4(a)
JEFFERSON NATIONAL LIFE INSURANCE COMPANY
Home Office: Dallas, Texas 75201
Administrative Office: ▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇., ▇▇▇▇▇ ▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇,
▇▇▇▇▇▇▇▇ ▇▇▇▇▇
Telephone: ▇-▇▇▇-▇▇▇-▇▇▇▇
A Stock Company
THIS IS A LEGAL CONTRACT BETWEEN THE CONTRACT OWNER AND THE COMPANY
READ YOUR CONTRACT CAREFULLY
Jefferson National Life Insurance Company ("the Company") agrees with the
contract Owner ("You/Your") to provide benefits to You, subject to the
provisions set forth in this contract and in consideration of the Purchase
Payments received.
RIGHT OF RETURN. WITHIN 10 DAYS OF THE RECEIPT OF THIS CONTRACT BY THE OWNER, IT
MAY BE RETURNED BY DELIVERING OR MAILING IT TO THE COMPANY AT ITS ADMINISTRATIVE
OFFICE. WHEN THE COMPANY RECEIVES THE CONTRACT, IT WILL BE VOIDED AS IF IT HAD
NEVER BEEN IN FORCE. THE COMPANY WILL REFUND THE CONTRACT VALUE COMPUTED AS OF
THE BUSINESS DAY THE COMPANY RECEIVES THE RETURNED CONTRACT AT ITS
ADMINISTRATIVE OFFICE.
ANNUITY PAYMENTS, WITHDRAWAL VALUES AND DEATH BENEFITS PROVIDED BY THIS
CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, MAY
INCREASE OR DECREASE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. NON FORFEITURE
VALUES MAY INCREASE OR DECREASE BASED ON THE MARKET VALUE ADJUSTMENT SPECIFIED
IN THIS CONTRACT.
Signed for the Company at its Administrative Office in Louisville, Kentucky.
/s/ ▇▇▇▇▇ ▇. ▇▇▇▇▇▇, Esq. /s/ ▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇
Secretary President
INDIVIDUAL FLEXIBLE PREMIUM DEFERRED ANNUITY CONTRACT
FIXED AND VARIABLE ACCOUNTS
NON-PARTICIPATING
JNL-2100 01/04
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TABLE OF CONTENTS
PROVISIONS PAGE NUMBERS
CONTRACT SCHEDULE [3
DEFINITIONS 12
PURCHASE PAYMENTS PROVISIONS 14
SEPARATE ACCOUNT PROVISIONS 14
FIXED ACCOUNT PROVISIONS 15
MARKET VALUE ACCOUNT PROVISIONS 15
CONTRACT VALUE PROVISIONS 17
CONTRACT MAINTENANCE CHARGE PROVISIONS 17
TRANSFER PROVISIONS 17
WITHDRAWAL PROVISIONS 19
PROCEEDS PAYABLE AT DEATH PROVISIONS 19
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISIONS 21
OWNER, ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 21
ANNUITIZATION PROVISIONS 22
GENERAL CONTRACT PROVISIONS 24
ANNUITY TABLES 26]
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CONTRACT SCHEDULE
CONTRACT NUMBER: [3456]
OWNER: [▇▇▇▇ ▇▇▇]
JOINT OWNER: [NONE]
ANNUITANT: [▇▇▇▇ ▇▇▇]
JOINT ANNUITANT: [NONE]
CONTRACT ISSUE DATE: [MAY 1, 2004]
ANNUITY DATE: [MAY 1, 2059]
INITIAL PURCHASE PAYMENT: [$5,000]
BENEFICIARY: As designated by the Owner at the Contract
Issue Date or as subsequently changed by the
Owner.
MINIMUM INITIAL PURCHASE PAYMENT: [$5,000 nonqualified; $2,000 qualified]
MINIMUM SUBSEQUENT PURCHASE [Nonqualified - $500; if using automatic
PAYMENT: payment check check or electronic funds
transfer (EFT), $100/month.
Qualified - $50; if using automatic payment
check or electronic funds transfer (EFT),
$50/month.]
MAXIMUM TOTAL PURCHASE PAYMENTS: $2,000,000 (without prior Company approval)
ALLOCATION GUIDELINES: The Owner can select up to [25] Accounts.
The selection may be from the Variable
Sub-accounts of the Separate Account, any
Guarantee Periods of the MVA Account and the
Fixed Account.
If the initial Purchase Payment and forms
required to issue the contract have been
received in Good Order at the Company's
Administrative Office, the Purchase Payment
will be credited within two Business Days
after its receipt. After the contract is
issued, additional Purchase Payments will be
credited to the contract as of the Business
Day they are received.
Allocation percentages must be in whole
numbers. Each allocation must be at least
1%.
SEPARATE ACCOUNT: Variable Account: [Jefferson National Life
Separate Account J]
MVA ACCOUNT: MVA Account: Jefferson National Life Market
Value Adjustment Account for the portion of
the Contract that may be subject to a Market
Value Adjustment.
MINIMUM GUARANTEE INTEREST RATE: The minimum guaranteed interest rate will be
[1.5% to 3.0%, dependent upon the minimum
rate required by the state of issue.]
Benefits available under the contract are
not less than those required by any statute
of the state in which the contract is
issued.
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Current MVA Account Guaranteed Period Option and
Credited Interest Rates:
[1 Year: ______%]
[3 Years: ______%]
[5 Years: ______%]
[7 Years: ______%]
[10 Years ______%]
Jefferson National Life reserves the right to not offer any or all of the
MVA Accounts.
MARKET VALUE ADJUSTMENT FACTOR:
THE MARKET VALUE ADJUSTMENT FACTOR IS EQUAL TO:
(1 + A)
[----------](TO THE POWER OF N/365) -1
(1 + B)
Where: A = the U.S. Treasury rate in effect at the beginning of the
Guarantee Period for the length of the guarantee period
selected.
B = the current U.S. Treasury rate as of the transaction date plus
.005. Treasury rate period is determined by N/365 rounded to the
next highest year.
N = the number of days remaining on the MVA Guarantee Period.
If the Treasury rate is not available for the period, the rate will be
arrived at by interpolation. If no Treasury Rates are available, an Index
will be selected by the Company and approved by the State Insurance
Commissioner.
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FIXED ACCOUNT INTEREST RATE: The minimum guaranteed interest rate will be
[1.5% to 3.0%, dependent upon the minimum
rate required by the state of issue.]
Benefits available under the contract are
not less than those required by any statute
of the state in which the contract is
issued.
INSURANCE CHARGES: The insurance charges, on an annual basis,
are equal to 1.60% of the average daily net
asset value of the separate Account for an
electronically administered contract. The
insurance charges are deducted daily. The
Company may increase insurance charges,
however, the maximum increase will never
exceed a total of 1.85% of the average daily
net asset value of the Separate Account, on
an annual basis.
The insurance charges, on an annual basis,
are equal to 1.65% of the average daily net
asset value of the Separate Account for a
paper administered contract using
communications sent by regular mail service.
The insurance charges are deducted daily.
The Company may increase insurance charges,
however, the maximum increase will never
exceed a total of 1.90% of he average daily
net asset value of the Separate Account, on
an annual basis; however,
If the Guaranteed Minimum Death Benefit
Option 1 is selected at the time of
application, for an electronically
administered contract, the insurance charges
for your contract, on an annual basis, will
be equal to 1.95% of the average daily net
asset value of the Separate Account, for
issue ages below age 70. The Company may
increase the insurance charges, however, the
maximum increase will never exceed a total
of 2.35% on an annual basis for issue ages
below age 70. The insurance charges for your
contract, on an annual basis, will be equal
to 2.05% of the average daily net asset
value of the Separate Account, for issue
ages of age 70 and above, for an
electronically administered contract. The
Company may increase the insurance charges,
however, the maximum increase will never
exceed a total of 2.45% on an annual basis
for issue ages of age 70 and above.
If the Guaranteed Minimum Death Benefit
Option 1 is selected at the time of
application, for a paper administered
contract using communications sent by
regular mail service, the insurance charges
for your contract, on an annual basis, will
be equal to 2.00% of the average daily net
asset value of the Separate Account, for
issue ages below age 70. The Company may
increase the insurance charges, however, the
maximum increase will never exceed a total
of 2.40% on an annual basis for issue ages
below age 70. The insurance charges for your
contract, on an annual basis, will be equal
to 2.10% of the average daily net asset
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value of the Separate Account, for issue
ages of age 70 and above, for a paper
administered contract using communications
sent by regular mail service. The Company
may increase the insurance charges, however,
the maximum increase will never exceed a
total of 2.50% on an annual basis for issue
ages of age 70 and above.
If the Guaranteed Minimum Death Benefit
Option 2 is selected at the time of
application, for an electronically
administered contract, the insurance charges
for your contract, on an annual basis, will
be equal to 2.15% of the average daily net
asset value of the Separate Account, for
issue ages below age 70. The Company may
increase the insurance charges, however, the
maximum increase will never exceed a total
of 2.65% on an annual basis for issue ages
below age 70. The insurance charges for your
contract, on an annual basis, will be equal
to 2.30% of the average daily net asset
value of the Separate Account, for issue
ages of age 70 and above, for an
electronically administered contract. The
Company may increase the insurance charges,
however, the maximum increase will never
exceed a total of 2.85% on an annual basis
for issue ages of age 70 and above.
If the Guaranteed Minimum Death Benefit
Option 2 is selected at the time of
application, for a paper administered
contract using communications sent by
regular mail service, the insurance charges
for your contract, on an annual basis, will
be equal to 2.20% of the average daily net
asset value of the Separate Account, for
issue ages below age 70. The Company may
increase the insurance charges, however, the
maximum increase will never exceed a total
of 2.70% on an annual basis for issue ages
below age 70. The insurance charges for your
contract, on an annual basis, will be equal
to 2.35% of the average daily net asset
value of the Separate Account, for issue
ages of age 70 and above, for a paper
administered contract using communications
sent by regular mail service. The Company
may increase the insurance charges, however,
the maximum increase will never exceed a
total of 2.90% on an annual basis for issue
ages of age 70 and above.
If both the Guaranteed Minimum Death Benefit
Option 1 and the Guaranteed Minimum Income
Benefit are selected at the time of
application, for an electronically
administered contract, the insurance charges
for your contract, on an annual basis, will
be equal to 2.25% of he average daily net
asset value of the Separate Account, for
issue ages below age 70. The Company may
increase the insurance charges, however, the
maximum increase will never exceed a total
of 2.85% on an annual basis for issue ages
below age 70. The insurance charges for your
contract, on an annual basis,
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will be equal to 2.45% of the average daily
net asset value of the Separate Account, for
issue ages of age 70 and above, for an
electronically administered contract. The
Company may increase the insurance charges,
however, the maximum increase will never
exceed a total of 3.05% on an annual basis
for issue ages of age 70 and above.
If both the Guaranteed Minimum Death Benefit
Option 1 and the Guaranteed Minimum Income
Benefit are selected at the time of
application, for a paper administered
contract using communications sent by
regular mail service, the insurance charges
for your contract, on an annual basis, will
be equal to 2.30% of he average daily net
asset value of the Separate Account, for
issue ages below age 70. The Company may
increase the insurance charges, however, the
maximum increase will never exceed a total
of 2.90% on an annual basis for issue ages
below age 70. The insurance charges for your
contract, on an annual basis, will be equal
to 2.50% of the average daily net asset
value of the Separate Account, for issue
ages of age 70 and above, for a paper
administered contract using communications
sent by regular mail service. The Company
may increase the insurance charges, however,
the maximum increase will never exceed a
total of 3.10% on an annual basis for issue
ages of age 70 and above.
If both the Guaranteed Minimum Death Benefit
Option 2 and the Guaranteed Minimum Income
Benefit are selected at the time of
application, for an electronically
administered contract, the insurance charges
for your contract, on an annual basis, will
be equal to 2.45% of the average daily net
asset value of the Separate Account, for
issue ages below age 70. The Company may
increase the insurance charges, however, the
maximum increase will never exceed a total
of 3.15% on an annual basis for issue ages
below age 70. The insurance charges for your
contract, on an annual basis, will be equal
to 2.70% of the average daily net asset
value of the Separate Account, for issue
ages of age 70 and above, for an
electronically administered contract. The
Company may increase the insurance charges,
however, the maximum increase will never
exceed a total of 3.45% on an annual basis
for issue ages of age 70 and above.
If both the Guaranteed Minimum Death Benefit
Option 2 and the Guaranteed Minimum Income
Benefit are selected at the time of
application, for a paper administered
contract using communications sent by
regular mail service, the insurance charges
for your contract, on an annual basis, will
be equal to 2.50% of the average daily net
asset value of the Separate Account, for
issue ages below age 70. The Company may
increase the insurance charges, however, the
maximum increase will never exceed a total
of 3.20% on
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an annual basis for issue ages below age 70.
The insurance charges for your contract, on
an annual basis, will be equal to 2.75% of
the average daily net asset value of the
Separate Account, for issue ages of age 70
and above, for a paper administered contract
using communications sent by regular mail
service. The Company may increase the
insurance charges, however, the maximum
increase will never exceed a total of 3.50%
on an annual basis for issue ages of age 70
and above.
In the event of any increase, the Company
gives 90 days prior notice.
CONTRACT MAINTENANCE CHARGE: The contract maintenance charge is $35 each
Contract Year. The Company reserves the
right to change the contract maintenance
charge but the charge will never exceed $60
per Contract Year.
During the Accumulation Period, if the
Contract Value on the Contract Anniversary
is at least $75,000, the contract
maintenance charge will be waived. During
the Accumulation Period, if a full
withdrawal is made on other than on a
Contract Anniversary and the Contract Value
for the Business Day during which the full
withdrawal is made is less than $75,000; the
full contract maintenance charge will be
deducted at the time of full withdrawal. If,
at annuitization, the Annuity Date is not
the Contract Anniversary and the Contract
Value on the Annuity Date is less than
$75,000, then the full contract maintenance
charge will be deducted on the Annuity Date.
During the Annuity Period, all contract
maintenance charges will be waived.
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DISTRIBUTION EXPENSE CHARGE: None
TRANSFERS PERMITTED: [During the Accumulation Period, subject to
terms of the contract, there are no limits
on the number of transfers that can be made.
During the Annuity Period, there are no
limits on the number of transfers that can
be made. No transfers may be made to or from
the Fixed Account during the Annuity
Period.]
TRANSFER FEE: [During the Accumulation Period, the
Company allows 12 free transfers per
contract year without a charge. If you
transfer more often, you may be assessed a
$25 transfer fee for each additional
transfer.
During the Annuity Period, the Company
allows 12 free transfers per contract year
without a charge. If you transfer more
often, you may be assessed a $25 transfer
fee for each additional transfer.
All reallocations made on a given date count
as one (1) transfer. Transfer fees will be
waived for: a) transfers made by the Company
at the end of the right to return period
shown on the face page of the contract; or
b) transfers made pursuant to a pre-approved
dollar cost averaging or rebalancing
program.]
MINIMUM TRANSFER AMOUNT: [None.]
MINIMUM ACCOUNT BALANCE [$1000 total of all Accounts.]
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CONTINGENT DEFERRED SALES A contingent deferred sales charge may be
CHARGE: assessed against each Purchase Payment
withdrawn and will result in a reduction of
the Contract Value. Each Purchase Payment is
tracked from its date of receipt and will be
subject to its own contingent deferred sales
charge. For the purpose of calculating
contingent deferred sales charges,
withdrawals are assumed to be made first
from Purchase Payments (oldest to newest)
and then from earned income. Charges are
determined as indicated below.
NO. OF YEARS FROM
RECEIPT CONTINGENT DEFERRED
OF PURCHASE PAYMENT SALES CHARGE PERCENT
0 to 1 7%
2 6%
3 5%
4 and more 0%
WAIVER OF CONTINGENT
DEFERRED SALES CHARGE: [Each Contract Year You may make withdrawals
free of contingent deferred sales charge(s)
in an amount equal to the greater of: (i)
10% of the Contract Value, on a
non-cumulative basis; (ii) the IRS minimum
distribution requirement, if the Contract
was issued in connection with certain IRAs;
or (iii) the Purchase Payments that have
been in the contract for more than four (4)
complete years. We may waive some or all of
the contingent deferred sales charge if this
contract is exchanged for another Company
contract or a contract with one of Our
affiliated insurance companies.]
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MINIMUM PARTIAL WITHDRAWAL: [The minimum partial withdrawal is $200
(electronic funds transfer minimum is $100)
from any Account. This includes withdrawals
from any Variable Sub-account of the
Separate Account, any Guarantee Period of
the MVA Account and the Fixed Account. The
minimum withdrawal requirement is waived if
the partial withdrawal from any Account is a
result of a systematic withdrawal program or
minimum distribution requirement if the
contract was issued in connection with
certain IRAs.]
MINIMUM CONTRACT VALUE AFTER
PARTIAL WITHDRAWAL: [After partial withdrawal, the minimum
Account balance for the entire Contract must
be at least $1000, as referenced in the
Minimum Account Balance. If the amount of a
withdrawal results in an amount less than
this amount, then the Company reserves the
right to terminate the contract, and pay you
the Contract Withdrawal Value. The Company
will notify you of its intent to terminate
the contract.]
MAXIMUM FIXED ACCOUNT [Subject to minimum Contract Value
WITHDRAWAL: requirements, there is currently no
limitation on the maximum amount that can be
withdrawn from the Fixed Account.]
RIDERS: [Unemployment, Nursing Care, Terminal
Illness, Guaranteed Minimum Death Benefit
Option 1, Guaranteed Minimum Death Benefit
Option 2, Guaranteed Minimum Income Benefit
1 and Guaranteed Minimum Income Benefit 2.]
COMPANY ADDRESS: [Jefferson National Life Insurance Company
Administrative Office: ▇▇▇▇ ▇▇▇▇▇▇▇▇▇
▇▇▇▇▇▇ ▇▇.
▇▇▇▇▇ ▇▇▇▇
▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇
Telephone Numbers: ▇-▇▇▇-▇▇▇-▇▇▇▇]
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DEFINITIONS
ACCOUNT(S): The Fixed Account and/or one or more of the Sub-accounts of the
Separate Account.
ACCUMULATION PERIOD: The period prior to the Annuity Date during which Purchase
Payments may be made by an Owner.
ACCUMULATION UNIT(S): A unit of measure used to determine the value of an
Owner's interest in a Sub-account of the Separate Account during the
Accumulation Period.
AGE: The Age of any Owner or Annuitant on his/her last birthday. For Joint
Owners, all provisions that are based on Age are based on the Age of the older
of the Joint Owners.
ADMINISTRATIVE OFFICE: The Company's administrative address is indicated on the
Contract Schedule. All notices, requests and Purchase Payments must be sent to
this address. All sums payable to the Company under this contract are payable to
this address unless otherwise designated in writing by the Company.
ANNUITANT: The natural person on whose life Annuity Payments are based. On or
after the Annuity Date, the Annuitant shall also include any Joint Annuitant.
ANNUITY DATE: The date that Annuity Payments begin.
ANNUITY OPTION(S): The different payment options available for Annuity Payments
under this contract.
ANNUITY PAYMENTS: A series of payments made to the Owner, or a named payee,
after the Annuity Date under the Annuity Option selected.
ANNUITY PERIOD: The period of time during which Annuity Payments are made.
ANNUITY UNIT: An accounting unit of measure used to calculate the amount of
Annuity Payments.
BENEFICIARY: The person(s) or entity(ies) who will receive the death benefit
payable under this contract.
BUSINESS DAY: Each day that the New York Stock Exchange is open for business.
The Separate Account will be valued each Business Day.
CONTRACT ANNIVERSARY: One year from Your Contract Issue Date and every year
thereafter on the same month and day.
CONTRACT ISSUE DATE: The date the contract is issued. The Contract Issue Date is
shown on the Contract Schedule page.
CONTRACT VALUE: The dollar value as of any Business Day of all amounts in the
Contract.
CONTRACT WITHDRAWAL VALUE: The Contract Value, less any applicable premium tax,
less any contingent deferred sales charge and less any applicable contract
maintenance charge.
CONTRACT YEAR(S): The annual period which begins on the Contract Issue Date.
Subsequent Contract Years begin on each Contract Anniversary.
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ELIGIBLE UNDERLYING FUND: An investment entity that is made available for this
contract.
FIXED ACCOUNT: An investment option within the General Account.
FIXED ACCOUNT CONTRACT VALUE: The sum of all amounts held under this Contract in
the Fixed Account.
FIXED ANNUITY: A series of payments made during the Annuity Period that are
guaranteed as to dollar amount by the Company.
FORMAL REQUEST: An electronic or written request in a form satisfactory to the
Company that is received by the Administrative Office.
GENERAL ACCOUNT: The Company's general investment account that contains all the
assets of the Company except for the Separate Account and other segregated asset
accounts.
GOOD ORDER: Receipt by the Company of all information necessary for processing a
request. Good Order will be determined by the Company.
MARKET VALUE ADJUSTMENT: An adjustment to the amount withdrawn or transferred
from an MVA Account prior to the end of the applicable Guarantee Period. The
adjustment reflects the change in the value of the funds withdrawn or
transferred due to the change in the interest rates since the beginning of the
Guarantee Period.
MVA ACCOUNT: An investment option within the General Account, which provides
investment options where the Company guarantees the rate of interest for a
specified Guarantee Period and where withdrawals or transfers may be subject to
a Market Value Adjustment.
OWNER/JOINT OWNER: The person(s) entitled to exercise all rights under this
contract (You, Your).
PORTFOLIO: A segment of an Eligible Fund which constitutes a separate and
distinct class of shares.
PREMIUM TAX(ES): Any Premium Taxes payable to any government entity and assessed
against Purchase Payments or Contract Value.
PURCHASE PAYMENT(S): A payment made by or for an Owner with respect to this
contract. All payments must be made payable to the Company.
SEPARATE ACCOUNT: A Separate Account is an account that provides investment
options where the benefits are held separate from other Company assets. The
Separate Account is not guaranteed as to the dollar amount shown on the Contract
Schedule.
SEPARATE ACCOUNT CONTRACT VALUE: The sum of all amounts held under this contract
in the Separate Account.
SUB-ACCOUNT(S): Separate Account assets are divided into Sub-accounts. Each
Sub-account will invest its assets in shares of a single Eligible Fund or a
single Portfolio of an Eligible Fund.
VARIABLE ANNUITY: A series of payments which vary in amount with the investment
experience of the Separate Account during the Annuity Period. The rate of return
is not guaranteed.
WE, US, OUR: The Company.
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PURCHASE PAYMENT PROVISIONS
PURCHASE PAYMENTS: Subject to the maximum and minimum amounts shown on the
Contract Schedule, Purchase Payments may be made at any time during the
Accumulation Period. You may increase, decrease and change the frequency of such
payments. The Company reserves the right to reject any Application or Purchase
Payment.
ALLOCATION OF PURCHASE PAYMENTS: Purchase Payments are allocated to the Fixed
Account and/or to a one or more Guarantee Period of the MVA Account and/or
Variable Sub-accounts of the Separate Account in accordance with the selections
made by the Owner. The allocation of the initial Purchase Payment is made in
accordance with the selection made by the Owner at the Contract Issue Date.
Unless otherwise changed by the Owner, subsequent Purchase Payments are
allocated in the same manner as the initial Purchase Payment. Allocation of
Purchase Payments are subject to the allocation guidelines shown on the Contract
Schedule.
SEPARATE ACCOUNT PROVISIONS
THE SEPARATE ACCOUNT: The Separate Account consists of assets set aside by the
Company, which are kept separate from that of the general assets and any other
Separate Account assets of the Company. The assets of the Separate Account will
not be charged with liabilities arising out of any other business the Company
may conduct.
The Separate Account assets are divided into Sub-accounts. The assets of the
Sub-accounts are allocated to the Eligible Fund(s) and the Portfolio(s), if any,
within an Eligible Fund. Should the shares of any such Eligible Fund(s), or any
Portfolio(s) within an Eligible Fund, become unavailable for investment by the
Separate Account, or the Company's Board of Directors deems further investment
in these shares inappropriate, the Company may limit further purchase of such
shares or substitute shares of another Eligible Fund or Portfolio for shares
already purchased under this contract.
VALUATION OF ASSETS: The assets of the Sub-accounts are valued at their fair
market value in accordance with Company procedures.
THE SEPARATE ACCOUNT CONTRACT VALUE: The Separate Account Contract Value is the
sum of all amounts held under this contract in the Separate Account.
ACCUMULATION UNITS: Accumulation Units shall be used to account for all amounts
allocated to, or withdrawn from, the Sub-accounts of the Separate Account as a
result of Purchase Payments, withdrawals, transfers, fees and charges. The
Company will determine the number of Accumulation Units of a Sub-account
purchased or cancelled. This will be done by dividing the amount allocated to
(or the amount withdrawn from) the Sub-account by the dollar value of one
Accumulation Unit of the Sub-account as of the Business Day that the request for
the transaction is received at Our Administrative Office.
ACCUMULATION UNIT VALUE: The initial Accumulation Unit value for each
Sub-account was arbitrarily set at $10. Subsequent Accumulation Unit values for
each Sub-account are determined each Business Day by multiplying the
Accumulation Unit value for the immediately preceding Business Day by the net
investment factor for the Sub-account for the current Business Day. The net
investment factor for each Sub-account is determined by dividing A by B and
subtracting C where:
A is: (i) the net asset value per share of the Eligible Fund or
Portfolio of an Eligible Fund held by the Sub-account as of the
current Business Day; plus
(ii) any dividend or capital gain per share declared on behalf of
such Eligible Fund or Portfolio that has an ex-dividend date as of
the current Business Day; plus
(iii) a charge-factor, if any, for any taxes or any tax reserve
established by the Company as a result of the operation or
maintenance of the Sub-account(s).
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B is the net asset value per share of the Eligible Fund or Portfolio
held by the Sub-account for the immediately preceding Business Day.
C is the Business Day equivalent of the insurance charges, if any, that
are shown in the Contract Schedule.
The Accumulation Unit value may increase or decrease from Business Day to
Business Day.
INSURANCE CHARGES: Each Business Day the Company deducts insurance charges from
the Separate Account that are equal, on an annual basis, to the amount shown on
the Contract Schedule. The insurance charges compensate the Company for assuming
the mortality and expense risks, costs associated with the administration of
this contract, and if so elected, to provide for certain benefits.
FIXED ACCOUNT PROVISIONS
FIXED ACCOUNT CONTRACT VALUE: The Fixed Account Contract Value at any time is
equal to:
1. the Purchase Payments allocated to the Fixed Account on behalf of an
Owner; plus
2. amounts transferred to the Fixed Account; plus
3. interest credited to the Fixed Account; less
4. prior withdrawals from the Fixed Account and any contingent deferred
sales charge; less
5. any amounts transferred from the Fixed Account; less
6. contract maintenance charges or transfer fees deducted from the Fixed
Account.
INTEREST TO BE CREDITED: The Company guarantees that the interest to be credited
to the Fixed Account will not be less than the minimum guaranteed interest rate
shown on the Contract Schedule. The Company may credit additional interest at
its sole discretion for any Fixed Account option. The initial current interest
rate is shown on the Contract Schedule. We reserve the right to limit transfers
into the Fixed Account or change interest rates for the Fixed Account with 30
days prior notice.
MVA ACCOUNT PROVISIONS
MVA ACCOUNT: Purchase Payments may be allocated to one or more of the MVA
Account Guarantee Period options which are available at the time the Purchase
Payment is made. The initial MVA Account Guarantee Period options are shown on
the Contract Schedule. In addition, during the Accumulation Period, Contract
Values can be transferred from the Variable Account and/or the Fixed Account to
one or more of the MVA Account Guarantee Period options.
Jefferson National Life reserves the right to not offer the MVA Accounts.
INTEREST TO BE CREDITED: The Credited Interest Rate for the Guarantee Period(s)
of the MVA Account is shown on the Contract Schedule. After the initial
Guarantee Period, the Credited Interest Rate for any subsequent Guarantee Period
of the MVA Account may change. All interest payable under this Contract is
compounded daily at the stated effective annual interest rate. In no event will
the Credited Interest Rate be less than the Minimum Guaranteed Interest Rate,
prior to the application of the Market Value Adjustment, specified on the
Contract Schedule.
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GUARANTEE PERIOD: The Current MVA Account Guarantee Periods are shown on the
Contract Schedule. During the thirty (30) days prior to the end of a current
Guarantee Period, the Owner may renew for the same or any other Guarantee Period
then available at the Credited Interest Rate or may elect to transfer all or a
portion of the amount to a Fixed Account option, if available, or the Variable
Account. Any transfer election during the thirty (30) days prior to the end of a
current Guarantee Period will be made as of the date the request is received by
the Company and will not be subject to any Market Value Adjustment.
If the Owner does not specify a Guarantee Period at the time of renewal, the
Company will select and transfer to the same Guarantee Period as has just
expired, as long as such Guarantee Period does not extend beyond the latest
Annuity Date that can be selected by an Owner. If such Guarantee Period does
extend beyond the latest Annuity Date, the Company will choose the one year
period. If there is no Guarantee for the same period available, the one year
period will be selected. If the one year period is no longer available, the next
longest available will be selected.
MULTIPLE GUARANTEE PERIODS: The Owner may elect one or more Guarantee Periods.
Multiple Guarantee Periods are treated separately for purposes of applying the
Market Value Adjustment. The Company reserves the right to credit different
Credited Interest Rates to the Contract Value attributable:
1. to different Guarantee Periods; and
2. to Guarantee Periods of the same duration with different Effective
Dates.
CHANGE IN GUARANTEE PERIOD: The Owner may, upon Written Request, change to any
Guarantee Period then being offered by the Company with respect to Contracts of
this type and class. The Market Value Adjustment will apply to a change made at
any time other than at the end of a Guarantee Period. The Market Value
Adjustment will not apply to a change made at the end of a Guarantee Period if
Written Request is received by the Company within thirty (30) days prior to the
end of the Guarantee period.
MARKET VALUE ADJUSTMENT: Any amount withdrawn, transferred or annuitized prior
to the end of that Guarantee Period may be subject to a Market Value Adjustment.
The Market Value Adjustment will be calculated by multiplying the amount
withdrawn, transferred or annuitized by the formula shown on the Contract
Schedule.
There will be no Market Value Adjustment on withdrawals from the MVA Account in
the following situations:(1) death benefit paid under a Contract; (2) amounts
withdrawn to pay fees or charges; (3) amounts withdrawn or transferred from MVA
Account during the thirty (30) days prior to the end of the Guaranteed Period;
(4) an Owner annuitizes this Contract under an Annuity Option providing for at
least sixty (60) monthly Annuity Payments; and (5) any withdrawal subject to the
MVA Waiver shown on the Contract Schedule.
MVA ACCOUNT VALUES: The MVA Account portion of a Contract at any time is equal
to:
1. the Purchase Payments allocated to the MVA Account on behalf of an
Owner; plus
2. the Contract Value transferred to the MVA Account; plus
3. interest credited to the Contract Value in the MVA Account; less
4. any prior withdrawals of Contract Value in the MVA Account and any
Contingent Deferred Sales Charges; less
5. any Contract Value transferred from the MVA Account; less
6. Contract Maintenance Charges or Transfer Fees deducted from the
Contract Value allocated to the MVA Account.
Any subsequent Purchase Payments and transfers to the MVA Account will be
allocated to a new Guarantee Period with a new Effective Date.
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CONTRACT VALUE PROVISIONS
CONTRACT VALUE: The Contract Value as of any Business Day is the sum of the
Separate Account Contract Value, the MVA Account and the Fixed Account Contract
Value. Withdrawals will result in the cancellation of Accumulation Units in a
Sub-account or a reduction in the Fixed Account Contract Value and MVA Account,
as applicable.
The Fixed Account Contract Value, MVA Account Value and the Separate Account
Contract Value are explained above.
CONTRACT MAINTENANCE CHARGE PROVISIONS
CONTRACT MAINTENANCE CHARGE DEDUCTION: On each Contract Anniversary the Company
will deduct a contract maintenance charge from the Contract Value for
reimbursement of expenses relating to maintenance of the contract as shown on
the Contract Schedule. The Company will do this by reducing the Fixed Account
Contract Value and by canceling Accumulation Units from each applicable
Sub-account. The contract maintenance charge will be deducted first from the
Fixed Account. If there is insufficient value in the Fixed Account, then the
contract maintenance charge will be deducted from the Sub-account of the
Separate Account with the largest balance.
TRANSFER PROVISIONS
TRANSFERS DURING THE ACCUMULATION PERIOD: Subject to any limitation imposed by
the Company on the number of transfers during the Accumulation Period, shown on
the Contract Schedule, an Owner may transfer all or part of the Contract Value
in the Fixed Account or a Sub-account. The Owner may do this by Formal Request.
All transfers are subject to the following:
1. If more than the number of free transfers have been made, the Company
may deduct a transfer fee for each subsequent transfer made. The
frequency and number of free transfers are shown on the Contract
Schedule. The transfer fee is deducted from the Account that is the
source of the transfer. However, if the Owner's entire interest in an
Account is being transferred, then the transfer fee will be deducted
from the amount being transferred. If there are multiple-source
Accounts, the transfer fee will be allocated first to the Fixed
Account and then to the Sub-account with the largest balance that is
involved in the transfer transaction.
2. The Contract Schedule shows: a) the minimum amount that may be
transferred from a Sub-account; b) the minimum amount that must remain
in a Sub-account, and the Fixed Account; and c) the maximum amount
that may be transferred from the Fixed Account to the Separate
Account.
3. An Owner's right to make transfers is subject to modification if the
Company determines, in the Company's sole opinion, that the exercise
of the right by one or more Owners is or would be to the disadvantage
of other Owners. Restrictions may be applied in any manner reasonably
designed to prevent any use of the transfer right which is considered
by the Company to be to the disadvantage of the Owners. A modification
could be applied to the transfers to or from one or more of the
Sub-accounts and could include, but not be limited to: a) not
accepting a transfer request from an agent acting under a power of
attorney on behalf of more than one Owner; or b) limiting the dollar
amount that may be transferred between the Sub-accounts by an Owner at
any one time.
4. The Company reserves the right, at any time, and without prior notice
to any party, to terminate, suspend or modify the transfer privileges
described in this contract.
If an Owner elects to use this transfer privilege, the Company will not be
liable for transfers made in
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accordance with the instructions received from the Owner or other authorized
persons. All amounts and Accumulation Units will be determined as of the
Business Day during which the request for transfer is received at Our
Administrative Office.
DOLLAR COST AVERAGING: Under dollar cost averaging (DCA), You may authorize the
automatic transfer of a set dollar amount at monthly, quarterly, semi-annual, or
annual intervals. You may elect to have transfers made from the money market
Portfolio or Fixed Account to one or more investment Portfolios. The transfers
made under DCA are not taken into account in determining any transfer fee. There
is no additional charge for this program. You may not cancel DCA once it begins.
We reserve the right to terminate, suspend, or modify this program.
REBALANCING: The Owner may elect to automatically rebalance the Sub-accounts of
the contract to return to the original percentage allocations. The Owner can
elect to rebalance quarterly, semi-annually, or annually. You can discontinue
rebalancing at any time. You can change your rebalancing request at any time in
writing, which we must receive before the next rebalancing date. The transfers
made under the program are not taken into account in determining any transfer
fee. There is no charge for participating in the rebalancing program. We reserve
the right to terminate, suspend, or modify this program.
TRANSFERS DURING THE ANNUITY PERIOD: Subject to any limitations imposed by the
Company on the number of transfers allowed during the Annuity Period, shown on
the Contract Schedule, the Owner may transfer Annuity Units as follows:
1. Transfers may be made upon Formal Request to the Company at least
thirty (30) days before the due date of the next Annuity Payment for
which the change will apply. Transfers will be made by converting the
number of Annuity Units being transferred to the number of Annuity
Units of the selected Sub-account to which the transfer is made, so
that the next Annuity Payment, if it were made at that time, would be
the same amount that it would have been without the transfer.
Thereafter, Annuity Payments will reflect changes in the value of the
new Annuity Units.
2. No transfers can be made between the Fixed Account and the Separate
Account.
3. The minimum amount that can be transferred from a Sub-account is shown
on the Contract Schedule. The minimum amount that must remain in a
Sub-account after a transfer is shown on the Contract Schedule.
4. The Company reserves the right, at any time and without prior notice,
to terminate, suspend or modify the transfer privilege described
above.
If an Owner elects to use the transfer privilege, the Company will not be liable
for transfers made in accordance with instructions received from the Owner or
other authorized persons. All amounts and Annuity Units will be determined as of
the Business Day during which the request for transfer is received at Our
Administrative Office.
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WITHDRAWAL PROVISIONS
WITHDRAWALS: During the Accumulation Period, the Owner may make full or partial
withdrawals of the Contract Withdrawal Value by Formal Request received in Good
Order. The Owner must indicate in the Formal Request which Sub-account or Fixed
Account is intended to be the source of the partial withdrawal.
We will pay the amount of any withdrawal from the Separate Account within seven
(7) days of receipt of a Formal Request received in Good Order unless the
Suspension or Deferral of Payments Provision is in effect.
Each partial withdrawal must be for an amount that is not less than the minimum
amount shown on the Contract Schedule. The minimum Contract Value that must
remain in a Sub-account and the Fixed Account after a partial withdrawal is
shown on the Contract Schedule. The maximum amount which may be withdrawn from
the Fixed Account is shown on the Contract Schedule.
CONTINGENT DEFERRED SALES CHARGE: Upon withdrawal of all or part of the
contract, a contingent deferred sales charge may be assessed as stated on the
Contract Schedule.
SYSTEMATIC WITHDRAWAL: The systematic withdrawal program allows you to choose to
receive systematic payments monthly, quarterly, semi-annually, or annually. You
can instruct us to withdraw a percentage of the value of your contract or a
specific dollar amount. All systematic withdrawals will be withdrawn from the
Fixed Account and the Sub-accounts on a pro-rata basis, unless instructed
otherwise. The systematic withdrawal program will end any time you designate by
Formal Request to us. Withdrawals may be subject to a contingent deferred sales
charge. We reserve the right to terminate, suspend, or modify this program.
PROCEEDS PAYABLE AT DEATH PROVISIONS
DEATH OF OWNER DURING ACCUMULATION PERIOD: Upon the death of the Owner, or any
Joint Owner, during the Accumulation Period, the death benefit will be paid to
the Beneficiary(ies) designated by the Owner(s). Upon the death of a Joint
Owner, the surviving Owner will be treated as the primary Beneficiary. Any other
Beneficiary designation on record at the time of death will be treated as a
contingent Beneficiary. The death benefit must be paid under one of the death
benefit options below. However, if the Beneficiary is the spouse of the Owner,
he or she may elect to continue the contract, at the then current Contract
Value, in his or her own name and exercise all the ownership rights under the
contract.
DEATH BENEFIT AMOUNT: During the Accumulation Period, if death of an Owner
occurs prior to Age 80, the death benefit will be the greater of: a) the
Contract Value; or b) total Purchase Payments less any Adjusted Partial
Withdrawals and contingent deferred sales charges. Adjusted Partial Withdrawals
are equal to; the Partial Withdrawal including the contingent deferred sales
charge any applicable premium tax withheld, multiplied by the Death Benefit
immediately prior to the Partial Withdrawal, divided by the Contract Value
immediately prior to the Partial Withdrawal. An optional Guaranteed Minimum
Death Benefit ("GMDB") may also be elected at the time of application.
If Age 80 or older, the death benefit will be equal to the Contract Value.
The Contract Value will be determined as of the Business Day the Company
receives both due proof of death and an election for the payment method. If
Joint Owners are named, the death benefit is determined based on the Age of the
oldest Owner.
After the death benefit amount is determined, such amount remains in the
Separate Account and/or Fixed Account until distribution begins. From the time
the death benefit amount is determined until complete distribution is made, any
such amount in the Separate Account will be subject to investment risk, which is
borne by the Beneficiary.
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DEATH BENEFIT OPTIONS DURING ACCUMULATION PERIOD: The Owner may designate by
Formal Request received in Good Order that the death benefit be paid under one
of the options available below. If the Owner does not designate an option, then
the Beneficiary must elect the death benefit to be paid under one of the
following options in the event of the death of the Owner or a Joint Owner during
the Accumulation Period; However, if the Beneficiary is the spouse of the Owner,
he or she may elect to continue the contract, at the then current Contract
Value, in his or her own name and exercise all the ownership rights under the
contract.
- Option 1 - Lump sum payment of the death benefit; or
- Option 2 - Payment of the entire death benefit within five (5) years
of the date of the death of the Owner or any Joint Owner; or
- Option 3 - Payment of the death benefit under an Annuity Option over
the lifetime of the Beneficiary, or over a period not extending beyond
the life expectancy of the Beneficiary, with distribution beginning
within one (1) year of the date of death of the Owner or Joint Owner.
Any portion of the death benefit not applied under Option 3, within one (1) year
of the date of the Owner's death, must be distributed within five (5) years of
the date of death.
Unless the Owner has previously designated one of the above payment options, a
Beneficiary who is a spouse of the Owner may elect to: a) continue the contract
in his or her own name at the then current Contract Value; b) elect a lump sum
payment of the death benefit; or c) or apply the death benefit to an Annuity
Option.
If a lump sum payment is requested, the amount will be paid within seven (7)
days of receipt of proof of death and the payment election, unless the
Suspension or Deferral of Payments provision, as set forth in this contract is
in effect. Payment to the Beneficiary, other than in a lump sum, may only be
elected during the sixty-day (60) period beginning with the date of receipt of
proof of death.
DEATH BENEFIT DURING THE ANNUITY PERIOD: If the Owner, or any Joint Owner, who
is not the Annuitant, dies during the Annuity Period, any remaining payments
under the Annuity Option elected will continue at least as rapidly as under the
method of distribution in effect at such Owner's or Joint Owner's death. Upon
the death of any Owner during the Annuity Period, the Beneficiary becomes the
Owner. Upon the death of any Joint Owner during the Annuity Period, the
surviving Owner, if any, will be treated as the primary Beneficiary. Any other
Beneficiary designation on record at the time of death will be treated as a
contingent Beneficiary.
DEATH OF ANNUITANT: Upon the death of an ▇▇▇▇▇▇▇▇▇, who is not the Owner, during
the Accumulation Period, the Owner automatically becomes the Annuitant. The
Owner may designate a new Annuitant, subject to the Company's underwriting rules
then in effect. If the Owner is a non-natural person, the death of an Annuitant
will be treated as the death of the Owner and a new Annuitant may not be
designated.
Upon the death of an Annuitant during the Annuity Period, the death benefit, if
any, will be as specified in the Annuity Option elected. Death benefits will be
paid at least as rapidly as under the method of distribution in effect at the
Annuitant's death.
PAYMENT OF DEATH BENEFIT: The Company will require due proof of death before any
death benefit is paid. Due proof of death will be:
1. a certified death certificate; or
2. a certified decree of a court of competent jurisdiction as to the
finding of death; or
3. any other proof satisfactory to the Company
All death benefits will be paid in accordance with applicable law or regulations
governing death benefit payments. The contract will be continued and
administered in accordance with Section 72(s) of the Internal Revenue Code, as
amended.
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BENEFICIARY: The Beneficiary designation in effect on the Contract Issue Date
will remain in effect until changed. The Beneficiary is entitled to receive the
benefits to be paid at the death of the Owner. Unless the Owner provides
otherwise, the death benefit will be paid in equal shares to the survivor(s) as
follows:
1. the primary Beneficiary(ies) who survive the Owner's and/or the
Annuitant's death, as applicable; or if none
2. the contingent Beneficiary(ies) who survive the Owner's and/or the
Annuitant's death, as applicable; or if none
3. the estate of the Owner.
BENEFICIARY CHANGE: Subject to the rights of any irrevocable Beneficiary(ies),
the Owner may change the primary Beneficiary(ies) or contingent
Beneficiary(ies). A change may be made by Formal Request. The change will take
effect as of the date the Formal Request is signed. The Company will not be
liable for any payment made or action taken before it records the change.
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISIONS
The Company reserves the right to suspend or postpone payments from the Separate
Account for a withdrawal or transfer for any period listed below, provided that
applicable rules and regulations of the Securities and Exchange Commission will
govern as to whether the conditions described in (2) and (3) below exist. The
Company further reserves the right to postpone payments from the Fixed Account
for a period of up to six (6) months.
1. the New York Stock Exchange is closed (other than customary weekend
and holiday closings); or
2. trading on the New York Stock Exchange is restricted; or
3. an emergency exists as a result of which disposal of securities held
in the Separate Account is not reasonably practicable or it is not
reasonably practicable to determine the value of the Separate
Account's net assets; or
4. during any other period when the Securities and Exchange Commission,
by order, so permits consistent with the protection of Owners.
OWNER, ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS
OWNER: The Owner has all interest and right to amounts held in this contract.
The Owner is the person designated as such on the Contract Issue Date, unless
changed. The Owner may change ownership of the contract at any time by Formal
Request. A change of ownership will automatically revoke any prior designation
of Owner. The change will become effective as of the date the Formal Request is
received by Us. The Company will not be liable for any payment made or action
taken before it records the change.
JOINT OWNER: A contract may be owned by Joint Owners. If Joint Owners are named,
the Joint Owner must be the spouse of the other Owner, unless limited by law.
Upon the death of either Owner, the surviving Joint Owner will be the primary
Beneficiary. Any other Beneficiary designation will be treated as a contingent
Beneficiary unless otherwise indicated in a Formal Request.
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ANNUITANT/JOINT ANNUITANT: The Annuitant(s) is the person on whose life Annuity
Payments are based. The Annuitant(s) is the person designated by the Owner at
the Contract Issue Date, unless changed prior to the Annuity Date. The Annuitant
may not be changed in a contract that is owned by a non-natural person. Any
change of Annuitant(s) is subject to the Company's underwriting rules in effect
at the time the Formal Request is recorded by the Company.
ASSIGNMENT OF CONTRACT: A Formal Request specifying the terms of an assignment
of a Contract must be provided to Our Administrative Office. The Company will
not be liable for any payment made or action taken before it records the
assignment. The Company will not be responsible for the validity or tax
consequences of any assignment. Any assignment made after the Annuity Date, or
after the death benefit has become payable will be valid only with the Company's
consent. If the contract is assigned, the Owner's rights may only be exercised
with the consent of the assignee of record.
ANNUITIZATION PROVISIONS
GENERAL: On the Annuity Date, the Contract Withdrawal Value will be applied
under the Annuity Option selected by the Owner. The Owner may elect to have the
Contract Withdrawal Value applied to provide a Fixed Annuity, a Variable Annuity
or a combination Fixed and Variable Annuity. The Contract Value may be applied
under the Annuity Option selected if the Annuity Date occurs on or after the
fifth (5) Contract Anniversary and the Annuity Option is life contingency for a
minimum of five (5) years. If an Annuity Option combination is elected, the
Owner must specify what portion of the Contract Withdrawal Value is to be
applied to the fixed and variable options. In addition, the Owner may select a
lump sum payment.
ANNUITY DATE: The Annuity Date is selected by the Owner at the Contract Issue
Date and must be at least ninety (90) days after the Contract Issue Date. The
Annuity Date may not be later than the earlier of: a) the date the Annuitant
reaches attained Age 90; or b) the maximum date permitted under applicable law.
Prior to the Annuity Date, the Owner, subject to the above, may change the
Annuity Date by Formal Request. Any change must be requested at least thirty
(30) days prior to the new Annuity Date.
SELECTION OF AN ANNUITY OPTION: An Annuity Option may be selected by Formal
Request of the Owner. If no Annuity Option is selected, Option 2 with 120
monthly payments guaranteed will automatically be applied. Unless specified
otherwise, that portion of the Contract Withdrawal Value allocated to the
Separate Account shall be used to provide a Variable Annuity, and that portion
of the Contract Withdrawal Value allocated to the Fixed Account will be used to
provide a Fixed Annuity. Prior to the Annuity Date, the Owner can change the
Annuity Option selected by Formal Request. Any change must be requested at least
thirty (30) days prior to the Annuity Date.
FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS: Annuity Payments are paid in monthly
installments. The Contract Withdrawal Value or Contract Value, as described
above, is applied to the annuity table for the Annuity Option selected. If the
Contract Withdrawal Value or Contract Value, as described above, applied under
an Annuity Option is less than $5,000, the Company reserves the right to make a
lump sum payment in lieu of Annuity Payments. If the Annuity Payment is ever
less than $50, the Company reserves the right to reduce the frequency of
payments to an interval which will result in each payment being at least $50.
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ANNUITY OPTIONS: The following Annuity Options or any other Annuity Option
acceptable to the Company may be selected:
OPTION 1. INCOME FOR SPECIFIED PERIOD: We will pay an income for a specific
number of years in equal installments. However, when the Annuitant dies, if
We have made Annuity Payments for less than the specified period elected,
We will continue to make Annuity Payments to the Owner for the rest of the
specified period. If an Owner does not want to receive Annuity Payments, he
or she may ask Us for a single lump sum. A single sum payment will be equal
to the present value of remaining payments as of the date of receipt of
proof of death commuted at the assumed investment rate for a Variable
Annuity option and at the Fixed Account guaranteed rate for a Fixed Annuity
option.
OPTION 2. LIFE INCOME WITH PERIOD CERTAIN: We will pay equal monthly
payments for a specified period certain and then for the life of the
Annuitant. If the Annuitant dies during period certain, We will continue to
make payments to the Owner (or any person designated by the Owner) for the
rest of the guaranteed specified period. If the Owner does not want to
receive payments after the Annuitant's death, he/she can ask Us for a lump
sum. A single sum payment will be equal to the present value of remaining
payments as of the date of receipt of proof of death commuted at the
assumed investment rate for a Variable Annuity option and at the Fixed
Account guaranteed rate for a Fixed Annuity option.
OPTION 3. INCOME OF SPECIFIED AMOUNT: We will pay income of a specified
amount until the principal and interest are exhausted. However, when the
Annuitant dies, if We have made Annuity Payments for less than the
specified amount, We will continue to make Annuity Payments to the Owner
for the balance of the specified amount. If the Owner does not want to
receive Annuity Payments, he or she can ask Us for a single lump sum. A
single sum payment will be equal to the present value of remaining payments
as of the date of receipt of proof of death commuted at the assumed
investment rate for a Variable Annuity option and at the Fixed Account
guaranteed rate for a Fixed Annuity option.
OPTION 4. JOINT AND SURVIVOR INCOME: We will pay equal monthly payments
during the joint lifetime of the Annuitant and the named Joint Annuitant.
We will determine the payment from Table 4 based on the Age of each person.
The Annuitant must be at least 50 years old, and the Joint Annuitant must
be at least 45 years old, at the time of the first monthly payment.
ANNUITY: If the Owner selects a Fixed Annuity, the Contract Withdrawal Value
will be allocated to the General Account and the annuity paid as a Fixed
Annuity. If the Owner selects a Variable Annuity, the Contract Withdrawal Value
will be allocated to the Sub-accounts of the Separate Account in accordance with
the selection made by the Owner, and the annuity will be paid as a Variable
Annuity. If no selection is made, the Contract Withdrawal Value will be applied
in the same proportions, to the same Sub-accounts, as the allocations are at the
time of election. Unless the Owner specifies otherwise, the payee of the Annuity
Payments shall be the Owner. The Contract Withdrawal Value will be applied to
the applicable annuity table contained in this contract based upon the Annuity
Option selected by the Owner. The amount of the first payment for each $1,000 of
Contract Withdrawal Value is shown in the annuity tables.
FIXED ANNUITY: The Owner may elect to have the Contract Withdrawal Value applied
to provide a Fixed Annuity. The dollar amount of each Fixed Annuity payment
shall be determined in accordance with annuity tables contained in the contract
which are based on the minimum guaranteed interest rate of 3% per year.
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VARIABLE ANNUITY: The Owner may elect to have the Contract Withdrawal Value
applied to provide a Variable Annuity. Variable Annuity payments reflect the
investment performance of the Separate Account in accordance with the allocation
of the Contract Withdrawal Value to the Sub-accounts during the Annuity Period.
Variable Annuity payments are not guaranteed as to dollar amount.
The dollar amount of the first Variable Annuity payment is determined in
accordance with the annuity tables contained in the contract which are based on
the minimum guaranteed interest rate of 3% per year. The dollar amount of the
Variable Annuity payment for each applicable Sub-account after the first
Variable Annuity payment is determined as follows:
1. The dollar amount of the first Variable Annuity payment is divided by
the value of an Annuity Unit for each applicable Sub-account as of the
Annuity Date. This sets the number of Annuity Units for each monthly
payment for the applicable Sub-accounts.
2. The fixed number of Annuity Units per payment in each Sub-account is
multiplied by the Annuity Unit value for that Sub-account for the last
Business Day of the month proceeding the month for which the payment
is due. This result is the dollar amount of the payment for each
applicable Sub-account.
The dollar amount of variable benefits may decrease or increase according to the
above procedure.
The total dollar amount of each Variable Annuity payment is the sum of all
Sub-account Variable Annuity payments reduced by the applicable portion of the
contract maintenance charge.
ANNUITY UNIT: The value of any Annuity Unit for each Sub-account of the Separate
Account was initially set at $10.
The Sub-account Annuity Unit value for any subsequent Business Day is determined
as follows:
1. The net investment factor for the current Business Day is multiplied
by the value of the Annuity Unit for the Sub-account for the
immediately preceding Business Day.
2. The result in (1) is then divided by the assumed investment rate
factor, which equals 1.00, plus the assumed investment rate for the
number of days since the preceding Business Day. The Owner can choose
either a 5% or a 3% assumed investment rate.
MORTALITY TABLES: The Annuity 2000 Mortality Table is used in establishing the
annuity table. The dollar amount of an Annuity Payment for any Age or
combination of ages not shown in the tables, or for any other form of Annuity
Option agreed to by the Company, will be provided by the Company upon Formal
Request.
GENERAL CONTRACT PROVISIONS
THE CONTRACT: The entire contract consists of this contract, the application, if
any, amendments and any riders or endorsements attached to it. This contract may
be changed or altered in writing only, by the President, Senior Vice President
or Secretary of the Company. No agent has the authority to change or waive any
provision of this contract.
EVIDENCE OF SURVIVAL: The Company may require satisfactory evidence of the
continued survival of any person(s) on whose life Annuity Payments under this
Contract are based.
CONFORMITY WITH STATE LAWS: This contract will be interpreted under the law of
the state in which it is issued. Any provision which is in conflict with the law
of such state is amended to conform to the minimum requirements of such law.
INCONTESTABILITY: This contract will be incontestable from the Contract Issue
Date.
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MISSTATEMENT OF AGE OR SEX: If the Age or sex of any Annuitant has been
misstated, any annuity benefits payable will be the annuity benefits that would
have been provided at the correct Age and sex. After Annuity Payments have
begun, any underpayments will be made up in one sum with the next Annuity
Payment. Any overpayment will be deducted from future Annuity Payments until the
total is repaid.
MODIFICATION: This contract may be modified in order to maintain compliance with
applicable state and/or federal law.
NON-PARTICIPATING: This contract will not share in any distribution of
dividends, profits or income of the Company.
PREMIUM TAXES: Any taxes paid to any governmental entity relating to the
contract will be deducted from the Purchase Payment or Contract Value. The
Company may, at its sole discretion, pay taxes when due and deduct that amount
from the Contract Value at a later date. Payment of taxes at an earlier date
does not waive the rights of the Company to deduct that amount from the Contract
Value at a later date.
PROOF OF AGE AND SEX: The Company may require evidence of Age and sex of any
Annuitant and any Owner.
PROTECTION OF PROCEEDS: To the extent permitted by law, death benefits and
Annuity Payments shall be free from legal process and the claim of any creditor
other than the person entitled to them under a valid legal contract. No payment,
nor any amount under this contract, shall be taken or assigned in advance of its
payment date unless the Company receives the Owner's Formal Request.
OTHER TAXES: The Company reserves the right to establish a provision for federal
income taxes if it determines, at its sole discretion, that it will incur a tax
as a result of the operation of the Separate Account. The Company will deduct
for any income taxes incurred by it as a result of the operation of the Separate
Account whether or not there was a provision for taxes and whether or not that
provision was sufficient. The Company will deduct any withholding taxes required
by applicable law.
REGULATORY REQUIREMENTS: All values payable under any contract will not be less
than the minimum benefits required by the laws and regulations of the state in
which the contract is delivered.
REPORTS: Prior to the Annuity Date, the Company will furnish each Owner with a
report at least once each calendar year showing the Contract Value and any other
information required by law.
25
TABLE 1
INCOME FOR SPECIFIED PERIOD FACTORS
Installments shown are for each $1,000 of net proceeds applied. Amounts based on
3% interest.
ANNUAL SEMI
YEARS ANNUAL ANNUAL QUARTERLY MONTHLY
----------------------------------------------------------------------------------
1 N/A N/A N/A N/A
2 N/A N/A N/A N/A
3 N/A N/A N/A N/A
4 N/A N/A N/A N/A
5 $ 211.99 $ 106.78 $ 53.59 $ 17.91
6 179.22 90.27 45.30 15.14
7 155.83 78.49 39.39 13.16
8 138.31 69.66 34.96 11.68
9 124.69 62.81 31.52 10.53
10 113.82 57.33 28.77 9.61
11 104.93 52.85 26.52 8.86
12 97.54 49.13 24.65 8.24
13 91.29 45.98 23.08 7.71
14 85.95 43.29 21.73 7.26
15 81.33 40.96 20.56 6.87
16 77.29 38.93 19.54 6.53
17 73.24 37.14 18.64 6.23
18 70.59 35.56 17.84 5.96
19 67.78 34.14 17.13 5.73
20 65.26 32.87 16.50 5.51
* Equal monthly payment for the number of years elected, not to exceed 25 years.
Payments will begin on the Annuity Date.
26
TABLE 2
MONTHLY INCOME FOR LIFE WITH GUARANTEED PERIOD CERTAIN
Equal monthly payments for a guaranteed period of 10, 15, or 20 years, as
elected, and for life thereafter as shown in the table below. Amount of each
monthly installment per $1,000 net proceeds. Amounts based on Annuity 2000
Mortality Tables and 3% interest.
MALE
AGE OF
PAYEE 10 YEARS 15 YEARS 20 YEARS
--------------------------------------------------
25 $ 3.08 $ 3.08 $ 3.07
26 3.10 3.10 3.09
27 3.12 3.12 3.11
28 3.15 3.14 3.14
29 3.17 3.17 3.16
30 3.20 3.19 3.19
31 3.22 3.22 3.21
32 3.25 3.25 3.24
33 3.28 3.28 3.27
34 3.31 3.31 3.30
35 3.34 3.34 3.33
36 3.38 3.37 3.36
37 3.41 3.40 3.39
38 3.45 3.44 3.42
39 3.49 3.48 3.46
40 3.53 3.52 3.50
41 3.57 3.56 5.53
42 3.62 3.60 3.57
43 3.66 3.64 3.62
44 3.71 3.69 3.66
45 3.76 3.74 3.70
46 3.81 3.79 3.75
47 3.87 3.84 3.80
48 3.92 3.89 3.85
49 3.98 3.95 3.90
50 4.05 4.01 3.95
51 4.11 4.07 4.00
52 4.18 4.13 4.06
53 $ 4.25 $ 4.20 $ 4.12
54 4.33 4.27 4.18
55 4.41 4.34 4.24
56 4.49 4.42 4.30
57 4.58 4.49 4.36
58 4.68 4.58 4.43
59 4.78 4.66 4.49
60 4.88 4.75 4.56
61 4.99 4.84 4.62
62 5.10 4.93 4.69
63 5.23 5.03 4.75
64 5.35 5.13 4.82
65 5.48 5.22 4.88
66 5.62 5.33 4.94
67 5.77 5.43 5.00
68 5.92 5.53 5.06
69 6.07 5.63 5.11
70 6.23 5.73 5.16
71 6.39 5.83 5.21
72 6.56 5.93 5.25
73 6.73 6.02 5.29
74 6.90 6.11 5.33
75 7.08 6.20 5.36
76 7.25 6.28 5.39
77 7.43 6.35 5.41
78 7.61 6.42 5.43
79 7.78 6.49 5.45
80 7.95 6.55 5.46
27
TABLE 2
MONTHLY INCOME FOR LIFE WITH GUARANTEED PERIOD CERTAIN
Equal monthly payments for a guaranteed period of 10, 15, or 20 years, as
elected, and for life thereafter as shown in the table below. Amount of each
monthly installment per $1,000 net proceeds. Amounts based on Annuity 2000
Mortality Tables and 3% interest.
FEMALE
AGE OF
PAYEE 10 YEARS 15 YEARS 20 YEARS
----------------------------------------------------
25 $ 2.99 $ 2.99 $ 2.99
26 3.01 3.01 3.00
27 3.03 3.03 3.02
28 3.05 3.05 3.04
29 3.07 3.07 3.06
30 3.09 3.09 3.09
31 3.11 3.11 3.11
32 3.14 3.14 3.13
33 3.16 3.16 3.15
34 3.19 3.19 3.18
35 3.22 3.21 3.21
36 3.24 3.24 3.23
37 3.27 3.27 3.26
38 3.30 3.30 3.29
39 3.34 3.33 3.32
40 3.37 3.36 3.35
41 3.41 3.40 3.39
42 3.44 3.44 3.42
43 3.48 3.47 3.46
44 3.52 3.51 3.50
45 3.57 3.55 3.54
46 3.61 3.60 3.58
47 3.66 3.64 3.62
48 3.71 3.69 3.66
49 3.76 3.74 3.71
50 3.81 3.79 3.76
51 3.87 3.85 3.81
52 3.93 3.90 3.86
53 $ 3.99 $ 3.96 $ 3.92
54 4.06 4.02 3.97
55 4.13 4.09 4.03
56 4.20 4.16 4.09
57 4.28 4.23 4.15
58 4.36 4.30 4.22
59 4.45 4.38 4.28
60 4.54 4.46 4.35
61 4.63 4.55 4.42
62 4.73 4.64 4.49
63 4.84 4.73 4.57
64 4.95 4.83 4.64
65 5.07 4.93 4.71
66 5.20 5.03 4.78
67 5.33 5.14 4.85
68 5.47 5.25 4.92
69 5.62 5.36 4.99
70 5.78 5.47 5.05
71 5.94 5.58 5.11
72 6.11 5.70 5.17
73 6.29 5.81 5.22
74 6.48 5.92 5.27
75 6.67 6.03 5.31
76 6.86 6.13 5.35
77 7.06 6.22 5.38
78 7.26 6.31 5.40
79 7.46 6.39 5.43
80 7.66 6.47 5.45
28
TABLE 3
EQUAL PAYMENTS OF A SPECIFIED AMOUNT
Equal monthly payments of at least $4.71 per month for each $1,000 of proceeds.
Payments will begin on the Annuity Date and will continue until the proceeds and
interest, at a rate of 3% compounded annually, are exhausted.
TABLE 4
JOINT SURVIVOR INCOME FACTORS
MALE AGE
----------------------------------------------------------------------------
FEMALE AGE 45 50 55 60 65 70
45 $ 3.34 $ 3.41 $ 3.46 $ 3.50 $ 3.54 $ 3.58
50 3.44 3.54 3.62 3.69 3.74 3.79
55 3.53 3.66 3.79 3.90 3.99 4.06
60 3.60 3.78 3.95 4.12 4.27 4.38
65 3.66 3.87 4.10 4.34 4.57 4.77
70 3.71 3.95 4.22 4.54 4.87 5.19
Installments shown are monthly and are for each $1,000 of net proceeds applied.
Based on Annuity 2000 Tables and 3% interest.
We will furnish values for Age combinations not shown in the table upon request.
29
JEFFERSON NATIONAL LIFE INSURANCE COMPANY
FIXED ACCOUNT
ACCUMULATION TABLE FOR FLEXIBLE PREMIUM DEFERRED ANNUITY
$1,000 Annual Premium
Guaranteed Values*
END OF CONTRACT
POLICY CONTRACT VALUE CONTRACT WITHDRAWAL
YEAR INCREASE VALUE VALUE
---------------------------------------------------------------------------------
1 1030.00 1030.00 967.21
2 1060.90 2090.90 1973.45
3 1092.73 3183.63 3019.55
4 1125.51 4309.14 4129.14
5 1159.27 5468.41 5288.41
6 1194.05 6662.46 6482.46
7 1229.87 7892.34 7712.34
8 1266.77 9159.11 8979.11
9 1304.77 10463.88 10283.88
10 1343.92 11807.80 11627.80
11 1384.23 13192.03 13012.03
12 1425.76 14617.79 14437.79
13 1468.53 16086.32 15906.32
14 1512.59 17598.91 17418.91
15 1557.97 19156.88 18976.88
16 1604.71 20761.59 20581.59
17 1652.85 22414.44 22234.44
18 1702.43 24116.87 23936.87
19 1753.51 25870.37 25690.37
20 1806.11 27676.49 27496.49
21 1860.29 29536.78 29356.78
22 1916.10 31452.88 31272.88
23 1973.59 33426.47 33246.47
24 2032.79 35459.26 35279.26
25 2093.78 37553.04 37373.04
26 2156.59 39709.63 39529.63
27 2221.29 41930.92 41750.92
28 2287.93 44218.85 44038.85
29 2356.57 46575.42 46395.42
30 2427.26 49002.68 48822.68
31 2500.08 51502.76 51322.76
32 2575.08 54077.84 53897.84
33 2652.34 56730.18 56550.18
34 2731.91 59462.08 59282.08
35 2813.86 62275.94 62095.94
36 2898.28 65174.22 64994.22
37 2985.23 68159.45 67979.45
38 3074.78 71234.23 71054.23
39 3167.03 74401.26 74221.26
40 3262.04 77663.30 77483.30
*Values shown are based on an interest rate of 3% for all years.
30
END OF CONTRACT
POLICY CONTRACT VALUE CONTRACT WITHDRAWAL
YEAR INCREASE VALUE VALUE
---------------------------------------------------------------------------------
1 1015.00 1015.00 952.11
2 1030.23 2045.23 1927.50
3 1045.68 3090.90 2926.36
4 1061.36 4152.27 3972.27
5 1077.28 5229.55 5049.55
6 1093.44 6322.99 6142.99
7 1109.84 7432.84 7252.84
8 1126.49 8559.33 8379.33
9 1143.39 9702.72 9522.72
10 1160.54 10863.26 10683.26
11 1177.95 12041.21 11861.21
12 1195.62 13236.83 13056.83
13 1213.55 14450.38 14270.38
14 1231.76 15682.14 15502.14
15 1250.23 16932.37 16752.37
16 1268.99 18201.36 18021.36
17 1288.02 19489.38 19309.38
18 1307.34 20796.72 20616.72
19 1326.95 22123.67 21943.67
20 1346.86 23470.52 23290.52
21 1367.06 24837.58 24657.58
22 1387.56 26225.14 26045.14
23 1408.38 27633.52 27453.52
24 1429.50 29063.02 28883.02
25 1450.95 30513.97 30333.97
26 1472.71 31986.68 31806.68
27 1494.80 33481.48 33301.48
28 1517.22 34998.70 34818.70
29 1539.98 36538.68 36358.68
30 1563.08 38101.76 37921.76
31 1586.53 39688.29 39508.29
32 1610.32 41298.61 41118.61
33 1634.48 42993.09 42753.09
34 1659.00 44592.09 44412.09
35 1683.88 46275.97 46095.97
36 1709.14 47985.11 47805.11
37 1734.78 49719.89 49539.89
38 1760.80 51480.68 51300.68
39 1787.21 53267.89 53087.89
40 1814.02 55081.91 54901.91
*Values shown are based on an interest rate of 1.5% for all years.
31
JEFFERSON NATIONAL LIFE INSURANCE COMPANY
[ADMINISTRATIVE OFFICE: ▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇., ▇▇▇▇▇ ▇▇▇▇
▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇
TELEPHONE: ▇-▇▇▇-▇▇▇-▇▇▇▇]
A STOCK COMPANY
INDIVIDUAL FLEXIBLE PREMIUM DEFERRED ANNUITY CONTRACT
FIXED AND VARIABLE ACCOUNTS
NON-PARTICIPATING
32