Exhibit 4
FLEXIBLE PREMIUM VARIABLE
DEFERRED ANNUITY CONTRACT
________________________________________________________________________________
To the contractowner:
Please read your Contract carefully. This Contract is a legal contract between
you and the Company. You, the Owner, have benefits and rights described in this
Contract. The Annuitant is named in the Contract. We will make Income Payments
beginning on the Annuity Commencement Date, if the Annuitant is still living on
that date.
THIS CONTRACT'S INCOME PAYMENTS DEPEND ON THE CONTRACT VALUE. CONTRACT VALUE MAY
BE ALLOCATED TO THE SEPARATE ACCOUNT AND THE GUARANTEE ACCOUNT. THE CONTRACT
VALUE IN THE SEPARATE ACCOUNT IS BASED ON THE INVESTMENT EXPERIENCE OF THAT
ACCOUNT, AND MAY INCREASE OR DECREASE DAILY. IT IS NOT GUARANTEED AS TO DOLLAR
AMOUNT. CONTRACT VALUE IN THE GUARANTEE ACCOUNT IS GUARANTEED BY THE COMPANY AS
TO DOLLAR AMOUNT.
RIGHT TO CANCEL. You may return this Contract to our Home Office within 10 days
(20 days in North Dakota) after its delivery for a refund. The amount of the
refund will equal the Contract Value with any adjustments required by applicable
law or regulation.
For GE Life and Annuity Assurance Company
/s/ ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇ /s/ ▇▇▇▇▇▇ ▇. ▇▇▇▇
▇▇▇▇▇▇ ▇.▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇. ▇▇▇▇
PRESIDENT SECRETARY
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. Flexible Premium Variable Deferred Annuity
. Income Payments begin at Annuity Commencement Date
. No Dividends
. Some benefits reflect investment results
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GE LIFE AND ANNUITY
ASSURANCE COMPANY
▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇
▇-▇▇▇-▇▇▇-▇▇▇▇
A Stock Company
CONTRACT DATA
SCHEDULE OF BENEFITS SCHEDULE OF PURCHASE PAYMENTS
AMOUNT PAYABLE
ANNUITY [$10,000.00] INITIAL PURCHASE PAYMENT
INITIAL PURCHASE PAYMENT: [$10,000.00]
MINIMUM ADDITIONAL PURCHASE PAYMENT: [$1,000.00]
MINIMUM WITHDRAWAL: [$100.00 WITH A CONTRACT VALUE AFTER THE WITHDRAWAL
OF NO LESS THAN $5,000.00]
MINIMUM CONTRACT VALUE ALLOWED TO REMAIN IN AN INVESTMENT OPTION AFTER A
TRANSFER FROM INVESTMENT OPTION: [$100.00]
CHARGES:
PREMIUM TAX RATE: [0.00%]
ASSET CHARGE: [1.90% ANNUALLY (.005255% DAILY)]
MAXIMUM TRANSFER CHARGE: [$10.00]
OWNER [THE ANNUITANT]
ANNUITANT [▇▇▇▇ ▇▇▇] [MALE] [35] AGE [LAST] BIRTHDAY
CONTRACT NUMBER [0000000]
CONTRACT DATE [APRIL 1, 2002] [APRIL 1, 2057]ANNUITY COMMENCEMENT DATE
PLAN FLEXIBLE PREMIUM VARIABLE DEFERRED ANNUITY
CONTRACT NUMBER [▇▇▇▇▇▇▇]
SEPARATE ACCOUNT 4
INVESTMENT OPTIONS
SUBACCOUNTS ARE INVESTED IN
----------- ---------------
[AIM VARIABLE INSURANCE FUNDS
AIM CAPITAL APPRECIATION AIM V.I. CAPITAL APPRECIATION FUND
AIM PREMIER EQUITY AIM V.I. PREMIER EQUITY FUND
ALLIANCE VARIABLE PRODUCTS SERIES FUND, INC.
AVP GROWTH AND INCOME GROWTH AND INCOME PORTFOLIO
AVP PREMIER GROWTH PREMIER GROWTH PROTFOLIO
AVP TECHNOLOGY TECHNOLOGY PORTFOLIO
▇▇▇▇▇ ▇▇▇▇▇ VARIABLE TRUST
EVM FLOATING-RATE VT FLOATING-RATE INCOME FUND
EVM WORLDWIDE HEALTH VT WORLDWIDE HEALTH SCIENCES FUND
SCIENCES
FEDERATED INSURANCE SERIES
FED HIGH INCOME BOND FEDERATED HIGH INCOME BOND FUND II
FED INTERNATIONAL SMALL FEDERATED INTERNATIONAL SMALL COMPANY FUND II
COMPANY
FIDELITY VARIABLE INSURANCE PRODUCTS FUND
FID EQUITY-INCOME EQUITY-INCOME PORTFOLIO
FID GROWTH GROWTH PORTFOLIO
FIDELITY VARIABLE INSURANCE PRODUCTS FUND II
FID CONTRAFUND CONTRAFUND PORTFOLIO
FIDELITY VARIABLE INSURANCE PRODUCTS FUND III
FID GROWTH & INCOME GROWTH & INCOME PORTFOLIO
FID MID CAP MID CAP PORTFOLIO
GE INVESTMENTS FUNDS, INC.
GEI MID-CAP VALUE EQUITY MID-CAP VALUE EQUITY FUND
GEI MONEY MARKET MONEY MARKET FUND
GEI PREMIER GROWTH EQUITY PREMIER GROWTH EQUITY FUND
GEI S&P 500 INDEX * S&P 500 INDEX FUND
GEI SMALL-CAP VALUE EQUITY SMALL-CAP VALUE EQUITY FUND
GEI U.S. EQUITY U.S. EQUITY FUND
GEI VALUE EQUITY VALUE EQUITY FUND
GEI INCOME INCOME FUND
CONTINUED EFFECTIVE [05/01/02]
JANUS ASPEN SERIES
JAN BALANCED BALANCED PORTFOLIO
JAN CAPITAL APPRECIATION CAPITAL APPRECIATION PORTFOLIO
JAN INTERNATIONAL GROWTH INTERNATIONAL GROWTH PORTFOLIO
MFS VARIABLE INSURANCE TRUST
MFS GROWTH STOCK MFS INVESTORS GROWTH STOCK SERIES
MFS INVESTORS TRUST MFS INVESTORS TRUST
MFS NEW DISCOVERY MFS NEW DISCOVERY SERIES
MFS UTILITIES MFS UTILITIES SERIES
▇▇▇▇▇▇▇▇▇▇▇ VARIABLE ACCOUNT FUNDS
OPP GLOBAL SECURITIES/VA ▇▇▇▇▇▇▇▇▇▇▇ GLOBAL SECURITIES FUND/VA
OPP MAIN STREET GROWTH & ▇▇▇▇▇▇▇▇▇▇▇ MAIN STREET GROWTH & INCOME
INCOME/VA FUND/VA
OPP AGGRESSIVE GROWTH/VA ▇▇▇▇▇▇▇▇▇▇▇ AGGRESSIVE GROWTH FUND/VA
OPP CAPITAL APPRECIATION/VA ▇▇▇▇▇▇▇▇▇▇▇ CAPITAL APPRECIATION FUND/VA
OPP MAIN STREET SMALL CAP/VA ▇▇▇▇▇▇▇▇▇▇▇ MAIN STREET SMALL CAP FUND/VA
PIMCO VARIABLE INSURANCE TRUST
PIM HIGH YIELD HIGH YIELD PORTFOLIO
PIM LONG TERM U.S. LONG-TERM U.S. GOVERNMENT PORTFOLIO
GOVERNMENT
PIM TOTAL RETURN TOTAL RETURN PORTFOLIO
RYDEX VARIABLE TRUST
RYD OTC ** RYDEX OTC FUND
▇▇▇ ▇▇▇▇▇▇ LIFE INVESTMENT TRUST
▇▇▇ ▇▇▇▇▇▇▇▇ LIT ▇▇▇▇▇▇▇▇ PORTFOLIO
VAN EMERGING GROWTH LIT EMERGING GROWTH PORTFOLIO]
GUARANTEE ACCOUNT
-----------------
MINIMUM GUARANTEED INTEREST RATE [3%]
YOU MAY ALLOCATE YOUR CONTRACT VALUE TO AS MANY AS [TEN] SUBACCOUNTS IN ADDITION
TO THE GUARANTEE ACCOUNT. YOUR ALLOCATIONS MUST BE IN PERCENTAGES TOTALING 100%.
EACH ALLOCATION PERCENTAGE MUST BE A WHOLE NUMBER AND AT LEAST 1%.
CONSULT YOUR PROSPECTUS FOR INVESTMENT DETAILS.
* "STANDARD & POOR'S," "S&P," "S&P 500," "STANDARD & POOR'S 500," AND "500" ARE
TRADEMARKS OF THE ▇▇▇▇▇▇-▇▇▇▇ COMPANIES, INC. AND HAVE BEEN LICENSED FOR USE BY
GE ASSET MANAGEMENT INCORPORATED. THE S&P 500 INDEX FUND IS NOT SPONSORED,
ENDORSED, SOLD OR PROMOTED BY STANDARD & POOR'S AND STANDARD & POOR'S MAKES NO
REPRESENTATION REGARDING THE ADVISABILITY OF INVESTING IN THE FUND.
** THE NASDAQ 100 INDEX(TM) IS AN UNMANAGED INDEX THAT IS A WIDELY RECOGNIZED
INDICATOR OF OTC MARKET PERFORMANCE.
EFFECTIVE [05/01/02]
CONTRACT NUMBER [0000000]
TABLE OF SURRENDER CHARGES
YEARS SINCE SURRENDER CHARGE
PURCHASE PAYMENT MADE PERCENTAGE
[LESS THAN 1 6]
[1 BUT LESS THAN 2 5]
[2 BUT LESS THAN 3 4]
[3 BUT LESS THAN 4 2]
[4 OR MORE 0]
FREE WITHDRAWAL AMOUNT: [FOR EACH CONTRACT YEAR, 10% OF THE TOTAL PURCHASE
PAYMENTS MADE THROUGH THE DATE OF WITHDRAWAL. THE FREE
WITHDRAWAL AMOUNT NOT WITHDRAWN IS NOT CUMULATIVE FROM
CONTRACT YEAR TO CONTRACT YEAR.]
TABLE OF CONTENTS
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Contract Data..................................................... 3
Definitions....................................................... 4
Introduction...................................................... 6
▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇ and Beneficiary Provisions....................... 6
Death Provisions.................................................. 7
Purchase Payments................................................. 9
Monthly Income Benefit............................................ 9
Guarantee Account................................................. 10
Separate Account.................................................. 11
Transfers......................................................... 13
Contract Value Benefits........................................... 14
General Information............................................... 16
Optional Payment Plans............................................ 17
Copies of any application, riders and endorsements follow page 21.
DEFINITIONS
________________________________________________________________________________
ACCUMULATION UNIT - Unit of measure used in calculating the Contract Value in
the Separate Account prior to the Annuity Commencement Date.
ANNUITANT / JOINT ANNUITANT - The person(s) named on the Contract data pages
whose age and, where appropriate, gender are used in determining the amount of
the monthly income benefits.
ANNUITY COMMENCEMENT DATE - The date stated on the Contract data pages, unless
changed after issue, on which Income Payments are scheduled to commence, if the
Annuitant(s) is living on that date.
ANNUITY COMMENCEMENT VALUE - The Surrender Value on the day immediately
preceding the Annuity Commencement Date.
ANNUITY UNIT - Unit of measure used in determining the amount of the second and
each subsequent Variable Income Payment.
ASSUMED INTEREST RATE - Interest rate used in calculating the Variable Income
Payment amounts.
THE COMPANY - GE Life and Annuity Assurance Company. "We", "us" or "our" refers
to the Company.
CONTRACT - This Contract with any attached application and any riders and
endorsements.
CONTRACT DATE - Date the Contract is issued and becomes effective. The Contract
Date is shown on the Contract data pages and is used to determine Contract years
and anniversaries.
CONTRACT VALUE - The sum of the values allocated to each Investment Option.
DEATH BENEFIT - The benefit provided under the Contract on the death of any
Annuitant prior to the Annuity Commencement Date.
DESIGNATED BENEFICIARY - The person or entity designated in the Contract who on
the date of any Annuitant's death will be treated thereafter as the sole Owner
of the Contract.
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FIXED INCOME PAYMENTS - Income Payments that are supported by the General
Account and which do not vary in amount based on the investment experience of
the Separate Account.
FUND - Any open-end management investment company or unit investment trust in
which a Subaccount invests.
GENERAL ACCOUNT - Assets of the Company other than those allocated to the
Separate Account or any other separate account of the Company.
GUARANTEE ACCOUNT - Amounts allocated under this Contract to be held in our
General Account.
HOME OFFICE - The Company's offices at ▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇,
▇▇▇▇▇▇▇▇ ▇▇▇▇▇.
INCOME PAYMENT - One of a series of payments made under either the monthly
income benefit or one of the Optional Payment Plans.
INVESTMENT OPTIONS - The Guarantee Account and the Separate Account
Subaccount(s) shown on the Contract data pages.
OPTIONAL PAYMENT PLAN - A plan whereby some or all of a Death Benefit, Surrender
Value or Annuity Commencement Value can be left with us to provide Income
Payments to a Payee.
OWNER / JOINT OWNERS - The person(s) or entity entitled to receive Income
Payments after the Annuity Commencement Date. The Owner or Joint Owners are also
entitled to the ownership rights stated in the Contract during the lifetime of
the Annuitant(s) and are shown on the Contract data pages and in any
application. "You" or "your" refers to the Owner or Joint Owners.
PAYEE - Person or entity who receives Income Payments under an Optional Payment
Plan.
PURCHASE PAYMENT - A payment received by the Company and applied to this
Contract. When used in connection with this Contract, the term "Purchase
Payment" means the same as the term "premium payment".
SEPARATE ACCOUNT - The segregated asset account of the Company shown on the
Contract data pages.
SUBACCOUNT - A Subaccount of the Separate Account, the assets of which are
invested exclusively in a corresponding Fund.
SURRENDER VALUE - The Contract Value on the date we receive your written request
for surrender in our Home Office less any premium tax and any applicable
charges. These charges include any optional benefit charges.
VALUATION DAY - For each Subaccount, each day on which the New York Stock
Exchange is open for regular trading except for days that the Subaccount's
corresponding Fund does not value its shares.
VALUATION PERIOD - Period that starts at the close of regular trading on the New
York Stock Exchange on any Valuation Day and ends at the close of regular
trading on the next succeeding Valuation Day.
VARIABLE INCOME PAYMENTS - Income Payments that vary in amount from one Income
Payment to the next based on the investment experience of one or more
Subaccounts.
INTRODUCTION
________________________________________________________________________________
This is a flexible premium variable deferred annuity contract. The initial
Purchase Payment is due on the Contract Date. Additional Purchase Payments may
be paid at any time before the Annuity Commencement Date. In return for these
Purchase Payments and any application, we provide certain benefits. These
benefits are not less than any minimum benefits required by law in the state in
which the Contract is delivered.
The Contract provides a monthly income beginning on the Annuity Commencement
Date. The amount of monthly income will depend on:
. the Annuity Commencement Value;
. the amount of any premium tax;
. the Annuitant(s)'s gender, where appropriate, and settlement age on the
Annuity Commencement Date; and
. the payment plan chosen.
See Optional Payment Plans section for the payout plans available. See
conditions described in the Death Provisions section for details regarding
payment or the continuation of the Contract at the death of any Owner or
Annuitant prior to the Annuity Commencement Date.
On your request, we will provide you with your current Contract Value.
The Contract and Its Parts
This Contract is a legal contract. It is the entire contract between you and us.
An agent cannot change this Contract. Any change to it must be in writing and
approved by us. Only an authorized officer can give our approval. READ THIS
CONTRACT CAREFULLY.
All statements in any application are considered representations and not
warranties.
We reserve the right to amend this Contract as needed to maintain its status as
an annuity under the Internal Revenue Code. If the Contract is amended, we will
send you a copy of the amendment complying with the requirements imposed by the
Internal Revenue Service ("IRS"). This Contract is intended to constitute an
annuity within the meaning of the Internal Revenue Code. Its provisions should
be interpreted consistently with this intent.
OWNER, ANNUITANT AND BENEFICIARY PROVISIONS
________________________________________________________________________________
The Owner
You have rights while this Contract is in force. These rights are subject to the
rights of any irrevocable beneficiary and any assignee under an assignment filed
with us.
You may name only your spouse as a Joint Owner. Joint Owners own the Contract
equally with the right of survivorship. Right of survivorship means that if a
Joint Owner dies, his or her interest in the Contract will pass to the surviving
Joint Owner. Disposition of the Contract on death of an Owner is subject to the
Death Provisions.
The Annuitant
The Contract names you or someone else as the Annuitant. You may name a Joint
Annuitant.
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The Beneficiary
The primary beneficiary and any contingent beneficiary can be named in any
application for this Contract or by sending a written request to our Home
Office.
Changing the Owner or Beneficiary
During the Annuitant(s)'s life, you can change the Owner(s) and any beneficiary
if you reserved this right. A person named irrevocably may be changed only with
that person's written consent. To make a change, send a written request to our
Home Office. The request and the change must be in a form satisfactory to us.
The change will take effect as of the date you sign the request. The change will
be subject to any transaction we make before we record the change. The
Annuitant(s) cannot be changed.
Using the Contract as Collateral for a Loan
This Contract may be assigned as collateral security for a loan. We must be
notified in writing if you assign the Contract. Any payment we make before we
record the assignment at our Home Office will not be affected. We are not
responsible for the validity of an assignment. Your rights and the rights of a
beneficiary may be affected by an assignment. The basic benefits of the Contract
are assignable. Additional benefits added by any rider may or may not be
available/eligible for assignment.
Trustee
If a trustee is named as the Owner or beneficiary of this Contract and
subsequently exercises ownership rights or claims benefits hereunder, we will
have no obligation to verify that a trust is in effect. We will have no
obligation to verify that the trustee is acting within the scope of his/her
authority. Payment of Contract benefits to the trustee will release us from all
obligations under the Contract to the extent of the payment. When we make a
payment to the trustee, we will have no obligation to ensure that such payment
is applied according to the terms of the trust agreement.
DEATH PROVISIONS
________________________________________________________________________________
When a Distribution Is Required
In certain circumstances, federal tax law requires that distributions be made
under this Contract. Except as described below, a distribution is required at
the first death of:
(a) an Owner or Joint Owner; or
(b) the Annuitant or Joint Annuitant if any Owner is a non-natural entity.
The amount of proceeds available on death and the methods available for
distributing such proceeds are also described in this section.
Designated Beneficiary
At the first death of (a) an Owner or Joint Owner, or (b) the Annuitant or Joint
Annuitant if any Owner is a non-natural entity, the person or entity first
listed below who is alive or in existence on the date of that death will become
the Designated Beneficiary:
(1) Owner or Joint Owners
(2) primary beneficiary
(3) contingent beneficiary
(4) Owner's estate
The Designated Beneficiary will be treated thereafter as the sole Owner of the
Contract and may choose one of the payment choices below, subject to the
distribution rules stated below. For purposes of this section, if there is more
than one Designated Beneficiary, each one will be treated separately with
respect to their portion of the Contract.
Distribution Rules When Death Occurs Before Income Payments Begin
If the Designated Beneficiary is the surviving spouse of the deceased person, we
will continue the Contract in force with the surviving spouse as the new Owner.
If the deceased person was an ▇▇▇▇▇▇▇▇▇, the surviving spouse will automatically
become the new sole Annuitant. Any other surviving Joint Annuitant will be
removed from the Contract. At the death of the surviving spouse, this provision
may not be used again. The provision below regarding If the Designated
Beneficiary is not the surviving spouse must be used instead.
If the Designated Beneficiary is not the surviving spouse of the deceased
person, this Contract cannot be continued in force indefinitely. Instead, after
the date of death:
. No further Purchase Payments will be accepted.
. Payments must be made to, or for the benefit of, the Designated
Beneficiary under one of the payment choices listed below.
. If no choice is made by the Designated Beneficiary within 30 days
following receipt of due proof of death, we will use payment choice 2.
. If the Designated Beneficiary dies before the entire Surrender Value has
been distributed, we will pay in a lump sum payment any Surrender Value
still remaining to the person named by the Designated Beneficiary or, if
no person is so named, to the Designated Beneficiary's estate.
Payment Choices:
(1) Receive the Surrender Value in one lump sum payment upon receipt of due
proof of death;
(2) Receive the Surrender Value at any time during the five year period
following the date of death by withdrawing Contract Value or surrendering
the Contract. At the end of that five year period, we will pay in a lump
sum payment any Surrender Value still remaining;
(3) Apply the Surrender Value to provide an income under Optional Payment Plan
1 or 2. The first Income Payment must be made no later than one year after
the date of death. The income payment period must be either (1) the
lifetime of the Designated Beneficiary, or (2) a period not exceeding the
Designated Beneficiary's life expectancy. If a lifetime payout is
selected, any period certain guarantee must not exceed the Designated
Beneficiary's life expectancy.
Under payment choices (1) and (2), this Contract will terminate upon payment of
the entire Surrender Value. Under payment choice (3), this Contract will
terminate when the Surrender Value is applied to the Optional Payment Plan. Due
proof of death must be provided within 90 days of death.
Proceeds When Death Occurs Before Income Payments Begin
If any Owner dies and that person is someone other than an Annuitant, the amount
of proceeds available is the Surrender Value. We will distribute the Surrender
Value to, or for the benefit of, the Designated Beneficiary as described
previously in this section.
If any Annuitant dies, regardless of whether he/she is also an Owner or Joint
Owner, the amount of proceeds available is the Death Benefit. On receipt of due
proof of death, the Surrender Value will equal the Death Benefit and will be
treated in accordance with instructions you provided subject to the distribution
rules and termination of Contract provisions described above.
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Death Benefit Available at Death of Any Annuitant
The Death Benefit is equal to the greater of:
(a) Purchase Payments less any withdrawals and any applicable premium tax; and
(b) the Contract Value on the date of receipt of due proof of death.
When Death Benefit is Calculated at Death of Any Annuitant
The Death Benefit is calculated on the date that we receive due proof of death.
Until we receive complete written settlement instructions from the beneficiary,
the calculated Death Benefit will remain allocated to the various Investment
Options according to your last instructions. Therefore, the Death Benefit will
fluctuate with the performance of the underlying Investment Options.
Distribution Rules When Death Occurs After Income Payments Begin
If any Owner, Annuitant or Payee dies after Income Payments have begun, the
entire interest remaining in the Contract will be distributed at least as
rapidly as under the method of distribution being used on the date of death.
Under this scenario, "entire interest" means any guaranteed payments remaining
under the payment plan in effect on the date of death.
PURCHASE PAYMENTS
________________________________________________________________________________
The initial Purchase Payment is due on the Contract Date.
Additional Purchase Payments
You may make additional Purchase Payments at any time before the Annuity
Commencement Date. The minimum amount allowed as an additional Purchase Payment
is defined on the Contract data pages. We reserve the right to limit the maximum
amount of any additional Purchase Payment we will accept based on our rules in
effect at the time of the payment.
Where to Send Purchase Payments
Send each Purchase Payment to our Home Office. Make any checks payable to GE
Life and Annuity Assurance Company.
Allocation of Purchase Payments
You may allocate Purchase Payments to one or more Investment Options. The
maximum number of Investment Option allocations allowed is shown on the Contract
data pages. The minimum percentage of each Purchase Payment that may be
allocated to any particular Investment Option is also provided on the Contract
data pages. Purchase Payments will be allocated in accordance with your
instructions we have on file.
You may change the allocation of later Purchase Payments at any time, without
charge, by sending a notice to us at our Home Office. The notice must be in
writing or in any form acceptable to us. The allocation will apply to Purchase
Payments received after we receive the change.
MONTHLY INCOME BENEFIT
________________________________________________________________________________
We will pay you a monthly income for a guaranteed minimum period beginning on
the Annuity Commencement Date if the Annuitant(s) is still living. The monthly
income will be a Variable Income Payment similar to that described in the
provision titled "Variable Income Options" under the Optional Payment Plans
section. Payments will be made automatically under a Life Income with 10 Years
Certain plan or a Joint Life and Survivor Income with 10 years Certain plan,
unless you choose otherwise.
Under the Life Income 10 Years Certain plan, if the Annuitant lives longer than
10 years, payments will continue for his or her life. If the Annuitant dies
before the end of ten years, the remaining payments for the ten year period will
be discounted at the same rate used to calculate the monthly income. The
discounted amount will be paid in one sum to you.
Under the Joint Life and Survivor Income plan, if any Annuitant lives longer
than 10 years, payments will continue for the surviving Annuitant's lifetime. If
both Annuitants die before the end of ten years, the remaining payments for the
ten year period will be discounted at the same rate used to calculate the
monthly income. The discounted amount will be paid in one sum to you.
At any time, while the Annuitant(s) is living, and before the Annuity
Commencement Date, you may choose to change the payment plan by written request.
If you do choose a different plan, the monthly income will reflect the plan
chosen. Payment plans which base payment on the life or lives of one or more
individuals will base such payment on the life of the Annuitant or the Annuitant
and Joint Annuitant. You may elect to receive the Annuity Commencement Value in
a lump sum instead of receiving a monthly income. If we pay the Annuity
Commencement Value in a lump sum, we will have no further obligations under the
Contract.
The initial Income Payment under the automatic monthly payment plan is
calculated by multiplying (a) times (b), divided by (c) where:
(a) is the monthly payment rate per $1000, shown under the Optional Payment
Plans for either the Life Income 10 years Certain or the Joint Life and
Survivor Income, using the gender(s) and settlement age(s) of the
Annuitant(s), instead of the Payee, on the Annuity Commencement Date. The
age used to determine the payment may be subject to an age adjustment as
shown in the "Maximum Age Adjustment" table in the Optional Payment Plans
section;
(b) is the Annuity Commencement Value; and
(c) is $1000.
Income Payments will be made monthly unless quarterly, semi-annual or annual
payments are chosen by written request. However, if any payment made more
frequently than annually would be or becomes less than $100, we reserve the
right to reduce the frequency of payments to an interval that would result in
each payment being at least $100. If the annual payment is less than $20, we
will pay the Annuity Commencement Value and the Contract will terminate
effective as of the Annuity Commencement Date.
Annuity Commencement Date
The Annuity Commencement Date is provided on the Contract data pages, unless
changed after issue. You may change the Annuity Commencement Date until Income
Payments begin. The Annuity Commencement Date cannot be a date later than the
Contract anniversary on which the Annuitant, or younger of the Joint Annuitants,
reaches age 90, unless a later date is approved by the Company. To make a
change, send us written notice before the Annuity Commencement Date then in
effect. If you change the Annuity Commencement Date, ▇▇▇▇▇▇▇ Commencement Date
will then mean the new Annuity Commencement Date you selected.
GUARANTEE ACCOUNT
________________________________________________________________________________
You may allocate Purchase Payments and/or transfer Contract Value to the
Guarantee Account. Amounts allocated to the Guarantee Account earn interest at
the rate applicable to the particular allocation. With respect to each
allocation, the applicable rate will remain in effect for a specified period
(the interest rate guarantee period). You may also make transfers or withdrawals
from the Guarantee Account as described in this Contract.
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Amounts allocated to the Guarantee Account are held in, and are part of, our
General Account. The General Account consists of our assets other than those
allocated to our separate accounts. Subject to statutory authority, we have sole
discretion over the investment of the assets of the General Account. Those
assets may be chargeable with liabilities arising out of any business we may
conduct.
Any Surrender Value or Death Benefit available under the Guarantee Account will
not be less than required by the laws of your state.
SEPARATE ACCOUNT
________________________________________________________________________________
The Separate Account named on the Contract data pages supports the operation of
this Contract and certain other variable annuity contracts we may offer. We will
not allocate assets to the Separate Account to support the operation of any
contracts that are not variable annuities.
We own the assets in the Separate Account. These assets are held separately from
our other assets and are not part of our General Account.
The Separate Account is registered with the Securities and Exchange Commission
("SEC") as a unit investment trust under the Investment Company Act of 1940. The
Separate Account is also subject to ▇▇▇▇▇▇▇▇ ▇▇▇▇ which regulate the operations
of insurance companies incorporated in Virginia. The investment policies of the
Separate Account will not be changed without the approval of the Virginia
Insurance Commissioner.
Insulation of Assets
The Separate Account assets equal the reserves and other Contract liabilities
supported by the Separate Account. These assets will not be charged with
liabilities arising from any other business we conduct. We have the right to
transfer to our General Account any assets of the Separate Account which are in
excess of such reserves and other Contract liabilities.
Subaccounts
The Separate Account is divided into Subaccounts. The Subaccount's income, gains
and losses, whether realized or unrealized, are credited to or charged against
such Subaccounts. This transaction is made without regard to other income, gains
or losses of the Company or any other Subaccount.
The Subaccounts available under this Contract are shown on the Contract data
pages. Each Subaccount invests exclusively in shares of a corresponding Fund.
Shares of a Fund are purchased and redeemed at their net asset value per share.
Any amounts of income, dividends and gains distributed from the shares of a Fund
are reinvested in additional shares of that Fund at its net asset value.
Changes To The Separate Account And Subaccounts
Where permitted by applicable law, we may:
. create new separate accounts;
. combine separate accounts, including the Separate Account;
. transfer assets of the Separate Account to another separate account;
. add new Subaccounts to or remove existing Subaccounts from the Separate
Account or combine Subaccounts;
. make Subaccounts (including new Subaccounts) available to such classes of
contracts as we may determine;
. add new Funds or remove existing Funds;
. substitute new Funds for any existing Fund whose shares are no longer
available for investment;
. substitute new Funds for any existing Fund which we determine is no longer
appropriate in light of the purposes of the Separate Account;
. deregister the Separate Account under the Investment Company Act of 1940;
and
. operate the Separate Account under the direction of a committee or in any
other form permitted by law.
In the event of any substitution or change, we may, by endorsement, make such
changes in this and other contracts as may be necessary or appropriate to
reflect the substitution or change.
Valuation of Separate Account Assets
We will value the assets of the Separate Account each Valuation Day at their
fair market value in accordance with accepted accounting practices and
applicable laws and regulations.
Accumulation Units
Purchase Payment(s) allocated to a Subaccount or amounts transferred to a
Subaccount are converted into Accumulation Units. The number of Accumulation
Units is determined by dividing the dollar amount allocated to each Subaccount
by the value of the Accumulation Unit for that Subaccount for the Valuation Day
on which the Purchase Payment(s) or transferred amount is invested in the
Subaccount. Purchase Payment(s) allocated to or amounts transferred to a
Subaccount increase the number of Accumulation Units of that Subaccount.
The events which will reduce the number of Accumulation Units of a Subaccount
are as follows:
(1) withdrawals or transfers of Contract Value from a Subaccount;
(2) surrender of the Contract;
(3) payment of a Death Benefit;
(4) application of Contract Value to an Income Payment option; and
(5) applicable Contract and/or rider fees and charges.
Accumulation Units are canceled as of the end of the Valuation Period in which
we receive notice regarding the event.
Accumulation Unit Value
The value of an Accumulation Unit for each Subaccount was arbitrarily set when
the Subaccount began operations. Thereafter, the value of an Accumulation Unit
at the end of every Valuation Day is the value of the Accumulation Unit at the
end of the previous Valuation Day multiplied by the net investment factor, as
described below. On any day that is a Valuation Day, the Contract Value in a
Subaccount is determined by multiplying the number of Accumulation Units in that
Subaccount by the value of the Accumulation Unit for that Subaccount.
Net Investment Factor
The net investment factor is used to measure the investment performance of a
Subaccount. The net investment factor for any Subaccount for any Valuation
Period is determined by (a) divided by (b), minus (c), where:
(a) is the result of:
(1) the value of the assets in the Subaccount at the end of the preceding
Valuation Period; plus
(2) the investment income and capital gains, realized or unrealized,
credited to those assets at the end of the Valuation Period for which
the net investment factor is being determined; minus
(3) the capital losses, realized or unrealized, charged against those
assets during the Valuation Period; minus
(4) any amount charged against the Separate Account for taxes. This
includes any amount we
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set aside during the Valuation Period as a provision for taxes
attributable to the operation or maintenance of the Separate Account;
and
(b) is the value of the assets in the Subaccount at the end of the preceding
Valuation Period; and
(c) is a factor for the Valuation Period representing the asset charge
deducted from the Subaccount. The rate for this charge is shown on the
Contract data pages.
TRANSFERS
________________________________________________________________________________
Transfers Before Income Payments Begin
You may transfer amounts among the Investment Options by sending a request to us
at our Home Office. Transfers involving the Guarantee Account are subject to
limitations defined in this Contract. Transfer requests must be in writing or in
any form acceptable to us. We do not currently charge for transfers. We reserve
the right to impose a transfer charge.
The maximum amount of any transfer charge is provided on the Contract data
pages. When we perform transfers, the Contract Value on the date of the transfer
will not be affected by the transfer except to the extent of any transfer
charge. Any transfer charge will be taken from the amount transferred.
Transfers involving the Guarantee Account will be effective on the date we
receive your request at our Home Office. With respect to transfers between the
Guarantee Account and the Separate Account, we reserve the right to impose the
following restrictions:
(1) No transfers from the Separate Account to the Guarantee Account may be
made during the six month period following the transfer of any amount from
the Guarantee Account to the Separate Account; and
(2) For each allocation to the Guarantee Account, transfers to the Separate
Account may be made only during the 30-day period following the end of the
allocation's interest rate guarantee period. We may limit the amount that
you can transfer during that time, but the limit will not be less than a
percentage of the original allocation, plus any accrued interest on that
allocation. The percentage used to determine this limit will be the lesser
of (a) 100% and (b) 25% times the number of years in the guarantee period
that just ended.
On written notice, we reserve the right to limit the number of transfers to one
per month or to twelve each calendar year. We reserve the right to limit the
number of transfers to a lower number. This may be necessary for the Contract to
continue to be treated as an annuity by the IRS. We reserve the right to refuse
to execute any transfer:
(1) if any of the Subaccounts that would be affected by the transfer is unable
to purchase or redeem shares of the Fund in which the Subaccount invests;
or
(2) if the transfer is a result of more than one trade involving the same
Subaccount within a 30 day period; or
(3) if the transfer would adversely affect accumulation unit values. This may
occur if the transfer would affect one percent or more of the relevant
Fund's total assets.
Transfers will be effective as of the end of the Valuation Period during which
we receive your request at our Home Office. If the amount of your Contract Value
remaining in an Investment Option after the transfer is less than the minimum
balance stated on the Contract data pages, we will transfer the remaining
balance in addition to the amount requested for transfer. We will not allow a
transfer into any Investment Option unless the value of that Investment Option
after the transfer is at least equal to the amount stated on the Contract data
pages.
Where permitted by law, we may accept your authorization of third party
transfers. We may restrict the Subaccounts that will be available to you for
transfers. This restriction may occur during any period such third party is
authorized to act for you. We will give you prior notice of any restrictions. We
will not enforce such restrictions if you provide us with satisfactory evidence
that:
(1) a court of competent jurisdiction has appointed such third party to act
for you; or
(2) you have appointed such third party to act for you for all of your
financial affairs.
Transfers After Variable Income Payments Begin
If Variable Income Payments are being made, you may transfer Annuity Units among
Subaccounts by sending a request to us at our Home Office. This request must be
in writing or in any form acceptable to us. You may make three such transfers in
each calendar year. We reserve the right to limit the number of transfers. This
may be necessary for the Contract to continue to be treated as an annuity by the
IRS. We reserve the right to refuse to execute any transfer if any of the
Subaccounts that would be affected by the transfer is unable to purchase or
redeem shares of the Fund in which the Subaccount invests. If the number of
Annuity Units remaining in a Subaccount after a transfer is less than 1, we will
transfer the remaining balance in addition to the amount requested for transfer.
We will not allow a transfer into any Subaccount unless the number of Annuity
Units of that Subaccount after the transfer is at least 1. No transfer charge is
imposed for transfers of Annuity Units. The amount of the Income Payment as of
the date of the transfer will not be affected by the transfer.
The number of Annuity Units for the new Subaccount is (a) times (b), divided by
(c), where:
(a) is the number of Annuity Units for the current Subaccount:
(b) is the value of the Annuity Unit for the current Subaccount;
(c) is the value of the Annuity Unit for the new Subaccount.
CONTRACT VALUE BENEFITS
________________________________________________________________________________
The Contract Value is equal to the Contract Value allocated to the Investment
Options. On the date the initial Purchase Payment is received and accepted, the
Contract Value equals the initial Purchase Payment.
Contract Value of the Separate Account
At the end of each Valuation Period after the Contract Date, the Contract Value
allocated to each Subaccount is (a) plus (b) plus (c) minus (d) minus (e) minus
(f), where:
(a) is the Contract Value allocated to the Subaccount at the end of the
preceding Valuation Period, multiplied by the Subaccount's net investment
factor for the current Valuation Period;
(b) is Purchase Payments allocated to the Subaccount during the current
Valuation Period;
(c) is any other amounts transferred into the Subaccount during the current
Valuation Period;
(d) is Contract Value transferred out of the Subaccount during the current
Valuation Period;
(e) is any withdrawal made from the Subaccount during the current Valuation
Period; and
(f) is any premium tax deductions.
Contract Value of the Guarantee Account
The Contract Value of the Guarantee Account is (a) plus (b) minus (c) minus (d),
where:
(a) is the sum of all amounts allocated to it;
(b) is any interest credited on those amounts;
(c) is any amounts removed by transfer or surrender; and
(d) is any amounts deducted for charges made under the Contract and any riders
that may apply.
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You may distribute any allocation to one or more of the interest rate guarantee
periods available at the time of your allocation. Unless you choose otherwise,
the initial interest rate guarantee period will be one year. Each interest rate
guarantee period must be at least one year. At the end of each interest rate
guarantee period, a new interest rate guarantee period of one year, with a new
rate, will begin. We will notify you of the new rate.
Interest rates that apply to allocations to the Guarantee Account are determined
by us in our sole discretion. The minimum guaranteed interest rate is shown on
the Contract data pages.
Deductions from the Contract Value for any charges that may apply are made first
from the Contract Value of the Separate Account. These charges are deducted
proportionally from the Subaccounts in which you are invested. Any remaining
charge will be deducted from the Contract Value of the Guarantee Account. This
charge will be taken proportionally from the money in the Guarantee Account. No
deduction will occur if it would reduce the Surrender Value below any minimum
value that might be required by applicable state law.
Surrender
You can surrender this Contract by sending the Contract and a written request to
our Home Office. We must receive the request before Income Payments begin. The
amount payable is the Surrender Value as of the Valuation Day we receive the
request.
Withdrawal
You may make a withdrawal from the Contract Value at any time before Income
Payments begin. The allowable withdrawal amount is subject to limitations as
defined on the Contract data pages. The amount payable will be the amount of the
withdrawal less any applicable premium tax as of the date we receive the
request.
You may tell us how to deduct the withdrawal from the Investment Options. If you
do not, the withdrawal will be deducted first from each Subaccount in the same
proportion that the Contract Value in that Subaccount bears to the total
Contract Value in all Subaccounts on the Valuation Day we receive the request in
our Home Office. If the amount of the withdrawal exceeds the Contract Value in
the Subaccount(s), any remaining deductions will be made from the Guarantee
Account. The amounts deducted from the Guarantee Account will be taken on a
first-in, first-out basis. "First-in, first-out" means the order in which
Purchase Payments and transferred amounts were allocated to the Guarantee
Account.
Postponement of Payments
We will make payment within seven days from the date of withdrawal or surrender.
We will make payment within seven days from the receipt of due proof of death
for a lump sum claim settlement. We may postpone these payments when:
. the New York Stock Exchange is closed other than customary weekend and
holiday closings; or
. the SEC restricts trading on the New York Stock Exchange; or
. the SEC permits postponement for the protection of contractowners; or
. the SEC determines an emergency exists and due to the emergency, disposal
of securities or the determination of the values of net assets of the
Separate Account is not reasonably practical.
We reserve the right to defer payment of any withdrawal or surrender from the
Guarantee Account for up to six months. We will not defer payment if we are
required by law to pay earlier. We will not defer payment if the amount is used
to pay Purchase Payments on contracts with us.
We have the right to defer payment which is derived from any amount recently
paid to us by check or draft. We will make payment when we are satisfied the
check or draft has been paid by the bank on which it is drawn.
GENERAL INFORMATION
________________________________________________________________________________
Statement of Values
At least once each year, we will send you a Contract statement. The statement
will be mailed within 30 days of the statement date. The statement date will be
on at least one of the following dates: March 31st, June 30th, September 30th
and December 31st. The statement will show the Contract Value, Purchase Payments
made, number of Accumulation Units, values of Accumulation Units, and charges
deducted during the statement period.
Evidence of Death, Age, Gender or Survival
We will require proof of death before we act on Contract provisions relating to
death of any person or persons. We may also require proof of the age, gender, or
survival of any person or persons before we act on any Contract provision
dependent upon age, gender or survival.
Incontestability
We will not contest this Contract.
Misstatement of Age or Gender
If any Annuitant's age or gender, where appropriate, is misstated on the
Contract data page, any Contract benefits or proceeds will be determined using
the correct age and gender.
Premium Tax
Premium tax rules vary by state and change from time to time. Some states assess
a tax against us on receipt of Purchase Payments and some states on
annuitization of proceeds. (Currently there is no premium tax in New Mexico.)
Tax assessed on receipt of Purchase Payments: The premium tax rate shown on the
Contract data pages is the rate that was in effect in your state at Contract
issue. To calculate any premium tax in effect on the date we receive the
Purchase Payment, multiply the Purchase Payment by the premium tax rate. This is
the amount of any state and/or local premium tax charged to us for this
Contract. We reserve the right to deduct any such tax either from your Purchase
Payment(s) when received, or from proceeds later when paid. (Proceeds includes
benefits from surrender, withdrawal, annuity commencement and death.)
Tax assessed on annuitization of proceeds: Since some states assess a premium
tax on proceeds used to purchase Income Payments, we reserve the right to deduct
from such proceeds any premium tax paid by us. Because state premium tax rules
change from time to time, any tax rate for proceeds used to purchase Income
Payments is not shown in your Contract. You may request notice of the amount of
this tax before Income Payments begin.
Nonparticipating
This Contract is nonparticipating. No dividends are payable.
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Written Notice
You should send written notice to our Home Office. Please include the Contract
number and the Annuitant(s)'s full name.
We will send notices to your last known address. You should request an address
change form if you move.
OPTIONAL PAYMENT PLANS
________________________________________________________________________________
Death Benefit and Surrender Value proceeds will be paid in one lump sum. Annuity
Commencement Value will be paid as described in the Monthly Income Benefit
section. Subject to the rules stated below, any part of the Death Benefit or
Surrender Value proceeds can be left with us and paid under an Optional Payment
Plan. If you choose to do so, the proceeds less any premium tax will be applied
to calculate your Income Payment. During the Annuitant(s)'s life you (or the
Designated Beneficiary at your death) can choose a plan. If a plan has not been
chosen at the death of the Annuitant or Owner, the Designated Beneficiary can
choose a plan if the Death Benefit is to be paid.
There are several important Optional Payment Plan rules:
. Our consent must be obtained prior to selecting an Optional Payment Plan if
any Payee is not a natural person.
. Payment made under an Optional Payment Plan at the death of any Owner or
Annuitant must conform with the rules in the Death Provisions section.
. If you change a beneficiary, your plan selection will no longer be in
effect unless you request that it continue.
. Any choice or change of a plan must be sent in writing to our Home Office.
. The amount of each payment under a plan must be at least $100.
. Fixed Income Payments will begin on the date we receive proof of any
Annuitant's or Owner's death, on surrender, or on the Annuity Commencement
Date.
. Variable Income Payments will begin within seven days after the date
payments would begin under the corresponding fixed option.
. Payments under Plan 4 will begin at the end of the first interest period
after the date proceeds are otherwise payable.
Fixed Income Options
Optional Payment Plans 1 through 5 are available as fixed income options. Any
amount left with us under a fixed income option will be transferred to our
General Account. Payments made will equal or exceed those required by the state
where this Contract is delivered. The age used to determine the payment may be
subject to an adjustment as shown in the age adjustment table below.
Variable Income Options
Optional Payment Plans 1 and 5 are available as variable income options. This
means that Income Payments, after the first, will reflect the investment
experience of the Subaccounts. No minimum amount is guaranteed.
Determination of the Amount of the First Variable Income Payment: The tables for
Optional Payment Plans 1 and 5 are used to determine the first Income Payment.
They show, for various plans, ages and genders, the monthly payment that can be
purchased with $1,000 of proceeds. The first payment is equal to (a) times (b),
divided by 1,000, where:
(a) is the Contract Value as of the Annuity Commencement Date, less any
premium taxes; and
(b) is the monthly payment from the table for the chosen plan and appropriate
age(s) and gender(s) of the Annuitant(s). The age used to determine the
payment may be subject to an adjustment as shown in the age adjustment
table below.
These amounts use the 1983 'a' Individual Annuity Mortality Table, modified,
with an Assumed Interest Rate of 3%.
Determination of the Amount of Subsequent Variable Income Payments: Subsequent
payments are determined by means of Annuity Units. The amount may be greater or
less than the initial payment.
The number of Annuity Units will be determined on the Annuity Commencement Date.
The number will not change unless a transfer is made. The number of Annuity
Units for a Subaccount is (a) divided by (b), where:
(a) is the portion of the first payment from that Subaccount; and
(b) is the Annuity Unit value for that Subaccount on the day the first payment
is due.
Each subsequent payment is equal to the sum of payments for each Subaccount. The
payment for a Subaccount is the number of Annuity Units for that Subaccount
times the Annuity Unit value for that Subaccount seven days before the monthly
anniversary of the Annuity Commencement Date.
We guarantee that each subsequent payment will not be affected by variations in
mortality experience from the mortality assumptions on which the first payment
is based.
Determination of Annuity Unit Value: Initially, the Annuity Unit value was
arbitrarily set at the start of the Subaccount. The Annuity Unit value of each
Subaccount for any Valuation Period is equal to the Annuity Unit value for the
preceding Valuation Period multiplied by the product of (a) and (b), where:
(a) is the net investment factor for the Valuation Period for which the
Annuity Unit value is being calculated; and
(b) is an Assumed Interest Rate factor equal to .99991902 raised to a power
equal to the number of days in the Valuation Period.
The Assumed Interest Rate factor in (b) is the daily equivalent of dividing by
one plus the Assumed Interest Rate of 3%. If a plan with a different Assumed
Interest Rate is used to determine the initial payment, a different Assumed
Interest Rate factor will be used to determine subsequent payments.
As described above, our determination of an Accumulation Unit value or Annuity
Unit value will be binding on you and any Designated Beneficiary.
Payment Plans
The fixed income options are shown below. Variable income options, with an
Assumed Interest Rate of 3%, have the same initial monthly payment rate per
$1000 as the fixed income options shown in the Plan 1 and Plan 5 Tables. The
monthly payment rate is based on the 1983 Table `a', using 3% interest. Other
plans may be available upon request.
Plan 1. Life Income with Period Certain. We will make monthly payments for a
guaranteed minimum period. If the Payee lives longer than the minimum period,
payments will continue for his or her life. The minimum period can be 10, 15 or
20 years. Payments will be according to the table below. Guaranteed amounts
payable under this plan will earn interest at 3% compounded yearly. We may
increase the interest rate and the amount of any payment. If the Payee dies
before the end of the guaranteed period, the amount of remaining payments for
the minimum period will be discounted at the same rate used in calculating
Income Payments. Discounted means we will deduct the amount of interest each
remaining payment would have earned had it not been paid out early. The
discounted amounts will be paid in one sum to the Payee's estate unless
otherwise provided.
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Plan 1 Table
Monthly payment rates for each $1,000 of proceeds under Plan 1.
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Male Payee Female Payee Male Payee Female Payee
Settlement ------------------------------------------------------ ------------------------------------------------------
Age 10 Years 15 Years 20 Years 10 Years 15 Year 20 Years Settlement 10 Years 15 Years 20 Years 10 Years 15 Years 20 Years
Certain Certain Certain Certain Certain Certain Age Certain Certain Certain Certain Certain Certain
-----------------------------------------------------------------------------------------------------------------------------------
20 $2.90 $2.90 $2.89 $2.81 $2.81 $2.81 65 $5.51 $5.22 $4.86 $4.91 $4.77 $4.58
25 3.00 2.99 2.99 2.88 2.88 2.88 66 5.66 5.33 4.92 5.03 4.88 4.65
30 3.11 3.11 3.10 2.97 2.97 2.97 67 5.81 5.43 4.99 5.17 4.99 4.73
35 3.26 3.25 3.24 3.09 3.08 3.08 68 5.97 5.54 5.05 5.31 5.10 4.80
40 3.45 3.43 3.41 3.23 3.23 3.22 69 6.13 5.65 5.10 5.46 5.21 4.88
45 3.68 3.66 3.62 3.42 3.41 3.39 70 6.30 5.75 5.16 5.62 5.33 4.95
50 3.98 3.94 3.88 3.65 3.64 3.61 71 6.48 5.85 5.21 5.79 5.45 5.02
51 4.05 4.00 3.93 3.71 3.69 3.66 72 6.66 5.95 5.25 5.97 5.57 5.08
52 4.12 4.07 3.99 3.77 3.74 3.71 73 6.84 6.05 5.29 6.15 5.69 5.14
53 4.20 4.14 4.05 3.83 3.80 3.76 74 7.02 6.14 5.33 6.34 5.81 5.20
54 4.28 4.21 4.11 3.89 3.86 3.82 75 7.20 6.23 5.36 6.54 5.92 5.25
55 4.36 4.29 4.18 3.96 3.93 3.88 76 7.39 6.31 5.39 6.74 6.03 5.29
56 4.45 4.37 4.24 4.03 3.99 3.94 77 7.57 6.39 5.41 6.95 6.13 5.33
57 4.55 4.45 4.31 4.11 4.07 4.00 78 7.75 6.46 5.43 7.15 6.23 5.36
58 4.65 4.53 4.38 4.19 4.14 4.07 79 7.93 6.52 5.45 7.36 6.32 5.39
59 4.75 4.62 4.45 4.28 4.22 4.13 80 8.09 6.58 5.47 7.57 6.41 5.42
60 4.86 4.72 4.52 4.37 4.30 4.20 81 8.26 6.63 5.48 7.78 6.48 5.44
61 4.98 4.81 4.59 4.46 4.39 4.27 82 8.41 6.67 5.49 7.97 6.55 5.46
62 5.10 4.91 4.65 4.56 4.48 4.35 83 8.56 6.71 5.49 8.16 6.60 5.47
63 5.23 5.01 4.72 4.67 4.57 4.42 84 8.69 6.74 5.50 8.34 6.65 5.48
64 5.37 5.11 4.79 4.79 4.67 4.50 85&over 8.81 6.77 5.50 8.50 6.70 5.49
--------------------------------------------------------------------------------------------------------------------------------
Values for ages not shown will be furnished upon request..
Plan 2. Income for a Fixed Period. We will make periodic payments for a fixed
period, not longer than 30 years. Payments can be annual, semi-annual, quarterly
or monthly. Payments will be made according to the table below. Guaranteed
amounts payable under this plan will earn interest at 3% compounded yearly. We
may increase the interest and the amount of any payment. If the Payee dies, the
amount of the remaining guaranteed payments will be discounted to the date of
the Payee's death at the same rate used in calculating Income Payments. The
discounted amount will be paid in one sum to the Payee's estate unless otherwise
provided.
Plan 2 Table
Monthly payment rates for each $1,000 of proceeds under Plan 2.
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Years 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Payable
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Monthly $84.47 $42.86 $28.99 $22.06 $17.91 $15.14 $13.16 $11.68 $10.53 $9.61 $8.86 $8.24 $7.71 $7.26 $6.87
Payment
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Years 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Payable
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Monthly $6.53 $6.23 $5.96 $5.73 $5.51 $5.32 $5.15 $4.99 $4.84 $4.71 $4.59 $4.47 $4.37 $4.27 $4.18
Payment
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Annual, semi-annual or quarterly payments are determined by multiplying the
monthly payment by 11.838, 5.963 or 2.992, respectively.
Plan 3. Income of a Definite Amount. We will make periodic payments of a
definite amount. Payments can be annual, semi-annual, quarterly or monthly. The
amount paid each year must be at least $120 for each $1,000 of proceeds.
Payments will continue until the proceeds are exhausted. The last payment will
equal the amount of any unpaid proceeds. Unpaid proceeds will earn interest at
3% compounded yearly. We may increase the interest rate. If we do, the payment
period will be extended. If the Payee dies, the amount of the remaining proceeds
with earned interest will be paid in one sum to his or her estate unless
otherwise provided.
Plan 4. Interest Income. We will make periodic payments of interest earned from
the proceeds left with us. Payments can be annual, semi-annual, quarterly or
monthly, and will begin at the end of the first period chosen. Proceeds left
under this plan will earn interest at 3% compounded yearly. We may increase the
interest rate and the amount of any payment. If the Payee dies, the amount of
remaining proceeds and any earned but unpaid interest will be paid in one sum to
his or her estate unless otherwise provided.
Plan 5. Joint Life and Survivor Income. We will make monthly payments to two
Payees for a guaranteed minimum of 10 years. Each Payee must be at least 35
years old when payments begin. The amount payable under this plan will earn
interest at 3% compounded yearly. We may increase the interest rate and the
amount of any payment. Payments will continue as long as either Payee is living.
If both Payees die before the end of the minimum period, the amount of the
remaining payments for the 10 year period will be discounted at the same rate
used in calculating the monthly income. The discounted amount will be paid in
one sum to the survivor's estate unless otherwise provided.
Plan 5 Table
Monthly payment rates for each $1000 of proceeds under Plan 5.
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Male Settlement Female Settlement Age
Age
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35 40 45 50 55 60 65 70 75 80 85&over
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35 $2.95 $3.02 $3.07 $3.12 $3.16 $3.19 $3.21 $3.23 $3.24 $3.25 $3.26
40 2.99 3.07 3.15 3.22 3.28 3.33 3.37 3.40 3.42 3.43 3.44
45 3.02 3.11 3.21 3.31 3.41 3.49 3.55 3.60 3.64 3.66 3.68
50 3.04 3.15 3.27 3.40 3.53 3.65 3.76 3.84 3.90 3.94 3.97
55 3.05 3.18 3.32 3.48 3.65 3.82 3.98 4.12 4.22 4.29 4.33
60 3.07 3.20 3.35 3.54 3.75 3.97 4.21 4.42 4.60 4.73 4.80
65 3.07 3.21 3.38 3.58 3.82 4.11 4.42 4.74 5.03 5.25 5.39
70 3.08 3.22 3.39 3.61 3.88 4.21 4.60 5.04 5.47 5.84 6.09
75 3.08 3.22 3.40 3.63 3.92 4.28 4.74 5.28 5.87 6.42 6.82
80 3.09 3.23 3.41 3.64 3.94 4.33 4.82 5.45 6.18 6.91 7.50
85&over 3.09 3.23 3.41 3.65 3.95 4.35 4.87 5.55 6.37 7.26 8.00
--------------------------------------------------------------------------------------------------------------
Figures for intermediate ages, for two males or two females will be furnished
upon request.
20
21
Maximum Age Adjustment
Settlement Age: The settlement age is the Payee's age last birthday on the date
payments begin, minus an age adjustment from the table below. The actual age
adjustment may be less than the numbers shown.
-----------------------------------------------------------------
Year Payments Begin Maximum Age
After Prior To Adjustment
-----------------------------------------------------------------
---- 2001 0
2000 2026 5
2025 2051 10
2050 ---- 15
-----------------------------------------------------------------
GE LIFE AND ANNUITY ASSURANCE COMPANY
SURRENDER CHARGE ENDORSEMENT
--------------------------------------------------------------------------------
The Contract to which this endorsement is attached is amended as follows:
Definition of Surrender Value
The definition of Surrender Value is deleted and replaced by the following:
SURRENDER VALUE - The Contract Value on the date we receive your written request
for surrender at our Home Office less any premium tax and any applicable
charges. These charges include any surrender charge and any optional benefit
charges.
The Withdrawal provision is deleted and replaced by the following:
Withdrawal
You may make a withdrawal from the Contract Value at any time before Income
Payments begin. The allowable withdrawal amount is subject to limitations as
defined on the Contract data pages. The amount payable will be the amount of the
withdrawal, less any surrender charge and any applicable premium tax as of the
date we receive the request.
You may tell us how to deduct the withdrawal from the Investment Options. If you
do not, the withdrawal will be deducted first from each Subaccount in the same
proportion that your assets in that Subaccount bears to the total of your assets
in all Subaccounts on the Valuation Day we receive the request in our Home
Office. If the amount of the withdrawal exceeds your assets in the
Subaccount(s), any remaining deductions will be made from the Guarantee Account.
The amounts deducted from the Guarantee Account will be taken on a first-in,
first-out basis. "First-in, first-out" means the order in which Purchase
Payments and transferred amounts were allocated to the Guarantee Account.
The Surrender Charge provision is added to the Contract Value Benefits section
as follows:
Surrender Charge
All or part of the amount withdrawn or surrendered may be subject to a surrender
charge. The surrender charge is a percentage of each Purchase Payment. The
applicable percentage for each Purchase Payment is shown in the Table of
Surrender Charges on the contract data pages. The number of years shown in the
table represents the number of full and partially completed years since the
Purchase Payment was received.
For each Contract year, an amount equal to the free withdrawal amount may be
withdrawn during each Contract year without a surrender charge (the "free
withdrawal amount"). The free withdrawal amount is defined on the Contract data
pages. Any amount withdrawn in excess of the free withdrawal amount may be
subject to a surrender charge. For purposes of determining the applicable
surrender charge, the amount subject to a surrender charge will be deducted from
Purchase Payments on a first-in, first-out basis. Amounts withdrawn which are
not subject to surrender charge may be taken as a series of periodic payments
instead of a lump sum.
There will be no surrender charge if you choose one of the following Optional
Payment Plans:
. Plan 1;
. Plan 2 for a period of 5 or more years;
. Plan 5;
For GE Life and Annuity Assurance Company,
/s/ ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇
--------------------
▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇
President
GE LIFE AND ANNUITY ASSURANCE COMPANY
DEATH BENEFIT AVAILABLE AT DEATH OF ANY ANNUITANT ENDORSEMENT
--------------------------------------------------------------------------------
The Contract to which this endorsement is attached is amended by deleting the
Death Benefit Available at Death of Any Annuitant provision in its entirety and
adding the following:
Death Benefit Available at Death of Any Annuitant
The Death Benefit is equal to the greatest of (a), (b) and (c), where:
(a) is the Purchase Payments less any withdrawals and any applicable
premium tax;
(b) is the Contract Value on the date of receipt of due proof of death; and
(c) is as follows:
o If the Annuitant is, or both the Annuitant and Joint Annuitant
are, age 80 or younger at issue, the value of (c) is equal to
the greatest sum of (1) and (2), where:
(1) is the Contract Value as of any Contract anniversary up to and
including the later of the fifth Contract anniversary or the
Contract anniversary next following or coincident with the
80th birthday of the older of any Annuitant; and
(2) is any Purchase Payments paid since then adjusted for any
applicable premium tax.
o If any Annuitant is older than age 80 at issue, the value of (c)
is equal to the greatest sum of (1) and (2), where:
(1) is the Contract Value as of any Contract anniversary up to and
including the Contract anniversary next following or coincident
with the 85th birthday of the older of any Annuitant; and
(2) is any Purchase Payments paid since then adjusted for any
applicable premium tax.
Withdrawals reduce the value of (c) proportionally by the same
percentage that the withdrawal (including any applicable surrender
charges) reduces the Contract Value.
For GE Life and Annuity Assurance Company,
/s/ ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇
▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇
President
Form P5177 4/02
GE LIFE AND ANNUITY ASSURANCE COMPANY
DEATH BENEFIT AVAILABLE AT DEATH OF ANY ANNUITANT ENDORSEMENT
--------------------------------------------------------------------------------
The Contract to which this endorsement is attached is amended by deleting the
Death Benefit Available at Death of Any Annuitant provision in its entirety and
adding the following:
Death Benefit Available at Death of Any Annuitant
The Death Benefit is equal to the greatest of (a), (b) and (c), where:
(a) is the Purchase Payments less any withdrawals and any applicable
premium tax;
(b) is the Contract Value on the date of receipt of due proof of death;
and
(c) is the value of Purchase Payments increased with interest at 6% per
Contract year, but not more than 200% of Purchase Payments.
Withdrawals for each Contract year up to 6% of Purchase Payments,
calculated at the time of the withdrawals, reduce the value of (c) by the
same amount that the withdrawal (including any applicable surrender
charges) reduces the Contract Value. If withdrawals greater than 6% of
Purchase Payments are made in the current or any prior Contract year, the
value of (c) will be reduced proportionally for that Contract year and for
each Contract year thereafter by the same percentage that the withdrawal
(including any applicable surrender charges) reduces Contract Value.
For GE Life and Annuity Assurance Company,
/s/ ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇
▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇
President
Form P5178 4/02
GE LIFE AND ANNUITY ASSURANCE COMPANY
ENHANCED DEATH BENEFIT ENDORSEMENT
--------------------------------------------------------------------------------
This endorsement provides for an Enhanced Death Benefit which is added to the
Death Benefit payable under your Contract.
Enhanced Death Benefit
Enhanced Death Benefit if the Annuitant is, or both the Annuitant and Joint
Annuitant are, age 70 or younger at issue: The Enhanced Death Benefit is equal
to 40% of (a) minus (b), where:
(a) is the Contract Value as of the date of receipt of due proof of death;
and
(b) is the sum of Purchase Payments not previously withdrawn.
The Enhanced Death Benefit cannot exceed 70% of Purchase Payments adjusted for
withdrawals. Purchase Payments, other than the initial Purchase Payment, paid
within 12 months of death are not included in this calculation. The Enhanced
Death Benefit will never be less than zero.
Enhanced Death Benefit if the Annuitant, or the Joint Annuitant if applicable,
is older than age 70 at issue: The Enhanced Death Benefit is equal to 25% of (a)
minus (b), where:
(a) is the Contract Value as of the date of receipt of due proof of death;
and
(b) is the sum of Purchase Payments not previously withdrawn.
The Enhanced Death Benefit cannot exceed 40% of Purchase Payments adjusted for
withdrawals. Purchase Payments, other than the initial Purchase Payment, paid
within 12 months of death are not included in this calculation. The Enhanced
Death Benefit will never be less than zero.
Under both age scenarios listed above, withdrawals are taken first from gain and
then from Purchase Payments made. For purposes of this rider, gain is calculated
as (a) plus (b) minus (c) minus (d), but not less than zero where:
(a) is the Contract Value on the date we receive your withdrawal request;
(b) is the total of any withdrawals, excluding surrender charges,
previously taken;
(c) is the total of Purchase Payments; and
(d) is the total of any gain previously withdrawn.
When Enhanced Death Benefit is Calculated at Death of Annuitant or Any Joint
Annuitant: The Enhanced Death Benefit is calculated on the date that we receive
due proof of death at our Home Office. Until we receive complete written
settlement instructions satisfactory to us from the beneficiary, the calculated
Enhanced Death Benefit will remain allocated to the various Investment Options
according to your last instructions. Therefore, the Enhanced Death Benefit will
fluctuate with the performance of the underlying Investment Options.
For GE Life and Annuity Assurance Company,
/s/ ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇
▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇
President
Form P5187 4/02
FLEXIBLE PREMIUM VARIABLE
DEFERRED ANNUITY CONTRACT
--------------------------------------------------------------------------------
. Income payments begin at Annuity Commencement Date
. No Dividends.
. Some benefits reflect investment results
--------------------------------------------------------------------------------
GE LIFE AND ANNUITY
ASSURANCE COMPANY