EXHIBIT (4)
FORM OF CONTRACT
PFL LIFE INSURANCE COMPANY
(Hereafter, We, Our, Us, the Company)
Administrative Office: ▇▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇. ▇., ▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇ ▇▇▇▇▇
Telephone (▇▇▇) ▇▇▇-▇▇▇▇ (▇▇▇) ▇▇▇-▇▇▇▇ ▇▇▇ ▇▇▇▇
OUR ANNUITY AGREEMENT
We will pay, subject to the conditions and limitations of this Contract, the
Annuity Payments to the Payee, if living on the First Payment Date. We will
make these payments in accordance with the Payment Option described in Section
1, Contract Specifications.
Our Company and You, the Owner, are bound by the conditions and provisions of
this Contract. We issue this Contract in consideration of the Single Premium
paid.
RIGHT TO CANCEL YOUR CONTRACT
After You receive this Contract, You have 10 days to examine it. Within that
period, You can return the Contract to the Company or its agent for any reason.
If You return the Contract, it will be canceled and We will consider the
Contract void from the beginning. We will refund Your premium plus or minus the
investment performance of the Subaccounts on the date of cancellation less any
Annuity Payments made.
Signed for the Company at Our Home Office, Cedar Rapids, Iowa.
/s/ ▇▇▇▇▇ ▇. ▇▇▇▇▇▇ /s/ ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇
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SECRETARY PRESIDENT
This Contract is a legal Contract between You and the Company.
READ YOUR CONTRACT CAREFULLY
FIXED AND VARIABLE
SINGLE PREMIUM IMMEDIATE INCOME ANNUITY
CONTRACT CONTENTS
PAGE SECTION DESCRIPTION
---- ------- -----------
3 1 CONTRACT SPECIFICATIONS
4 2 DEFINITIONS
5 3 PAYMENT OF PREMIUM
6 4 ANNUITY PAYMENTS
7 5 TRANSFERS
8 6 SEPARATE ACCOUNT
9 7 GENERAL PROVISIONS
12 8 DEATH PROCEEDS
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SECTION 1---CONTRACT SPECIFICATIONS
Contract Number: [ ]
CONTRACT ISSUE DATE: [Mm/Dd/Yy]
PARTIES TO THE CONTRACT:
Owner(s): [ ]
Payee(s): [ ]
Primary Annuitant: [ ]
Primary Annuitant Issue Age and Sex: [Nn, Male, Female]
Secondary Annuitant: [ ]
Secondary Annuitant Issue Age and Sex: [Nn, Male, Female]
Beneficiary(ies): [ ]
SINGLE PREMIUM:
Single Premium Amount: [$N,Nnn,Nnn.Nn]
Initial Allocation to: Fixed Annuity Payments: [ % ] Variable Annuity
Payments: [% ] Premium Tax : [State, %]
ANNUITY PAYMENTS:
First Payment Date: [Mm/Dd/Yy]
Frequency of Payments: [Monthly, Quarterly, Semiannual, Annual]
Fixed Payment Amount on First Payment Date: [$]
Estimated Variable Payment Amount on First Payment Date: [$]
Assumed Investment Return for Variable Payment: [4.0%,5.5% Annually]
The Single Premium allocated to variable Annuity Payments will be invested as
shown below:
VIP: Equity Income [%] VIP II: Contrafund [%]
VIP: Growth [%] VIP II: Index 500 Portfolio [%]
VIP: High Income [%] VIP II: Investment Grade Bond [%]
VIP: Money Market [%] VIP III: Balanced [%]
VIP: Overseas [%] VIP III: Growth & Income [%]
VIP II: Asset Manager [%] VIP III: Growth Opportunities [%]
VIP II: Asset Manager Growth [%]
CHARGES APPLICABLE TO VARIABLE PAYMENTS:
Separate Account Charge: [%]
PAYMENT OPTION:
[Life Only Payment Option:
We will make payments for the Annuitant's lifetime beginning on the First
Payment Date. The final payment will be the one made immediately prior to
the Annuitant's death.
No additional payments will be made after the Annuitant dies.]
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SECTION 2---DEFINITIONS
This section contains the standard meaning of terms used in Your Contract.
ALLOCATION DATE
The date on which a transfer is made from one Subaccount to another.
ANNUITANT
The person upon whose life the Annuity Payments are based. For joint options,
Annuity Payments are based upon the lives of both the Primary and Secondary
Annuitant.
ANNUITY PAYMENTS
Payments made by Us pursuant to the Payment Option chosen. We may require
evidence that any Annuitant and/or Payee are alive on the due date of each
Annuity Payment. Annuity Payments may be either fixed or variable, or a
combination of both. We guarantee fixed Annuity Payments to be a specific
amount. Variable Annuity Payments fluctuate in amount based on the investment
performance of the Subaccount relative to the Assumed Investment Return. Your
fixed and variable Annuity Payment options are explained in Section 1, Contract
Specifications.
ANNUITY PAYMENT FREQUENCY
The payment frequency is either monthly or quarterly. Semiannual or annual
payments are available with Our approval.
ASSUMED INVESTMENT RETURN (AIR)
The annual effective rate shown in Section 1, Contract Specifications, that is
used in the calculation of each variable Annuity Payment. If the performance
(minus all expenses) of the Subaccount(s) matches the AIR, the variable Annuity
Payments will remain constant. If the performance exceeds the AIR, the variable
Annuity Payments will increase. If the performance falls below the AIR, the
variable Annuity Payments will decrease.
BENEFICIARY
The person(s) to whom We will pay a death benefit or other guaranteed payments,
if any, when the Annuitant (or last Annuitant for joint options) dies.
CONTRACT ISSUE DATE
The date, as shown on the Contract Specifications Page, on which the Single
Premium is allocated to the Subaccounts and the Contract becomes effective.
CONTRACT YEAR
The 12-month period following the Contract Issue Date shown in Section 1,
Contract Specifications. The first Contract Year starts on the Contract Issue
Date. Each subsequent Contract Year starts on the anniversary of the Contract
Issue Date.
ISSUE AGE
The Annuitant's age at the nearest birthday on the Contract Issue Date.
NET INVESTMENT FACTOR
The unit of measure used to reflect the change in Variable Annuity Unit values
in a Subaccount from one Valuation Period to the next.
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OWNER
"You", "Your", and "Yours". The person or entity, as named in Section 1,
Contract Specifications, who may, while any Annuitant is living, exercise all
rights granted by this Contract.
PAYEE
The person or entity to whom We will pay the Annuity Payments.
SECTION 2---DEFINITIONS (CONTINUED)
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Right to Cancel Period
The period during which this Contract can be canceled by the Owner.
SEPARATE ACCOUNT CHARGE
An expense that is deducted from each subaccount for Our assumption of mortality
and expense risk, and for Our administration and distribution expenses. (This
charge is commonly referred to as M&E, or mortality and expense charge.)
SUBACCOUNTS
The portfolios of the Separate Account, as described in Section 6, Separate
Account. Section 1, Contract Specifications, lists the allocation to the
Subaccounts You selected.
VALUATION DAY
Each day the New York Stock Exchange is open for trading and any other day when
the Securities and Exchange Commission requires mutual funds or unit investment
trusts to be valued.
VALUATION PERIOD
The period of time beginning at the close of business each Valuation Day and
ending at the close of business on the next Valuation Day.
VARIABLE ANNUITY UNIT
Variable Annuity Payments are expressed in terms of Variable Annuity Units, the
value of which fluctuates in relation to the selected Subaccounts. The value of
Variable Annuity Units is determined at the end of each Valuation Day.
VARIABLE ANNUITY PAYMENT CALCULATION DATE
The day when the amount of the variable Annuity Payment is determined. Payments
will be determined no greater than seven business days before the date of Your
Annuity Payment.
WRITTEN REQUEST
A request in a form suitable to Us, signed by You and delivered to Us.
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SECTION 3---PAYMENT OF PREMIUM
SINGLE PREMIUM
You purchase this Contract with a Single Premium. You may not make additional
premium payments.
The Single Premium will be reduced by any applicable Premium Taxes required by
federal, state or local authorities.
ALLOCATION OF YOUR SINGLE PREMIUM
The amount of the Single Premium You allocated to fixed and/or variable Annuity
Payments is shown in Section 1, Contract Specifications. The initial allocation
of Your premium for variable Annuity Payments to the Subaccounts is also shown
in Section 1, Contract Specifications. The minimum allocation to any Subaccount
must not be less than 5% of the total amount allocated to the Subaccounts.
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SECTION 4---ANNUITY PAYMENTS
GENERAL PAYMENT PROVISIONS
Annuity Payments may be fixed, variable or a combination of both. Your elections
are shown in Section 1, Contract Specifications. Your Annuity Payments will be
made according to the provisions detailed in Section 1, Contract Specifications.
Your First Payment Date is shown in Section 1, Contract Specifications.
If at any time the amount of a payment to a Payee is less than $100 (Our minimum
payment), We may change the Frequency of Payment so that the payment is at least
equal to the minimum.
DETERMINATION OF THE VARIABLE ANNUITY PAYMENTS
The portion of the Single Premium allocated to variable Annuity Payments will
initially purchase Variable Annuity Units in the Subaccount(s) which You elect.
We determine the number of Variable Annuity Units based upon:
a. the Single Premium reduced by any Premium Taxes shown in Section 1,
Contract Specifications;
b. the age and sex of the Annuitant and Secondary Annuitant, if any;
c. the Payment Option You chose;
d. the Frequency of Payment You chose;
e. the First Payment Date You chose;
f. the Assumed Investment Return You chose; and
g. the Variable Annuity Unit value of the Subaccount(s) on the Contract Issue
Date.
DETERMINATION OF THE VARIABLE ANNUITY PAYMENTS (CONTINUED)
On each Variable Annuity Payment Calculation Date, the number of Variable
Annuity Units in each Subaccount is multiplied by the Variable Annuity Unit
value of each Subaccount to determine the variable Annuity Payment from that
Subaccount. Your total variable Annuity Payment will be the sum of the payments
from each Subaccount.
The number of Variable Annuity Units allocated to each Subaccount will not
change unless You request:
1. A transfer from one Subaccount to another;
2. A transfer from variable Annuity Payments to fixed Annuity Payments;
3. A partial or full surrender that may be available under Your Payment
Option.
Also, if You chose a joint life payment option, We will reduce the number of
Variable Annuity Units if payments are to be reduced upon the death of either
joint Annuitant.
VARIABLE ANNUITY UNITS
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The number of Variable Annuity Units in each selected Subaccount is determined
by dividing the Estimated Variable Annuity Payment Amount on the First Payment
Date by the Variable Annuity Unit value of that Subaccount on the Contract Issue
Date. The value of the Variable Annuity Unit in Your chosen Subaccounts will
increase or decrease reflecting the investment experience of those Subaccounts.
SECTION 4---ANNUITY PAYMENTS (CONTINUED)
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VARIABLE ANNUITY UNITS (CONTINUED)
----------------------------------
Amounts transferred to the Subaccounts will be applied to provide Variable
Annuity Units in Your chosen Subaccounts. The number of Variable Annuity Units
purchased in a Subaccount will be determined by dividing any amount transferred
to that Subaccount, by the Variable Annuity Unit value for that Subaccount on
the applicable Allocation Date.
The number of Variable Annuity Units withdrawn or transferred from the
Subaccounts will be determined by dividing the amount withdrawn or transferred
by the Variable Annuity Unit value for that Subaccount on the applicable
withdrawal or Allocation Date.
The Variable Annuity Unit value in a particular Subaccount on any Valuation Day
is equal to (a) multiplied by (b) multiplied by (c), where:
(a) is the Variable Annuity Unit value for that Subaccount on the immediately
preceding Valuation Day;
(b) is the Net Investment Factor for that Subaccount for the Valuation Period;
and
(c) is the daily factor for the Valuation Period.
The daily factor for the Valuation Period is a discount factor that reflects the
Assumed Investment Return.
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The Net Investment Factor used to calculate the Variable Annuity Unit value in
each Subaccount for the Valuation Period is determined by dividing (a) by (b)
and subtracting (c) from the result, where:
(a) is the net result of:
(1) the net asset value of a fund share held in that Subaccount determined
as of the end of the current Valuation Period, plus
(2) the per share amount of any dividend or capital gain distributions made
by the fund for shares held in that Subaccount if the ex-dividend date
occurs during the Valuation Period; plus or minus
(3) a per share credit or charge for any taxes reserved for, which We
determine to have resulted from the investment operation of the
Subaccount.
(b) is the net asset value of a fund share held in that Subaccount as
determined at the end of the immediately preceding Valuation Period.
(c) is an amount representing the Separate Account Charge. The percentages are
shown in Section 1, Contract Specifications.
SECTION 5---TRANSFERS
Transfers Among Subaccounts
You may transfer the value of the Variable Annuity Units from one Subaccount to
another. If You want to transfer the value of the Variable Annuity Units, You
must tell Us in a Written Request or by an electronic notice that gives Us the
information that We need.
SECTION 5---TRANSFERS (CONTINUED)
Transfers Among Subaccounts (Continued)
You may currently transfer among Subaccounts as often as You wish without
charge. We have the right to charge an administrative fee of $15 for each
transfer after the first six transfers made in any Contract Year. All transfers
made simultaneously will be treated as a single request.
Transfers From Variable Annuity Payments to Fixed Annuity Payments
You may transfer all or a part of the value of variable Annuity Payments to
fixed Annuity Payments.
If You transfer variable Annuity Payments to fixed Annuity Payments, the fixed
Annuity Payments will be a continuation of the Payment Option under which the
variable Annuity Payments were being made. For example, if You were receiving
variable Annuity Payments for two years under a 10-Year Period Certain and Life
Option and elect to transfer to a fixed Annuity Payment, Your fixed Annuity
Payment would be an 8-Year Period Certain and Life Option.
The amount of the fixed Annuity Payment will be based on Our fixed annuity rates
at the time of the transfer.
You may not transfer from fixed Annuity Payments to variable Annuity Payments.
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SECTION 6---SEPARATE ACCOUNT
The Separate Account
We have established, and will maintain, a Separate Account under the laws of the
state of Iowa. Any realized or unrealized income, net gains or losses from the
assets of the Separate Account are credited to or charged against it without
regard to Our other income, gains or losses. Assets are put in the Separate
Account for this Contract, as well as for other variable annuity policies and
life insurance. The Separate Account may invest assets in shares of one or more
mutual funds. Fund shares are purchased, redeemed and valued on behalf of the
Separate Account.
The Separate Account is divided into Subaccounts. Each Subaccount invests
exclusively in shares of one of the portfolios of an underlying fund. We
reserve the right to add or remove any Subaccount of the Separate Account.
The assets of the Separate Account are Our property. These Assets will equal or
exceed the reserves and other Contract liabilities of the Separate Account.
These assets will not be chargeable with liabilities arising out of any other
business We conduct. We reserve the right to transfer assets of a Subaccount,
in excess of the reserves and other Contract liabilities with respect to that
Subaccount, to another Subaccount or to Our General Account.
We will determine the fair market value of the assets of the Separate Account in
accordance with a method of valuation, which We establish in good faith.
Valuation Period means the period of time from one determination of the value of
each Subaccount to the next. Such determinations are made when the value of the
assets and liabilities of each Subaccount is calculated. This is generally each
day on which the New York Stock Exchange is open.
We also reserve the right to transfer assets of the Separate Account, which We
determine to be associated with the class of policies to which this Contract
belongs, to another Separate Account. If this type of transfer is made, the term
"Separate Account," as used in this Contract, shall then mean the Separate
Account to which the assets were transferred.
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SECTION 6---SEPARATE ACCOUNT (CONTINUED)
The Separate Account (Continued)
We also reserve the right, when permitted by law, to:
(a) deregister the Separate Account under the Investment Company Act of 1940;
(b) manage the Separate Account under the direction of a committee at any time;
(c) restrict or eliminate any voting rights of Contract Owners or other persons
who have voting rights as to the Separate Account; and
(d) combine the Separate Account with one or more other Separate Accounts;
(e) create new Separate Accounts;
(f) add new Subaccounts to, or remove existing Subaccounts from, the Separate
Account, or combine Subaccounts;
(g) add new underlying mutual funds, remove existing mutual funds, or
substitute a new fund for an existing fund.
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Change in Investment Objective or Policy of the Separate Account
If required by law or regulation, an investment policy of the Separate Account
will only be changed if approved by the appropriate insurance official of the
state of Iowa or deemed approved in accordance with such law or regulation. If
so required, the process for obtaining such approval is filed with the insurance
official of the state or district in which this Contract is delivered.
SECTION 7---GENERAL PROVISIONS
Entire Contract
The entire Contract is made up of this Contract, and any riders, endorsements,
or application. No change in or waiver of any provision of this Contract is
valid unless the change or waiver is signed by the President or Secretary of the
Company.
Assignment
Only You may make an assignment of this contract. You must notify Us by Written
Request to assign this Contract. No change will apply to any action taken by Us
before the Written Request was received by Us. We are not responsible for the
validity or the effect of an assignment. You should consult Your tax advisor
prior to making an assignment.
Beneficiary
The Beneficiary is named in Section 1, Contract Specifications, or if
applicable, in a subsequent endorsement. More than one Beneficiary may be named.
The rights of any Beneficiary will be subject to all the provisions of this
Contract.
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SECTION 7---GENERAL PROVISIONS (CONTINUED)
Beneficiary (Continued)
If any primary or contingent Beneficiary dies before the Annuitant, that
Beneficiary's interest in this Contract ends with that Beneficiary's death.
Only those Beneficiaries living at the time of the Annuitant's death will be
eligible to receive their share of the death benefits. Payment will be made to
the named contingent Beneficiary(ies) only if all primary Beneficiaries have
died before the death benefits become payable. In the event no contingent
Beneficiaries have been named and all primary Beneficiaries have died when the
death benefits become payable, the Owner(s) or Estate of the Owner(s) will
become the Beneficiary(ies) unless elected otherwise. If both primary and
contingent Beneficiaries have been named, payment will be made to the named
primary Beneficiaries living at the time the death benefits become payable. If
there is more than one Beneficiary and You failed to specify their interest,
they will share equally. If any primary Beneficiary is alive at the time the
death benefits become payable, but dies before receiving their payment, their
share will be paid to their estate.
Change of Beneficiary
You may change the Beneficiary while the Annuitant is living, unless an
irrevocable one has been named. Change is made by Written Notice. The change
takes effect on the date the Written Request was signed, and the Written Request
must have been postmarked on or before the date of the Annuitant's death.
Annuity Payment(s) made before the Written Request was received will not be
reissued. We may require return of this Contract for endorsement before making
a change.
Incontestability
This Contract is 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, the Annuity Payments will
be those which the Single Premium paid would have purchased for the correct age
and sex. Any underpayment made by Us will be paid with the next Annuity
Payment. Any overpayment made by Us will be deducted from future Annuity
Payments. Any underpayment or overpayment will include interest at 5% per year,
from the date of the incorrect payment to the date of the adjustment.
Modification of Contract
No change in this Contract is valid unless made in writing by Us and approved by
one of Our officers. No agent has authority to change or waive any provision of
Your Contract.
Nonparticipating
Your Contract is nonparticipating. This means We do not pay dividends on it.
Your Contract will not share in Our profits or surplus earnings.
Owner
You, the Owner, are named in Section 1,Contract Specifications. You may, while
any Annuitant is living, exercise all rights granted by this Contract. These
rights are subject to the rights of any assignee or living irrevocable
Beneficiary. "Irrevocable" means that You have given up Your right to change
the Beneficiary named.
If You die, the rights of Ownership will vest in the executors, administrators
or assigns of the Owner.
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SECTION 7---GENERAL PROVISIONS (Continued)
Owner (Continued)
Unless We have been notified of a community or marital property interest in this
Contract, We will rely on Our good faith belief that no such interest exists and
will assume no responsibility for inquiry.
Annuity Payments are generally taxable to the Owner.
Proof of Death
Any Beneficiary claiming an interest in the Contract must provide the Company in
writing with due proof of death of the Payee/Annuitant and/or Secondary
Annuitant (if any). If payments have been paid prior to receiving due proof of
death, We will deduct the payment(s) from the calculated death benefit.
PROOF OF SURVIVAL
If Annuity Payments under this Contract depend on a person being alive on a
given date, proof of survival may be required by the Company prior to making the
payments.
Protection Of Proceeds
Unless You so direct by filing Written Request with Us, no Beneficiary may
assign payments under this Contract before the same are due. To the extent
permitted by law, no payments under this Contract will be subject to the claims
of creditors of any Beneficiary.
Reserves
The reserves held by Us for this Contract shall not be less than the minimum
required by the laws and regulations of the state in which this Contract is
delivered.
Reports To Owner
You will receive a confirmation statement each time You transfer Annuity Units
among the Subaccounts or make transfers from variable Annuity Payments to fixed
Annuity Payments.
We will also send you reports containing financial statements for the Funds, and
a list of portfolio securities of the Funds, as required by the Investment
Company Act of 1940.
Successor Owner
The person named by the Owner to whom ownership of this Contract passes upon the
Owner's death, unless the Owner was also the Annuitant, in which case the
Annuitant's Beneficiary is entitled to benefits described in Section 8, Death
Proceeds.
Tax Qualification
This Contract is intended to qualify as an annuity Contract for federal income
tax purposes. The provisions of this Contract are to be interpreted to maintain
such qualification, notwithstanding any other provisions to the contrary. To
maintain such tax qualification, We reserve the right to amend this Contract to
reflect any clarifications that may be needed or are appropriate to maintain
such tax qualification or to conform this Contract to any applicable changes in
the tax qualification requirements. We will send a copy to You in the event of
any such amendment. If You refuse such an amendment, it must be by giving Us
Written Request, and Your refusal may result in adverse tax consequences.
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SECTION 8---DEATH PROCEEDS
If an Owner, who is also an Annuitant, dies before the First Payment Date, the
amount of the death proceeds is the premium plus or minus the investment
performance of the Subaccounts. If an Owner, who is not an Annuitant, dies
before the First Payment Date, the Successor Owner may direct the Owner's
interest in the Contract to be distributed as follows:
(i) one cash lump sum to be distributed within five years of the deceased
owner's death;
(ii) annuitize the death proceeds over the lifetime of the Successor Owner;
or
(iii) annuitize the death proceeds over a period that does not exceed the
life expectancy of the Successor Owner as defined by the Code.
Subparagraphs (ii) and (iii) apply only to individuals, and such payments must
start within one year of the date of the Owner's death.
If the owner, who may or may not also be an Annuitant, dies, on or after the
First Payment Date, the remaining portion of the Annuity Payments due under the
Contract, if any, will be distributed to the Beneficiary in the same manner and
frequency (at least as rapidly) as under the method of distribution used before
the Owner's death.
If the Owner's surviving spouse, if any, is the Successor Owner, then on the
Owner's death he or she may elect to become the Owner under the Contract and to
continue the Contract as his or her own. If no such election is made, the rules
outlined in the foregoing paragraphs of this section will apply.
If the Owner, who is also the Annuitant, dies and no Beneficiary is named or the
Beneficiary has predeceased the Owner/Annuitant, the Owner's estate shall be
deemed the Beneficiary.
If at any time the Annuitant, or last Annuitant for a joint contract, dies, the
Beneficiary will receive the remaining portion of the Annuity Payments due under
the contract, if any. Payments will be made in the same manner and frequency
(at least as rapidly) as under the method of distribution used before the
Annuitant's death.
If a non-natural person is named as an Owner, then the primary Annuitant shall
be treated as an Owner solely for the purposes of this Section 8. The entire
interest in the Contract must be distributed upon the Annuitant's death, if the
Annuitant dies prior to the First Payment Date.
In all events, notwithstanding anything to the contrary in this Contract,
distributions on the death of an Owner shall conform to the requirements of
Section 72(s) of the Code.
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PFL LIFE INSURANCE COMPANY
Administrative Office: ▇▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇. ▇., ▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇ ▇▇▇▇▇
FIXED AND VARIABLE
SINGLE PREMIUM IMMEDIATE INCOME ANNUITY
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