VA-101 (10/99)
Valley Forge Life Insurance Company
A Stock Company
Executive Office: Home Office:
CNA Plaza ▇▇▇ ▇▇▇▇ ▇▇.
▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇
We agree to pay the benefits described in this contract in accordance with its
provisions.
PLEASE READ THIS CONTRACT CAREFULLY. THIS IS A LEGAL CONTRACT BETWEEN YOU AND
VALLEY FORGE LIFE INSURANCE COMPANY.
NOTICE OF 10 DAY FREE LOOK PERIOD
If, for any reason, you are not satisfied with this contract, you may return it
to us for cancellation within 10 days of the day you receive it by delivering or
mailing it to us at our Administrative Office or to the agent from whom it was
purchased. This contract will be void as of the date we receive it and we will
promptly return the contract value.
Signed for the Company at its Executive Office, CNA Plaza, Chicago, Illinois
60685.
Chief Executive Officer Group Vice President
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Annuity payments and other values provided by this contract, when based on the
investment performance of the Variable Account, may increase or decrease daily
as a function of the investment performance of the subaccounts you select and
are not guaranteed as to dollar amount. No minimum contract value is guaranteed.
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INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT
Non Participating
Valley Forge Life Insurance Company
A Stock Company
Executive Office: Home Office:
CNA Plaza ▇▇▇ ▇▇▇▇ ▇▇.
▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇
We agree to pay the benefits described in this contract in accordance with its
provisions.
PLEASE READ THIS CONTRACT CAREFULLY. THIS IS A LEGAL CONTRACT BETWEEN YOU AND
VALLEY FORGE LIFE INSURANCE COMPANY.
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NOTICE OF 10 DAY FREE LOOK PERIOD
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If, for any reason, you are not satisfied with this contract, you may return it
to us for cancellation within 10 days of the date you receive it by delivering
or mailing it to us at our Administrative Office or to the agent from whom it
was purchased. This contract will be void as of the date we receive it and we
will promptly return the sum of all purchase payments.
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VAR-101 (10/99)
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Signed for the Company at its Executive Office, CNA Plaza, Chicago, Illinois
60685.
Chief Executive Officer Group Vice President
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Annuity payments and other values provided by this contract, when based on the
investment performance of the Variable Account, may increase or decrease daily
as a function of the investment performance of the subaccounts you select and
are not guaranteed as to dollar amount. No minimum contract value is guaranteed.
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INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT
VA-101 (10/99)
CONTRACT DATA PAGE
OWNER: [▇▇▇▇ ▇▇▇] AGE AT ISSUE: [35]
JOINT OWNER: [▇▇▇▇ ▇▇▇] AGE AT ISSUE: [32]
ANNUITANT: [▇▇▇▇ ▇▇▇] AGE AT ISSUE: [35]
CONTRACT NUMBER: [12345] CONTRACT DATE: [July 1, 1999]
PLAN TYPE: [Non-Qualified] ANNUITY DATE: [July 1, 2034]
ADMINISTRATIVE OFFICE: [Valley Forge Life, ▇▇▇ ▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇]
[▇-▇▇▇-▇▇▇-▇▇▇▇]
PURCHASE PAYMENTS:
Initial Purchase Payment: [$25,000]
Minimum Subsequent Purchase Payment: [$1,000]
Maximum Total Purchase Payments: [$1,000,000 without approval]
BENEFICIARY:
[As designated by the owner on the contract date unless changed in
accordance with the contract provisions.]
CONTRACT MAINTENANCE CHARGE:
The contract maintenance charge is currently [$30.00] each contract year.
We reserve the right to change the contract maintenance charge and will
provide notice of the change. The maximum contract maintenance charge is
$50.00 per contract year. The contract maintenance charge will be deducted
from the contract value on each contract anniversary while this contract is
in force. If during the accumulation period, your contract value on a
contract anniversary is at least [$50,000] then no contract maintenance
charge is deducted. If a total withdrawal is made on other than a contract
anniversary and your contract value for the business day when the total
withdrawal is made is less than [$50,000], the full contract maintenance
charge will be deducted at the time of total withdrawal. The contract
maintenance charge will be deducted from the subaccounts and any fixed
account selected in the same proportion that the amount of contract value
in each subaccount and/or any fixed account bears to the total contract
value. During the annuity period, the contract maintenance charge will be
collected pro rata from each annuity payment If the owner is not a natural
person, we will look to the annuitant in determining the above.
PRODUCT EXPENSE CHARGE:
Equal on an annual basis to [1.40%] of the average daily net asset value of
the Variable Account.
[TAX CHARGES:
We reserve the right to deduct from purchase payments or from the Variable
Account any federal, state or municipal taxes that may be attributable to
this contract.]
FIXED ACCOUNT OPTIONS:
[Fixed Account I:
Minimum Guaranteed Interest Rate: [3.00%]
Current Interest Rate as of Contract Date: [x%.] [The current interest
rates applies only to purchase payments allocated or transferred to
Fixed Account I during the calendar month in which this contract is
issued. This rate is guaranteed for one contract year.]
INVESTMENT OPTIONS:
[Federated Prime Money Fund II]
[Federated Utility Fund II]
[Federated High Income Bond Fund II]
[Fidelity VIP Equity-Income Portfolio]
[Fidelity VIP II Asset Manager Portfolio]
[Fidelity VIP II Index 500 Portfolio]
[Fidelity VIP II Contrafund]
[▇▇▇▇▇ American Small Capitalization Portfolio]
[▇▇▇▇▇ American Growth Portfolio]
[▇▇▇▇▇ American MidCap Growth Portfolio]
[MFS Emerging Growth Series]
[MFS Research Series]
[MFS Growth with Income Series]
[MFS Limited Maturity Series]
[MFS Total Return Series]
[SoGen Overseas Variable Fund]
[▇▇▇ ▇▇▇ Worldwide Hard Assets Fund]
[▇▇▇ ▇▇▇ Worldwide Emerging Markets Fund]
[JanusAspen Capital Appreciation Portfolio]
[Janus Aspen Growth Portfolio]
[Janus Aspen Balanced Portfolio]
[Janus Aspen Flexible Income Portfolio]
[Janus Aspen International Growth Portfolio]
[Janus Aspen Worldwide Growth]
VARIABLE ACCOUNT: [VFL Variable Annuity Separate Account]
[ALLOCATION GUIDELINES:
1. Currently, you may select as many investment options as you wish. We
reserve the right to limit this in the future.
2. Currently, you may also select any available fixed account at the time the
purchase payment or transfer is made.
3. The initial purchase payment will be credited to your contract within two
(2) business days after receipt at our Administrative Office. Additional
purchase payments will be credited to your contract as of the business day
they are received.
4. Allocation percentages must be in whole numbers. Each allocation must be at
least [1%].]
TRANSFERS:
Number of Transfers Permitted
During the Accumulation Period: [Subject to any transfer
fees and any minimum and maximum amounts that may be
transferred, currently there is no limitation on the number
of transfers that may be made between subaccounts.
Currently, you may make unlimited transfers to any fixed
account option, subject to any transfer fees and any
required minimum or maximum amounts that may be transferred.
We reserve the right to limit the number of transfers, but
you will always be allowed at least [12] transfers between
subaccounts in a contract year during the accumulation
period.]
During the Annuity Period: [Currently, during a contract
year you may make [4] transfers between subaccounts, or,
from one or more subaccounts to the general account. The
amounts transferred are subject to any minimums and maximums
we may establish. You may not make a transfer from the
general account to the subaccounts.]
Number of Free Transfers: [Currently, you are allowed [12] free
transfers each contract year during the accumulation period and [4]
free transfers each contract year during the annuity period.]
Transfer Fee: [For each transfer in excess of the free transfers
permitted, the transfer fee is [$25]. Transfers made pursuant to a
prescheduled transfer will not be counted in determining the
application of the transfer fee.]
Minimum and Maximum Amount to be Transferred: [The minimum amount
which may be transferred is [$500] or your entire interest in any
subaccount or any fixed account, if less. This requirement is waived
if the transfer is pursuant to a prescheduled transfer or applied to a
specified annuity option.]
Prescheduled Transfers: [You may elect the dollar cost averaging
option or the automatic transfer option. We reserve the right to limit
the availability of any subaccount or fixed account for a prescheduled
transfer.]
WITHDRAWALS:
Withdrawal Charge: [A withdrawal charge is assessed against each
purchase payment withdrawn. The withdrawal charge is calculated at the
time of each withdrawal. Each purchase payment is tracked from its
contract year of receipt and the withdrawal charges are determined in
accordance with the following:
Contract Year
Since Receipt of
Purchase Payment Withdrawal Charge
1 7%
2 7%
3 6%
4 6%
5 5%
6 4%
7 3%
8 0%]
[The withdrawal charge is separately calculated and applied to each
purchase payment when the purchase payment is withdrawn. No withdrawal
charge applies to withdrawals in excess of the sum of all purchase
payments less prior withdrawals of purchase payments. The order of
withdrawal is as follows: 1.) the amount subject to waiver of
withdrawal charge as described below; 2.) purchase payments from
oldest to newest; 3.) contract value in excess of 1.) and 2.) above.
For purposes of computing withdrawal charges, the deduction of any tax
and withdrawal charges is considered to be made from contract value in
excess of aggregate purchase payments less prior withdrawals of
purchase payments. We reserve the right to limit the number of partial
withdrawals in a contract year that are not subject to a withdrawal
charge.]
Waiver of Withdrawal Charge: [In each contract year after the first
contract year, you may withdraw an amount equal to 10% of the "free
partial withdrawal basis" without incurring withdrawal charge. We
reserve the right to limit the number of such free partial withdrawals
in any contract year.
"Free partial withdrawal basis" means the greater of: (1) Aggregate
purchase payments (less prior withdrawals of purchase payments) as of
the first business day of the contract year; or (2) contract value as
of the business day the written notice for withdrawal is received.]
Minimum partial withdrawal amount: [[$500] Withdrawals made pursuant
to the systematic withdrawal option [or any minimum distribution
option] are not subject to this minimum.] [Withdrawals made pursuant
to the systematic withdrawal option must be at least [$100].]
[Minimum contract value which must remain in an account or subaccount
after a partial withdrawal: [[$1,000] in any subaccount or [$5,000] in
any fixed account
Minimum contract value which must remain in the contract after a
partial withdrawal: [$10,000 for non-qualified contracts] [$2,000 for
qualified contracts]
[IMMEDIATE INTEREST RATE: [3%]
Immediate Interest: Each purchase payment received during the first contract
year will be credited immediate interest at the rate shown above. The immediate
interest will be allocated in the same manner as the purchase payments at the
time of receipt. The dollar amount of this immediate interest will be excluded
from any withdrawal value, including the exercise of any Free Look right, if the
contract value is withdrawn before the first day of the second contract year. If
a partial withdrawal is taken during the first contract year, the immediate
interest will be reduced in the same proportion that the amount of the partial
withdrawal bears to the total of purchase payments.]
RIDERS AND ENDORSEMENTS
[Individual Retirement Annuity Endorsement]
[Tax Sheltered Annuity Endorsement]
[Pension/Profit Sharing Endorsement]
[▇▇▇▇ ▇▇▇ Endorsement]
[Simple IRA Endorsement]
[457 Endorsement]
[Terminal Illness - Confinement Rider]
[Dollar Cost Averaging]
[Systematic Withdrawal Rider]
[Automatic Transfer Rider]
ATTACHED RIDERS
RIDER
TABLE OF CONTENTS
Contract Data Page .....................
Definitions ............................
General Provisions .....................
Ownership and Assignment................
Beneficiary Provisions..................
Purchase Payments ......................
Contract Value .........................
Fixed Account..................
The Variable Account...........
Transfers ..............................
Withdrawals ............................
Payment of Benefits ....................
Death Benefit ..........................
Annuity Provisions and Payment Options..
Annuity Tables..........................
DEFINITIONS
Accumulation Period: The period prior to the annuity date during which you may
make purchase payments.
Accumulation Unit: A unit of measure used to calculate the contract value in a
subaccount.
Age: The age as of the nearest birthday.
Annuitant: The person or person(s) whose life (or lives) determines the annuity
payments under this contract.
Annuity Date: The date when annuity payments begin. This is shown on the
contract data page.
Annuity Payments: The periodic payment we make under an annuity payment option.
Annuity Payment Date: The date when we make annuity payments. This is the same
day of the month as the annuity date.
Annuity Period: The period starting on the annuity date during which annuity
payments are paid.
Annuity Unit: A unit of measure used to calculate variable annuity payments.
Annuity Value: The value of the contract available to be applied to an annuity
option.
Beneficiary: The person(s) who will receive the death benefit.
Business Day: Each day that both the New York Stock Exchange and we are open for
business. The Variable Account will be valued each business day.
Contract Anniversary: The same date each calendar year as the contract date.
Contract Date: The date on which the contract becomes effective as shown on the
contract data page.
Contract Value: The sum of the variable contract value and any fixed account.
Contract Year: A twelve-month period beginning on the contract date or contract
anniversary.
Fixed Account: A portion of the general account into which you may allocate
purchase payments or transfer contract value. It is equal to the sum of all
purchase payments allocated to any fixed account less withdrawals and charges.
At our discretion, we may from time to time declare an excess interest rate for
Fixed Account I. The excess interest rate will be guaranteed for one contract
year. A fixed account is available only during the accumulation period.
General Account: Our assets other than those allocated to any Variable Account
of the Company. The general account is available only during the annuity period.
Investment Option: The investment choices within the Variable Account available
under the contract. Current investment options are shown on the contract data
page.
Owner: The person(s) or entity(ies) who is (are) entitled to exercise all
ownership rights and privileges provided in the contract. All references to
owner shall include any named joint owner. Any joint owner must be the spouse of
the other owner unless limited by state law.
Subaccount: A subdivision of the Variable Account which is invested in a
corresponding investment option.
Subaccount Value: The amount equal to that part of any purchase payment
allocated or transferred to the subaccount adjusted by interest income,
dividends, net capital gains or losses, realized or unrealized, and decreased by
withdrawals (including any applicable withdrawal and tax charges) and any
amounts transferred out of that subaccount.
The Company, We, Us, Our: Valley Forge Life Insurance Company
Variable Account: Valley Forge Life Insurance Company Variable Annuity Separate
Account.
Variable Contract Value: The sum of all subaccount values.
Withdrawal Value: The contract value plus or minus any applicable interest
adjustment, less any applicable tax charges not previously deducted, less the
contract maintenance fee and less any applicable withdrawal charges.
Written Notice: A notice or request submitted in writing in a form satisfactory
to us that is signed by you and received at our Administrative Office.
You, Your: The owner(s).
GENERAL PROVISIONS
Entire Contract: The contract is made up of this contract and any attached
endorsements or riders.
Incontestability: We will not contest the validity of this contract.
Misstatement of Age or Sex: If the age or sex of the owner or annuitant has been
misstated, we will adjust the benefits paid under this contract to reflect the
correct age and/or sex. Underpayments will be made up immediately, overpayments
will be deducted from future annuity payments until the total is repaid.
Periodic Reports: At least once each contract year we will furnish you with a
report showing the contract value and any other information as may be required
by law. Reports will be sent to your last known address.
Non Participating: This contract does not participate in the surplus or profits
of the Company.
Protection of Benefits: To the extent permitted by law, no benefits payable or
account values under this contract are subject to the claims of creditors. No
beneficiary may commute, encumber, alienate or assign any payments under this
contract.
Taxes: Any taxes paid to any governmental entity relating to this contract will
be deducted from the purchase payments or contract value when incurred. We will,
at our sole discretion, determine when taxes have resulted from the investment
experience of the Variable Account, receipt by us of purchase payments or
commencement of annuity payments. We may, at our sole discretion, pay taxes when
due and deduct that amount from the contract value at a later date. Payment at
an earlier date does not waive any right we may have to deduct amounts at a
later date. We will deduct any withholding taxes required by applicable law.
Proof of Age and Survival: We have the right to require proof of the owner or
annuitant's age prior to the annuity date. We also reserve the right to require
proof of the owner or annuitant's survival before any annuity payment date.
Modification: We may modify this contract in order to maintain compliance with
applicable state and federal law. This contract may be changed or altered only
by one of our officers. Any change or alteration must be in writing.
Currency: Any money we pay, or that is paid to us, must be in United States
currency.
OWNERSHIP AND ASSIGNMENT
Owner: You, as the owner, have all the interest and rights under this contract.
The owner is designated on the contract date unless changed.
You may change the owner at any time. A change of owner will automatically
revoke any prior designation of owner. A request for change must be made by
written notice. The change will be effective as of the date the written notice
is signed. A new designation of owner will not apply to any payment made or
action taken by us prior to the time the new designation was recorded.
Joint Owner: A contract may be owned by joint owners. Any joint owner must be
the spouse of the other owner, unless limited by state law. Any actions which
are to be performed by the owner, in the case of joint owners, require the
signature of both owners, unless otherwise allowed by us. Upon the death of
either owner, the surviving joint owner will be the primary beneficiary. Any
other beneficiary designation will be treated as a contingent beneficiary unless
otherwise indicated in a written notice.
Annuitant: The person on whose life annuity payments are based. You designate
the annuitant on the contract date, and you may change the annuitant prior to
the annuity date. The annuitant may not be changed in a contract which is owned
by a non-individual. Any change of annuitant is subject to our consent.
Assignment: You may, at any time during your lifetime, assign your rights under
this contract. We will not be bound by any assignments until we record written
notice of the assignment. We are not responsible for the validity or sufficiency
of any assignments. We will not be liable as to any payment or other settlement
we make before we record the assignment.
BENEFICIARY PROVISIONS
Beneficiary: The beneficiary designation in effect on the contract date will
remain in effect unless changed. Unless you provide otherwise, the death benefit
will be paid in equal shares or all to the survivor as follows:
1. to the primary beneficiaries who survive you, and/or the annuitant(s), as
applicable; or if there are none,
2. to the contingent beneficiaries who survive you, and/or the annuitant(s),
as applicable; or if there are none,
3. to your estate.
Changing the Beneficiary: Subject to the rights of any irrevocable beneficiary,
you may change the primary or contingent beneficiary. A change may be made by
filing written notice. The change will take effect as of the date the written
notice is signed. We will not be liable for any payment made or action taken
before we record the change.
PURCHASE PAYMENTS
Purchase Payments: The initial purchase payment is due on the contract date. The
minimum subsequent purchase payments and maximum total purchase payments are
shown on the contract data page. Subject to the minimum and maximum payments
shown on the contract data page, you may increase or decrease or change the
frequency of subsequent purchase payments. We reserve the right to reject any
purchase payment.
Allocation of Purchase Payments: The allocation of purchase payments is made in
accordance with your selection made at the contract date. We reserve the right
to allocate initial purchase payments to the money market or similar subaccount
during the free look period. Unless you elect otherwise, subsequent purchase
payments will be allocated in accordance with your initial selection.
You may change the allocation of purchase payments by written notice. Any
additional purchase payments will be allocated in accordance with the allocation
schedule in effect unless accompanied by written notice requesting a different
allocation. Only whole percentages may be applied. The minimum percentage that
may be allocated is shown on the contract data page. Purchase payments may be
allocated net of any government imposed tax charges.
CONTRACT VALUE
FIXED ACCOUNT
Fixed Account I Value - The value of Fixed Account I at any time is equal to:
1. the purchase payments allocated to Fixed Account I; plus
2. amounts transferred to Fixed Account I; plus
3. any interest credited to Fixed Account I; less
4. any prior withdrawals and withdrawal charges deducted from Fixed Account I;
less
5. any amounts transferred from Fixed Account I; less
6. any applicable taxes or charges deducted from Fixed Account I.
Interest To Be Credited - We guarantee that the interest to be credited to any
fixed account will not be less than the minimum guaranteed interest rate shown
on the contract data page or any supplemental data page. We may credit
additional interest at our sole discretion to Fixed Account I. Declared interest
will be guaranteed one contract year.
THE VARIABLE ACCOUNT
Variable Account: The Variable Account is named on the contract data page and
consists of assets set aside by us, which are kept separate from our general
assets and all of our other Variable Account assets. The assets of the Variable
Account, equal to reserves and other liabilities of your contract and those of
other owners, will not be charged with liabilities arising out of any other
business we may do.
The Variable Account assets are divided into subaccounts. The assets of the
subaccounts are allocated to the investment options shown on the contract data
page.
Investments of the Variable Account: Purchase payments applied to the Variable
Account are allocated to subaccounts. We may, from time to time, add additional
investment options to those options shown on the contract data page. You may be
permitted to transfer contract values to the additional investment option(s).
However, the right to make any transfer will be limited by any terms and
conditions in effect at the time of transfer.
If the shares of any of the investment options become unavailable for investment
by the Variable Account, or if we deem further investment in these shares
inappropriate, we may limit further purchase of such shares or substitute shares
of another investment option for shares already purchased under this contract.
Valuation of Assets: Assets of the Variable Account are valued each business day
at their fair market value in accordance with our procedures.
Change in Operation of the Variable Account: We reserve the right to modify the
structure or operation of the Variable Account. If we do so, we guarantee that
such modification will not affect the value of your contract.
Accumulation Units: Accumulation units shall be used to account for all amounts
allocated to or withdrawn from a subaccount as a result of purchase payments,
transfers, withdrawals, or fees and charges. We will determine the number of
accumulation units of a subaccount purchased or canceled. This is done by
dividing the amount allocated to (or the amount withdrawn from) the subaccount,
by the dollar value of one accumulation unit of the subaccount as of the
business day during which the request for transfer is received at our
Administrative Office.
Accumulation Unit Value: The Accumulation Unit Value for each subaccount was set
at $10 when the subaccount became part of the Variable Account. Subsequent
accumulation unit values for each subaccount are determined by multiplying the
accumulation unit value for the immediate preceding business day by the net
investment factor of the subaccount for the current business day. The
accumulation unit value may increase or decrease from business day to business
day.
Net Investment Factor: The net investment factor for each subaccount is
determined by dividing (1) by (2) and subtracting (3) from the result, where:
(1) is the result of:
(a) the net asset value per share of the investment option held in the
subaccount, determined at the end of the normal business day; plus
(b) the per share amount of any divided or capital gain distributions made
by the investment option held in the subaccount, if the "ex-dividend"
date occurs as of the current business day; plus or minus
(c) a per share charge or credit for any taxes reserved for, which we
determine to have resulted from the operations of the subaccount.
(2) is the net asset value per share of the investment option held in the
subaccount, determined at the end of the prior business day.
(3) is a daily factor representing the product expense charge deducted from the
subaccount.
TRANSFERS
A transfer is subject to the following:
1. The maximum number of transfers without a transfer fee is shown on the
contract data page;
2. We reserve the right to assess a transfer fee if the number of transfers
exceeds the maximum number of free transfers. We will notify you of the
imposition of any transfer fee. Any transfer fee we may impose is deducted
from the amount which is transferred;
3. You may not make a transfer until after the end of the free look period;
4. The minimum amount which may be transferred is shown on the contract data
page;
5. A transfer will be effected as of the end of the normal business day when
we receive an acceptable transfer request;
6. We are not liable for a transfer made in accordance with your instructions;
7. We reserve the right to restrict transfers between subaccounts to a maximum
of twelve (12) per contract year and to restrict transfers from being made
on consecutive business days. We also reserve the right to restrict
transfers into and out of the any fixed account;
8. Your right to make transfers is subject to modification if we determine, in
our sole opinion, that the exercise of the right by one or more owners is,
or would be, to the disadvantage of other owners. Restrictions may be
applied in any manner reasonably designed to prevent any use of the
transfer right which we considered to be to the disadvantage of other
owners. A modification could be applied to transfers to or from, one or
more of the subaccounts and could include, but is not limited to:
a. the requirement of a minimum time period between each transfer;
b. not accepting a transfer request from an agent acting under a power of
attorney on behalf of more than one owner; or
c. limiting the dollar amount that may be transferred between the
subaccounts by an owner at any one time;
9. During times of severe economic or market conditions, we may suspend the
transfer privilege temporarily without notice and treat transfer requests
based on their separate components (a redemption order with a simultaneous
request for purchase of another subaccount). In such a case, the redemption
order would be processed at the source subaccount's next determined
accumulation unit. However, the purchase into the new subaccount would be
effective at the next determined accumulation unit value for the new
subaccount only after we receive proceeds from the source subaccount, or we
otherwise receive cash on behalf of the source subaccount;
10. Transfers do not change the allocation instructions for future purchase
payments;
11. You may elect to make transfers by telephone. To elect this option you must
first make a written request. If there are joint owners, unless we are
instructed to the contrary, instructions by telephone will be accepted from
either one of the joint owners. We will use reasonable procedures to
confirm that instructions communicated by telephone are genuine;
12. Transfers made during the annuity period are also subject to the following:
a. The number of transfers is limited to the number of transfers set
forth on the contract data page;
b. You may not make a transfer from the general account to a subaccount;
c. The amount transferred to the general account from a subaccount will
be based on current company
practice for such requests at the time of the transfer; and d. You may not
make a transfer within three (3) business days of an annuity payment
date.
WITHDRAWALS
Withdrawals during the Accumulation Period: You may withdraw all or part of the
contract value subject to the following:
1. The minimum partial withdrawal amount is shown on the contract data page.
2. The maximum partial withdrawal is the amount that would leave a minimum
contract value of the amount shown on the contract data page.
This contract ends when we pay the withdrawal value. The withdrawal value will
be determined as of the date we receive your written notice and this contract.
We will withdraw the amount you request from the contract value as of the day
that we receive your written notice and send that amount to you. We will deduct
any applicable withdrawal, contract maintenance and/or other charges.
If your written notice does not specify the amount to be withdrawn from each
subaccount or any fixed account, we will make the withdrawal based on the
proportion that each subaccount and each fixed account bears to the contract
value as of the date of the withdrawal.
For purposes of withdrawal charges, all withdrawals will be determined on a
first in, first out basis.
Termination: We may terminate this contract and pay you the withdrawal value, if
before the annuity date your withdrawal will result in your contract value
falling below the minimum stated on the contract data page.
We will mail you a notice of our intent to terminate this contract. This
contract will automatically terminate unless we receive additional purchase
payments in excess of the minimum amount specified on the contract data page
within thirty (30) days.
Minimum Benefit: The value of this contract is at least equal to the minimum
under any nonforfeiture law where this contract has been issued.
PAYMENT OF BENEFITS
Payment of Benefits from Subaccounts: We will make any transfer and will pay the
proceeds of any withdrawal, death benefit or annuity payment within seven
business days after receipt of all written notices and/or due proofs of death.
This payment or transfer may be postponed if:
1. The New York Stock Exchange is closed, other than customary weekend or
holiday closing, or trading on the exchange is restricted as determined by
the Securities and Exchange Commission ("SEC"); or
2. The SEC permits, by an order, the postponement for your protection; or
3. The SEC determines that an emergency exists that would make the disposal of
securities held in the Variable Account or determination of their value not
reasonably practicable.
Right to Defer Payments or Transfers from the fixed account: We have the right
to defer payment of any withdrawal or transfer from the any fixed account for up
to six (6) months from the date we receive your written notice, unless the law
in your state provides otherwise.
DEATH BENEFIT
Minimum Guaranteed Death Benefit: The minimum guaranteed death benefit during
the accumulation period is equal to the greater of:
1. total purchase payments less any adjusted withdrawals and related
withdrawal charges; or
2. the contract value determined as of the end of the normal business day
during which we receive both due proof of death and an election for the
payment method.
The adjusted withdrawal amount is dependent upon the relationship between the
contract value and the minimum guaranteed death benefit.
If the contract value equal equals or exceeds the minimum guaranteed death
benefit at the time of withdrawal, the adjusted withdrawal will equal 100% of
the actual withdrawal amount.
If the contract value is less than the minimum guaranteed death benefit at the
time of withdrawal, the adjusted withdrawal will equal the actual withdrawal
times the ratio of the minimum guaranteed death benefit to the contract value.
Death of Owner During the Accumulation Period: Upon your death or the death of
any joint owner during the accumulation period, the death benefit will be paid
to the beneficiary(ies) you had designated. Upon death of a joint owner, the
surviving joint owner, if any, will be treated as the primary beneficiary. Any
other beneficiary designation on record at the time of death will be treated as
a contingent beneficiary.
Death Benefit Options During the Accumulation Period: Unless already selected by
the owner, a beneficiary must elect the death benefit to be paid under one (1)
of the options below in the event of the death of an owner during the
accumulation period. Furthermore, if the beneficiary is the spouse of the owner,
he or she may elect to continue this contract in his or her own name and
exercise all the owner's rights under the contract. In this event, the contract
value will be adjusted to equal the death benefit.
Option 1 - lump sum payment of the death benefit;
Option 2 - payment of the entire death benefit within five (5) years of the
date of the death of the owner or any joint owner; or
Option 3 - payment of the death benefit under an annuity option over the
lifetime of the beneficiary or over a period not extending beyond the life
expectancy of the beneficiary with distribution beginning within one (1)
year of the date of death of the owner or any joint owner.
Any portion of the death benefit not applied to option 2 within one (1) year of
the date of death of the owner or joint owner must be distributed within five
(5) years of the date of death.
If a lump sum payment is requested, the amount will be paid within seven (7)
days of receipt of proof of death and election, unless payment is postponed as
described above.
Payment to the beneficiary, other than in a single sum, may be elected only
during the 60-day period beginning with the date we receive due proof of death.
Contract value is computed as of the date we receive due proof of death of the
owner. From the time the death benefit is determined until complete distribution
is made, any amount in any subaccount will be subject to investment risk which
is borne by the beneficiary.
Death Benefits on or After the Annuity Date: If the owner or joint owner, who is
not the annuitant, dies after the annuity date, any remaining payments under the
annuity option elected will continue at least as rapidly as under the method of
distribution in effect on the date of the owner's death. Upon the death of the
owner during the annuity period, the beneficiary becomes the new owner.
Death of the Annuitant: Upon the death of an annuitant, who is not the owner,
during the accumulation period, the owner automatically becomes the annuitant.
The owner may designate a new annuitant, subject to the Company's underwriting
rules then in effect. If the owner is a non-natural person, the death of the
primary annuitant will be treated as death of the owner and a new annuitant may
not be designated.
Upon the death of the annuitant during the annuity period, the death benefit, if
any, will be as specified in the annuity option elected. Death benefits will be
paid at least as rapidly as under the method of distribution in effect at the
annuitant's death.
ANNUITY PROVISIONS AND PAYMENT OPTIONS
The Annuity Date: The annuity date may not be sooner than the first day of the
second contract year nor may it be later than the 95th birthday of the
annuitant, or earlier if required by law. Upon your request to annuitize, we
will issue a supplemental contract. If you do not elect an annuity option,
Option 4 with 10 year period certain is the default.
Annuity Payments: Annuity payments start at least 30 days after the annuity
date, provided the annuitant is alive. All annuity payments are made to you,
unless you elect otherwise.
Minimum Annuity Benefit: The minimum annuity benefit will be greater than or
equal to that mandated by law in the state of issue.
Fixed Annuity Payments: Fixed annuity payments are periodic payments that depend
only on the form and duration of the annuity payment option selected, the
annuity value applied to purchase the annuity payments and the age and sex of
the annuitant.
Variable Annuity Payments: The value of a variable annuity payment is based on
the annuity units on the annuity date. The number of annuity units attributable
to each subaccount under a contract remains fixed unless there is an exchange of
annuity units.
Annuity Unit: An annuity unit is the unit of measure used to calculate variable
annuity payments. An annuity unit is calculated by dividing the dollar amount of
the first variable annuity payment attributable to that subaccount by the
annuity unit value of that subaccount.
Annuity Unit Value: The annuity unit value of each subaccount for any business
day is equal to (a) multiplied by (b) divided by (c) where:
(a) is the net investment factor for the business day for which the annuity
unit value is being calculated;
(b) is the annuity unit value for the preceding valuation period;
(c) is the Assumed Investment Factor adjusted for the number of days in the
valuation period. The Annual Investment Factor is equal to one plus 3% or
1.03. The annual factor can be translated into a daily factor of
1.00008098.
Annuity Value: The annuity value is the contract value less any contract
maintenance charge less any applicable taxes.
Payment Option Rate Tables: The amount of monthly payments per $1,000 applied is
shown for a fixed annuity in these tables. For a variable annuity, the tables
show the amount of the first variable annuity payment only. Subsequent variable
annuity payments will change with changes in annuity unit value.
Option 1 - Payment Certain - We pay the annuity value in equal payments as you
specify. The total of all payments made in each year must be at least 5% of the
annuity value applied under this option. The amount of each fixed annuity
payment and the first variable annuity payment for each $1,000 of annuity value
applied is shown in Table 1. The owner has the right of commutation at the
interest rate used for determination of payments less any applicable withdrawal
charges.
Option 2 - Period Certain - We pay the annuity value in equal installments over
a designated period of time you choose of not less than six (6) nor more than
thirty (30) years. The amount of each fixed annuity payment and the first
variable annuity payment for each $1,000 of annuity value applied is shown in
Table 2. The owner has the right of commutation at the interest rate used for
determination of payments less any applicable withdrawal charges.
Option 3 - Life Annuity -- We apply the annuity value to make monthly payments
while the annuitant lives.
Option 4 - Life Annuity with Period Certain - We apply the annuity value to make
monthly payments until the later of the death of the annuitant or the period
certain. The period certain is not to be less than six (6) years nor more than
thirty (30) years. The amount of each fixed annuity payment and the first
variable annuity payment is shown in Table 2. If the annuitant dies during the
period certain payout, the owner has the right of commutation at the interest
rate used for determination of payments .
Option 5 - Joint Life and Survivor Annuity - We apply the annuity value to make
monthly payments while both annuitants are living. After the death of either
annuitant, payments continue as long as the other annuitant still lives. The
amount of each fixed annuity payment and the first variable annuity payment is
shown in Table 3.
Additional Options: We may make other income options available.
TABLE 1 - PAYMENTS CERTAIN (per $1,000 of annuity value applied)
-------------------------------- -------------------------------------------------------------------------------------
Number Amount of
-------------------------------- -------------------------------------------------------------------------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
Annual Semi-Annual Quarterly Monthly
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
6 179.22 90.27 45.30 15.14
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
7 155.83 78.49 39.39 13.16
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
8 138.31 69.67 34.96 11.68
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
9 31.52 10.53 31.52 10.53
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
10 28.77 9.61 28.77 9.61
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
11 26.52 8.86 26.52 8.86
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
12 24.66 8.24 24.66 8.24
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
13 23.08 7.71 23.08 7.71
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
14 21.73 7.26 21.73 7.26
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
15 20.56 6.87 20.56 6.87
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
16 19.54 6.53 19.54 6.53
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
17 73.74 37.14 18.64 6.23
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
18 70.59 35.56 17.84 5.96
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
19 67.78 34.14 17.13 5.73
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
20 65.26 32.87 16.50 5.51
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
25 55.76 28.08 14.09 4.71
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
30 49.53 24.95 12.52 4.18
-------------------------------- ------------------------- --------------------- ------------------ ------------------
1983(a) mortality tables at 3% interest with a five (5) year setback for females
Table 2 - Period Certain and Life (per $1,000 of annuity value applied)
------------------------- ------------------ ------------------- ------------------ ------------------ ===================
Number of Number Of Number of
------------------------- ------------------ ------------------- ------------------ ------------------ ===================
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ---------- --------- =========
Male Female 15 20 Male Female 15 20 Male Female 15 20
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ---------- --------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
16 and 21 and 39 44 $3.59 $3.56 63 68 $5.26 $4.91
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
under under $2.96 $2.96 40 45 3.63 3.60 64 69 5.37 4.97
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
17 22 2.98 2.97 41 46 3.67 3.64 65 70 5.47 5.03
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
18 23 2.99 2.99 42 47 3.72 3.68 66 71 5.57 5.09
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
19 24 3.01 3.01 43 48 3.77 3.73 67 72 5.67 5.14
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
20 25 3.03 3.03 44 49 3.82 3.78 68 73 5.77 5.19
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
21 26 3.05 3.05 45 50 3.87 3.82 69 74 5.87 5.23
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
22 27 3.07 3.07 46 51 3.93 3.87 70 75 5.97 5.27
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
23 28 3.09 3.09 47 52 3.98 3.92 71 76 6.06 5.31
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
24 29 3.11 3.11 48 53 4.04 3.98 72 77 6.15 5.35
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
25 30 3.14 3.13 49 54 4.10 4.03 73 78 6.24 5.37
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
26 31 3.16 3.16 50 55 4.17 4.09 74 79 6.32 5.40
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
27 32 3.19 3.18 51 56 4.24 4.15 75 80 6.39 5.42
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
28 33 3.21 3.20 52 57 4.31 4.20 76 81 6.46 5.44
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
29 34 3.24 3.23 53 58 4.38 4.26 77 82 6.52 5.46
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
30 35 3.27 3.26 54 59 4.45 4.33 78 83 6.58 5.47
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
31 36 3.30 3.29 55 60 4.53 4.39 79 84 6.63 5.48
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
32 37 3.33 3.32 56 61 4.61 4.45 80 85 6.67 5.49
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
33 38 3.36 3.35 57 62 4.70 4.52 81 and 6.71 5.50
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
34 39 3.39 3.38 58 63 4.79 4.58 82 over 6.74 5.50
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
35 40 3.43 3.41 59 64 4.88 4.65 83 6.77 5.50
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
36 41 3.47 3.45 60 65 4.97 4.72 84 6.79 5.51
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
37 42 3.50 3.48 61 66 5.07 4.78 85+ 6.81 5.51
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
38 43 3.54 3.52 62 67 5.16 4.85
------------ ------------ -------- --------- ------- ----------- -------- --------- ------- ----------- -------- =========
o Use the Payee's age nearest the Date of Settlement.
o 1983(a) mortality tables at 3% interest with a five (5) year setback for
females
Joint and Survivor (per $1,000 of annuity value applied)
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
Age of
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
Male Female 60 61 62 63 64 65 66
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
51 56 $3.89 $3.92 $3.94 $3.97 $3.99 $4.01 $4.04
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
52 57 3.93 3.96 3.98 4.01 4.04 4.06 4.08
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
53 58 3.96 3.99 4.02 4.05 4.08 4.11 4.13
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
54 59 4.00 4.03 4.06 4.09 4.12 4.15 4.18
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
55 60 4.03 4.07 4.10 4.14 4.17 4.20 4.23
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
56 61 4.07 4.11 4.14 4.18 4.21 4.25 4.28
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
57 62 4.10 4.14 4.18 4.22 4.26 4.30 4.33
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
58 63 4.14 4.18 4.22 4.26 4.30 4.34 4.38
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
59 64 4.17 4.21 4.26 4.30 4.35 4.39 4.44
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
60 65 4.20 4.25 4.30 4.34 4.39 4.44 4.49
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
61 66 4.23 4.28 4.33 4.38 4.44 4.49 4.54
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
62 67 4.26 4.32 4.37 4.42 4.48 4.53 4.59
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
63 68 4.29 4.35 4.41 4.46 4.52 4.58 4.63
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
64 69 4.32 4.38 4.44 4.50 4.56 4.62 4.68
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
65 70 4.35 4.41 4.47 4.54 4.60 4.66 4.73
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
66 71 4.37 4.44 4.50 4.57 4.64 4.71 4.78
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
67 72 4.40 4.47 4.53 4.60 4.67 4.75 4.82
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
68 73 4.42 4.49 4.56 4.64 4.71 4.79 4.86
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
69 74 4.45 4.52 4.59 4.67 4.74 4.82 4.90
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
70 75 4.47 4.54 4.62 4.70 4.78 4.86 4.94
----------------- ----------- ---------- ---------- ---------- -------------- -------------- ------------- ==============
1983(a) mortality tables at 3% interest with a five (5) year setback for females
Joint and Survivor (con't.)
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
Age of
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
Male Female 67 68 69 70 71 72 73 74 75
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
51 56 4.06 4.08 4.10 4.12 4.13 4.15 4.17 4.18 4.19
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
52 57 4.11 4.13 4.15 4.17 4.19 4.21 4.23 4.24 4.26
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
53 58 4.16 4.18 4.21 4.23 4.25 4.27 4.29 4.31 4.33
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
54 59 4.21 4.24 4.26 4.29 4.31 4.33 4.36 4.38 4.40
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
55 60 4.26 4.29 4.32 4.35 4.37 4.40 4.42 4.45 4.47
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
56 61 4.32 4.35 4.38 4.41 4.44 4.47 4.49 4.52 4.54
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
57 62 4.37 4.41 4.44 4.47 4.50 4.53 4.56 4.59 4.62
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
58 63 4.42 4.46 4.50 4.54 4.57 4.60 4.64 4.67 4.70
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
59 64 4.48 4.52 4.56 4.60 4.64 4.67 4.71 4.74 4.78
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
60 65 4.53 4.58 4.62 4.66 4.71 4.75 4.79 4.82 4.86
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
61 66 4.59 4.63 4.68 4.73 4.78 4.82 4.86 4.90 4.94
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
62 67 4.64 4.69 4.74 4.80 4.85 4.89 4.94 4.99 5.03
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
63 68 4.69 4.75 4.81 4.86 4.92 4.97 5.02 5.07 5.12
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
64 69 4.74 4.81 4.87 4.93 4.99 5.05 5.10 5.16 5.21
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
65 70 4.80 4.86 4.93 4.99 5.06 5.12 5.18 5.24 5.30
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
66 71 4.85 4.92 4.99 5.06 5.13 5.19 5.26 5.33 5.39
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
67 72 4.89 4.97 5.05 5.12 5.19 5.27 5.34 5.41 5.48
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
68 73 4.94 5.02 5.10 5.18 5.26 5.34 5.42 5.50 5.58
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
69 74 4.99 5.07 5.16 5.24 5.33 5.41 5.50 5.58 5.67
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
70 75 5.03 5.12 5.21 5.30 5.39 5.48 5.58 5.67 5.76
----------------- ---------- ----------- ---------- -------- ---------- ----------- -------- --------- --------- ========
1983(a) mortality tables at 3% interest with a five (5) year setback for females
Valley Forge Life Insurance Company
A Stock Company
Executive Office: Home Office:
CNA Plaza ▇▇▇ ▇▇▇▇ ▇▇.
▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇
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Annuity payments and other values provided by this contract, when based on the
investment performance of the Variable Account, may increase or decrease daily
as a function of the investment performance of the subaccounts you select and
are not guaranteed as to dollar amount. No minimum contract value is guaranteed.
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INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT