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Exhibit 4(b)
Form of Individual Certificate
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EXHIBIT (4)(b)
PAINEWEBBER LIFE
PAINEWEBBER LIFE INSURANCE COMPANY
Administrative Office
▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇ ▇▇▇▇▇
CERTIFICATE NUMBER: [99999999]
CERTIFICATEHOLDER: [▇▇▇▇ ▇▇▇]
GROUP CONTRACT NO. [9999999]
CONTRACTHOLDER: [THE ABC TRUST]
CONTRACT GOVERNED BY THE LAWS OF: [RHODE ISLAND]
DATE OF ISSUE: [SEPTEMBER 1, 1995]
[PageNum]This is a legal contract between the Certificateholder and PaineWebber
Life Insurance Company. Read this Certificate with care. PaineWebber Life
Insurance Company agrees, in accordance with the provisions of the Certificate,
to pay benefits to the extent required by this Certificate, to those persons
entitled to such benefits.
10 DAY RIGHT TO EXAMINE CERTIFICATE
This Certificate may be returned by mailing or delivering the Certificate to
us, or to our agent. If returned, the Certificate will be considered void from
the beginning. The Certificate Owner will be sent any Net Purchase Payment
allocated to the Fixed Account plus any Variable Account Value, plus any
charges deducted from any Purchase Payment, computed at the end of the
Valuation Period in which this Certificate is received by us at our
Administrative Office.
Signed by PaineWebber Life Insurance Company on the Issue Date.
President Secretary
ALL PAYMENTS, VALUES, AND BENEFITS, WHEN BASED ON THE INVESTMENT EXPERIENCE OF
THE SEPARATE ACCOUNT, MAY INCREASE OR DECREASE DEPENDING ON INVESTMENT RESULTS,
AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT.
GROUP DEFERRED VARIABLE ANNUITY CERTIFICATE
FLEXIBLE PURCHASE PAYMENTS
WITH FIXED ACCOUNT OPTION
COUNTERSIGNED BY
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TABLE OF CONTENTS
SECTION PAGE
1 DEFINITIONS ......................................................................................
2 OWNER ............................................................................................
3 ANNUITANT ........................................................................................
4 BENEFICIARY ......................................................................................
5 SEPARATE ACCOUNT .................................................................................
6 FIXED ACCOUNT ....................................................................................
7 PURCHASE PAYMENTS ................................................................................
8 TRANSFERS ........................................................................................
9 WITHDRAWALS ......................................................................................
10 DEATH OF OWNER PRIOR TO THE ANNUITY DATE .........................................................
11 CHARGES AND DEDUCTIONS ...........................................................................
12 GENERAL PROVISIONS ...............................................................................
13 TERMINATION PROVISIONS ...........................................................................
14 ANNUITY PROVISIONS ...............................................................................
15 FIXED ANNUITY PAYMENTS ...........................................................................
16 VARIABLE ANNUITY PAYMENTS.........................................................................
17 DEATH OF ANNUITANT ...............................................................................
18 ANNUITY OPTIONS ..................................................................................
19 ANNUITY TABLES - NONQUALIFIED ....................................................................
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SCHEDULE PAGE
ELIGIBLE CLASSES: [All customers and employees of Sponsor]
ANNUITANT ISSUE AGES: [0 - 85]
CERTIFICATE OWNER ISSUE AGES: [0 - 85]
(Applies to both Owners if Joint Owners exist.)
ELIGIBLE OWNER ISSUE AGES
ANNUAL RESET DEATH BENEFIT OPTION: 0-80
INTEREST ACCRUAL DEATH BENEFIT OPTION: 0-80
ANNUAL RESET INCOME BENEFIT OPTION: 0-80
INTEREST ACCRUAL INCOME BENEFIT OPTION: 0-80
(Applies to both Owners if Joint Owners exist):
EARLIEST ANNUITY DATE: [99/99/99*]
LATEST ANNUITY DATE: [99/99/99*]
AUTOMATIC ANNUITY DATE: [99/99/99*]
MAXIMUM MATURITY AGE: OWNER'S AGE [90]
If there are Joint Owners, Maximum Maturity Age refers to the age of the
youngest Joint Owner.
(* date based on Owner's age.)
NONQUALIFIED QUALIFIED IRA
MINIMUM INITIAL CERTIFICATE
PURCHASE PAYMENT:
[$5,000] [$1,000] [$200]
MINIMUM ADDITIONAL CERTIFICATE
PURCHASE PAYMENTS:
[$ 500] [$ 50] [$ 50]
MAXIMUM AGGREGATE PURCHASE PAYMENTS WITHOUT PRIOR HOME OFFICE APPROVAL:
[$1,500,000]
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SCHEDULE PAGE (CONTINUED)
AVAILABLE SEPARATE ACCOUNT DIVISIONS
EACH DIVISION OF THE PAINEWEBBER LIFE VARIABLE ANNUITY ACCOUNT INVESTS IN A
SPECIFIC INVESTMENT PORTFOLIO INDICATED BELOW. FOLLOWING ARE THE SEPARATE
ACCOUNT DIVISIONS AND THE INVESTMENT PORTFOLIOS IN WHICH THEY INVEST:
[Money Market Division Money Market Portfolio of PaineWebber Series
Trust
High Grade Fixed Income Division* High Grade Fixed Income Portfolio of AAA
Series Trust
Global Income Division* Global Income Portfolio of BBB Series Trust
Balanced Division* Balanced Portfolio of CCC Series Trust
Growth Division* Growth Portfolio of DDD Series Trust
Aggressive Growth Division* Aggressive Growth Portfolio of EEE Series Trust
Global Growth Division* Global Growth Portfolio of FFF Series Trust
Strategic Fixed Income Division* Strategic Fixed Income Portfolio of GGG Series
Trust
Growth and Income Division* Growth and Income Portfolio of HHH Series Trust
[*Indicates Eligible Divisions as set out in the Interest Accrual Death Benefit
Option and the Interest Accrual Income Benefit Option]
AVAILABLE FIXED ACCOUNT OPTIONS
FIXED ACCOUNTS:
STABLE VALUE FIXED ACCOUNT A:
MINIMUM GUARANTEED INTEREST RATE: [3%] PER YEAR
BONUS INTEREST RATE: [1%] FOR [1] YEAR(S)
STABLE VALUE FIXED ACCOUNT B:
MINIMUM GUARANTEED INTEREST RATE: [3%] PER YEAR
BONUS INTEREST RATE: [0%] for [1] YEAR(S)
Stable Value Fixed Account B is only available for allocations of
Certificate Value subject to our Dollar Cost Averaging Program.
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SCHEDULE PAGE (CONTINUED)
SCHEDULE OF CHARGES
CERTIFICATE MAINTENANCE CHARGE: $0
DAILY CHARGE: On an annual basis the asset charges are the percentage, shown
below, of the daily net asset value of the Divisions of the Separate Account.
BASIC BENEFIT RISK CHARGE: [1.00%]
TRADITIONAL DEATH BENEFIT CHARGE: [0.20%]
[ANNUAL RESET DEATH BENEFIT CHARGE: [0.15%]
[ANNUAL RESET INCOME BENEFIT CHARGE [0.15%]
[INTEREST ACCRUAL DEATH BENEFIT CHARGE: [0.15%]
[INTEREST ACCRUAL INCOME BENEFIT CHARGE: [0.15%]
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TOTAL: [1.80%]
The Daily Charge is equal to the annual charges divided by 365.
[EARLY WITHDRAWAL CHARGE: The Early Withdrawal Charge is a percentage of each
Net Purchase Payment made and is based on the period of time after it is
received by us.
Age of Purchase Payment in Calendar Years
-----------------------------------------
1 2 3 4 5 6 7 8+
Early Withdrawal Charge 6% 6% 5% 4% 3% 2% 1% 0%
TRANSFER OPTIONS AND CHARGES:
NUMBER OF FREE TRANSFERS IN A CERTIFICATE YEAR: [12]
EXCESS TRANSFER CHARGE: [$10]
PARTIAL WITHDRAWAL OPTIONS AND CHARGES:
WITHDRAWALS:
MINIMUM WITHDRAWAL AMOUNT: [$500], except for a
SYSTEMATIC WITHDRAWAL SERVICE (ACCEPTABLE TO US): [$100]
MINIMUM CERTIFICATE VALUE AFTER WITHDRAWAL: If a withdrawal would reduce the
Certificate Value below the greater of A or the sum of B and C, then we will
treat the transaction as a full withdrawal.
(A) is [$1,000];
(B) is the Early Withdrawal Charge on any Purchase
Payments with a Early Withdrawal Charge Period
remaining; and
(C) is the amount of state premium tax owed, if any.
EARLY WITHDRAWAL CHARGE PERIOD for a Purchase Payment is the 7-year period
following the date the Purchase Payment was made.
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NUMBER OF WITHDRAWALS IN A CERTIFICATE YEAR NOT SUBJECT TO A TRANSACTION
CHARGE: [2]
EXCESS WITHDRAWAL TRANSACTION CHARGE: [FOR EACH WITHDRAWAL: $25 or 2% of the
amount withdrawn, whichever is less.] The Excess Withdrawal Transaction Charge
does not apply on or after the Annuity Date or to any withdrawal made through a
systematic withdrawal service acceptable to us. However, withdrawals through a
systematic withdrawal service may be assessed a [$1.50] administrative fee for
each payment.
FREE WITHDRAWAL AMOUNT: The Free Withdrawal Amount is the amount that may be
withdrawn each Certificate Year without the application of the Early Withdrawal
Charge. The Free Withdrawal Amount is equal to [15% of the Certificate Value on
the first Valuation Day of the Certificate Year.]
For the purpose of determining the Early Withdrawal Charge, we assume that all
withdrawals are taken:
(A) first from any remaining Free Withdrawal Amount;
(B) next from Net Purchase Payments with no Early Withdrawal Charge Period
remaining;
(C) next from Net Purchase Payments with an Early Withdrawal Charge Period
remaining, starting with the shortest Early Withdrawal Charge Period remaining
and progressing to the longest;
(D) next from any remaining amount.
For purposes of determining Early Withdrawal Charges on future withdrawals, any
Free Withdrawal Amount is not considered a liquidation of Purchase Payments.
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SCHEDULE PAGE (CONTINUED)
[ANNUAL RESET DEATH BENEFIT OPTION: The ANNUAL RESET DEATH BENEFIT OPTION may
be elected by the Owner in the application for the Certificate.
ANNUAL RESET DEATH BENEFIT OPTION: If the Owner dies prior to the Annuity
Date and on or prior to the Maximum Maturity Age, the Death Benefit is the
greatest of (A), (B), or (C) where:
(A) is the Certificate Value
(B) is the sum of all Net Purchase Payments less any prior partial withdrawals,
Early Withdrawal Charges, Excess Withdrawal Transaction Charges and Excess
Transfer Charges.
(C) is the greatest Certificate Value as measured on each Certificate
Anniversary, plus any Purchase Payments after that anniversary; less any
partial withdrawals, Early Withdrawal Charges, Excess Withdrawal Transaction
Charges and Excess Transfer Charges imposed after that anniversary.
The Certificate Values taken into account for purpose of calculating
(C) are based on the Owner's age at issue. If Joint Owners exist, the age of
the youngest Joint Owner is used.
1) If the age at issue is 0-75, (C) will take into account
Certificate Values for Certificate Anniversaries when the Owner's age is less
than or equal to age 80. Thereafter, no additional Certificate Values will be
taken into account, but prior Certificate Values will continue to be adjusted
as described in (C).
2) If the age at issue is 76-80, (C) will take into account Certificate
Values on each of the first five Certificate Anniversaries. Thereafter, no
additional Certificate Values will be taken into account, but prior Certificate
Values will continue to be adjusted as described in (C).
DEATH BENEFIT AFTER THE MAXIMUM MATURITY AGE AND BEFORE THE ANNUITY DATE: The
Death Benefit after the Maximum Maturity Age and before the Annuity Date is the
Net Certificate Value.
ANNUAL RESET DEATH BENEFIT CHARGE: The Annual Reset Death Benefit Risk Charge
will be computed and deducted from the Separate Account Divisions for each day
this Certificate is in force prior to the Annuity Date. On an annual basis it
equals the percentage, shown on the Schedule Page, of the daily net asset value
of the Divisions.
The PAYMENT OF THE DEATH BENEFIT and PAYMENT OPTION provisions in section 10 of
this Certificate also apply to Annual Reset Death Benefit Option.]
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SCHEDULE PAGE (CONTINUED)
[INTEREST ACCRUAL DEATH BENEFIT OPTION: The Interest Accrual Death Benefit may
be elected by the Owner in the application for the Certificate.
INTEREST ACCRUAL DEATH BENEFIT OPTION: If the Owner dies prior to the Annuity
Date and on or prior to the Maximum Maturity Age, the Death Benefit is the
greatest of (A) or (B), where:
(A) is the Certificate Value.
(B) is Net Purchase Payments less any partial withdrawals, Early
Withdrawal Charges, Excess Withdrawal Transaction Charges, and Excess
Transfer Charges all accumulated at the Death Benefit Accrual Rate.
The Death Benefit Accrual Rate is a weighted average of the accrual
rates for Eligible Divisions, each Ineligible Division, and each Fixed
Account Option. The calculation is done on a daily basis. The daily
accrual rate for Eligible Divisions is .0159654%, which is equivalent
to 6% on an annual basis. The daily accrual rate for each Ineligible
Division and each Fixed Account option is equal to the actual net rate
of return of each. The daily accrual rates are weighted by the daily
Certificate Values in the Eligible Divisions, each Ineligible
Division, and each Fixed Account option.
The calculation of (B) is based on the Owner's age at issue. If Joint
Owners exist, the age of the youngest Joint Owner is used.
1) If the age at issue is 0-75, (B) accumulates until the Certificate
Anniversary when the Owner reaches age 80. After the Certificate Anniversary
when the Owner reaches age 80, (B) is increased by any Net Purchase Payments
and decreased by any partial withdrawals, Early Withdrawal Charges, Excess
Withdrawal Transaction Charges, and Excess Transfer Charges since that date but
no further interest accumulates.
2) If the age at issue is 76-80, (B) accumulates until the Certificate
Anniversary five years after the issue date of the Certificate. Beyond this
anniversary, (B) is increased by any Net Purchase Payments and decreased by any
partial withdrawals, Early Withdrawal Charges, Excess Withdrawal Transaction
Charges and Excess Transfer Charges since that date, but no further interest
accumulates.
DEATH BENEFIT AFTER THE MAXIMUM MATURITY AGE AND BEFORE THE ANNUITY DATE: The
Death Benefit after the Maximum Maturity Age and before the Annuity Date is the
Net Certificate Value.
ELIGIBLE DIVISIONS: The current Eligible Divisions are shown in the Schedule
Page. We reserve the right to add, delete, or substitute Eligible Divisions.
The Owner will be notified of
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any such change in Eligible Divisions.
INTEREST ACCRUAL DEATH BENEFIT CHARGE: The Interest Accrual Death Benefit Risk
Charge will be computed and deducted from the Separate Account Divisions for
each day this Certificate is in force prior to the Annuity Date. On an annual
basis it equals the percentage, shown in the Schedule Page, of the daily net
asset value of the Divisions.
The PAYMENT OF THE DEATH BENEFIT and PAYMENT OPTION provisions in Section 10 of
this certificate also apply to Interest Accrual Death Benefit option.]
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SCHEDULE PAGE (CONTINUED)
[TRADITIONAL DEATH BENEFIT: The TRADITIONAL DEATH BENEFIT may be elected by
the Owner in the application for the Certificate.
TRADITIONAL DEATH BENEFIT: If the Owner dies prior to the Annuity Date and on
or prior to the Maximum Maturity Age, the Death Benefit is the greater of (A)
or (B), where:
(A) is the Certificate Value.
(B) is the sum of all Net Purchase Payments, less any prior partial
withdrawals, Early Withdrawal Charges, Excess Withdrawal Transaction Charges
and Excess Transfer Charges.
DEATH BENEFIT AFTER THE MAXIMUM MATURITY AGE AND BEFORE THE ANNUITY DATE: The
Death Benefit after Maximum Maturity Age and before the Annuity Date is the Net
Certificate Value.
TRADITIONAL DEATH BENEFIT CHARGE: The Traditional Death Benefit Risk Charge
will be computed and deducted from the Separate Account Divisions for each day
this Certificate is in force prior to the Annuity Date. On an annual basis it
equals the percentage, shown on the Schedule Page, of the daily net asset value
of the Divisions.
The PAYMENT OF THE DEATH BENEFIT and PAYMENT OPTION provisions in Section 10 of
this Certificate also apply to the Death Benefit.]
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SCHEDULE PAGE (CONTINUED)
[BASIC DEATH BENEFIT: The BASIC DEATH BENEFIT may be elected by the Owner in
the application for the Certificate.
BASIC DEATH BENEFIT: If the Owner dies prior to the Annuity Date, the Death
Benefit equals the Net Certificate Value.
The PAYMENT OF DEATH BENEFIT and PAYMENT OPTION provisions in Section 10 of
this certificate also apply to this Death Benefit.]
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SCHEDULE PAGE (CONTINUED)
[ANNUAL RESET INCOME BENEFIT OPTION may be selected by the Owner in the
application for the Certificate if the Owner also selects the Annual Reset
Death Benefit Option.
ANNUAL RESET INCOME BENEFIT OPTION: This Benefit Option provides that the
Fixed Annuity Payment on the Annuity Date will be the greater of (A) or (B):
(A) The Net Certificate Value on the Annuity Date at the Current Annuity
Settlement Option Rates, as explained in Section 15; or
(B) The amount determined under the Annual Reset Death Benefit, applied to any
Life Contingent Annuity Options for Fixed Annuity Payments at the Guaranteed
Annuity Settlement Option Rates. Life Contingent Annuity Options are methods
for determining the amount of each Annuity Payment over the Life of the
Annuitant. The Life Contingent Annuity Options for this Certificate are
currently Option 2 - Life Annuity, Option 3 - Life Annuity with Payments
Guaranteed for 10 or 20 years, and Option 4 - Joint and Survivor Life Annuity.
The Options are explained in Sections 18 and 19 of this Certificate.
Additional Life Contingent Annuity Options may be made available in the future.
This amount can not be applied to Current Annuity Settlement Option Rates.
The value of this benefit is not available to be taken as a withdrawal of
Certificate Value.
This benefit is not available for Variable Annuity Payments.
This benefit option may be exercised on or after the 7th Certificate
Anniversary, but must be exercised prior to the Latest Annuity Date.
ANNUAL RESET INCOME BENEFIT CHARGE will be computed and deducted from the
Separate Account Divisions for each day this Certificate is in force prior to
the Annuity Date. On an annual basis, it equals the percentage shown on the
Schedule Page, of the daily net asset value of the Divisions.
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SCHEDULE PAGE (CONTINUED)
[INTEREST ACCRUAL INCOME BENEFIT OPTION may be selected by the Owner in the
application for the Certificate if the Owner also selects the Interest Accrual
Death Benefit Option.
INTEREST ACCRUAL INCOME BENEFIT OPTION: This Benefit Option provides that the
Fixed Annuity Payment on the Annuity Date will be the greater of (A) or (B):
(A) The Net Certificate Value on the Annuity Date at the Current Annuity
Settlement Option Rates, as explained in Section 15; or
(B) The amount determined under the Interest Accrual Death Benefit, applied to
any Life Contingent Annuity Options for Fixed Annuity Payments at the
Guaranteed Annuity Settlement Option Rates. Life Contingent Annuity Options
are methods for determining the amount of each Annuity Payment over the Life of
the Annuitant. The Life Contingent Annuity Options for this Certificate are
currently Option 2 - Life Annuity, Option 3 - Life Annuity with Payments
Guaranteed for 10 or 20 years, and Option 4 - Joint and Survivor Life Annuity.
The Options are explained in Sections 18 and 19 of this Certificate.
Additional Life Contingent Annuity Options may be made available in the future.
This amount can not be applied to Current Annuity Settlement Option Rates.
The value of this benefit is not available to be taken as a withdrawal of
Certificate Value.
This benefit is not available for Variable Annuity Payments.
This benefit option may be exercised on or after the 7th Certificate
Anniversary, but must be exercised prior to the Latest Annuity Date.
The INTEREST ACCRUAL INCOME BENEFIT CHARGE will be computed and deducted from
the Separate Account Divisions for each day this Certificate is in force prior
to the Annuity Date. On an annual basis it equals the percentage, shown in the
Schedule Page, of the daily net asset value of the Divisions.]
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SCHEDULE PAGE (CONTINUED)
[STABLE VALUE FIXED ACCOUNT: The Stable Value Fixed Account is credited with
interest rate(s) which will not be less than the minimum guaranteed interest
rate shown in the Schedule Page. We may declare, from time to time at our sole
discretion, a current interest rate which is higher than the minimum guaranteed
interest rate and which is guaranteed for at least one year.
Net Purchase Payments allocated to, or transfers made into, the Stable Value
Fixed Account will earn interest at the current interest rate being declared at
that time. When the current interest rate expires, a new current interest
rate will be declared. The Value in the Stable Value Fixed Account will be
adjusted for any Early Withdrawal Charge, Excess Transaction Charge, or Excess
Transfer Charge that is allocated to the Stable Value Fixed Account.
The guaranteed benefits under this Certificate are provided through our General
Account and are subject to the claims arising out of other business we may
conduct.
BONUS INTEREST RATE: Interest, in addition to the declared current interest
rate, which will be credited in the amount shown in the Schedule Page, for the
length of time shown in the Schedule Page. The Bonus Interest Rate will not be
available beyond the length of time shown in the Schedule Page.
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SECTION 1 DEFINITIONS
ACCUMULATION UNIT is a unit of measurement we use to compute values in a
Division prior to the Annuity Date.
ANNUITANT means the natural person on whose life the annuity benefit for this
certificate is based.
ANNUITY DATE means the date on which the first Annuity Payment is made.
ANNUITY UNIT means a unit of measurement we use to compute the Variable Annuity
Payments from a Division.
BENEFICIARY means the person named to receive the payments under this
certificate due to the Owner's death.
CERTIFICATE means a form which describes a Certificate Owner's interest in this
Group Contract.
CERTIFICATE ANNIVERSARY means the date 12 months from the date of issue of this
certificate and annually thereafter.
CERTIFICATE YEAR means each 12 month period from the date of issue of the
Certificate.
CERTIFICATE VALUE means the sum of a Certificate Owner's values in each
Division of the Separate Account and in each Fixed Account option.
CONTRACT means the Master Group Contract form, A-3422, issued to the [ABC
Trust.]
CONTRACT ANNIVERSARY means the date 12 months from the date of issue of the
Contract and annually thereafter.
CONTRACTHOLDER means the person or entity shown in page 1 unless later changed,
that owns the master group contract under which an Annuity Certificate is
issued.
CURRENT ANNUITY SETTLEMENT OPTION RATES means the monthly income rates that
will be at least as favorable as those listed in section 19.
DIVISION means an investment option in the Separate Account. Each Division
invests in an investment portfolio shown on the Schedule Page. "Division" does
not include the Fixed Account.
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FIXED ACCOUNT means any account, as shown on the Schedule Page, for which
amounts allocated receive a fixed rate of interested determined by us from time
to time.
GUARANTEED ANNUITY SETTLEMENT OPTION RATES means the monthly income rates shown
in Section 19.
NET CERTIFICATE VALUE means the Owner's Certificate Value less all applicable
maintenance charges, Early Withdrawal Charges and premium taxes.
NET PURCHASE PAYMENT means a Purchase Payment less any premium taxes that may
be deducted from such Purchase Payment, as provided in this certificate under
which the Purchase Payment is made.
OWNER means the person named in a Certificate who is entitled to exercise all
rights and privileges of ownership under a Certificate. If Joint Owners exist,
both persons must agree to the exercise of any right and privilege of ownership
under the Certificate.
PURCHASE PAYMENT means any money the Owner paid us for his or her Certificate.
SEPARATE ACCOUNT means PaineWebber Life Variable Annuity Account, a separate
investment account of PaineWebber Life Insurance Company. Assets allocated to
the Separate Account remain our property. Assets of the Separate Account equal
to its reserves and other liabilities are not subject to the claims arising out
of any other business we may conduct.
VALUATION DAY means any day the New York Stock Exchange is open and PaineWebber
Life Insurance Company is open for business.
VALUATION PERIOD means the interval from the end of one Valuation Day to the
end of the next Valuation Day of an investment portfolio. Valuation occurs at
the end of each Valuation Day, which is the close of the New York Stock
Exchange (usually, 4pm Eastern Time).
WE, US, or OUR means PaineWebber Life Insurance Company.
YOU or YOUR means the Owner of this Certificate.
SECTION 2 OWNER
OWNER: The Owner is the person or persons named as such on the Schedule Page of
this Certificate, or by later change. The Owner owns his or her Certificate
while the Owner is alive.
OWNERSHIP RIGHTS: The Owner and we may agree to a change in the Ownership of
the Certificate, but our consent to a change will not be unreasonably withheld.
Also, unless we endorse it to say otherwise, the Owner can exercise the rights
given by various sections of the
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Certificate. If there are Joint Owners, both Owners must agree to exercise any
rights under this Certificate. These include:
(1) the right to choose and change the Beneficiary;
(2) the right to choose and change the Annuitant, subject to Section 3;
(3) the right to surrender the Certificate;
(4) the right to transfer this certificate Value among the Divisions and
the Fixed Account;
(5) the right to make withdrawals from the Certificate;
(6) the right to choose how the Death Benefit will be paid; and
(7) the right to assign this certificate as security for an obligation or
assign future guarantee payments.
SECTION 3 ANNUITANT
ANNUITANT: The Annuitant is the person named as such on the Schedule Page of
this Certificate, or as indicated by later change.
CHANGING THE ANNUITANT: The Owner and we may agree to change the Annuitant at
any time before the earlier of the Annuity Date or the death of the Annuitant.
DEATH OF ANNUITANT: If the Annuitant dies before the Owner, the Owner becomes
the Annuitant.
SECTION 4 BENEFICIARY
BENEFICIARY: The Beneficiary is the person who will receive the payments under
this Certificate due to the Owner's death. If Joint Owners have been named,
and one of the Joint Owners dies, the surviving Joint Owner takes precedence
over the named Beneficiary for all ownership rights, and the receipt of any
payments. If there is no Beneficiary when the Owner dies, payment will be made
to the Owner's estate.
CONTINGENT BENEFICIARY: The Owner may name a Contingent Beneficiary. The
Contingent Beneficiary will become the Beneficiary if all the Beneficiaries die
while the Owner is alive.
IRREVOCABLE BENEFICIARY: The Owner can name any Beneficiary to be an
Irrevocable Beneficiary. An Irrevocable Beneficiary must provide his or her
consent for any change of Beneficiary, withdrawal of any part of the Net
Certificate Value, or any collateral assignment of the Certificate. Otherwise,
the Owner can change a Beneficiary as set out below.
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CHANGING THE BENEFICIARY: The Owner names the Beneficiary in the Application
for this Certificate. The Owner may change the Beneficiary or Contingent
Beneficiary at any time during the Owner's lifetime. A change cancels all prior
Beneficiaries.
SIMULTANEOUS DEATH: If the Beneficiary dies at the same time or within 10 days
after the Owner dies, the payments under this Certificate due to the Owner's
death will be paid as if the Beneficiary had died before the Owner.
SECTION 5 SEPARATE ACCOUNT
SEPARATE ACCOUNT is a separate investment account of PaineWebber Life Insurance
Company established in accordance with California's insurance laws. Assets
allocated to the Separate Account remain our property. The income, gains and
losses, whether or not realized, from assets allocated to each Division are
credited to or charged against that Division in accordance with the terms of
the Certificate, without regard to other income, gains or losses of the
Company. Assets of the Separate Account equal to its reserves and other
liabilities are not subject to the claims arising out of any other business we
may conduct.
INVESTMENT PORTFOLIOS: Investment portfolios in which Separate Account
Divisions invest are shown in the Schedule Page. For each investment portfolio
there is a corresponding Separate Account Division.
CHANGES TO INVESTMENT PORTFOLIOS: We may add, substitute, or delete investment
portfolios. Such changes may be made to existing Certificate Values and the
investment of future Purchase Payments.
NET INVESTMENT FACTOR is the index used to measure the investment performance
of a Division from one Valuation Period to the next. For any Division, the Net
Investment Factor for a Valuation Period is found by dividing (A) by (B) and
subtracting (C):
(A) The net asset value per share of the investment portfolio held in the
Division, as of the end of the Valuation Period, plus the per share amount of
any dividend, capital gain or other distribution made by the investment
portfolio in the Valuation Period, plus or minus a per share charge or credit
for any taxes reserved for in the current Valuation Period, which we determine
resulted from the investment operations of the Division;
(B) The net asset value per share of the investment portfolio held in the
Division as of the end of the previous Valuation Period;
(C) The Daily Charge as set out in Section 11, Charges and Deductions.
VALUE OF EACH ACCUMULATION UNIT: For each Division, the value of an
Accumulation Unit was set at $10 when the Division was established. The value
may increase or decrease from one Valuation Period to the next. For any
Valuation Period the value is:
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(A) The value of an Accumulation Unit at the end of the last Valuation
Period; multiplied by
(B) The Net Investment Factor for that Division for the current Valuation
Period.
NUMBER OF ACCUMULATION UNITS: The number of your Accumulation Units for each
Division is the sum of:
(A) Each Net Purchase Payment allocated to the Division; divided by
(B) The value of an Accumulation Unit for that Division for the Valuation
Period in which we received the Net Purchase Payment.
The number will be adjusted for transfers, withdrawals, charges and deductions.
Adjustments will be made as of the Valuation Period in which we receive
satisfactory notice and any additional requirements for the transaction are
satisfied.
CERTIFICATE VALUE OF EACH DIVISION: The Certificate Value in each Division on
any Valuation Day is equal to the number of Accumulation Units attributable to
that Division multiplied by the value of each Accumulation Unit in that
Division.
SECTION 6 FIXED ACCOUNT
FIXED ACCOUNT: The Fixed Accounts are options to which your Purchase Payments
and Certificate Value may be allocated. Fixed Account options available are
described on the Schedule Page. Certain Fixed Account options may only be
available if an Owner has elected certain asset allocation or other services.
See Schedule Pages for details.
SECTION 7 PURCHASE PAYMENTS
MINIMUM PURCHASE PAYMENTS: The Minimum Initial Purchase Payment and Minimum
Additional Purchase Payment are shown in the Schedule Page.
Additional Purchase Payments may be made at any time. We have the right to
refuse any Purchase Payment that causes the sum of the Purchase Payments paid
to date to exceed the Maximum Aggregate Purchase Payments amount shown in the
Schedule Page.
PURCHASE PAYMENT ALLOCATION: Your Net Purchase Payments will be allocated to
the Divisions in the Separate Account and Fixed Account options as the Owner
directs. However, if the Owner resides in a state that requires us to refund
Purchase Payments if the Right To Examine Certificate is invoked, Purchase
Payment amounts received during the Right To Examine Certificate period which
are to be allocated to Fixed Account options will be immediately allocated.
Purchase Payment amounts that are to be allocated anywhere else will be
21
initially allocated to the Money Market Division. The Money Market Division
Certificate Value will be transferred automatically to the Separate Account
Divisions elected in the Certificate application, or any more recent allocation
instructions received by us, at the end of the Right To Examine Certificate
period.
Additional Net Purchase Payments received without satisfactory notice of
investment instructions will be allocated among the Divisions and Fixed Account
options, in the ratio of the Certificate Value in each to the total Certificate
Value.
We will notify the Owner of the acceptance of a Purchase Payment and how the
Net Purchase Payment was allocated.
SECTION 8 TRANSFERS
TRANSFERS: Upon satisfactory notice to us, the Owner may transfer all or part
of his or her Certificate Value among the Separate Account Divisions and the
Fixed Account. All transfers will be subject to any rules and procedures shown
on the Schedule Page. Transfers will be based on values for the Valuation
Period in which the Owner's notice is received at our Administrative Office. If
the instructions are not properly completed, the transfer will not be executed
and we will contact the Owner.
TRANSFER CHARGES: The Owner may make a transfer at any time. The number of free
transfers allowed in a Certificate Year and the transfer charge for transfers
in excess of that number are shown in the Schedule Page. We have the right to
waive the charge for transfers completed through an allocation service
acceptable to us.
Any Transfer Charge will be deducted from the Divisions and the Fixed Account
options to which the Certificate Value is transferred for transfers made before
the Annuity Date. The deduction will be in the ratio of the Certificate Value
transferred to each Division or Fixed Account option to the total Certificate
Value transferred. Transfers made after the Annuity Date will have the transfer
charge deducted from the next Annuity Payment.
SECTION 9 WITHDRAWALS
WITHDRAWALS: The Owner may withdraw all or part of the Net Certificate Value.
We must receive satisfactory notice of the Owner's request prior to the earlier
of the Annuity Date or the death of the Owner. If the notice is not
satisfactory, then no withdrawal will be made and we will contact the Owner.
SIZE AND FREQUENCY: The Owner may make a withdrawal at any time prior to the
Annuity Date. Our rules with regard to the permitted size and frequency of
withdrawals and withdrawal transaction charges are shown in the Schedule Page.
MINIMUM CERTIFICATE VALUE: If a withdrawal reduces the Certificate Value below
the Minimum Certificate Value after Withdrawal shown in the Schedule Page, we
will distribute the
22
Net Certificate Value to the Owner and the Certificate will terminate.
PAYMENT OF WITHDRAWALS: Withdrawals will be based on values for the Valuation
Period in which the Owner's satisfactory notice (and the Certificate, if
required) is received at our Administrative Office. Withdrawals will generally
be paid within 7 days.
DEDUCTION OF ANY WITHDRAWAL CHARGES: Any charges relating to a withdrawal,
Excess Withdrawal Transaction Charges and Early Withdrawal Charges, will be
deducted from the affected Divisions and Fixed Account in the ratio of the
Certificate Value withdrawn from each to the total Certificate Value withdrawn.
If the amount in any Division or Fixed Account is not enough to cover its share
of the charges, the excess will be deducted from the remaining Divisions and
Fixed Account in the ratio of the value in each to the total Certificate Value.
SECTION 10 DEATH OF OWNER PRIOR TO THE ANNUITY DATE
DEATH BENEFIT: [The death benefits available are shown in the Schedule Page of
the Certificate.]
Upon the death of the Owner (or if Joint Owners exist, upon the death of any
Owner) prior to the Annuity Date, the Beneficiary will be entitled to all
ownership rights under the Certificate and, if the Beneficiary elects the Death
Benefit, the Certificate Value will be increased so that it equals the Death
Benefit. For this purpose, if any Owner is not an individual, the death of any
Annuitant will be considered the death of an Owner.
The amount of the Death Benefit is determined as of the Valuation Day on or
next following the day on which we receive due proof of the Owner's death and
notice from the Beneficiary stating that he or she elects the Death Benefit at
our Administrative Office. The Beneficiary must choose the method of
settlement within 90 days of the determination of the death benefit amount.
DISTRIBUTION RULES: If the Owner or if Joint Owners exist, upon the death of
any Owner prior to the Annuity Date, the Certificate may continue for five
years from the date of death and, at the end of such five years, any
Certificate Value remaining must be distributed to the Beneficiary and the
Certificate will terminate. For this purpose, if any Owner is not an
individual, the death or change of any Annuitant will be considered the death
of an Owner.
If the Beneficiary is an individual, the distribution rule set forth above will
be considered satisfied as to the portion of this certificate which is payable
to or for the benefit of that Beneficiary and which will be distributed under
an Annuity Option over the life of the Beneficiary or Beneficiary (within the
meaning of the tax law), provided such distributions begin within one year of
the Owner's death, any Annuity Option selected will have to provide for full
payment within five years of the Owner's death.
SPOUSAL OPTION: If the Beneficiary is the surviving spouse of the deceased
Owner, that Beneficiary may, instead of electing the Death Benefit, continue
this certificate as its Owner, and
23
above distribution rules will be applied on the death of the surviving spouse.
If this certificate is continued pursuant to this spousal option, the Death
Benefit may be elected on the death of the surviving spouse. However, this
spousal exception to the above distribution rules will not again be available
upon the death of the surviving spouse.
DEATH OF OWNER AFTER ANNUITY DATE: If any Owner dies on or after the Annuity
Date and before the entire interest in this certificate has been distributed,
the remaining portion of such interest must be distributed at least as rapidly
as under the method of distributions being used as of the date of death.
SECTION 11 CHARGES AND DEDUCTIONS
MAINTENANCE CHARGE: Any Maintenance Charge is shown in the Schedule Page. It
will be deducted on the first Valuation Day on or next following each
Certificate Anniversary prior to the Annuity Date. It will also be deducted
upon a full withdrawal or if Annuity Payments begin on other than the first
Valuation Day on or next following a Certificate Anniversary. This charge will
be deducted from the Divisions and Fixed Account in the ratio of the
Certificate Value in each to the total Certificate Value.
DAILY CHARGE: The Daily Charge will be computed and deducted from each Division
for each day this certificateis in force. On an annual basis it equals the
percentage of the daily net asset value of the Divisions of the Separate
Account, as shown in the Schedule Page.
WITHDRAWAL TRANSACTION CHARGES: There may be Withdrawal Transaction Charges as
set forth in the Schedule Page.
EARLY WITHDRAWAL CHARGES: Early Withdrawal Charges for a partial or full
withdrawal of the Certificate Value are shown in the Schedule Page.
DEDUCTION OF ANY WITHDRAWAL CHARGES: Any charges relating to a withdrawal will
be deducted from the affected Divisions and Fixed Account options in the ratio
of the Certificate Value withdrawn from each to the total Certificate Value
withdrawn. If the amount in any Division or Fixed Account option is not enough
to cover its share of the charges, then the excess will be deducted from the
remaining Divisions or Fixed Account options in the ratio of the Certificate
Value in each to the total Certificate value.
PREMIUM AND OTHER TAXES: Any taxes imposed by a state or other government on us
because of this Certificate will be deducted. We can deduct such taxes when
incurred. However, we may delay deducting them until annuitization or
surrender.
SECTION 12 GENERAL PROVISIONS
THE CERTIFICATE: This Certificate, any Application and any attachments make up
the entire certificate. This Certificate cannot be changed unless the
Certificate holder has asked for the
24
change in writing. Only an Executive Officer of the Company can agree to the
change for us. No agent of ours can change this Certificate. At any time we may
make such changes in this Certificate as are required to make it conform with
any law, regulation or ruling issued by a government agency.
INCONTESTABILITY: We will not contest this Certificate.
PERIODIC REPORTS: At least once a year, prior to the Annuity Date, we will
furnish each Owner a report of his or her Certificate Value. It will set forth
the current number of Accumulation Units, the value of each Accumulation Unit,
the total value of the Separate Account and the total value of the Fixed
Account. Each person with voting rights in the Separate Account will be
furnished reports required by the Investment Company Act of 1940.
CERTIFICATE PAYMENTS: All sums payable to or by us under a Certificate are
payable to or from our Administrative Office. We may require return of a
Certificate prior to making any payment. Annuity payments, Net Certificate
Values, and Death Benefits will not be less than the minimum required by any
statute of the state in which this Certificate is delivered.
NOTICES, CHANGES AND CHOICES: All notices, changes and choices must be made by
the Owner and received by us at our Administrative Office. We allow written
notices, changes and choices by the Owner regarding the Certificate. However,
forms of communication other than written may be acceptable to us. If
satisfactory, notices, changes and choices relating to Beneficiaries, Ownership
and Annuitants will take effect as of the date signed unless we have already
acted in reliance on the prior status. We are not responsible for their
validity. We may require return of the Certificate prior to any change.
DELAYS: For withdrawals and transfers from the Separate Account Divisions, we
may defer payment if:
(A) The New York Stock Exchange is closed (other than customary weekend
and Holiday closings) or trading on the New York Stock Exchange is restricted;
(B) An emergency exists such that it is not reasonably practicable to
dispose of securities in the Separate Account or to determine the value of its
net assets; or
(C) The Securities and Exchange Commission has by order permitted
suspension of redemptions for the protection of security holders.
Conditions (B) and (C) will be decided by or in accordance with rules of the
Securities and Exchange Commission.
Payment of amounts derived from Net Purchase Payments paid by check may also be
delayed until the check has cleared the Owner's bank.
For withdrawals and transfers from the Fixed Account, we may defer payment for
up to 6 months
25
except for withdrawals to pay premiums under insurance or annuity contracts
issued by us.
AGES: Ages are figured on a last birthday basis.
NONPARTICIPATING: This Certificate does not pay dividends. It will not share
in our earnings or surplus.
PROOF OF AGE, SEX OR SURVIVAL: We may require due proof of the age, sex or
survival of any person on whose continued life any payment under this
Certificate or Certificate thereunder depends.
MISSTATEMENT OF AGE OR SEX: If the age or sex of the annuitant or any payee is
misstated, we will adjust the Annuity Payments to reflect the correct age and
sex. Any amount we have overpaid as a result of such misstatement will be
deducted from future payments. Interest on the overpayment will be charged at
the rate of 6% per year compounded annually. Any amount we have underpaid will
be paid in full with the next payment. We will pay interest on the underpayment
at the rate of 6% per year compounded annually.
PROTECTION OF PROCEEDS: To the extent allowed by law, payments are not subject
to legal process for debts.
COLLATERAL ASSIGNMENT: The Owner may assign his or her Certificate as security
for an obligation upon written notice to us. This assignment will not change
the Ownership of the Certificate. The rights of an assignee have priority over
the rights of a Beneficiary.
FUTURE PAYMENT ASSIGNMENT: Upon notice to us, the Owner may assign future
guaranteed payments.
SECTION 13 TERMINATION PROVISIONS
TERMINATION OF CERTIFICATE: This Certificate may be discontinued by us or the
Contractholder. The party who initiates the discontinuance will send a notice
to each Owner of record, at his or her last known address, at least 15 days
prior to the date of discontinuance.
No new applications for new Owners will be accepted on or after the date notice
of discontinuance is received or sent by us, whichever is applicable. Any
Certificates in force on the date of discontinuance will not be affected by
the discontinuance.
The Group Contract will terminate when all Certificates issued under the Group
Contract have terminated.
SECTION 14 ANNUITY PROVISIONS
26
ANNUITY DATE: The Annuity Date must be on the first day of a month. It may not
be earlier than the first day of the next month after the Earliest Annuity
Date. It may not be later than the first day of the next month after the Latest
Annuity Date or any later date that we approve. If the Owner has not specified
an Annuity Date, it will be the first day of the next month after the Automatic
Annuity Date. The Earliest, Latest and Automatic Annuity Dates are shown in the
Schedule Page. The Annuity Date may be delayed even further to a date agreed
upon by the Owner and us.
The Owner may change the Annuity Date up to [30]days prior to the Annuity Date
by sending us satisfactory written notice. We must receive any request of
change at our Administrative Office at least [30] days prior to when such
change is to be effective.
ANNUITY OPTIONS: The Annuity Options available are set out in Section 18. All
Options are available as fixed or variable payment annuities. Other Annuity
Options not set forth in this Certificate may be chosen if they are acceptable
to us. The Owner may change the Annuity Option at any time up to [30] days
prior to the Annuity Date. We reserve the right to make additional Annuity
Options available. If the Owner has not chosen an Annuity Option, Option 3 with
a variable payment for life with payments guaranteed for 10 years will apply.
ANNUITIZED VALUE: The amount to be annuitized on the Annuity Date (the
"Annuitized Value") is the Net Certificate Value on the Valuation Day on or
next following the Annuity Date.
An Early Withdrawal Charge will be assessed at the Annuity Date, if applicable.
This charge will be waived if the Annuity Date is the latest allowed, if the
Annuity Option chosen contains life contingencies, or the Annuity Option is for
[5] years or more with no ability to commute the remaining payments.
ANNUITY PAYMENT SIZE AND FREQUENCY: If the amount to be applied at the Annuity
Date is less than [$5,000], we may pay such amount in a lump sum. If any
Annuity Payment would be less than [$100], we may change the frequency so the
payments are at least $100 each.
Annuity Payments will be made on the first Valuation Day of each month starting
with the month in which the Annuity Date falls. Prior to the Annuity Date, you
may choose a less frequent payment interval. The amount of each payment on an
annual, semiannual or quarterly basis will not be less than the monthly payment
computed from the appropriate Annuity Tables multiplied by the factors shown
in Section 19.
SECTION 15 FIXED ANNUITY PAYMENTS
FIXED ANNUITY: A fixed annuity is a series of level periodic payments. The
amount of each payment does not vary with the investment experience of the
Separate Account.
AMOUNT OF FIXED ANNUITY PAYMENTS: The Annuitized Value will be applied to the
Annuity Option chosen at our Current Annuity Settlement Option rates. These
rates will be given to you upon request. The Annuity Tables show the amount of
the first Annuity Payment for each
27
$1,000 applied, based on the Annuitant's age and sex where appropriate at the
Annuity Date. [The Tables are based on the 1983 Table 'a' for Individual
Annuity Valuation with projection scale G and interest at 2.5% if the Annuity
Date is prior to the 9th Certificate Anniversary and 3% for Annuity Dates on or
after the 9th Certificate Anniversary.]
SECTION 16 VARIABLE ANNUITY PAYMENTS
VARIABLE ANNUITY: A variable annuity is a series of periodic payments. The
amount of each payment will vary with the investment experience of the
Divisions in which your Certificate Value is allocated.
FIRST VARIABLE ANNUITY PAYMENT: The Annuitized Value will be applied to the
Table for the Annuity Option chosen. The Tables show the amount of the first
Annuity Payment for each $1,000 applied, based on the Annuitant's age and sex
where appropriate at the Annuity Date. [The Tables are based on the 1983 Table
'a' for Individual Annuity Valuation with a projection scale G and an assumed
investment return of 2.5% if the Annuity Date is prior to the 9th Certificate
Anniversary and 3% for Annuity Dates on or after the 9th Certificate
Anniversary.] Other assumed investment return rates may be made available in
the future.
NUMBER OF ANNUITY UNITS: The number of Annuity Units for a Division is:
(A) The amount of the first monthly variable Annuity Payment attributable
to that Division; divided by
(B) The value of an Annuity Unit for that Division as of the first
Valuation Day on or next following the Annuity Date.
The number of Annuity Units is fixed on the first Valuation Day on or next
following the Annuity Date except for adjustments for Division transfers.
Adjustments will be made as of the Valuation Period in which we receive
satisfactory notice for the transfer request.
VALUE OF EACH ANNUITY UNIT: For each Division, the value of an Annuity Unit was
set at $10 when the Division was established. The value may increase or
decrease from one Valuation Period to the next. The Annuity Unit value for any
Valuation Period is:
(A) The value of an Annuity Unit at the end of the last Valuation Period;
multiplied by
(B) The Net Investment Factor for that Division for the current Valuation
Period; multiplied by
(C) A daily factor to offset the effect of the assumed investment return
built into the Annuity Tables.
SUBSEQUENT VARIABLE ANNUITY PAYMENTS: Payments after the first will vary in
amount according to the investment performance of the Divisions you have
chosen. The amount
28
may change from month to month. The amount of each subsequent payment is the
sum of:
(A) The number of Annuity Units for each Division; multiplied by
(B) The value of an Annuity Unit for that Division at the end of the
Valuation Period immediately preceding the Valuation Period in which
payment is made.
We guarantee that subsequent Annuity Payments will not be affected by
variations in our expenses or mortality experience
SECTION 17 DEATH OF ANNUITANT
PRIOR TO THE ANNUITY DATE: If the Annuitant dies before the Annuity Date, the
Owner then becomes the Annuitant if the Owner is an individual. If Joint Owners
exist and if the death of the Annuitant occurs before the Annuity Date, the
younger of the Joint Owners will become the Annuitant.
AFTER THE ANNUITY DATE: If there are guaranteed payments which are unpaid under
the Annuity Option when the Annuitant dies, the Owner may choose to have the
payments continue for the guarantee period to a designated payee; or to receive
the present value of the remaining guaranteed payments in a lump sum.
Present values will be computed at the investment rate assumed when the first
Annuity Payment was calculated.
SECTION 18 ANNUITY OPTIONS
OPTION 1 - PAYMENTS FOR A GUARANTEED FIXED PERIOD: Payments will be made for
the period chosen. The period must be at least 5 years. If this Option is
taken as a Variable Annuity Payment, you may at any time choose to receive in a
lump sum the value of the remaining payments commuted at the investment rate
assumed when first Annuity Payment was calculated.
OPTION 2 - LIFE ANNUITY: Payments will be made for the life of the Annuitant.
Payments will end with the last payment due prior to the Annuitant's death.
OPTION 3 - LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 10 OR 20 YEARS: Payments
will be made for the guaranteed period chosen (10 or 20 years), and for as long
thereafter as the Annuitant lives.
OPTION 4 - JOINT AND SURVIVOR LIFE ANNUITY: Payments will be made during the
lifetimes of the Annuitant and the second individual selected by the Owner. The
amount of such payments will not change due to the first death. Payments will
end with the last payment due prior to the second death.
29
SECTION 19 ANNUITY TABLES - NONQUALIFIED
GUARANTEED FIRST MONTHLY ANNUITY PAYMENTS FOR EACH $1,000
APPLIED FOR ANNUITY DATES PRIOR TO THE 9TH CERTIFICATE
ANNIVERSARY
OPTION I (PAYMENTS FOR A GUARANTEED FIXED PERIOD)
Years Each Years Each Years Each Years Each
Payable Payment Payable Payment Payable Payment Payable Payment
5 17.70 9 10.32 13 7.49 17 6.00
6 14.93 10 9.39 14 7.03 18 5.73
7 12.95 11 8.64 15 6.64 19 5.49
8 11.47 12 8.02 16 6.30 20 5.27
OPTION 2 (LIFE ANNUITY)
Age Male Female Age Male Female Age Male Female
56 3.89 3.53 66 4.85 4.28 76 6.56 5.68
57 3.96 3.59 67 4.98 4.38 77 6.79 5.88
58 4.04 3.65 68 5.12 4.49 78 7.04 6.09
59 4.12 3.72 69 5.27 4.61 79 7.30 6.32
60 4.21 3.78 70 5.42 4.73 80 7.59 6.57
61 4.30 3.85 71 5.59 4.86 81 7.89 6.84
62 4.40 3.93 72 5.76 5.00 82 8.22 7.13
63 4.50 4.01 73 5.94 5.16 83 8.57 7.44
64 4.61 4.10 74 6.13 5.32 84 8.96 7.76
65 4.73 4.19 75 6.34 5.49 85 9.37 8.16
OPTION 3 (LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 10 YEARS)
Age Male Female Age Male Female Age Male Female
56 3.86 3.52 66 4.73 4.24 76 6.07 5.47
57 3.93 3.57 67 4.84 4.33 77 6.23 5.63
58 4.00 3.63 68 4.96 4.43 78 6.40 5.79
59 4.07 3.70 69 5.08 4.54 79 6.57 5.97
60 4.16 3.76 70 5.21 4.65 80 6.74 6.15
61 4.24 3.83 71 5.34 4.77 81 6.92 6.35
62 4.33 3.90 72 5.48 4.89 82 7.11 6.54
63 4.42 3.98 73 5.62 5.03 83 7.29 6.75
30
64 4.52 4.06 74 5.76 5.17 84 7.48 6.96
65 4.62 4.15 75 5.91 5.31 85 7.67 7.17
OPTION 3 (LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 20 YEARS)
Age Male Female Age Male Female Age Male Female
56 3.74 3.47 66 4.35 4.07 76 4.96 4.80
57 3.80 3.52 67 4.42 4.14 77 5.01 4.87
58 3.85 3.57 68 4.48 4.21 78 5.06 4.93
59 3.91 3.63 69 4.55 4.28 79 5.11 5.00
60 3.97 3.68 70 4.61 4.36 80 5.15 5.06
61 4.03 3.74 71 4.68 4.43 81 5.18 5.11
62 4.09 3.80 72 4.74 4.51 82 5.21 5.16
63 4.16 3.87 73 4.80 4.58 83 5.23 5.19
64 4.22 3.93 74 4.85 4.65 84 5.25 5.22
65 4.29 4.00 75 4.91 4.73 85 5.26 5.24
31
OPTION 4 (JOINT AND SURVIVOR LIFE ANNUITY)
Male Age
Female
Age 50 55 60 65 70 75 80 85
50 3.02 3.08 3.13 3.17 3.22 3.32 3.48 3.71
55 3.13 3.22 3.29 3.35 3.40 3.47 3.60 3.80
60 3.22 3.35 3.46 3.56 3.63 3.69 3.79 3.96
65 3.30 3.47 3.63 3.78 3.91 4.01 4.08 4.21
70 3.37 3.57 3.79 4.01 4.21 4.38 4.51 4.61
75 3.42 3.65 3.92 4.21 4.52 4.79 5.03 5.21
80 3.46 3.72 4.02 4.39 4.79 5.21 5.61 5.95
85 3.48 3.76 4.10 4.52 5.02 5.58 6.19 6.80
Information for ages not shown will be furnished on request.
Factor for payments other than monthly:
Annual: 11.86526 Semi-annual: 5.96925 Quarterly: 2.99384
32
SECTION 19 ANNUITY TABLES - NONQUALIFIED
GUARANTEED FIRST MONTHLY ANNUITY PAYMENTS FOR EACH $1,000
APPLIED FOR ANNUITY DATES ON OR AFTER THE 9TH CERTIFICATE
ANNIVERSARY
OPTION I (PAYMENTS FOR A GUARANTEED FIXED PERIOD)
Years Each Years Each Years Each Years Each
Payable Payment Payable Payment Payable Payment Payable Payment
5 17.91 9 10.53 13 7.71 17 6.53
6 15.14 10 9.61 14 7.26 18 5.96
7 13.16 11 8.86 15 6.87 19 5.73
8 11.68 12 8.24 16 6.53 20 5.51
OPTION 2 (LIFE ANNUITY)
Age Male Female Age Male Female Age Male Female
56 4.18 3.82 66 5.13 4.56 76 6.84 5.96
57 4.25 3.87 67 5.26 4.66 77 7.08 6.16
58 4.33 3.93 68 5.40 4.77 78 7.33 6.37
59 4.41 4.00 69 5.55 4.88 79 7.59 6.60
60 4.49 4.06 70 5.71 5.00 80 7.88 6.85
61 4.58 4.14 71 5.87 5.14 81 8.18 7.11
62 4.68 4.21 72 6.04 5.28 82 8.51 7.40
63 4.78 4.29 73 6.23 5.43 83 8.86 7.72
64 4.89 4.37 74 6.42 5.59 84 9.24 8.06
65 5.01 4.46 75 6.62 5.77 85 9.66 8.43
OPTION 3 (LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 10 YEARS)
Age Male Female Age Male Female Age Male Female
56 4.14 3.80 66 5.01 4.51 76 6.33 5.73
57 4.21 3.86 67 5.12 4.60 77 6.49 5.89
58 4.28 3.91 68 5.23 4.70 78 6.55 6.05
59 4.35 3.98 69 5.35 4.81 79 6.82 6.23
60 4.44 4.04 70 5.48 4.92 80 6.99 6.41
61 4.52 4.11 71 5.61 5.04 81 7.17 6.60
62 4.61 4.18 72 5.74 5.16 82 7.35 6.79
63 4.70 4.26 73 5.88 5.29 83 7.54 7.00
64 4.80 4.34 74 6.03 5.43 84 7.72 7.20
65 4.90 4.42 75 6.18 5.58 85 7.91 7.42
33
OPTION 3 (LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 20 YEARS)
Age Male Female Age Male Female Age Male Female
56 4.02 3.75 66 4.61 4.33 76 5.21 5.04
57 4.07 3.80 67 4.68 4.40 77 5.25 5.11
58 4.13 3.85 68 4.74 4.47 78 5.30 5.18
59 4.18 3.90 69 4.80 4.54 79 5.35 5.24
60 4.24 3.96 70 4.87 4.61 80 5.39 5.30
61 4.30 4.01 71 4.93 4.69 81 5.42 5.35
62 4.36 4.07 72 4.99 4.76 82 5.45 5.40
63 4.42 4.13 73 5.05 4.83 83 5.47 5.43
64 4.49 4.20 74 5.10 4.90 84 5.49 5.46
65 4.55 4.26 75 5.16 4.97 85 5.50 5.48
OPTION 4 (JOINT AND SURVIVOR LIFE ANNUITY)
Male Age
Female
Age 50 55 60 65 70 75 80 85
50 4.19 4.27 4.34 4.39 4.43 4.45 4.47 4.48
55 4.32 4.45 4.55 4.64 4.71 4.76 4.79 4.81
60 4.45 4.62 4.79 4.94 5.06 5.14 5.20 5.24
65 4.56 4.79 5.03 5.27 5.47 5.63 5.74 5.82
70 4.65 4.94 5.27 5.61 5.94 6.22 6.44 6.59
75 4.73 5.06 5.46 5.93 6.43 6.90 7.31 7.61
80 4.78 5.15 5.62 6.20 6.87 7.60 8.30 8.89
85 4.81 5.21 5.72 6.39 7.23 8.22 9.29 10.32
Information for ages not shown will be furnished upon request.
Factors for payments other than monthly:
Annual: 11.83895 Semi-annual: 5.96322 Quarterly: 2.99263