EXHIBIT 4(c)
AIG SUNAMERICA LIFE ASSURANCE COMPANY
A STOCK COMPANY LOS ANGELES, CALIFORNIA
CERTIFICATE NUMBER P9999999999
PARTICIPANT ▇▇▇▇ ▇▇▇
STATUTORY HOME OFFICE EXECUTIVE OFFICE ANNUITY SERVICE CENTER
▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇ ▇▇., ▇▇▇ ▇▇▇ ▇ SUNAMERICA CENTER P. O. BOX 54299
PHOENIX, AZ 85018 LOS ANGELES, CA 90067-6022 LOS ANGELES, CA 90054-0299
AIG SUNAMERICA LIFE ASSURANCE COMPANY ("We", "Us", the "Company", or "AIG
SunAmerica Life") agrees to provide benefits to the Participant in accordance
with the provisions set forth in this Certificate and in consideration of the
Enrollment Form or confirmation thereof, and Purchase Payments We receive.
THIS CERTIFICATE IS EVIDENCE OF COVERAGE UNDER THE GROUP CONTRACT IF A
PARTICIPANT ENROLLMENT FORM IS ATTACHED. THE COVERAGE WILL BEGIN AS OF THE
CERTIFICATE DATE, SHOWN ON THE CERTIFICATE DATA PAGE.
THE VALUE OF AMOUNTS ALLOCATED TO THE SEPARATE ACCOUNT DURING THE ACCUMULATION
AND ANNUITY PERIODS IS NOT GUARANTEED, AND WILL INCREASE OR DECREASE BASED UPON
THE INVESTMENT EXPERIENCE OF THE VARIABLE PORTFOLIOS YOU CHOOSE.
THE CASH SURRENDER BENEFIT OF AMOUNTS ALLOCATED TO ANY AVAILABLE FIXED-MVA
ACCOUNT OPTION INCREASES OR DECREASES BASED ON THE APPLICATION OF THE MARKET
VALUE ADJUSTMENT EXCEPT DURING THE 30 DAYS AFTER THE END OF THE GUARANTEE
PERIOD. THERE IS NO MARKET VALUE ADJUSTMENT TO AMOUNTS ALLOCATED TO ANY
AVAILABLE NON-MVA FIXED ACCOUNT OPTION.
RIGHT TO EXAMINE - YOU MAY RETURN THIS CERTIFICATE TO OUR ANNUITY SERVICE CENTER
OR TO THE AGENT THROUGH WHOM THE CERTIFICATE WAS PURCHASED WITHIN 10 DAYS OR
LONGER AS MAY BE REQUIRED BY STATE LAW AFTER YOU RECEIVE IT, IF YOU ARE NOT
SATISFIED WITH IT. THE COMPANY WILL REFUND THE CERTIFICATE VALUE, LESS ANY
PAYMENT ENHANCEMENT(S), ON THE BUSINESS DAY DURING WHICH THE CERTIFICATE IS
RECEIVED. UPON SUCH REFUND, THE CERTIFICATE SHALL BE VOID.
For Individual Retirement Annuities or if a refund of the Purchase Payment(s) is
otherwise required, We reserve the right to allocate Your Purchase Payment(s)
and any Payment Enhancement to the Cash Management Portfolio until the end of
the Right To Examine period.
THIS IS A LEGAL DOCUMENT. READ IT CAREFULLY.
ALLOCATED GROUP FIXED AND VARIABLE
ANNUITY CERTIFICATE
Nonparticipating
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TABLE OF CONTENTS
CERTIFICATE DATA PAGE...................................... PAGE 3
DEFINITIONS................................................ PAGE 4
PURCHASE PAYMENT PROVISIONS................................ PAGE 7
ACCUMULATION PROVISIONS.................................... PAGE 8
PAYMENT ENHANCEMENT PROVISIONS............................. PAGE 10
CHARGES AND DEDUCTIONS..................................... PAGE 10
TRANSFER PROVISIONS........................................ PAGE 11
WITHDRAWAL PROVISIONS...................................... PAGE 11
DEATH PROVISIONS........................................... PAGE 13
ANNUITY PROVISIONS......................................... PAGE 17
GENERAL PROVISIONS......................................... PAGE 19
ANNUITY PAYMENT OPTIONS ................................... PAGE 21
FIXED ANNUITY PAYMENT OPTIONS TABLE........................ PAGE 22
VARIABLE ANNUITY PAYMENT OPTIONS TABLE..................... PAGE 25
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CERTIFICATE DATA PAGE
CERTIFICATE NUMBER: ANNUITY SERVICE CENTER:
P9999999999 P. O. BOX 54299
LOS ANGELES, CA 90054-0299
PARTICIPANT: AGE AT ISSUE:
▇▇▇▇ ▇▇▇ 35
ANNUITANT: INITIAL PURCHASE PAYMENT:
▇▇▇▇ ▇▇▇ $10,000.00
CERTIFICATE DATE: FIXED ACCOUNT OPTIONS -
March 1, 2004 Minimum Guarantee Rate:
The greater of [1.5%] or the
minimum allowable in the state
of issue
SPECIFIED ANNUITY DATE: INITIAL PAYMENT ENHANCEMENT:
March 1, 2029 [2.0%]
LATEST ANNUITY DATE: SEPARATE ACCOUNT CHARGE:
March 1, 2054 [1.52%]
ANNUAL CERTIFICATE MAINTENANCE FEE: SEPARATE ACCOUNT:
$35.00 [Variable Separate Account]
BENEFICIARY:
As named by You.
DEATH BENEFIT OPTION:
Option I: Purchase Payment Accumulation
PAYMENT ENHANCEMENT SCHEDULE FOR INITIAL PURCHASE PAYMENT
PAYMENT ENHANCEMENT DATE PAYMENT ENHANCEMENT
------------------------------------- --------------------
INITIAL PAYMENT ENHANCEMENT:
March 1, 2004 $200.00
DEFERRED PAYMENT ENHANCEMENT(S):
[March 1, 2013] [$200.00*]
*May be reduced by certain withdrawals of Certificate Value. Please see Payment
Enhancement Provisions.
FOR INQUIRIES
CALL 1-800-445-SUN2
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DEFINITIONS
Defined in this section are some of the words and phrases used in this
Certificate. These terms are capitalized when used in the Certificate with the
meaning set forth below.
ACCUMULATION UNIT
A unit of measurement used to compute the Certificate Value in a Variable
Portfolio prior to the Annuity Date.
AGE
Age as of last birthday.
ANNUITANT
The natural person or persons (collectively, Joint Annuitants) whose life or
lives is/are used to determine the annuity benefits under the Certificate. If
the Certificate is in force and the Annuitant(s) is/are alive on the Annuity
Date, We will begin payments to the Payee. This Certificate cannot have Joint
Annuitants if it is issued in connection with a tax-qualified retirement plan.
ANNUITY DATE
The date on which annuity payments ("income payments") to the Payee begin. This
date cannot be later than the Latest Annuity Date.
ANNUITY SERVICE CENTER
As specified on the Certificate Data Page.
ANNUITY UNIT
A unit of measurement determined on or after the Annuity Date used to compute
annuity payments from the Variable Portfolio(s).
BENEFICIARY
The Beneficiary is as named by You at issue to receive the death benefit under
this Certificate upon Your death. You may later change Your Beneficiary in a
written request to Us at Our Annuity Service Center.
CONTINUATION DATE
The Date on which We receive at Our Annuity Service Center: (a) the Spousal
Beneficiary's written request to continue the Certificate, and (b) Due Proof of
Death of the Participant. If We receive (a) and (b) on different dates, the
Continuation Date will be the later date.
CERTIFICATE DATE
The date Your Certificate is issued, as shown on the Certificate Data Page. It
is the date from which Certificate Years and anniversaries are measured.
CERTIFICATE VALUE
The sum of: (1) Your share of the Variable Portfolios Accumulation Unit Values
and (2) the value of amounts, if any, allocated to any Fixed Account Options.
CERTIFICATE YEAR
One year starting from the Certificate Date in one calendar year and ending on
the day preceding the anniversary of such date in the succeeding calendar year.
CONTRIBUTION YEAR
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A year starting from the date a Purchase Payment is made in one calendar year
and ending on the day preceding the anniversary of such date in succeeding
calendar years.
DEATH BENEFIT ADJUSTMENT
Any increase or reduction to the amount of the Death Benefit payable to account
for Purchase Payment and/or Withdrawal activity after a specified point in time
which will equal (a), (b) or (c), whichever is applicable, as follows:
(a) Where only Purchase Payments are received after the specified point in
time, the dollar value of the Purchase Payments will be added to the
Death Benefit payable; or
(b) Where only Withdrawals are made after the specified point in time, the
Withdrawal will reduce the Death Benefit payable in the same
proportion that the Certificate Value was reduced at the time of the
Withdrawal; or
(c) Where Purchase Payments have been received and Withdrawals made after
the specified point in time, the Death Benefit amount payable will be
adjusted by Purchase Payment(s) received after a specified point in
time, reduced by any Withdrawal, received after that specified point
in time in the same proportion that the Certificate Value was reduced
at the time of the Withdrawal.
DEFERRED PAYMENT ENHANCEMENT
Any Payment Enhancement allocated to Your Certificate Value on any Deferred
Payment Enhancement Date.
DOLLAR COST AVERAGING (DCA)
An optional program under which You authorize the systematic transfer of
specified amounts or percentages from any [Variable Portfolio(s)] or any
available non-MVA Fixed Account into any [Variable Portfolio(s)] other than the
source account.
FIXED ACCOUNT OPTIONS
The investment options, if available, under this Certificate that become part of
the Company's general asset account and are credited with a fixed rate of
interest declared by the Company. The general asset account contains all the
assets of the Company except for the Separate Account and other segregated asset
accounts. The amount You have in any Fixed Account Option at any time is a
result of any Purchase Payment You have allocated to it or any part of Your
Certificate Value You have transferred to it.
FIXED ANNUITIZATION
A series of periodic income payments of predetermined amounts that do not vary
with investment experience. Such payments are made from the Company's general
asset account. This Certificate provides several fixed annuity payment options.
GUARANTEE PERIOD
The period for which interest is credited to amounts allocated to available
Fixed Account Options. We determine in our sole discretion the periods, if any,
which will be offered.
INITIAL PAYMENT ENHANCEMENT
The Payment Enhancement allocated to Your Certificate Value on the date a
Purchase Payment is credited to Your Certificate.
IRC
The Internal Revenue Code of 1986, as amended, or as it may be amended or
superseded.
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JOINT PARTICIPANT
Any person named as Joint Participant on the Enrollment Form and listed on the
Certificate Data Page, unless subsequently changed. The Joint Participant, if
any, possesses an undivided interest in this Certificate in conjunction with the
Participant. All references within this Certificate to Participant will also
apply to the Joint Participant. We reserve Our right to require that Joint
Participants be each others' spouse.
LATEST ANNUITY DATE
The later of the Participant's 90th birthday or ten years after the Certificate
Date.
MULTI-YEAR FIXED ACCOUNT OPTIONS
If available, Fixed Accounts for a Guarantee Period of at least two (2) years.
NET PURCHASE PAYMENT
The sum of all Purchase Payment(s), reduced for each Withdrawal in the same
proportion that the Certificate Value is reduced by such Withdrawal.
NYSE
New York Stock Exchange.
PARTICIPANT
The person or entity named in the Certificate who is entitled to exercise all
rights and privileges of ownership under the Certificate. Participant means both
Joint Participants, if applicable.
PAYEE
The person receiving payment of annuity benefits under this Certificate.
PAYMENT ENHANCEMENT
Payment Enhancements are amounts allocated to Your Certificate Value by Us.
Payment Enhancements are not considered Purchase Payments.
PURCHASE PAYMENTS
Payments in U.S. currency made by or on behalf of the Participant to the Company
to fund the Certificate.
REQUIRED DOCUMENTATION
Is: (a) Due Proof of Death that the Participant or the Spousal Beneficiary died
before the Annuity Date; and (b) an election form specifying the payment
options; and (c) any other documentation We may require.
SEPARATE ACCOUNT
A segregated asset account named on the Certificate Data Page. The Separate
Account consists of several Variable Portfolios, each investing in shares of the
Underlying Fund(s) of the trust(s). The assets of the Separate Account are not
co-mingled with the general assets and liabilities of the Company. The value of
amounts allocated to the Variable Portfolios of the Separate Account is not
guaranteed.
SPECIFIED ANNUITY DATE:
The anticipated Annuity Date specified by You on the Enrollment Form. This date
may be changed by You in writing prior to the Annuity Date, but in no event can
it be later than the Latest Annuity Date. If this date is not specified, it will
be the Latest Annuity Date.
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SPOUSAL BENEFICIARY
The original deceased Participant's surviving spouse who is designated as the
primary Beneficiary at the time of the Participant's death and may continue the
Certificate as the Participant on the Continuation Date.
SUBSEQUENT PURCHASE PAYMENTS
Purchase Payments made after the Initial Purchase Payment.
TOTAL INVESTED AMOUNT
The sum of all Purchase Payments less amounts previously withdrawn that incurred
a Withdrawal Charge, less Purchase Payments withdrawn that were no longer
subject to a Withdrawal Charge.
UNDERLYING FUND
The variable investment options in which the corresponding Variable Portfolio(s)
invest.
VARIABLE ANNUITIZATION
A series of periodic income payments which vary in amount according to the
investment experience of one or more Variable Portfolio, as selected by You.
This Certificate provides several variable annuity payment options.
VARIABLE PORTFOLIO
One or more divisions of the Separate Account, which provides for the variable
investment options available under this Certificate. Each Variable Portfolio has
its own investment objective and is invested in the Underlying Fund(s) of the
trusts. A Variable Portfolio is not chargeable with liabilities arising out of
any other Variable Portfolio. The available Variable Portfolios are shown on the
Enrollment Form. Additional Variable Portfolios may become available in the
future.
WE, OUR, US, THE COMPANY
AIG SunAmerica Life Assurance Company.
WITHDRAWAL(S)
Amount(s) withdrawn from the Certificate Value including any charges and fees
applicable to each such Withdrawal.
YOU, YOUR
The Participant.
PURCHASE PAYMENT PROVISIONS
PURCHASE PAYMENTS
Purchase Payments are flexible. This means that, subject to Company disclosed
restrictions, You may change the amounts, frequency and/or timing of Purchase
Payments. Purchase Payments will be allocated in accordance with instructions
from You to the Variable Portfolio(s) and/or Fixed Account Option(s), if
available. We reserve the right to specify the minimum or maximum Purchase
Payment that may be allocated to a Variable Portfolio or available Fixed Account
Option under the Certificate.
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SUBSTITUTION OF VARIABLE PORTFOLIO
If the shares of an Underlying Fund should no longer be available for investment
by the Separate Account, then We may substitute shares of another Underlying
Fund, for shares already purchased, or to be purchased in the future.
Substitutions of securities will be carried out in accordance with any
applicable state and/or federal laws or regulations.
ACCUMULATION PROVISIONS
Prior to the Annuity Date, the Certificate Value is the sum of the Separate
Account Accumulation Value and the Fixed Account Accumulation Value.
SEPARATE ACCOUNT ACCUMULATION VALUE
The Separate Account Accumulation Value under the Certificate shall be the sum
of the values of the Accumulation Units held in the Variable Portfolios for the
Participant.
NUMBER OF ACCUMULATION UNITS
Your Certificate is credited with Accumulation Units of the Separate Account
when amounts are allocated to the Variable Portfolio(s). For that portion of
each Purchase Payment and/or transfer amount allocated to a Variable Portfolio,
the number of Accumulation Units credited is equal to the sum of each Purchase
Payment, any Payment Enhancement and/or transfer amount allocated to the
Variable Portfolio, reduced by premium taxes, if any:
Divided by
The Accumulation Unit value for that Variable Portfolio for the NYSE business
day in which the Purchase Payment, Payment Enhancement or transfer amount is
allocated.
The number of Accumulation Units will be reduced for Withdrawals of Certificate
Value, annuitizations, amounts transferred out of a Variable Portfolio, the
Certificate Maintenance Fee and applicable charges for elected features as set
forth in endorsements to this Certificate. Reductions will be made as of the
NYSE business day on which We receive all requirements for the transaction, as
appropriate.
ACCUMULATION UNIT VALUE (AUV)
The AUV of a Variable Portfolio for any NYSE business day is calculated by
subtracting (2) from (1) and dividing the result by (3) where:
(1) is the total value at the end of the given NYSE business day of the assets
attributable to the Variable Portfolio minus any applicable liabilities
other than those owed to the Certificateholders;
(2) is the amount equal to the daily Separate Account Charge plus the daily
charge for any optional features that impose a daily charge;
(3) is the number of Accumulation Units outstanding at the end of the given
NYSE business day.
FIXED ACCOUNT ACCUMULATION VALUE
The Fixed Account Accumulation Value, if any, shall be the sum of all monies
allocated or transferred to the Fixed Account Option(s) if available, reduced by
any applicable premium taxes, plus all interest credited on the Fixed Account
Option(s) during the period that You have
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Certificate Value allocated to the Fixed Account Option(s). This amount shall be
adjusted for Withdrawals, annuitizations, transfers, and the deduction of the
Certificate Maintenance Fee. The Fixed Account Accumulation Value shall not be
less than the minimum values required by law in the state where this Certificate
is issued.
FIXED ACCOUNT GUARANTEE PERIOD OPTIONS AND INTEREST CREDITING
The portion of Your Certificate Value within the Fixed Account, if any, is
credited with interest at rates guaranteed by Us for the Guarantee Period(s)
selected. Interest is credited on a daily basis at the then applicable effective
interest rate for the applicable Guarantee Period. You may select from one or
more Guarantee Periods which we may offer at any particular time. We reserve the
right at any time to add or delete Guarantee Periods. If You have allocated any
part of Your initial Purchase Payment to a Guarantee Period, the amount
allocated, as well as the duration of the Guarantee Period is shown on the
Enrollment Form or confirmation thereof as completed by You. The interest rate
applicable to an allocation of Purchase Payment or transfer of Certificate Value
to a Guarantee Period is the rate in effect for that Guarantee Period at the
time of the allocation or transfer. If You have allocated or transferred amounts
at different times to the Fixed Account, each allocation or transfer may have a
unique effective interest rate associated with that amount. We guarantee that
the effective annual rate of interest for the Fixed Account, including any of
the Guarantee Periods, will not be less than the Minimum Guarantee Rate as
mandated by Your state, and shown on the Certificate Data Page.
MARKET VALUE ADJUSTMENT (MVA)
Any payments and values based on available Fixed Account Options may be subject
to a MVA, the operation of which may result in upward or downward adjustments in
the Certificate Value, if withdrawn, transferred or annuitized prior to the end
of the respective Guarantee Period. The MVA will be calculated by multiplying
the amount withdrawn, transferred or annuitized by the following formula:
{(1 + I)/(1+J+0.0050)}(N/12) -1
I = The interest rate currently in effect for that Guarantee Period.
J = The interest rate available for the Guarantee Period equal to the number of
years (rounded up to an integer) remaining in the current Guarantee Period at
the time of withdrawal, transfer or annuitization. In the determination of J, if
the Company currently does not offer the applicable Guarantee Period, then the
rate will be determined by linear interpolation of the interest rate for the
nearest two Guarantee Periods that are available.
N = The number of full months remaining in the current Guarantee Period at the
time the withdrawal or annuitization request is processed.
If a Withdrawal Charge is applied to a Withdrawal, then the MVA will be applied
to the withdrawal amount net of the Withdrawal Charge.
There will be no MVA assessed against any Fixed Account Options subject to an
MVA in the following situations: (1) to pay a Death Benefit paid upon death of
the Participant; (2) on amounts withdrawn to pay fees or charges; (3) on amounts
withdrawn from the Fixed Account Option(s) within thirty (30) days after the end
of the Guarantee Period; (4) on annuitizations on the Latest Annuity Date.
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PAYMENT ENHANCEMENT PROVISIONS
Payment Enhancements are amounts allocated to Your Certificate Value by Us.
Payment Enhancements are not considered Purchase Payments. Payment Enhancements
are subject to Our terms and conditions as discussed below.
PAYMENT ENHANCEMENT FOR INITIAL PURCHASE PAYMENT
We will allocate the Initial Payment Enhancement shown on the Certificate Data
Page to available Fixed Account Option(s), and Variable Portfolio(s) in the same
proportion as Your Initial Purchase Payment. The Initial Payment Enhancement
will be allocated on Your Certificate Date.
We will allocate any Deferred Payment Enhancement(s) shown on the Certificate
Data Page to the [Cash Management Portfolio] on the corresponding Deferred
Payment Enhancement Date(s) shown. Any Deferred Payment Enhancement(s) will be
reduced proportionately by Partial Withdrawals of the Initial Purchase
Payment(s), prior to the Deferred Payment Enhancement Date(s).
PAYMENT ENHANCEMENT FOR SUBSEQUENT PURCHASE PAYMENT(S)
The Initial Payment Enhancement for Subsequent Purchase Payments is a percentage
of each Subsequent Purchase Payment. We will allocate the Initial Payment
Enhancement for the Subsequent Purchase Payment to any then available Fixed
Account Option(s) and Variable Portfolio(s) in the same proportion as that
Subsequent Purchase Payment.
The Initial Payment Enhancement, and if applicable, any Deferred Payment
Enhancement(s) and Deferred Payment date(s) for Subsequent Purchase Payments
will be the Payment Enhancement percentages and Payment Enhancement dates in
effect at the time We receive Your Subsequent Purchase Payment. The amount of
any applicable Payment Enhancement(s) will be shown on the confirmation report
We send to you after Your Subsequent Purchase Payment is received by Us. We will
allocate any Deferred Payment Enhancement(s) for Subsequent Purchase Payments to
the [Cash Management Portfolio]. Deferred Payment Enhancement(s) corresponding
to Subsequent Purchase Payments will be reduced proportionately by Partial
Withdrawals of that Subsequent Purchase Payment, prior to the Deferred Payment
Enhancement Date(s).
DEFERRED PAYMENT ENHANCEMENTS
For purposes of determining a Deferred Payment Enhancement, Partial Withdrawals
are assumed to be withdrawn from earnings first, then from Purchase Payments on
a first-in-first-out (FIFO) basis. No Deferred Payment Enhancement will be
allocated if prior to the Deferred Payment Enhancement Date: (a) the Certificate
Value is fully withdrawn; or (b) a death benefit has been paid; or (c) Annuity
payments have begun; or (d) the entire Purchase Payment has been withdrawn.
CHARGES AND DEDUCTIONS
We will deduct the following charges from the Certificate:
CERTIFICATE MAINTENANCE FEE
10
The charge specified on the Certificate Data Page will be deducted on each
Certificate anniversary that occurs on or prior to the Annuity Date. It will
also be deducted when the Certificate Value is withdrawn in full if the
Withdrawal is not on the Certificate anniversary. We reserve the right to assess
this charge on a class basis that differs from the charge specified on the
Certificate Data Page. We also reserve the right to waive the fee for certain
Certificate Values [$50,000 and up].
WITHDRAWAL CHARGE
The charge, if any, may be deducted upon withdrawal of any portion of the
Certificate Value. See WITHDRAWAL PROVISIONS.
SEPARATE ACCOUNT CHARGE
This charge, as shown on the Certificate Data Page, on an annualized basis
equals a percentage of the average daily ending value of the assets attributable
to the Accumulation Units of the Variable Portfolio(s) to which the Certificate
is allocated. This charge compensates Us for mortality and expense risks,
distribution, and administration expenses associated with the Certificate. We
subtract this charge daily. We reserve the right to assess a charge on a class
basis which differs from the charge specified on the Certificate Data Page.
TRANSFER PROVISIONS
Prior to the Annuity Date, You may transfer all or part of Your Certificate
Value from any Variable Portfolio to any other Variable Portfolio(s) or
available Fixed Account Option(s) subject to applicable restrictions. The
minimum amount that can be transferred and the amount that can remain in a
Variable Portfolio or available Fixed Account Option are subject to Company
limits. We further reserve the right to restrict Your transfer privileges,
including possible termination of those privileges in Our sole discretion.
TRANSFERS OF ACCUMULATION AND ANNUITY UNITS BETWEEN VARIABLE PORTFOLIOS AND
FIXED ACCOUNTS
Prior to the Annuity Date, transfers are subject to certain restrictions. You
may transfer all or a portion of Your Certificate Value from one Variable
Portfolio to another Variable Portfolio(s) or available Fixed Account Option(s).
You may transfer from any available Fixed Account Option(s) to the Variable
Portfolio(s) and/or any available Fixed Account Option(s) of the Certificate. A
transfer will result in the redemption of Accumulation Units in a Variable
Portfolio and the purchase of Accumulation Units in the other Variable
Portfolio. Transfers will be effected at the end of the NYSE business day in
which We receive Your completed request for the transfer.
After the Annuity Date, transfers into and out of any available Fixed Account
Option(s) are not allowed. You may transfer all or a portion of Your Certificate
Value from one Variable Portfolio to another Variable Portfolio(s). A transfer
will result in the redemption of Annuity Units in a Variable Portfolio and the
purchase of Annuity Units in the other Variable Portfolio. Transfers will be
effected for the last NYSE business day of the month in which We receive Your
request for the transfer.
WITHDRAWAL PROVISIONS
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On or before the Annuity Date and while the Participant is living, You may
withdraw all or part of Your Certificate Value under this Certificate by
informing Us at Our Annuity Service Center. For a full withdrawal, this
Certificate must be returned to Our Annuity Service Center. The minimum amount
that can be withdrawn and the amount remaining after withdrawal are subject to
Company limits.
Unless You tell Us otherwise in writing, Withdrawals will be deducted from the
Certificate Value in proportion to their allocation among any available Fixed
Account Options and the Variable Portfolios. Withdrawals will be based on values
for the NYSE business day in which the request for withdrawal and the
Certificate (in the case of a full withdrawal), are received at Our Annuity
Service Center. Unless the SUSPENSION OF PAYMENTS or DEFERMENT OF PAYMENTS
sections are in effect, payment of withdrawals will be made within seven
calendar days.
WITHDRAWAL CHARGE
Withdrawals of all or a portion of the Certificate Value may be subject to a
Withdrawal Charge as shown in the chart below. The Withdrawal Charge percentage
applied to any withdrawal will depend on how long the Purchase Payment to which
the withdrawal is attributed has been in the Certificate. No Withdrawal Charge
is deducted on an amount which is considered a Penalty-Free Withdrawal.
For the purpose of determining the Withdrawal Charge, a withdrawal will be
attributed to amounts in the following order: (1) penalty-free earnings in the
Certificate; (2) Purchase Payments which are no longer subject to the Withdrawal
Charge and not yet withdrawn; (3) any remaining Penalty-Free Withdrawal amount
(except in the case of a full surrender); and (4) Purchase Payments subject to a
Withdrawal Charge. Purchase Payments, when withdrawn, are assumed to be
withdrawn on a first-in-first-out (FIFO) basis. You will not receive the benefit
of a Penalty-Free Withdrawal in the case of a full surrender.
Number of Years Elapsed Withdrawal Charge as a
Between Purchase Payment Contribution Percentage of Withdrawn
and Date of Withdrawal Purchase Payment
------------------------------------- ------------------------
0 9%
1 9%
2 8%
3 7%
4 6%
5 5%
6 4%
7 3%
8 2%
9+ 0%
The Withdrawal Charge will be assessed against the Variable Portfolio(s) and the
available Fixed Account Option(s) in the same proportion as the remaining
Certificate Value is allocated unless You request that the Withdrawal come from
a particular Variable Portfolio or available Fixed Account Option. After a
Withdrawal is taken, the remaining Certificate Value must be sufficient to cover
any Withdrawal Charge remaining upon full surrender of the Certificate.
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PENALTY-FREE WITHDRAWALS
As of any day, You may make a withdrawal of up to the Penalty-Free Withdrawal
amount for that day without incurring a Withdrawal Charge. Any Penalty-Free
Withdrawal made in excess of penalty-free earnings in the Certificate is
considered to be a withdrawal of future penalty-free earnings and is therefore
not a withdrawal of the Total Invested Amount. On any day, penalty-free earnings
in the Certificate are calculated as the Certificate Value at the end of that
day less the Total Invested Amount.
During the first Certificate Year, the Penalty-Free Withdrawal amount is equal
to the penalty-free earnings in the Certificate as of the date of withdrawal.
Alternatively, during the first Certificate Year, You may make withdrawals of
the Penalty-Free Withdrawal amount through the Systematic Withdrawal Program.
The Penalty-Free Withdrawal amount as of any systematic withdrawal date is 10%
of the Total Invested Amount less any withdrawals already made during the
Certificate Year.
After the first Certificate Year, the maximum Penalty-Free Withdrawal amount as
of the date of the withdrawal is the greater of:
(a) penalty-free earnings in the Certificate as of that date; or
(b) 10% of the Total Invested Amount on deposit for at least one year, less any
withdrawals already made during the year.
Although amounts withdrawn free of a Withdrawal Charge reduce Certificate Value,
they do not reduce the Total Invested Amount for purposes of calculating the
Withdrawal Charge or for the purposes of calculating penalty-free earnings in
the Certificate. As a result, You will not receive the benefit of a Penalty-Free
Withdrawal in a full surrender.
SYSTEMATIC WITHDRAWAL PROGRAM
Prior to the Annuity Date, You may elect to participate in a Systematic
Withdrawal Program by informing Us at Our Annuity Service Center. The Systematic
Withdrawal Program allows You to make automatic withdrawals from Your account
monthly, quarterly, semiannually or annually. The minimum systematic withdrawal
amount is subject to Company limits. Any amount withdrawn through the Systematic
Withdrawal Program may be subject to a Withdrawal Charge [and a Market Value
Adjustment] as discussed in the WITHDRAWAL CHARGE and PENALTY-FREE WITHDRAWAL
[and MARKET VALUE ADJUSTMENT] provisions. You may terminate Your participation
in the Systematic Withdrawal Program at any time by sending Us a written
request. We reserve the right to modify, suspend or terminate the Systematic
Withdrawal Program at any time.
Systematic withdrawals will be deducted from the Penalty-Free Withdrawal amount
available each Certificate Year.
DEATH PROVISIONS
Notwithstanding any provision of this Certificate to the contrary, all payments
of benefits under this Certificate will be made in a manner that satisfies the
requirements of IRC Section 72(s), as amended from time to time. If the
Certificate is owned by a trust or other non-natural person, We
13
will treat the death of any Annuitant as the death of the "Primary Annuitant"
and as the death of any Participant.
DUE PROOF OF DEATH
Due Proof of Death means:
1. a certified copy of a death certificate; or
2. a certified copy of a decree of a court of competent
jurisdiction as to the finding of death; or
3. a written statement by a medical doctor who attended the
deceased Participant at the time of death; or
4. any other proof satisfactory to Us.
DEATH OF PARTICIPANT BEFORE THE ANNUITY DATE
We will pay a death benefit to the Beneficiary upon Our receiving all Required
Documentation. Unless You have previously designated a payment option on behalf
of the Beneficiary, the Beneficiary must select one of the following options:
1. Immediately collect the death benefit in a lump sum payment.
If a lump sum payment is elected, payment will be in
accordance with any applicable laws and regulations
governing payments on death; or
2. Collect the death benefit in the form of one of the Annuity
Payment Options. If an Annuity Payment Option is desired, an
option must be elected within 60 days of Our receipt of: (a)
Due Proof of Death of the Participant; (b) an election form
specifying the payment option and (c) any other
documentation We may require. The payments must be over the
life of the Beneficiary or over a period not extending
beyond the life expectancy of the Beneficiary. Payments
under this option must commence within one year after the
Participant's death, otherwise, the death benefit will be
paid in accordance with option 1 above; or
3. If eligible, continue the Certificate as the Spousal
Beneficiary. On the Continuation Date, We will contribute to
the Certificate any amount by which the Death Benefit
exceeds the Certificate Value, calculated as of the
Participant's date of death. This amount is not considered a
Purchase Payment except in the calculation of certain death
benefits upon the death of the Spousal Beneficiary. If this
option is elected, no death benefit is paid.
You cannot change any elected death benefit option specified on the
Certificate Data Page. Your Spousal Beneficiary may discontinue any
optional death benefit option on the Continuation Date but cannot change
the death benefit option elected by You on the Enrollment Form. Upon the
Spousal Beneficiary's death, the entire interest of the Certificate must be
distributed immediately under option 1 or 2 as provided under DEATH OF
PARTICIPANT BEFORE THE ANNUITY DATE.
In any event, the entire interest in the Certificate will be distributed within
five years from the date of the death of the Participant unless payment option 1
or 2 was selected under DEATH OF PARTICIPANT BEFORE THE ANNUITY DATE.
14
AMOUNT OF DEATH BENEFIT
The amount of the death benefit will be determined based upon Your death benefit
option selection. Once selected, the death benefit option cannot be changed. The
death benefit options are as described below.
OPTION I: PURCHASE PAYMENT ACCUMULATION ("PPA") DEATH BENEFIT OPTION
If the Participant was age [74 or younger] on the Certificate Date, upon
Our receipt at Our Annuity Service Center of all Required Documentation, We
will calculate the Death Benefit and it will be the greatest of:
1. [100% of] Certificate Value for the NYSE business day during which We
receive all Required Documentation at Our Annuity Service Center; or
2. [100% of] Net Purchase Payment(s) compounded at [3%] interest until
the earlier of the Participant's [75th] birthday or the date of death;
and a Death Benefit Adjustment for Purchase Payment(s) transacted
after the Participant's [75th] birthday but prior to the Participant's
[86th] birthday and/or Withdrawals transacted after the Participant's
[75th] birthday; or
3. [100% of] Certificate Value at the [seventh] Certificate anniversary;
and a Death Benefit Adjustment for Purchase Payment(s) transacted
after the [seventh] Certificate anniversary but prior to the
Participant's [86th] birthday and/or Withdrawals transacted after the
[seventh] Certificate anniversary.
PPA SPOUSAL BENEFICIARY CONTINUATION
If the Spousal Beneficiary continues the Certificate on the Continuation Date,
the death benefit payable upon the death of the Spousal Beneficiary will be as
follows:
If the Spousal Beneficiary was age [74 or younger] on the Continuation
Date, upon Our receipt at Our Annuity Service Center of all Required
Documentation, We will calculate the Death Benefit and it will be the
greatest of:
(1) [100% of] Certificate Value for the NYSE business day during which We
receive all Required Documentation at Our Annuity Service Center; or
(2) [100% of] Certificate Value on the Continuation Date; and a Death Benefit
Adjustment for Purchase Payment(s) and/or Withdrawals transacted since
the Continuation Date, compounded at [3%] interest until the earlier of
the Spousal Beneficiary's [75th] birthday or date of death; and a further
Death Benefit Adjustment for Purchase Payment(s) transacted after the
Spousal Beneficiary's [75th] birthday but prior to the Spousal
Beneficiary's [86th] birthday and/or Withdrawals transacted after the
Spousal Beneficiary's [75th] birthday; or
(3) [100% of] Certificate Value at the [seventh] Certificate anniversary; and
a Death Benefit Adjustment for Purchase Payment(s) transacted after the
[seventh] Certificate anniversary but prior to the Spousal Beneficiary's
[86th] birthday and/or Withdrawals transacted after the [seventh]
Certificate anniversary.
15
If the Spousal Beneficiary was age [75 but younger than 81] on the Continuation
Date, upon Our receipt of all Required Documentation at Our Annuity Service
Center, the Death Benefit will be the greatest of:
1. [100% of] Certificate Value for the NYSE business day during
which We receive all Required Documentation at Our Annuity
Service Center; or
2. [100% of] Certificate Value on the Continuation Date, and a Death
Benefit Adjustment for Purchase Payment(s) transacted after the
Continuation Date but prior to the Spousal Beneficiary's [86th]
birthday and/or Withdrawals transacted after the Continuation
Date; or
3. [100% of] the Maximum Anniversary Value after the Continuation
Date that occurs prior to the Spousal Beneficiary's [81st]
birthday. The Maximum Anniversary Value is equal to the greatest
anniversary value attained from the following:
As of the date of receipt at Our Annuity Service Center of all Required
Documentation, anniversary value is equal to the Certificate Value on a
Certificate anniversary and a Death Benefit Adjustment for Purchase Payment(s)
transacted after the Certificate anniversary but prior to the Spousal
Beneficiary's [86th] birthday and/or Withdrawals transacted since that
Certificate anniversary.
If the Spousal Beneficiary was age [81 or older] at the time of death, the Death
Benefit will be [100% of] Certificate Value for the NYSE business day during
which We receive all Required Documentation at Our Annuity Service Center.
OPTION II: MAXIMUM ANNIVERSARY VALUE ("MAV") DEATH BENEFIT OPTION
If the Participant was age [80 or younger] on the Certificate Date and
death occurs prior to Age [90], upon Our receipt of all Required
Documentation at Our Annuity Service Center, We will calculate the Death
Benefit and it will be the greatest of:
1. [100% of] Certificate Value for the NYSE business day during which We
receive all Required Documentation at Our Annuity Service Center; or
2. [100% of] of Net Purchase Payment(s) received prior to the earlier of
the Participant's [86th] birthday or date of death; or
3. [100% of] of the Maximum Anniversary Value that occurs prior to the
Participant's [83rd] birthday. The Maximum Anniversary Value is equal
to the greatest anniversary value attained from the following:
As of the date of receipt at our Annuity Service Center of all
Required Documentation, anniversary value is equal to the Certificate
Value on a Certificate anniversary, and a Death Benefit Adjustment for
Purchase Payment(s) transacted since that Certificate anniversary but
prior to the Participant's [86th] birthday and/or Withdrawals
transacted since that Certificate anniversary.
If the Participant was at age [81 or older] at the time of death, the Death
Benefit will be [100% of] Certificate Value for the NYSE business day during
which We receive all Required Documentation at Our Annuity Service Center.
16
MAV SPOUSAL BENEFICIARY CONTINUATION
If the Spousal Beneficiary continues the Certificate on the Continuation Date,
the Death Benefit payable upon the death of the Spousal Beneficiary will be as
follows:
If the Spousal Beneficiary was age [80 or younger] on the Continuation
Date, upon Our receipt of all Required Documentation at Our Annuity Service
Center, We will calculate the Death Benefit and it will be the greatest of:
1. [100% of] Certificate Value for the NYSE business day during which We
receive all Required Documentation at Our Annuity Service Center; or
2. [100% of] Certificate Value on the Continuation Date; and a Death
Benefit Adjustment for Purchase Payment(s) transacted after the
Continuation Date but prior to the Spousal Beneficiary's [86th]
birthday and/or Withdrawals transacted after the Continuation Date; or
3. [100% of] the Maximum Anniversary Value after the Continuation Date
and preceding the date of death that occurs prior to the Spousal
Beneficiary's [83rd] birthday. The Maximum Anniversary Value is equal
to the greatest anniversary value attained from the following:
As of the date of receipt at Our Annuity Service Center of all Required
Documentation, anniversary value is equal to the Certificate Value on a
Certificate anniversary and a Death Benefit Adjustment for Purchase
Payments transacted after that Certificate anniversary but prior to the
Spousal Beneficiary's [86th] birthday and/or Withdrawals transacted since
that Certificate anniversary.
If the Spousal Beneficiary was age [81 or older] on the Continuation
Date, the Death Benefit will be [100% of] Certificate Value for the
NYSE business day during which We receive all Required Documentation
at Our Annuity Service Center.
DEATH OF PARTICIPANT OR ANNUITANT ON OR AFTER THE ANNUITY DATE.
If any Participant or Annuitant dies on or after the Annuity Date and before the
entire interest in the Certificate has been distributed, We will pay the
remaining portion of the annuity payout to the Beneficiary upon Our receipt of
Required Documentation. For further information pertaining to death of the
Annuitant, see ANNUITY PAYMENT OPTIONS.
BENEFICIARY
The Beneficiary is selected by the Participant. While the Participant is living
and before the Annuity Date, the Participant may change the Beneficiary by
written notice in a form satisfactory to Us. A change in Beneficiary will take
effect on the date We receive the written notice at Our Annuity Service Center.
If two or more persons are named as Beneficiaries under the Certificate, those
surviving the Participant will share equally unless otherwise stated; and each
must elect to receive their respective portions of the death benefit according
to the options listed under DEATH OF PARTICIPANT BEFORE THE ANNUITY DATE. If the
Annuitant survives the Participant, and there are no surviving Beneficiaries,
the Annuitant will be deemed the Beneficiary.
Joint Participants, if applicable, shall be each other's primary Beneficiary.
Joint Annuitants, if any, when the Participant is a non-natural person, shall be
each other's primary Beneficiary. Any other Beneficiary designation will be
treated as a contingent Beneficiary.
17
If the Participant is also the Annuitant and there are no surviving
Beneficiaries upon Our receipt of all Required Documentation, We will calculate
the Death Benefit and it will be paid to the estate of the Participant in
accordance with option 1, under DEATH OF PARTICIPANT BEFORE THE ANNUITY DATE.
ANNUITY PROVISIONS
ANNUITY DATE
The Participant specifies an anticipated Annuity Date on the Enrollment Form.
The Participant may change the Annuity Date at least seven days prior to the
Annuity Date, by written notice to the Company at its Annuity Service Center.
The Annuity Date must always be the first day of the calendar month and must be
at least two years after the Certificate Date, but not beyond the later of the
Participant's [90th birthday or ten years after the Certificate Date] ("Latest
Annuity Date"). If the Participant is a non-natural person, the Latest Annuity
Date is the later of the Annuitant's [90th birthday or ten years after the
Certificate Date]. If no Annuity Date is specified on the Enrollment Form, the
Annuity Date will be the Latest Annuity Date, as set by the Company.
PAYMENTS TO PARTICIPANT
Unless You request otherwise, We will make annuity payments to You. If You want
the annuity payments to be made to some other Payee, We will make such payments
subject to receipt of a written request filed at the Annuity Service Center no
later than thirty (30) days before the due date of the first annuity payment.
Any such request is subject to the rights of any assignee. No payments available
to or being paid to the Payee while the Annuitant is alive can be transferred,
commuted, anticipated or encumbered.
FIXED ANNUITIZATION
If a Fixed Annuitization has been elected, the proceeds payable under this
Certificate less any applicable premium taxes, shall be applied to the payment
of the fixed annuity payment option elected at rates which are at least equal to
the annuity rates based upon the applicable tables. In no event will the Fixed
Annuitization be changed once it begins.
AMOUNT OF FIXED ANNUITY PAYMENTS
The amount of each fixed annuity payment will be determined by applying the
portion of the Certificate Value allocated by You for Fixed Annuitization, less
any applicable premium taxes to the annuity table applicable to the fixed
annuity payment option chosen.
AMOUNT OF VARIABLE ANNUITY PAYMENTS
(a) FIRST VARIABLE ANNUITY PAYMENT: The dollar amount of the first Variable
Annuitization payment will be determined by applying the portion of the
Certificate Value allocated to the Variable Portfolio(s), less any
applicable premium taxes, to rates which are equal to the annuity rates
based upon the annuity table applicable to the variable annuity payment
option chosen. If the Certificate Value is allocated to more than one
Variable Portfolio, the value of Your interest in each Variable Portfolio
is applied
18
separately to the variable annuity payment option table to determine the
amount of the first annuity payment attributable to each Variable
Portfolio.
(b) NUMBER OF VARIABLE ANNUITY UNITS: The number of Annuity Units for each
applicable Variable Portfolio is the amount of the first annuity payment
attributable to that Variable Portfolio divided by the value of the
applicable Annuity Unit for that Variable Portfolio as of the Annuity Date.
The number will not change as a result of investment experience.
(c) VALUE OF EACH VARIABLE ANNUITY UNIT: The value of an Annuity Unit may
increase or decrease from one month to the next. For any month, the value
of an Annuity Unit of a particular Variable Portfolio is the value of that
Annuity Unit as of the last NYSE business day of the preceding month,
multiplied by the Net Investment Factor for that Variable Portfolio for the
last NYSE business day of the current month.
The Net Investment Factor for any Variable Portfolio for a certain month is
determined by dividing (1) by (2) where:
(1) is the Accumulation Unit Value of the Variable Portfolio
determined as of the last business day at the end of that month,
and
(2) is the Accumulation Unit Value of the Variable Portfolio
determined as of the last business day at the end of the
preceding month.
The result is then multiplied by a factor that neutralizes the assumed
investment rate of 3.5%.
(d) SUBSEQUENT VARIABLE ANNUITY PAYMENTS: After the first Variable
Annuitization payment, future payments will vary in amount according to the
investment performance of the applicable Variable Portfolio(s) to which
Your Purchase Payments are allocated. The amount may change from month to
month. The amount of each subsequent payment for each Variable Portfolio
is:
The number of Annuity Units for each Variable Portfolio as determined for the
first annuity payment
Multiplied by
The value of an Annuity Unit for that Variable Portfolio at the end of the month
immediately preceding the month in which payment is due.
We guarantee that the amount of each Variable Annuitization payments will not be
affected by variations in expenses or mortality experience.
GENERAL PROVISIONS
ENTIRE CERTIFICATE
The Entire Certificate between You and Us consists of this Certificate, this
Enrollment Form or confirmation thereof, and any attached endorsement(s) or
rider(s). An agent cannot change the terms or conditions of this Certificate.
Any change must be in writing and approved by Us. Only Our President, Secretary,
or one of Our Vice-Presidents can give Our approval.
19
CHANGE OF ANNUITANT
If the Participant is an individual, the Participant may change the Annuitant(s)
at any time prior to the Annuity Date. To make a change, the Participant must
send a written notice to Us at least 30 days before the Annuity Date. If the
Participant is a non-natural person, the Participant may not change the
Annuitant.
DEATH OF ANNUITANT
If the natural Participant and Annuitant are different, and the Annuitant dies
before the Annuity Date, the Participant becomes the Annuitant until the
Participant elects a new Annuitant. If there are Joint Annuitants, upon the
death of any Annuitant prior to the Annuity Date, the Participant may elect a
new Joint Annuitant. However, if the Participant is a non-natural person, We
will treat the death of any Annuitant as the death of the "Primary Annuitant"
and as the death of the Participant, see DEATH PROVISIONS.
MISSTATEMENT OF AGE OR SEX
If the Age or sex of any Annuitant has been misstated, future annuity payments
will be adjusted using the correct Age and sex, according to Our rates in effect
on the date that annuity payments were determined. Any overpayment from the
fixed annuity payment options, plus interest at the rate of 4% per year, will be
deducted from the next payment(s) due. Any underpayment from the fixed annuity
payment options, plus interest at the rate of 4% per year, will be paid in full
with the next payment due. Any overpayment from the Variable Portfolios will be
deducted from the next payment(s) due. Any underpayment from the Variable
Portfolios will be paid in full with the next payment due.
With respect to Certificate issue Age and other Age driven features in the
Certificate, should We discover a misstatement of Age, We reserve the right to
fully pursue Our remedies including possible termination of the Certificate
and/or revocation of any Age driven benefits.
PROOF OF AGE, SEX, OR SURVIVAL
The Company may require satisfactory proof of correct Age or sex at any time. If
any payment under this Certificate depends on the Annuitant being alive, the
Company may require satisfactory proof of survival.
DEFERMENT OF PAYMENTS
We may defer making payment from the available Fixed Account Option(s) for up to
six (6) months. Interest, subject to state requirements, will be credited during
the deferral period.
SUSPENSION OF PAYMENTS
We may suspend or postpone any payments from the Variable Portfolios if any of
the following occur:
(a) the NYSE is closed;
(b) trading on the NYSE is restricted;
(c) an emergency exists that it is not reasonable practical to dispose of
securities in the Variable Portfolios or determine the value of its
assets; or
(d) the Securities and Exchange Commission, by order, so permits for the
protection of Participants.
Conditions in (b) and (c) will be decided by or in accordance with rules of
the Securities and Exchange Commission.
CONFORMITY WITH STATE LAWS
The provisions of this Certificate will be interpreted by the laws of the state
in which the Enrollment Form or confirmation thereof was signed or such other
state as is required by law.
20
Any provision which, on the Certificate Date, is in conflict with the law of
such state is amended to conform to the minimum requirements of such law.
CHANGES IN LAW
If the laws governing this Certificate or the taxation of benefits under the
Certificate change, We reserve the right to amend this Certificate to comply
with these changes.
ASSIGNMENT
You may assign this Certificate before the Annuity Date, but We will not be
bound by an assignment unless it is received by Us in writing. Your rights and
those of any other person referred to in this Certificate will be subject to the
assignment. Certain assignments may be taxable. We do not assume any
responsibility for the validity or tax consequences of any assignment. We
reserve the right to not recognize assignments if it changes the risk profile of
the Participant of the Certificate, as determined in Our sole discretion.
CLAIMS OF CREDITORS
To the extent permitted by law, no right or proceeds payable under this
Certificate will be subject to claims of creditors or legal process.
PREMIUM TAXES OR OTHER TAXES
The Company may deduct from Your Certificate Value any premium tax or other
taxes payable to a state or other government entity, if applicable. Should We
advance any amount so due, We are not waiving any right to collect such amount
at a later date. The Company will deduct any withholding taxes required by
applicable law.
WRITTEN NOTICE
Any notice We send to You will be sent to Your address shown in the Enrollment
Form or confirmation thereof unless You request otherwise. Any written request
or notice to Us must be sent to Our Annuity Service Center, as specified on the
Certificate Data Page.
PERIODIC REPORTS
At least once during each Certificate Year, We will send You a statement of the
account activity of the Certificate. The statement will include all transactions
that have occurred during the accounting period shown on the statement.
INCONTESTABILITY
This Certificate will be incontestable from the Certificate Date, except as
otherwise stated under MISSTATEMENT OF AGE OR SEX.
NONPARTICIPATING
This Certificate does not share in Our surplus.
WAIVER
Our waiver of any of the terms and conditions under this Certificate will not be
deemed to constitute a waiver of the right to enforce strict compliance.
ANNUITY PAYMENT OPTIONS
During the Annuitant's life, upon written election and the return of this
Certificate to the Company at its Annuity Service Center, the Certificate Value
may be applied to provide one of the following options or any annuity payment
option that is mutually agreeable. After two years from the Certificate Date,
and prior to the Annuity Date, You can choose one of the options
21
described below. If no option has been selected by the Annuity Date, You will
automatically receive option 4, below, with 120 monthly payments guaranteed.
OPTIONS 1 & 1v - LIFE ANNUITY, LIFETIME PAYMENTS GUARANTEED
Payments payable to a Payee during the lifetime of the Annuitant. No further
payments are payable after the death of the Annuitant.
OPTIONS 2 & 2v - JOINT AND 100% SURVIVOR LIFE ANNUITY
Payments payable to the Payee during the lifetime of the Annuitant and during
the lifetime of a designated second person. No further payments are payable
after the deaths of both the Annuitant and the designated second person.
OPTIONS 3 & 3v - JOINT AND 100% SURVIVOR LIFE ANNUITY WITH PAYMENTS GUARANTEED
FOR 10 OR 20 YEARS
Payments are payable to the Payee during the lifetime of the Annuitant and
during the lifetime of a designated second person. If, at the death of the
survivor, payments have been made for less than the 10 or 20 years, as selected
at the time of annuitization, the remaining guaranteed annuity payments will be
continued to the Beneficiary.
OPTIONS 4 & 4v - LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 10 OR 20 YEARS
Payments payable to the Payee during the lifetime of the Annuitant. If, at the
death of the Annuitant, payments have been made for less than the 10 or 20
years, as selected at the time of annuitization, the remaining guaranteed
annuity payments will be continued to the Beneficiary.
OPTIONS 5 & 5v - FIXED PAYMENTS FOR A SPECIFIED PERIOD CERTAIN
Payments payable to the Payee for any specified period of time for five (5)
years or more, but not exceeding thirty (30) years, as selected at the time of
annuitization. The selection must be made for full twelve month periods. In the
event of death of the Annuitant, any remaining annuity payments will be
continued to the Beneficiary. If Variable Annuity Payments are elected under
this Annuity Payment Option, any remaining guaranteed Variable Annuity payments
may be redeemed for a discounted value determined by Us. Any applicable
Withdrawal Charges will be deducted from the discounted value as if You fully
surrendered Your Certificate.
22
FIXED ANNUITY PAYMENT OPTIONS TABLE
BASIS OF COMPUTATION
The actuarial basis for the Table of Annuity Rates is the 1983a Annuity
Mortality Table with projection and a guaranteed interest rate of 3%. The
mortality table is projected using Projection Scale G factors, assuming
annuitization in the year 2000. The Fixed Annuity Payment Options Table does not
included any applicable premium tax.
OPTIONS 1 & 4 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
OPTION 4 OPTION 4
LIFE ANNUITY LIFE ANNUITY
OPTION 1 (w/120 PAYMENTS (w/240 PAYMENTS
AGE OF LIFE ANNUITY GUARANTEED) GUARANTEED)
ANNUITANT MALE FEMALE MALE FEMALE MALE FEMALE
55 4.23 3.84 4.19 3.82 4.05 3.76
56 4.32 3.91 4.27 3.88 4.11 3.81
57 4.41 3.98 4.35 3.95 4.17 3.87
58 4.51 4.05 4.44 4.02 4.24 3.93
59 4.61 4.13 4.54 4.10 4.31 4.00
60 4.72 4.22 4.64 4.18 4.37 4.06
61 4.84 4.31 4.74 4.27 4.44 4.13
62 4.96 4.40 4.85 4.36 4.51 4.20
63 5.10 4.51 4.97 4.45 4.58 4.27
64 5.24 4.62 5.10 4.55 4.65 4.35
65 5.40 4.73 5.22 4.66 4.72 4.42
66 5.56 4.86 5.36 4.78 4.79 4.50
67 5.74 4.99 5.50 4.90 4.86 4.57
68 5.93 5.14 5.65 5.02 4.92 4.65
69 6.13 5.29 5.80 5.16 4.99 4.73
70 6.35 5.46 5.96 5.30 5.05 4.80
71 6.58 5.64 6.13 5.46 5.10 4.88
72 6.82 5.84 6.29 5.62 5.16 4.95
73 7.08 6.05 6.47 5.78 5.20 5.02
74 7.36 6.28 6.64 5.96 5.25 5.08
75 7.66 6.53 6.82 6.14 5.29 5.14
76 7.98 6.80 7.00 6.33 5.33 5.19
77 8.33 7.09 7.19 6.53 5.36 5.24
78 8.69 7.41 7.37 6.73 5.39 5.29
79 9.09 7.75 7.55 6.94 5.41 5.33
80 9.51 8.11 7.73 7.14 5.43 5.36
81 9.97 8.51 7.91 7.35 5.45 5.39
82 10.45 8.94 8.08 7.55 5.47 5.42
83 10.97 9.41 8.24 7.76 5.48 5.44
84 11.52 9.92 8.40 7.95 5.49 5.46
85 12.10 10.47 8.54 8.13 5.50 5.48
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OPTION 2 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
JOINT & 100% SURVIVOR LIFE ANNUITY
AGE OF
MALE AGE OF FEMALE ANNUITANT
ANNUITANT --------------------------------------------------------------------------------------
--------- 55 60 65 70 75 80 85
55 3.54 3.69 3.84 3.96 4.06 4.13 4.17
60 3.63 3.83 4.04 4.23 4.39 4.52 4.60
65 3.70 3.95 4.23 4.51 4.78 5.00 5.16
70 3.75 4.04 4.39 4.78 5.18 5.56 5.85
75 3.78 4.11 4.51 5.01 5.57 6.14 6.65
80 3.81 4.15 4.60 5.18 5.89 6.70 7.52
85 3.82 4.18 4.66 5.30 6.14 7.18 8.35
OPTION 3 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT & 100% SURVIVOR LIFE ANNUITY (w/120 PAYMENTS GUARANTEED)
AGE OF
MALE AGE OF FEMALE ANNUITANT
ANNUITANT --------------------------------------------------------------------------------------
--------- 55 60 65 70 75 80 85
55 3.54 3.69 3.83 3.96 4.05 4.12 4.16
60 3.63 3.83 4.03 4.22 4.38 4.50 4.57
65 3.70 3.95 4.22 4.50 4.76 4.97 5.10
70 3.75 4.04 4.38 4.76 5.15 5.48 5.72
75 3.78 4.10 4.50 4.98 5.50 6.00 6.40
80 3.80 4.14 4.58 5.13 5.78 6.46 7.04
85 3.81 4.16 4.62 5.22 5.97 6.80 7.55
OPTION 3 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT & 100% SURVIVOR LIFE ANNUITY (w/240 PAYMENTS GUARANTEED)
AGE OF
MALE AGE OF FEMALE ANNUITANT
ANNUITANT --------------------------------------------------------------------------------------
--------- 55 60 65 70 75 80 85
55 60 65 70 75 80 85
55 3.53 3.68 3.81 3.92 3.99 4.03 4.04
60 3.62 3.81 4.00 4.16 4.27 4.34 4.37
65 3.68 3.92 4.16 4.39 4.56 4.66 4.71
70 3.72 3.99 4.29 4.58 4.81 4.96 5.03
75 3.74 4.03 4.36 4.70 4.99 5.17 5.26
80 3.75 4.05 4.40 4.77 5.09 5.30 5.40
85 3.76 4.06 4.42 4.80 5.13 5.35 5.46
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OPTION 5 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
FIXED PAYMENT FOR SPECIFIED PERIOD
NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY
OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT
-------- ------- -------- ------- -------- ------- -------- -------
10 9.61 17 6.23 24 4.84
11 8.86 18 5.96 25 4.71
5 17.91 12 8.24 19 5.73 26 4.59
6 15.14 13 7.71 20 5.51 27 4.47
7 13.16 14 7.26 21 5.32 28 4.37
8 11.68 15 6.87 22 5.15 29 4.27
9 10.53 16 6.53 23 4.99 30 4.18
25
VARIABLE ANNUITY PAYMENT OPTIONS TABLE
BASIS OF COMPUTATION
The actuarial basis for the Table of Annuity Rates is the 1983a Annuity
Mortality Table with projection and an effective annual Assumed Investment Rate
of 3.5%. The mortality table is projected using Projection Scale G factors,
assuming annuitization in the year 2000. The Variable Annuity Payment Options
Table does not include any applicable premium tax.
OPTIONS 1v & 4v - TABLE OF MONTHLY INSTALLMENTS PER $1,000
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
OPTION 4v OPTION 4v
LIFE ANNUITY LIFE ANNUITY
OPTION 1v (w/120 PAYMENTS (w/240 PAYMENTS
AGE OF LIFE ANNUITY GUARANTEED) GUARANTEED)
ANNUITANT MALE FEMALE MALE FEMALE MALE FEMALE
55 4.53 4.13 4.48 4.11 4.33 4.05
56 4.62 4.20 4.56 4.18 4.39 4.10
57 4.71 4.27 4.64 4.24 4.45 4.16
58 4.80 4.34 4.73 4.31 4.52 4.22
59 4.90 4.42 4.82 4.39 4.58 4.28
60 5.01 4.51 4.92 4.47 4.65 4.34
61 5.13 4.60 5.03 4.55 4.71 4.41
62 5.26 4.69 5.14 4.64 4.78 4.48
63 5.39 4.80 5.25 4.74 4.85 4.55
64 5.54 4.91 5.38 4.84 4.92 4.62
65 5.69 5.02 5.51 4.94 4.99 4.69
66 5.86 5.15 5.64 5.06 5.05 4.77
67 6.03 5.28 5.78 5.18 5.12 4.84
68 6.22 5.43 5.93 5.30 5.18 4.92
69 6.43 5.58 6.08 5.44 5.24 4.99
70 6.64 5.75 6.23 5.58 5.30 5.06
71 6.87 5.93 6.40 5.73 5.36 5.14
72 7.12 6.13 6.56 5.89 5.41 5.21
73 7.38 6.34 6.73 6.06 5.46 5.27
74 7.66 6.57 6.91 6.23 5.50 5.33
75 7.96 6.82 7.09 6.41 5.54 5.39
76 8.28 7.09 7.27 6.60 5.57 5.44
77 8.63 7.38 7.45 6.79 5.61 5.49
78 9.00 7.70 7.63 6.99 5.63 5.54
79 9.40 8.04 7.81 7.19 5.66 5.58
80 9.82 8.41 7.98 7.40 5.68 5.61
81 10.28 8.81 8.16 7.60 5.70 5.64
82 10.76 9.24 8.32 7.81 5.71 5.66
83 11.28 9.71 8.48 8.00 5.72 5.69
84 11.83 10.23 8.64 8.19 5.73 5.70
85 12.42 10.78 8.78 8.38 5.74 5.72
26
OPTION 2v - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
JOINT & 100% SURVIVOR LIFE ANNUITY
AGE OF
MALE AGE OF FEMALE ANNUITANT
ANNUITANT -----------------------------------------------------------------------------------------
--------- 55 60 65 70 75 80 85
55 3.83 3.98 4.12 4.24 4.34 4.42 4.46
60 3.92 4.11 4.32 4.51 4.67 4.80 4.89
65 3.99 4.23 4.50 4.79 5.05 5.28 5.44
70 4.04 4.33 4.67 5.05 5.46 5.83 6.13
75 4.07 4.39 4.79 5.28 5.84 6.41 6.93
80 4.10 4.44 4.88 5.45 6.16 6.97 7.79
85 4.11 4.47 4.94 5.57 6.41 7.45 8.61
OPTION 3v - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT AND 100% SURVIVOR LIFE ANNUITY (w/120 PAYMENTS GUARANTEED)
AGE OF
MALE AGE OF FEMALE ANNUITANT
ANNUITANT -----------------------------------------------------------------------------------------
--------- 55 60 65 70 75 80 85
55 3.83 3.98 4.12 4.24 4.34 4.40 4.45
60 3.92 4.11 4.31 4.50 4.66 4.78 4.86
65 3.99 4.23 4.50 4.78 5.03 5.24 5.38
70 4.04 4.32 4.66 5.03 5.41 5.75 5.99
75 4.07 4.38 4.78 5.25 5.77 6.26 6.66
80 4.09 4.43 4.86 5.40 6.05 6.72 7.29
85 4.10 4.45 4.90 5.50 6.24 7.05 7.80
OPTION 3v - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT & 100% SURVIVOR LIFE ANNUITY (w/240 PAYMENTS GUARANTEED)
AGE OF
MALE AGE OF FEMALE ANNUITANT
ANNUITANT --------------------------------------------------------------------------------------
--------- 55 60 65 70 75 80 85
55 3.82 3.97 4.10 4.20 4.27 4.31 4.33
60 3.91 4.09 4.28 4.44 4.55 4.61 4.64
65 3.97 4.20 4.44 4.66 4.83 4.93 4.97
70 4.01 4.27 4.56 4.84 5.07 5.21 5.28
75 4.03 4.31 4.64 4.97 5.25 5.42 5.51
80 4.04 4.33 4.67 5.03 5.34 5.55 5.65
85 4.05 4.34 4.69 5.06 5.38 5.60 5.70
27
OPTION 5v - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
PAYMENTS FOR A SPECIFIED PERIOD
NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY
OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT
-------- ------- -------- ------- -------- ------- -------- -------
10 9.83 17 6.47 24 5.09
11 9.09 18 6.20 25 4.96
5 18.12 12 8.46 19 5.97 26 4.84
6 15.35 13 7.94 20 5.75 27 4.73
7 13.38 14 7.49 21 5.56 28 4.63
8 11.90 15 7.10 22 5.39 29 4.53
9 10.75 16 6.76 23 5.24 30 4.45
28
AIG SUNAMERICA LIFE ASSURANCE COMPANY
A STOCK COMPANY LOS ANGELES, CALIFORNIA
ALLOCATED GROUP FIXED AND VARIABLE
ANNUITY CERTIFICATE
Nonparticipating
29