EXHIBIT (4)(d)
FORM OF INDIVIDUAL CONTRACT FORM AND ENDORSEMENTS
Home Office: Transamerica Occidental Life
▇▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇ Insurance Company
[LOGO] Transamerica Cedar Rapids, IA 52499
OCCIDENTAL LIFE A Stock Company
ANNUITANT: [▇▇▇▇ ▇▇▇]
OWNER(S): [▇▇▇▇ ▇▇▇]
CONTRACT NUMBER: [07 - 12345]
CONTRACT DATE: [December 4, 2001]
WE AGREE
.. To provide annuity payments as set forth in Section 10 of this contract,
.. Or to pay Withdrawal benefits in accordance with Section 5 of this contract,
.. Or to pay death proceeds in accordance with Section 9 of this contract.
Withdrawals may be subject to an Excess Interest Adjustment reflecting changes
in interest rates in accordance with Section 5 of this contract. Transfers and
amounts applied to a Payment Option may also be subject to an Excess Interest
Adjustment in accordance with Sections 8 and 10, respectively, of this contract.
These agreements are subject to the provisions of this contract. This contract
is issued in consideration of the payment of the initial premium.
This contract may be applied for and issued to qualify as a tax-qualified
annuity under the applicable sections of the Internal Revenue Code.
20 DAY RIGHT TO CANCEL
You may cancel this contract by delivering or mailing a written notice or
sending a telegram to us. You must return the contract before midnight of the
twentieth day after the day You receive it. Notice given by mail and return of
the contract by mail are effective on being postmarked, properly addressed and
postage prepaid.
We will pay You an amount equal to the sum of:
.. the premiums paid;
.. less partial withdrawals; and
.. the accumulated gains or losses, if any, in the Separate Account on the date
of cancellation;
unless otherwise required by law.
Signed for us at our home office.
/s/ ▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ /s/ ▇▇▇ ▇. ▇▇▇▇▇▇
SECRETARY PRESIDENT
This contract is a legal contract between the contract owner and the Company.
READ YOUR CONTRACT CAREFULLY
Flexible Premium Deferred Variable Annuity
Income Payable At Annuity Commencement Date
Benefits Based On The Performance Of The Separate Account Are
Variable And Are Not Guaranteed As To Dollar Amount (See Sections 6 and 10C)
Non-Participating
AV696 101 145 901
SECTION 1 - DEFINITIONS
ACCOUNT VALUE - Amount defined in Section 4, that can be used to fund one of the
Payment Options.
ADJUSTED ACCOUNT VALUE - The Account Value increased or decreased by any Excess
Interest Adjustment.
ANNUITANT - The person whose life annuity payments will be based on.
ANNUITY COMMENCEMENT DATE - The Date the Annuitant will begin receiving payments
from this contract, which may not be later than the last day of the contract
month starting after the Annuitant attains age 85, except as expressly allowed
by us (within state restrictions), but in no event later than the last day of
the month in which the Annuitant attains age 95.
CASH VALUE - Amount, defined in Section 5 that is available for partial or full
Surrenders.
CONTRACT ANNIVERSARY - The anniversary of the Contract Date for each year the
contract remains in force.
CONTRACT DATE - The date shown on the Contract Data page of this contract and
the date on which this contract becomes effective.
CONTRACT YEAR - The 12-month period following the Contract Date shown on the
Contract Data page. The first Contract Year starts on the Contract Date. Each
subsequent year starts on the anniversary of the Contract Date.
CUMULATIVE EARNINGS - An amount equal to the Account Value at the time a lump
sum payout or systematic payout option payout is made, minus the sum of all
premium payments reduced by all prior partial Withdrawals deemed to have been
from premium, if any.
CUSTODIAL CARE - Care designed essentially to help a person with the activities
of daily living which does not require the continuous attention of trained
medical or paramedical personnel.
DISTRIBUTION - A Withdrawal or disbursement of funds from the Account Value or
Cash Value. Account Value and Cash Value will be reduced by any Distribution.
GAINS - Cumulative Earnings, if any, in the Account Value.
HOSPITAL - An institution which 1) is operated pursuant to the laws of the
jurisdiction in which it is located, 2) operates primarily for the care and
treatment of sick and injured persons on an inpatient basis, 3) provides 24-hour
nursing service by or under the supervision of registered graduate professional
nurses, 4) is supervised by a staff of one or more licensed Physicians, and 5)
has medical, surgical and diagnostic facilities or access to such facilities.
INVESTMENT OPTIONS - Any of the Guaranteed Period Options of the Fixed Account,
the Dollar Cost Averaging Fixed Account Option, and any of the Subaccounts of
the Separate Account.
MONTHLY ANNIVERSARY - The same date each month as the Contract Date. If there is
no day in the calendar month, which coincides with the Contract Date, the
Monthly Anniversary will be the first day of the next calendar month.
NURSING CARE - Care prescribed by a Physician and performed or supervised by a
registered graduate nurse. Such care includes nursing and rehabilitation
services available 24 hours.
NURSING FACILITY - A facility which 1) is operated pursuant to the laws of the
jurisdiction in which it is located, 2) provides Nursing Care or Custodial Care,
3) primarily provides Nursing Care under the direction of a licensed Physician,
registered graduate professional nurse, or licensed vocational nurse, except
when receiving Custodial Care, and 4) is not other than incidentally a Hospital,
a home for the aged, a retirement home, a rest home, a community living center
or a place mainly for the treatment of alcoholism, mental illness or drug abuse.
PAYEE - The person to whom annuity payments will be made.
PAYMENT OPTIONS - Options through which the distribution of the Adjusted Account
Value can be directed.
PHYSICIAN - Doctor of Medicine or Doctor of Osteopathy who is licensed as such
and operating within the scope of the license.
SEPARATE ACCOUNT - The separate investment account(s) established by us, as
described in Section 6.
SUBACCOUNT - A division of the Separate Account, as described in Section 6.
SURRENDER - A partial or full withdrawal of funds from the Account Value or Cash
Value.
TERMINAL CONDITION - A condition resulting from an accident or illness which, as
determined by a Physician, has reduced life expectancy to not more than 12
months, despite appropriate medical care.
WITHDRAWAL - A distribution of funds from the Account Value or Cash Value.
YOU, YOUR - The owner of this contract. Unless otherwise specified on the
Contract Data page, the Annuitant and the owner shall be one and the same
person.
AVB696 Page 2
SECTION 2 - CONTRACT DATA
CONTRACT NUMBER: [07 - 12345] ANNUITANT: [▇▇▇▇ ▇▇▇]
INITIAL PREMIUM
PAYMENT: [$5,000.00] ISSUE AGE/SEX: [35 / Male]
CONTRACT DATE: [December 4, 2001] OWNER(S): [▇▇▇▇ ▇▇▇]
ANNUITY
COMMENCEMENT GUARANTEED
DATE: [March 8, 2050] MINIMUM
DEATH BENEFIT
OPTION: [N]
BENEFICIARY: [▇▇▇▇ ▇▇▇]
Fixed Account Guaranteed Minimum Effective Annual Interest Rate: [3%]
Before the Annuity Commencement Date:
Death Benefit Option P - Return of Premium
Mortality and Expense Risk Fee and Administrative Charge: 1.30%
Death Benefit Option N - 6% / Monthly Double Enhanced
Mortality and Expense Risk Fee and Administrative Charge: 1.45%
After the Annuity Commencement Date:
Mortality and Expense Risk Fee and Administrative Charge: 1.25%
AV696 101 145 901SP Page 3
SECTION 3 - PREMIUM PAYMENTS
PAYMENT OF PREMIUMS
Premium payments may be made any time while this contract is in force before the
Annuity Commencement Date. You may start or stop, increase or decrease, or skip
any Premium Payments.
MAXIMUM AND MINIMUM PREMIUM PAYMENT
The premium payments may not be more than the amount permitted by law if this is
a tax-qualified annuity. The minimum initial premium payment is $5,000. If this
contract is being used as a tax-qualified annuity, the minimum initial premium
is $1,000, except that no minimum initial premium payment will be required for
403(b) annuities. The minimum subsequent premium payment we will accept is $50.
The maximum total premium payments which we will accept without prior Company
approval is $1,000,000.
PREMIUM PAYMENT DATE
The premium payment date is the date on which the premium payment is credited to
the contract. The initial premium payment less any applicable premium taxes will
be credited to the contract within two business days of receipt of the premium
payment and the information needed. Subsequent additional premium payments will
be credited to the contract as of the business day the premium payment and
required information are received. A business day is any day that the New York
Stock Exchange is open for trading.
ALLOCATION OF PREMIUM PAYMENTS
Premium payments may be applied to various Investment Options, which we make
available. For each premium payment, You must indicate what percentage to
allocate to various Investment Options. Each percent may be either zero or any
whole number; however, the allocation among all accounts must total 100%.
CHANGE OF ALLOCATION
You may change the allocation of premium payments to various Investment Options
by providing us notice containing the facts that we need. Premium payments
received after the date on which we receive Your notice will be applied on the
basis of the new allocation.
PREMIUM TAXES
Your state may impose a premium tax. It may be imposed either when a premium
payment is made, on the Annuity Commencement Date, on the date of death or on
the date of full Surrender. When permitted by state law, we will not deduct the
premium tax until the Annuity Commencement Date, date of death, or date of full
Surrender.
SECTION 4 - ACCOUNT VALUE
ACCOUNT VALUE
On or before the Annuity Commencement Date, the Account Value is equal to Your:
(a) premium payments; minus
(b) Gross Partial Withdrawals (as defined in Section 5); plus
(c) interest credited to the Fixed Account (see Section 7); plus
(d) accumulated gains in the Separate Account (see Section 6); minus
(e) accumulated losses in the Separate Account (see Section 6); minus
(f) service charges, premium taxes, rider fees and transfer fees, if any.
ADJUSTED ACCOUNT VALUE
The Adjusted Account Value is the Account Value increased or decreased by any
Excess Interest Adjustment. You may use the Adjusted Account Value on the
Annuity Commencement Date to provide lifetime income or income for a period of
no less than 60 months under the Payment Options in Section 10.
SERVICE CHARGE
On each Contract Anniversary and at the time of full Surrender during any
Contract Year before the Annuity Commencement Date, we reserve the right to
assess a service charge up to $35 for contract administration expenses. The
Service Charge will be deducted from each Investment Option in proportion to the
portion of Account Value (prior to such charge) in each Investment Option. In no
event will the Service Charge exceed 2% of the Account Value on the Contract
Anniversary or at the time of full Surrender.
The Service Charge will not be deducted on a Contract Anniversary or at the time
of full Surrender if, at either of these times, (1) the sum of all premium
payments less the sum of all Withdrawals taken equals or exceeds $50,000; or (2)
the Account Value equals or exceeds $50,000.
M1259 Page 4
SECTION 5 - CASH VALUE AND PARTIAL WITHDRAWALS
CASH VALUE
On or before the Annuity Commencement Date, the Cash Value is equal to the
Adjusted Account Value less any Surrender Charges. Information on the current
amount of Your contract's Cash Value is available upon request. The Cash Value
may be partially withdrawn or will be paid in the event of a full Surrender of
the contract. We must receive Your written partial Withdrawal or Surrender
request before the Annuity Commencement Date.
There is no Cash Value once an Annuity Payment Option has been selected.
EXCESS INTEREST ADJUSTMENT
Full Surrenders, partial Withdrawals, transfers, and amounts applied to a
Payment Option (prior to the end of any Guaranteed Payment Option) from
Guaranteed Period Options of the Fixed Account described in Section 7 will be
subject to an Excess Interest Adjustment except as provided for in the partial
Withdrawals provision below.
An Excess Interest Adjustment applies in the following situations:
1) When You withdraw all or any portion of Your Cash Value,
2) When You exercise Annuity Payment Options,
3) When death proceeds are calculated. However, death proceeds will not be
reduced if the Excess Interest Adjustment is negative.
The Excess Interest Adjustment is only applied to transactions affecting the
Guaranteed Period Options of the Fixed Account (see Section 7) and is based on
any change in interest rates from the time the affected Guaranteed Period(s)
started until the time the Excess Interest Adjustment occurs. The Excess
Interest Adjustment is applied as follows:
1) The Excess Interest Adjustment is only applied when the transactions occur
prior to the end of any Guaranteed Period Option;
2) Transfers to the Guaranteed Period Options of the Fixed Account are
considered Premium Payments for purposes of determining the
Excess Interest Adjustment;
3) The Excess Interest Adjustment is distinct from, and is applied prior to, the
surrender charge;
4) The Excess Interest Adjustment may affect the death proceeds defined in
Section 9;
5) If interest rates have decreased from the time the affected Guaranteed Period
(s) started until the time the transaction occurs, the Excess Interest
Adjustment will result in additional funds available to You;
6) If interest rates have increased from the time the affected Guaranteed Period
(s) started until the time the transaction occurs, the Excess Interest
Adjustment will result in a decrease in the funds available to You;
7) Certain amounts are not subject to the Excess Interest Adjustment as provided
in Sections 5, 7 and 8.
The formula for determining the amount of the Excess Interest Adjustment is as
follows:
Excess Interest Adjustment = S x (G-C) x (M/12)
where: S is the amount (before surrender charges and premium taxes, if any)
being Surrendered, partially withdrawn, transferred, or applied to a
Payment Option that is subject to the Excess Interest Adjustment.
G is the guaranteed interest rate for the Guaranteed Period applicable
to "S".
C is the current guaranteed interest rate then being offered on new
Premium Payments for the next longer Guaranteed Period than "M".
If this contract form or such a Guaranteed Period Option is no longer
offered, "C" will be the U.S. Treasury rate for the next longer
maturity (in whole years) than "M" on the 25th day of the previous
calendar month, plus up to 2%.
M is the number of months remaining in the Guaranteed Period for "S",
rounded up to the next higher whole number of months.
Upon full Surrender, the Excess Interest Adjustment (EIA) for each Guaranteed
Period Option will not reduce the Adjusted Account Value for that Guaranteed
Period Option below the amount paid into, less any prior Withdrawals and
transfers from, that Guaranteed Period Option, plus interest at the Fixed
Account Guaranteed Minimum Effective Annual Interest Rate shown on Page 3.
U1259 Page 5
SECTION 5 - CONTINUED
PARTIAL WITHDRAWALS
We will pay You a portion of the Cash Value as a Partial Withdrawal provided we
receive Your written request while the contract is in effect and before the
Annuity Commencement Date. When You request a Partial Withdrawal You must tell
us how it is to be allocated from among the Investment Options. If no selection
is made, the Partial Withdrawal will be taken prorata from Your Investment
Option. If Your request for a Partial Withdrawal from any Investment Option is
less than or equal to the Cash Value in that option, we will pay the amount of
Your request. However, if Your request for a Partial Withdrawal from any
Investment Option is greater than the Cash Value in that option, we will pay You
the Cash Value of that Investment Option.
The Gross Partial Withdrawal is the total amount which will be deducted from
Your Account Value as a result of each Partial Withdrawal. The Gross Partial
Withdrawal may be more or less than Your requested Partial Withdrawal amount,
depending on whether surrender charges and/or Excess Interest Adjustments apply
at the time You request the Partial Withdrawal.
The Excess Partial Withdrawal amount is the portion of the requested Partial
Withdrawal that is subject to surrender charge (that is, the portion which is in
excess of the surrender charge-free portion). For example, if the requested
withdrawal amount is $1,000, and the surrender charge-free amount is $200, then
the Excess Partial Withdrawal would be $800. Excess Partial Withdrawals will
reduce the Account Value by an amount equal to (X-Y+Z) where:
X = Excess Partial Withdrawal
A = Amount of Partial Withdrawal subject to Excess Interest Adjustment
Y = Excess Interest Adjustment = (A) x (G-C) x (M/12) where G, C and M are
defined in the Excess Interest Adjustment provision above, with "A"
substituted for "S" in the definitions of G and M.
Z = surrender charge on X minus Y.
The formula for determining the Gross Partial Withdrawal is as follows:
Gross Partial Withdrawal = R - E + SC, where:
R is the requested Partial Withdrawal;
E is the Excess Interest Adjustment; and
SC is the surrender charge on (EPW - E); where
EPW is the Excess Partial Withdrawal Amount (the portion of the requested
Partial Withdrawal that is subject to surrender charge).
If any Partial Withdrawal reduces the Cash Value below $500, we reserve the
right to pay the full Cash Value and terminate the contract.
We may delay payment of the Cash Value from the Fixed Account for up to 6 months
after we receive the request. If the owner dies after we receive the request,
but before the request is processed, the request will be processed before the
death proceeds are determined.
Each Partial Withdrawal consists of a portion that is subject to a surrender
charge (that is, the Excess Partial Withdrawal) and a remaining portion that is
free from surrender charge (that is, the surrender charge-free amount). Either
portion may be zero (0) depending on the Partial Withdrawal requested and prior
amounts withdrawn.
Partial Withdrawals in the amount of the cumulative interest in the Guaranteed
Period Option(s) of the Fixed Account at the time of Withdrawal may be withdrawn
from the GPO(s) of the Fixed Account free of any Excess Interest Adjustment.
Amounts withdrawn under one of these options may reduce the amount available
free of surrender charges under another option. Surrender charges and/or Excess
Interest Adjustment may be waived as described below:
LUMP SUM
Beginning in the second Contract Year, You may withdraw, free from surrender
charges, a lump sum amount equal to the maximum of A or B where:
A is the Cumulative Earnings, if any, in the Account Value and
B is an amount equal to 10% of the premium payments immediately prior to the
partial Withdrawal reduced by all prior partial Withdrawals deemed to have
been from premium, if any.
The minimum partial Withdrawal under this option is $500. This partial
Withdrawal option is available once per Contract Year.
P1246 Page 6
SECTION 5 - CONTINUED
SYSTEMATIC PAYOUT OPTION
Beginning in the first Contract Year, a Systematic Payout Option (SPO) is
available on a monthly, quarterly, semi-annual or annual basis. At the time a
SPO payout is made, such payout must be at least $50 and may not exceed the
maximum of A and B, divided by the number of payouts made per year (e.g. 12 for
monthly).
A is the Cumulative Earnings, if any, in the Account Value and
B is an amount equal to 10% of the premium payments immediately prior to the
partial Withdrawal reduced by all prior partial Withdrawals deemed to have
been from premium, if any.
No surrender charges or Excess Interest Adjustment will apply to the SPO payout.
Monthly and quarterly payouts must be sent through electronic funds transfer
directly to a checking or savings account. You may start or stop SPO payouts at
any time; however, 30 days' written notice is required to stop SPO payouts.
Once You have elected a SPO, You must wait a minimum time before the first SPO
payment: 1 month for monthly, 3 months for quarterly, 6 months for semi-annual,
or 12 months for annual.
MINIMUM REQUIRED DISTRIBUTION
For tax-qualified plans, partial Withdrawals taken to satisfy minimum
distribution requirements under Section 401(a)(9) of the Internal Revenue Code
(IRC) are available with no surrender charges and no Excess Interest
Adjustments. The amount available from this contract with respect to the minimum
distribution requirement is based solely on this contract.
The owner must be at least 70 1/2 years old in the calendar year of
distribution, must submit a written request to us and must take the distribution
before year-end. If the owner attains age 70 1/2 in the calendar year of
distribution, a written request, which is postmarked no later than the end of
the current calendar year, must be submitted to us.
Systematic minimum distributions must be at least $50 or a lump sum distribution
is available if minimum required distributions are less than $50.
Any amount requested in excess of the IRC minimum required distribution will
have the appropriate surrender charges and Excess Interest Adjustments applied,
unless the excess Distribution qualifies as surrender charge-free or Excess
Interest Adjustment-free under any additional options provided.
NURSING CARE AND TERMINAL CONDITION WITHDRAWAL OPTION
Beginning in the first Contract Year, if the owner or owner's spouse (Annuitant
or Annuitant's spouse if the owner is not a natural person) has been 1) confined
in a Hospital or Nursing Facility for 30 consecutive days or 2) diagnosed as
having a Terminal Condition, You may elect to withdraw all or a portion of the
Account Value without surrender charges and without an Excess Interest
Adjustment. The minimum Withdrawal under this option is $1000. This option is
available even during the contract years other partial Withdrawal options were
exercised prior to Nursing Care.
For Nursing Care, we must receive each Withdrawal request and proof of
eligibility with each request no later than 90 days following the date that
confinement has ceased, unless it can be shown that it was not reasonably
possible to provide the notice and proof within the above time period and that
the notice and proof were given as soon as reasonably possible. However, in no
event, except the absence of legal capacity, shall the notice and proof be
provided later than one year following the date that confinement has ceased.
Proof of confinement may be a Physician's statement or a statement from a
Hospital or Nursing Facility administrator. For a Terminal Condition, we must
receive each Withdrawal request and the applicable proof of eligibility no later
than one year following diagnosis of the Terminal Condition. Proof of a Terminal
Condition is required only with the initial Withdrawal request and must be
furnished by the owner's, owner's spouse's, ▇▇▇▇▇▇▇▇▇'s, or ▇▇▇▇▇▇▇▇▇'s spouse's
Physician.
UNEMPLOYMENT WAIVER
Beginning in the first Contract Year, You may withdraw all or a portion of the
Account Value free of any surrender charges and free of any Excess Interest
Adjustment if the owner or owner's spouse (Annuitant or Annuitant's spouse, if
the owner is not a natural person) becomes unemployed. In order to qualify, You
1) must have been employed full-time for at least two years prior to Your
becoming unemployed, 2) must have been employed full-time on Your Contract Date,
3) must have been unemployed for at least 60 consecutive days at the time of
Withdrawal and 4) must have a minimum Cash Value at the time of Withdrawal of
$5000. Proof of unemployment will consist of providing us with a determination
letter from the applicable State's Department of Labor, which verifies that You
qualify for and are receiving unemployment benefits at the time of Withdrawal.
The determination letter must be received by us no later than 15 days following
the date of the Withdrawal request.
PB1246 Page 7
SECTION 5 - CONTINUED
SURRENDER CHARGES
Amounts withdrawn in excess of the surrender charge-free amount specified in the
Withdrawal provisions above are subject to a surrender charge. The amount of
this charge, if any, will be a percentage, as shown in the table below, of the
amount of premium withdrawn:
Number of Years Percentage of
Since Premium Premium Withdrawn
Payment Date
0-1 7%
1-2 7%
2-3 6%
3-4 6%
4-5 5%
5-6 4%
6-7 3%
7 or more 0%
For surrender charge purposes, all earnings are considered to be withdrawn
first. After all earnings are withdrawn then the oldest premium payment is the
first premium payment considered to be withdrawn. If the amount withdrawn
exceeds this, the next oldest premium payment is considered to be withdrawn, and
so on until the most recent premium payments are deemed to be withdrawn (the
procedure being applied to Withdrawals of premium is a "First-In, First-Out" or
FIFO procedure).
GUARANTEED RETURN OF FIXED ACCOUNT PREMIUM PAYMENTS
Upon full Surrender of the contract, You will always receive at least the
premium payments made to, less prior Withdrawals and transfers from, the Fixed
Account.
MINIMUM VALUES
Benefits available under this contract, including any paid up annuity or death
benefits that may be available, are not less than those required by any statute
of the state in which the contract is delivered.
SECTION 6 - SEPARATE ACCOUNT
SEPARATE ACCOUNT
We have established and will maintain one or more Separate Account(s), under the
laws of the state of Iowa. Any realized or unrealized income, net gains and
losses from the assets of the Separate Account are credited to or charged
against it without regard to our other income, gains or losses. Assets are put
in the Separate Account for this contract, as well as for other variable annuity
contracts. Any Separate Account may invest assets in shares of one or more
mutual fund portfolio, or in the case of a managed Separate Account, direct
investments in stocks or other securities as permitted by law. Fund shares refer
to shares of underlying mutual funds or prorata ownership of the assets held in
a Subaccount of a managed Separate Account. Fund shares are purchased, redeemed
and valued on behalf of the Separate Account.
The Separate Account is divided into Subaccounts. Each Subaccount invests
exclusively in shares of one of the portfolios of an underlying fund. We reserve
the right to add or remove any Subaccount of the Separate Account.
The assets of the Separate Account are our property. These assets will equal or
exceed the reserves and other contract liabilities of the Separate Account.
These assets will not be chargeable with liabilities arising out of any other
business we conduct. We reserve the right, subject to regulations governing the
Separate Account, to transfer assets of a Subaccount, in excess of the reserves
and other contract liabilities with respect to that Subaccount, to another
Subaccount or to our General Account.
We will determine the fair market value of the assets of the Separate Account in
accordance with a method of valuation, which we establish in good faith.
Valuation Period means the period of time from one determination of the value of
each Subaccount to the next. Such determinations are made when the value of the
assets and liabilities of each Subaccount is calculated. This is generally the
close of business on each day on which the New York Stock Exchange is open.
We also reserve the right to transfer assets of the Separate Account, which we
determine to be associated with the class of contracts to which this contract
belongs, to another Separate Account. If this type of transfer is made, the term
"Separate Account", as used in the contract, shall then mean the Separate
Account to which the assets were transferred.
We also reserve the right, when permitted by law to:
(a) deregister the Separate Account under the Investment Company Act of 1940;
(b) manage the Separate Account under the direction of a committee at any time;
(c) restrict or eliminate any voting rights of contract owners or other persons
who have voting rights as to the Separate Account;
(d) combine the Separate Account with one or more other Separate Accounts;
(e) create new Separate Accounts;
(f) add new Subaccounts to or remove existing Subaccounts from the Separate
Account, or combine Subaccounts; and
(g) add new underlying mutual funds, remove existing mutual funds, or substitute
a new fund for an existing fund.
V1266 Page 8
SECTION 6 - CONTINUED
The Net Asset Value of a fund share is the per-share value calculated by the
mutual fund or, in the case of a managed Separate Account, by the Company. The
Net Asset Value is computed by adding the value of the Subaccount's investments,
cash and other assets, subtracting its liabilities, and then dividing by the
number of shares outstanding. Net Asset Values of fund shares reflect investment
advisory fees and other expenses incurred in managing a mutual fund or a managed
Separate Account.
CHANGE IN INVESTMENT OBJECTIVE OR POLICY OF A MUTUAL FUND
If required by law or regulation, an investment policy of the Separate Account
will only be changed if approved by the appropriate insurance official of the
state of Iowa or deemed approved in accordance with such law or regulation. If
so required, the process for obtaining such approval is filed with the insurance
official of the state or district in which this contract is delivered.
CHARGES AND DEDUCTIONS
The Mortality and Expense Risk Fee and the Administrative Charge are each
deducted both before and after the Annuity Commencement Date to compensate for
changes in mortality and expenses not anticipated by the mortality and
administration charges guaranteed in the contract.
The service charge is deducted prior to the Annuity Commencement Date only.
If the Mortality and Expense Risk Fee is more than sufficient, the Company will
retain the balance as profit or may reduce this fee in the future.
ACCUMULATION UNITS
The Account Value in the Separate Account before the Annuity Commencement Date
is represented by accumulation units. The dollar value of accumulation units for
each Subaccount will change from business day to business day reflecting the
investment experience of the Subaccount.
Premium payments allocated to and any amounts transferred to the Subaccounts
will be applied to provide accumulation units in those Subaccounts. The number
of accumulation units purchased in a Subaccount will be determined by dividing
the amount allocated to or transferred to that Subaccount, by the value of an
accumulation unit for that Subaccount on the premium payment or transfer date.
The number of accumulation units withdrawn or transferred from the Subaccounts
will be determined by dividing the amount withdrawn or transferred by the value
of an accumulation unit for that Subaccount on the Withdrawal or transfer date.
The value of an accumulation unit on any business day is determined by
multiplying the value of that unit at the end of the immediately preceding
valuation period by the net investment factor for the valuation period.
The net investment factor used to calculate the value of an accumulation unit in
each Subaccount for the Valuation Period is determined by dividing (a) by (b)
and subtracting (c) from the result, where:
(a) is the result of:
(1) the net asset value of a fund share held in that Subaccount
determined as of the end of the current valuation period; plus
(2) the per share amount of any dividend or capital gain Distributions made
by the fund for shares held in that Subaccount if the ex-dividend date
occurs during the valuation period; plus or minus
(3) a per share credit or charge for any taxes reserved for, which we
determine to have resulted from the investment operations of that
Subaccount.
(b) is the net asset value of a fund share held in that Subaccount determined
as of the end of the immediately preceding valuation period.
(c) is a factor representing the Mortality and Expense Risk Fee and
Administrative Charge before the Annuity Commencement Date. This factor
is less than or equal to, on an annual basis, the percentage shown on the
Contract Data Page of the daily net asset value of a fund share held in
that Subaccount.
Since the net investment factor may be greater or less than one, the
accumulation unit value may increase or decrease.
VB1266 Page 9
SECTION 7 - FIXED ACCOUNT
FIXED ACCOUNT
Premium payments applied to and any amounts transferred to the Fixed Account
will reflect a fixed interest rate. The interest rates we set will be credited
for increments of at least one year measured from each premium payment or
transfer date. These rates will never be less than the Fixed Account Guaranteed
Minimum Effective Annual Interest Rate shown on Page 3.
Upon full Surrender of the Contract, the minimum Cash Value provided by the
Fixed Account portion of the Account Value will be at least 90% of the premium
payments made to the Fixed Account, less prior Withdrawals and transfers from
the Fixed Account, plus interest credited using an Effective Annual Interest
Rate of 3%.
GUARANTEED PERIODS
We may offer optional Guaranteed Period Options, into which premium payments may
be paid or amounts transferred. The current interest rate we set for funds
entering each Guaranteed Period Option (GPO) is guaranteed until the end of that
option's Guaranteed Period. At that time, the premium payment made or amount
transferred into the GPO, less any Withdrawals or transfers from that GPO, plus
accrued interest, will be rolled into a new GPO or may be transferred to any
Subaccount(s) within the Separate Account(s).
You may choose the Investment Option(s) You want the funds rolled into by giving
us a written notice within 30 days before the end of the expiring option's
Guaranteed Period. However, any Guaranteed Period elected may not extend beyond
the maximum Annuity Commencement Date defined in Section 11. In the absence of
such election, the funds will be rolled into a new GPO which is the same as the
expiring GPO unless that GPO is no longer offered, in which case, the next
shorter GPO offered will be used. You will be mailed a notice of completion of
the rollover with the new interest rate applicable. The new GPO will be deemed
as accepted if we do not receive a written rejection within 30 days from the
postmark date of the completion notice.
We reserve the right for new premium payments, transfers, or rollovers to offer
or not to offer any GPO, except that we will always offer at least a one-year
GPO.
When funds are withdrawn or transferred from a GPO, the Account Value associated
with the oldest premium payment or rollover is considered to be
withdrawn/transferred first. If the amount withdrawn/transferred exceeds the
Account Value associated with the oldest premium, the Account Value associated
with the next oldest premium payment or rollover is considered to be
withdrawn/transferred next, and so on until the Account Value associated with
the most recent premium payment or rollover is considered to be
withdrawn/transferred (this is a "First-In, First-Out" or FIFO basis).
Partial Withdrawals, Surrenders, transfers, and amounts applied to a Payment
Option from the Guaranteed Period Option(s) are subject to an Excess Interest
Adjustment as described in Section 5.
DOLLAR COST AVERAGING FIXED ACCOUNT OPTION
We may offer a Dollar Cost Averaging (DCA) Fixed Account Option separate from
the Guaranteed Period Options. This option will have a one-year interest rate
guarantee. The current interest rate we set for the DCA Fixed Account may differ
from the rates credited on the one-year GPO in the Fixed Account. In addition,
the current interest rate we credit may vary on different portions of the DCA
Fixed Account. The credited interest rate will never be less than the Fixed
Account Guaranteed Minimum Effective Annual Interest Rate shown on Page 3. The
DCA Fixed Account Option will only be available under a Dollar Cost Averaging
program as described in Section 8.
SECTION 8 - TRANSFERS
A. TRANSFERS BEFORE THE ANNUITY COMMENCEMENT DATE
Prior to the Annuity Commencement Date, You may transfer the value of the
accumulation units from one Investment Option to another by providing us notice
containing the facts that we need.
Transfers of Account Value from the Guaranteed Period Options (GPO) of the Fixed
Account prior to the end of that GPO are subject to an Excess Interest
Adjustment. If the Excess Interest Adjustment at the time of such Account Value
transfer is a negative adjustment, then the maximum Account Value transfer is
25% of that GPO's Account Value, less Account Values previously transferred out
of that GPO during the current Contract Year. If the Excess Interest Adjustment
at the time of such Account Value transfer is a positive adjustment, no maximum
will apply to such Account Values transferred from the GPO.
No Excess Interest Adjustment will apply to Account Value transfers at the end
of a Guaranteed Period.
Transfers of interest credited in the GPOs to other Investment Options are
allowed on a "First-In, First-Out" basis. Such transfers may be made monthly,
quarterly, semi-annually, or annually. Each such transfer must be at least $50
and will not be subject to an Excess Interest Adjustment.
Transfers of Account Value from the Separate Account are subject to a minimum of
$500 or the entire Subaccount Account Value, if less. However, if the remaining
Subaccount Account Value is less than $500, we reserve the right to include that
amount as part of the transfer.
You may choose which GPO to transfer to or from, however, any GPO elected may
not extend beyond the maximum Annuity Commencement Date defined in Section 11.
L999 Page 10
SECTION 8 - CONTINUED
We reserve the right to limit transfers to no more than 18 in any one Contract
Year. Any transfers in excess of 18 per Contract Year may be charged a $10 per
transfer fee. Transfers among multiple Investment Options will be treated as one
transfer in determining the number of transfers that have occurred. We also
reserve the right to prohibit transfers to the Fixed Account if we are crediting
an interest rate equal to the Fixed Account Guaranteed Minimum Effective Annual
Interest Rate shown on Page 3.
The contract was not designed for professional market timing organizations or
other persons that use programmed, large, or frequent transfers. The use of such
transfers may be disruptive to an underlying portfolio. We reserve the right to
reject any transfer request from any person in the interest of overall fund
management or, if, in our judgment, an underlying fund would be unable to invest
effectively in accordance with its investment objectives and policies or would
otherwise be potentially adversely affected or if an underlying fund would
reject our purchase order. We also reserve the right to revoke Your telephone,
fax, and electronic transfer privileges at any time without revoking all owner's
telephone, fax and electronic transfer privileges.
DOLLAR COST AVERAGING OPTION
Prior to the Annuity Commencement Date, You may instruct us to automatically
transfer a specified amount from the Money Market Subaccount or the Dollar Cost
Averaging (DCA) Fixed Account Option to any other Subaccount(s) of the Separate
Account. The automatic transfers can occur monthly or quarterly.
Transfers will continue until the elected Subaccount or DCA Fixed Account value
is depleted. The amount transferred each time must be at least $250. All
transfers from the DCA account will be the same amount as the initial transfer.
Changes to the Subaccounts to which these transfers are allocated are not
restricted. Transfers must be scheduled for at least 6, but not more than 24
months or for at least 4, but not more than 8 quarters each time the Dollar Cost
Averaging program is started or restarted following termination of the program
for any reason.
Dollar Cost Averaging results in the purchase of more accumulation units when
the value of the accumulation unit is low, and fewer accumulation units when the
value of the accumulation unit is high. However, there is no guarantee that the
Dollar Cost Averaging program will result in higher Account Values or will
otherwise be successful.
Dollar Cost Averaging may be discontinued by providing notice to us. While
Dollar Cost Averaging is in effect, Asset Rebalancing is not available.
ASSET REBALANCING
Prior to the Annuity Commencement Date, You may instruct us to automatically
transfer amounts among the Subaccounts of the Separate Account on a regular
basis to maintain a desired allocation of the Account Value among the various
Subaccounts offered. Rebalancing will occur on a monthly, quarterly, semi-annual
or annual basis, beginning on a date selected by You. You must select the
percentage of the Account Value desired in each of the various Subaccounts
offered (totaling 100%). Any amounts in the Fixed Account are ignored for the
purposes of Asset Rebalancing. Rebalancing can be started, stopped or changed at
any time. Asset Rebalancing is not available while Dollar Cost Averaging is in
effect. Rebalancing will cease as soon as we receive a request for any other
transfer.
B. TRANSFERS AFTER THE ANNUITY COMMENCEMENT DATE
After the Annuity Commencement Date, You may transfer the value of the variable
annuity units from one Subaccount to another within the Separate Account or to
the Fixed Account. If You want to transfer the value of the variable annuity
units, You must provide a signed notice, containing the facts that we need. We
reserve the right to limit transfers between the Subaccounts or to the Fixed
Accounts to once per Contract Year.
The minimum amount which may be transferred is the lesser of $10 monthly income
or the entire monthly income of the variable annuity units in the Subaccount
from which the transfer is being made. If the monthly income of the remaining
units in a Subaccount is less than $10, we have the right to include the value
of those variable annuity units as part of the transfer.
After the Annuity Commencement Date, no transfers may be made from the Fixed
Account to any other Investment Options.
LB999 Page 11
SECTION 9 - DEATH PROCEEDS
A. DEATH PROCEEDS PRIOR TO ANNUITY COMMENCEMENT DATE
The amount of death proceeds will be the greatest of (a), (b) or (c) where:
(a) is the Account Value on the date we receive due proof of death and an
election of a method of settlement;
(b) is the Cash Value on the date we receive due proof of death and an election
of a method of settlement, and;
(c) is the Guaranteed Minimum Death Benefit (GMDB), if any, plus any additional
premium payments received, less any Gross Partial Withdrawals from the date
of death to the date of payment of death proceeds.
If You have not selected a payment option by the date of death, the beneficiary
may make such election within one year of the date we receive due proof of the
owner's or ▇▇▇▇▇▇▇▇▇'s death as described in C below. The beneficiary may elect
to receive the death proceeds as a lump sum payment or may use the death
proceeds to provide any of the annuity Payment Options described in Section 10.
Interest on death proceeds will be paid as required by law.
B. GUARANTEED MINIMUM DEATH BENEFIT
The amount of the Guaranteed Minimum Death Benefit (GMDB) is based on the death
benefit option shown on the Contract Data Page. You may not change the GMDB
option after the contract is issued.
Option N: 6%/ Monthly Double Enhanced Death Benefit
This GMDB is equal to the greater of (1) and (2) where:
(1) is a 6% Annually Compounding through age 80 Death Benefit, equal to:
a) the total premium payments; minus Adjusted Partial Withdrawals, (as
described below); plus
b) Interest accumulated at 6% per annum from the payment or Withdrawal
date to the earlier of;
I) the date of death or the Annuitant's 81/st/ birthday, or
II) the date the sum of all premium payments less the sum of all
Adjusted Partial Withdrawals and any applicable Premium Taxes
has grown to two times it's original amount as a result of the
6% interest accumulation.
(2) is a Monthly Step-Up through age 80 Death Benefit, equal to:
a) the largest Account Value on the Contract Date or on the Monthly
Anniversary prior to the earlier of the date of death or the
Annuitant's 81st birthday; plus
b) any premium payments subsequent to the date of the Monthly
Anniversary with the largest Account Value; minus
c) any Adjusted Partial Withdrawals (as described below), subsequent
to the date of the Monthly Anniversary with the largest Account
Value.
Option P: Return of Premium Death Benefit
This GMDB is equal to the total premiums paid for this contract, less any
Adjusted Partial Withdrawals (as described below), as of the date of death.
A partial Withdrawal taken as provided in Section 5 will reduce the Guaranteed
Minimum Death Benefit by an amount referred to as the "Adjusted Partial
Withdrawal". The Adjusted Partial Withdrawal may be a different amount than the
Gross Partial Withdrawal described in Section 5. The Adjusted Partial Withdrawal
is the total amount deducted from the GMDB as a result of a partial Withdrawal
as used in the GMDB provision. It is equal to the Gross Partial Withdrawal
described in Section 5, multiplied by an Adjustment Factor. The Adjustment
Factor is equal to the amount of the death proceeds prior to the partial
Withdrawal divided by the Account Value prior to the partial Withdrawal.
D422 Page 12
SECTION 9 - CONTINUED
C. DEATH PRIOR TO ANNUITY COMMENCEMENT DATE
Death proceeds are payable contingent upon the relationships between the owner,
▇▇▇▇▇▇▇▇▇, and beneficiary as outlined below. The contract must be surrendered
upon settlement or on proof of death.
If there is a surviving owner(s), the surviving owner(s) automatically takes the
place of any beneficiary designation.
▇. ▇▇▇▇▇▇▇▇▇ Death
When we have due proof that the Annuitant died before the Annuity
Commencement Date, we will provide the death proceeds to the beneficiary. If
no beneficiary is designated, the owner or owner's estate will become the
beneficiary.
a) Beneficiary is the deceased ▇▇▇▇▇▇▇▇▇'s surviving spouse. The
beneficiary may elect to continue this contract as owner and Annuitant
rather than receiving the death proceeds. If the contract is continued,
an amount equal to the excess, if any, of the Guaranteed Minimum Death
Benefit over the Account Value will then be added to the Account Value.
This is a one-time only Account Value adjustment applied at the time the
contract is continued, and the Guaranteed Minimum Death Benefit will
continue on as applicable. If the contract is continued, all current
surrender charges will be waived.
If this beneficiary elects to have the death proceeds paid, the death
proceeds must be distributed:
(1) by the end of 5 years after the date of the deceased ▇▇▇▇▇▇▇▇▇'s
death, or
(2) payments must begin no later than one year after the deceased
▇▇▇▇▇▇▇▇▇'s death and must be made for a period certain or for
this beneficiary's lifetime, so long as any period certain does
not exceed this beneficiary's life expectancy.
In 1035 exchanges where there are joint Annuitants, the death proceeds will
only be payable upon the death of the surviving Annuitant.
II. Owner or Joint Owner dies.
If an owner or joint owner who is also an Annuitant dies, death proceeds
will be payable according to section I above.
If an owner or joint owner who is not an Annuitant dies prior to the Annuity
Commencement Date and before the entire interest in the contract is
distributed, the Annuitant will become the new owner.
DB422 Page 13
SECTION 9 - CONTINUED
If the new owner is the deceased owner's surviving spouse, the new owner may
elect to continue this contract rather than receiving the Adjusted Account
Value. If the contract is continued, all current surrender charges will be
waived.
If the new owner is a natural person but is not the sole surviving spouse,
OR if the new owner is the sole surviving spouse but elects to have the
Adjusted Account Value paid, the Adjusted Account Value must be distributed
by either a) or b) below:
(a) by the end of 5 years after the date of the deceased owner's death, or
(b) payments must begin no later than one year after the deceased owner's
death and must be made for a period certain or for the new owner's
lifetime, so long as any period certain does not exceed the new owner's
life expectancy.
D. DEATH ON OR AFTER THE ANNUITY COMMENCEMENT DATE
The death proceeds on or after the Annuity Commencement Date depend on the
payment option selected. If any owner dies on or after the Annuity Commencement
Date, but before the entire interest in the contract is distributed, the
remaining portion of such interest in the contract will be distributed to the
owner's beneficiary at least as rapidly as under the method of distribution
being used as of the date of that owner's death.
E. AN OWNER IS NOT AN INDIVIDUAL
In the case of a non tax-qualified annuity, if any owner or beneficial owner is
not an individual, then for purposes of the federal income tax mandatory
distribution provisions in subsection C or D above, (1) the primary Annuitant
will be treated as the owner of the contract, and (2) if there is any change in
the primary Annuitant, such a change will be treated as the death of the owner.
SECTION 10 - ANNUITY PAYMENTS
A. GENERAL PAYMENT PROVISIONS
Payment
If this contract is in force on the Annuity Commencement Date, we will use the
Fixed Account portion and/or the Separate Account portion of the Adjusted
Account Value to make annuity payments to the Payee under Option 3 and/or 3-V,
respectively, with 10 years certain, or if elected, under one or more of the
other options described in this section. However, the option(s) elected must
provide for lifetime income or income for a period of at least 60 months. You
will become the Annuitant at the Annuity Commencement Date. Payments will be
made at 1, 3, 6 or 12-month intervals. We reserve the right to change the
frequency of payments to avoid making payments of less than $50.00.
Before the Annuity Commencement Date, if the death proceeds become payable or if
You Surrender this contract, we will pay any proceeds in one sum, or if elected,
all or part of these proceeds may be placed under one or more of the options
described in this section. If we agree, the proceeds may be placed under some
other method of payment instead.
Adjusted Age
Payments under Options 3 and 5 and the first payment under Options 3-V and 5-V
are determined based on the adjusted age of the Annuitant. The adjusted age is
the Annuitant's actual age on the Annuitant's nearest birthday, at the Annuity
Commencement Date, adjusted as follows:
Annuity
Commencement Date Adjusted Age
----------------- ------------
Before 2010 Actual Age
2010 - 2019 Actual Age minus 1
2020 - 2026 Actual Age minus 2
2027 - 2033 Actual Age minus 3
2034 - 2040 Actual Age minus 4
After 2040 Determined by us
S1095 Page 14
SECTION 10 - CONTINUED
Election of Optional Method of Payment
Before the Annuity Commencement Date You can elect or change a payment option.
You may elect, in a notice You sign which gives us the facts that we need,
annuity payments that may be either variable, fixed, or a combination of both.
If You elect a combination, You must also tell us what part of the contract
proceeds on the Annuity Commencement Date are to be applied to provide each type
of payment. (You must also specify which Subaccounts.) The amount of a combined
payment will be the sum of the variable and fixed payments. Payments under a
variable payment option will reflect the investment performance of the selected
Subaccount of the Separate Account.
Payee
Unless You specify otherwise, the Payee shall be the Annuitant, or the
beneficiary as defined in the Beneficiary provision in Section 11.
Proof of Age
We may require proof of the age of any person who has an annuity purchased under
Options 3, 3-V, 5 and 5 -V of this section before we make the first payment.
Minimum Proceeds
If the proceeds are less than $2,000, we reserve the right to pay them out as a
lump sum instead of applying them to a payment option.
Premium Tax
We may be required by law to pay premium tax on the amount applied to a payment
option. If so, we will deduct the premium tax before applying the proceeds.
Supplementary Contract
Once proceeds become payable and a payment option has been selected, we will
issue a supplementary contract to reflect the terms of the selected option. The
contract will name the Payee(s) and will describe the payment schedule.
B. FIXED ACCOUNT PAYMENTS
Guaranteed Payment Options
The fixed account payment is determined by multiplying each $1,000 of contract
proceeds allocated to a fixed payment option by the amounts shown on page 18 for
the option You select. Options 1, 2 and 4 are based on a guaranteed interest
rate of 3%. Options 3 and 5 are based on a guaranteed interest rate of 3% and
the "Annuity 2000" (male, female, and unisex if required by law) mortality table
projected for improvement using projection scale G. The "Annuity 2000" mortality
rates are adjusted based on improvements in mortality since 2000 to more
appropriately reflect increased longevity. This is accomplished using a set of
improvement factors referred to as projection scale G.
Option 1 - Interest Payments
We will pay the interest on the amount we use to provide annuity payments in
equal payments or this amount may be left to accumulate for a period of time we
and You agree to. We and You will agree on Withdrawal rights when You elect this
option. The interest rate we declare for this option may be different than the
interest rate(s) credited prior to the Annuity Commencement Date.
Option 2 - Income for a Specified Period
We will make level payments only for the fixed period You choose. In the event
of the death of the person receiving payments prior to the end of the fixed
period elected, payments will be continued to that person's beneficiary or their
present value may be paid in a single sum. No funds will remain at the end.
Option 3 - Life Income - You may choose between:
1. No Period Certain - We will make level payments only during the Annuitant's
lifetime.
2. 10 Years Certain - We will make level payments for the longer of the
Annuitant's lifetime or ten years.
3. Guaranteed Return of Contract Proceeds - We will make level payments for
the longer of the Annuitant's lifetime or until the total dollar amount of
payments we made to You equals the amount applied to this option.
4. Life with Emergency Cash - We will make level payments during the
Annuitant's lifetime, but the annuity may be surrendered (in full or part).
The Cash Value is equal to a multiple of the payment where that multiple
reduces over time to zero at age 101. A surrender charge will be applied.
Should the Annuitant die before age 101 (or IRS Age Limitation Date if
earlier and the contract is qualified), the same Cash Value would be
payable, but without the surrender charge.
Option 4 - Income of a Specified Amount
Payments are made for any specified amount until the amount applied to this
option, with interest, is exhausted. This will be a series of level payments
followed by a smaller final payment. In the event of the death of the person
receiving payments prior to the time proceeds with interest are exhausted,
payments will be continued to that person's beneficiary or their present value
may be paid in a single sum.
SB1095 Page 15
SECTION 10 - CONTINUED
Option 5 - Joint and Survivor Annuity - You may choose between:
1. No Period Certain - Payments are made during the joint lifetime of the
Payee and a joint Payee of Your selection. Payments will be made as long as
either person is living.
2. Life with Emergency Cash - Level payments will be made during the joint
lifetime of the Payee and a joint Payee of Your selection. Payments will be
made as long as either person is living, but the annuity may be surrendered
(in full or part). The Cash Value is equal to a multiple of the payment,
where that multiple reduces over time to zero at age 101 of the younger
Annuitant. A surrender charge will be applied. Should the last surviving
Annuitant die before age 101 (or IRS Age Limitation Date if earlier and the
contract is qualified), the same Cash Value would be payable, but without
the surrender charge.
Current Payment Options
The amounts shown in the tables on page 18 are the guaranteed amounts. Current
amounts offered to individuals of the same class may be obtained from us.
C. VARIABLE ACCOUNT PAYMENT OPTIONS
Variable Annuity Units
The contract proceeds You tell us to apply to a variable payment option will be
used to purchase variable annuity units in Your chosen Subaccounts. The dollar
value of variable annuity units in Your chosen Subaccounts will increase or
decrease reflecting the investment experience of Your chosen Subaccounts. The
value of a variable annuity unit in a particular Subaccount on any business day
is equal to (a) multiplied by (b) multiplied by (c), where:
(a) is the variable annuity unit value for that Subaccount on the immediately
preceding business day;
(b) is the net investment factor for that Subaccount for the Valuation Period;
and
(c) is the Assumed Investment Return adjustment factor for the Valuation
Period.
The Assumed Investment Return adjustment factor for the valuation period is the
product of discount factors of .99986634 per day to recognize the 5.0% effective
annual Assumed Investment Return.
The net investment factor used to calculate the value of a variable annuity unit
in each Subaccount for the Valuation Period is determined by dividing (a) by (b)
and subtracting (c) from the result, where:
(a) is the net result of:
(1) the net asset value of a fund share held in that Subaccount determined
as of the end of the current valuation period; plus
(2) the per share amount of any dividend or capital gain Distributions
made by the fund for shares held in that Subaccount if the ex-dividend
date occurs during the Valuation Period; plus or minus
(3) a per share credit or charge for any taxes reserved for, which we
determine to have resulted from the investment operations of the
Subaccount.
(b) is the net asset value of a fund share held in that Subaccount determined
as of the end of the immediately preceding Valuation Period.
(c) is a factor representing the Mortality and Expense Risk Fee and
Administrative Charge applicable after the Annuity Commencement Date. This
factor is less than or equal to, on an annual basis, the percentage shown
on the Contract Data Page of the daily net asset value of a fund share held
in the Separate Account for that Subaccount.
Determination of the First Variable Payment
The amount of the first variable payment is determined by multiplying each
$1,000 of contract proceeds allocated to a variable payment option by the
amounts shown on page 20 for the variable option You select. The tables are
based on a 5% effective annual Assumed Investment Return and the "Annuity 2000"
(male, female, and unisex if required by law) mortality table projected for
improvement using projection scale G. The "Annuity 2000" mortality rates are
adjusted based on improvements in mortality since 2000 to more appropriately
reflect increased longevity. This is accomplished using a set of improvement
factors referred to as projection scale G.
C853 Page 16
SECTION 10 - CONTINUED
Option 3-V - Life Income - You may choose between:
1. No Period Certain - Payments will be made during the lifetime of the
Annuitant.
2. 10 Years Certain - Payments will be made for the longer of the Annuitant's
lifetime or ten years. In the event of the death of the person receiving
payments prior to the end of the guarantee period for which the election
was made, payments will be continued to that person's beneficiary or their
present value may be paid in a single sum.
3. Life with Emergency Cash - We will make payments during the Annuitant's
lifetime, but the annuity may be surrendered (in full or part). The Cash
Value is equal to a multiple of the Supportable Payment (see definition
below), where that multiple reduces over time to zero at age 101. A
surrender charge will be applied. Should the Annuitant die before age 101
(or IRS Age Limitation Date if earlier and the contract is qualified), the
same Cash Value would be payable, but without the surrender charge.
Option 5-V - Joint and Survivor Annuity - You may choose between:
1. No Period Certain - Payments are made as long as either the Annuitant or
the joint Annuitant is living.
2. Life with Emergency Cash - Payments will be made during the joint lifetime
of the Payee and a joint Payee of Your selection. Payments will be made as
long as either person is living, but the annuity may be surrendered (in
full or part). The Cash Value is equal to a multiple of the Supportable
Payment (see definition below), where that multiple reduces over time to
zero at age 101 of the younger Annuitant. A surrender charge will be
applied. Should the last surviving Annuitant die before age 101 (or IRS Age
Limitation Date if earlier and the contract is qualified), the same Cash
Value would be payable, but without the surrender charge.
Optional Initial Payment Guarantee
Upon annuitization, You may elect an option that guarantees Your variable
annuity payments will never be less than a percentage of the initial variable
annuity payment. You cannot terminate the payment guarantee after You have
selected the option. The percentage applicable to the initial payment and the
fee for the option will be those currently applicable at the time of
annuitization.
Supportable Payment
The Supportable Payment is the sum of each selected subaccount's variable
annuity unit value times the number of variable annuity units. The variable
annuity units are adjusted to reflect the year-to-date difference between the
stabilized payment and the payment had they not been stabilized. Supportable
Payments are used to determine surrender values, death benefits and transfers.
Determination of Subsequent Variable Payments
The amount of each variable annuity payment after the first will increase or
decrease according to the value of the variable annuity units which reflect the
investment experience of the selected Subaccounts. Each variable annuity payment
after the first will be equal to the number of variable annuity units in the
selected Subaccounts multiplied by the variable annuity unit value on the date
the payment is made. The number of variable annuity units in each selected
Subaccount is determined by dividing the first variable annuity payment
allocated to the Subaccount by the variable annuity unit value of that
Subaccount on the Annuity Commencement Date. If "Life with Emergency Cash" is
chosen (Option 3-V(3) or 5-V(2)), or if the Optional Initial Payment Guarantee
is chosen, payments would be "stabilized" (would change only once per year) but
"value adjustments" would be made to ensure full value would be received.
Page 17
CB853
GUARANTEED FIXED ACCOUNT PAYMENT OPTIONS
The amounts shown in these tables are the guaranteed amounts for each 1,000 of
the proceeds. Higher current amounts may be available at the time of settlement.
------------------------------------------------------------------------------------------------------------------------------------
Option 2, Table I Option 3, Table II Option 3, Table III Option 3, Table IV Option 3, Table V
------------------------------------------------------------------------------------------------------------------------------------
Amount of
Number of Monthly Monthly Installment For Monthly Installment For Monthly Installment For Monthly Installment for
Years Installment Life No Period Certain Life 10 Years Certain Life Guaranteed Return Of Life With Emergency Cash
Payable Proceeds
------------------------------------------------------------------------------------------------------------------------------------
Age* Male Female Unisex Male Female Unisex Male Female Unisex Male Female Unisex
------------------------------------------------------------------------------------------------------------------------------------
50 $ 3.82 $ 3.70 $ 3.74 $ 3.80 $ 3.69 $ 3.72 $ 3.70 $ 3.62 $ 3.65 $ 3.57 $ 3.52 $ 3.54
51 3.89 3.76 3.80 3.86 3.74 3.78 3.75 3.67 3.70 3.62 3.56 3.58
52 3.95 3.81 3.86 3.92 3.80 3.84 3.81 3.72 3.75 3.67 3.61 3.63
53 4.02 3.88 3.92 3.99 3.86 3.90 3.87 3.78 3.80 3.72 3.65 3.67
5 17.91 54 4.10 3.94 3.99 4.06 3.92 3.96 3.93 3.83 3.86 3.77 3.70 3.73
6 15.14 55 4.18 4.01 4.06 4.13 3.99 4.03 3.99 3.89 3.92 3.83 3.76 3.78
7 13.16 56 4.26 4.08 4.14 4.21 4.06 4.10 4.06 3.95 3.98 3.89 3.81 3.83
8 11.68 57 4.35 4.16 4.22 4.29 4.13 4.18 4.13 4.02 4.05 3.95 3.87 3.89
9 10.53 58 4.44 4.24 4.30 4.38 4.21 4.26 4.20 4.08 4.12 4.01 3.93 3.96
10 9.61 59 4.54 4.33 4.39 4.47 4.29 4.35 4.27 4.16 4.19 4.08 4.00 4.02
11 8.86 60 4.64 4.42 4.49 4.57 4.38 4.44 4.36 4.23 4.27 4.15 4.06 4.09
12 8.24 61 4.76 4.52 4.59 4.67 4.47 4.53 4.44 4.31 4.35 4.23 4.14 4.16
13 7.71 62 4.88 4.63 4.70 4.78 4.57 4.63 4.53 4.39 4.43 4.31 4.21 4.24
14 7.26 63 5.01 4.74 4.82 4.89 4.67 4.74 4.62 4.48 4.52 4.39 4.29 4.32
15 6.87 64 5.15 4.86 4.94 5.01 4.78 4.85 4.72 4.57 4.62 4.48 4.38 4.41
16 6.53 65 5.30 4.98 5.08 5.14 4.89 4.97 4.83 4.67 4.72 4.57 4.47 4.50
17 6.23 66 5.46 5.12 5.22 5.27 5.02 5.09 4.94 4.78 4.82 4.67 4.56 4.59
18 5.96 67 5.63 5.27 5.37 5.41 5.14 5.22 5.05 4.89 4.94 4.77 4.66 4.69
19 5.73 68 5.81 5.42 5.54 5.55 5.28 5.36 5.17 5.00 5.05 4.88 4.77 4.80
20 5.51 69 6.00 5.59 5.71 5.70 5.42 5.51 5.30 5.13 5.18 4.99 4.88 4.91
70 6.21 5.78 5.90 5.86 5.58 5.66 5.43 5.26 5.31 5.12 5.00 5.03
71 6.43 5.97 6.11 6.02 5.74 5.82 5.58 5.39 5.45 5.24 5.13 5.16
72 6.66 6.19 6.33 6.18 5.90 5.99 5.72 5.54 5.59 5.37 5.26 5.29
73 6.91 6.42 6.56 6.35 6.08 6.16 5.88 5.70 5.75 5.51 5.40 5.43
74 7.18 6.67 6.82 6.53 6.26 6.34 6.05 5.86 5.92 5.65 5.55 5.58
75 7.46 6.94 7.09 6.70 6.45 6.53 6.22 6.04 6.09 5.81 5.70 5.73
76 7.77 7.23 7.39 6.88 6.65 6.72 6.40 6.22 6.27 5.97 5.87 5.90
77 8.10 7.55 7.71 7.07 6.85 6.91 6.60 6.42 6.47 6.14 6.05 6.08
78 8.45 7.89 8.05 7.25 7.05 7.11 6.80 6.63 6.68 6.33 6.24 6.25
79 8.83 8.26 8.43 7.43 7.26 7.31 7.01 6.85 6.90 6.52 6.43 6.45
80 9.23 8.66 8.83 7.61 7.46 7.51 7.24 7.08 7.13 6.71 6.62 6.65
81 9.66 9.10 9.27 7.79 7.66 7.70 7.47 7.33 7.37 6.92 6.84 6.85
82 10.13 9.57 9.74 7.97 7.86 7.89 7.72 7.59 7.63 7.13 7.07 7.08
83 10.62 10.09 10.24 8.13 8.05 8.07 7.98 7.86 7.90 7.34 7.29 7.30
84 11.15 10.64 10.79 8.29 8.23 8.25 8.26 8.15 8.18 7.57 7.55 7.56
85 11.72 11.24 11.38 8.44 8.40 8.41 8.55 8.45 8.48 7.81 7.80 7.80
86 12.32 11.89 12.02 8.59 8.56 8.56 8.85 8.77 8.80 8.10 8.06 8.06
87 12.97 12.59 12.70 8.72 8.70 8.71 9.17 9.11 9.12 8.38 8.37 8.37
88 13.65 13.33 13.42 8.84 8.83 8.83 9.50 9.45 9.47 8.67 8.67 8.67
89 14.38 14.11 14.19 8.95 8.95 8.95 9.85 9.82 9.83 8.99 8.99 8.99
90 15.16 14.94 15.00 9.06 9.05 9.05 10.22 10.19 10.20 9.33 9.33 9.33
91 15.97 15.80 15.85 9.15 9.15 9.15 10.61 10.59 10.59 9.76 9.76 9.76
92 16.84 16.70 16.74 9.23 9.23 9.23 11.01 11.00 11.00 10.18 10.18 10.18
93 17.75 17.63 17.67 9.31 9.31 9.31 11.45 11.42 11.43 10.62 10.61 10.61
94 18.72 18.60 18.64 9.37 9.37 9.37 11.92 11.88 11.89 11.07 11.06 11.07
95 19.77 19.62 19.66 9.43 9.43 9.43 12.42 12.36 12.38 11.57 11.46 11.47
------------------------------------------------------------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A.
Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company.
T890 Page 18
Option 5, Table VI
Monthly Installment For Joint and Full Survivor
-----------------------------------------------------------------------------------------------------------------------------
Age of Age of Female Annuitant*
----------------------------------------------------------------------------------------------------------
Male 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years
Less Than Less Than Less Than Less Than Less Than Male More Than
Annuitant* Male Male Male Male Male Male
-----------------------------------------------------------------------------------------------------------------------------
50 $3.06 $3.12 $3.19 $3.25 $3.31 $3.38 $3.44
55 3.20 3.27 3.35 3.44 3.52 3.61 3.69
60 3.37 3.47 3.57 3.68 3.79 3.91 4.02
65 3.59 3.72 3.86 4.01 4.16 4.32 4.47
70 3.88 4.06 4.25 4.45 4.67 4.89 5.11
-----------------------------------------------------------------------------------------------------------------------------
Monthly Installment For Unisex Joint and Full Survivor
-----------------------------------------------------------------------------------------------------------------------------
Age of Age of Joint Annuitant*
----------------------------------------------------------------------------------------------------------
First 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years
Less Than Less Than Less Than Less Than Less Than First More ▇▇▇▇
▇▇▇▇▇▇▇▇▇* First First First First First First
-----------------------------------------------------------------------------------------------------------------------------
50 $3.07 $3.13 $3.19 $3.25 $3.31 $3.37 $3.43
55 3.20 3.28 3.36 3.44 3.52 3.60 3.67
60 3.38 3.48 3.58 3.68 3.79 3.89 4.00
65 3.61 3.73 3.87 4.01 4.16 4.30 4.44
70 3.90 4.07 4.26 4.46 4.66 4.86 5.05
-----------------------------------------------------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A.
-----------------------------------------------------------------------------------------------------------------------------
Option 5, Table VII
Monthly Installment for Joint & Full Survivor (Life with Emergency Cash)
-----------------------------------------------------------------------------------------------------------------------------
Age of Male Age of Female ▇▇▇▇▇▇▇▇▇
▇▇▇▇▇▇▇▇▇*
-----------------------------------------------------------------------------------------------------------
15 Years 12 Years 9 Years 6 Years 3 Years Same as 3 Years
Less Than Less Than Less Than Less Than Less Than Male More Than
Male Male Male Male Male Male
-----------------------------------------------------------------------------------------------------------------------------
50 $3.02 $3.08 $3.13 $3.20 $3.26 $3.32 $3.37
55 3.14 3.21 3.29 3.36 3.45 3.53 3.59
60 3.29 3.38 3.48 3.58 3.69 3.80 3.88
65 3.48 3.60 3.72 3.86 4.00 4.15 4.26
70 3.72 3.88 4.05 4.23 4.42 4.62 4.77
-----------------------------------------------------------------------------------------------------------------------------
Monthly Installment for Unisex Joint & Full Survivor (Life with Emergency Cash)
-----------------------------------------------------------------------------------------------------------------------------
Age of First Age of Joint ▇▇▇▇▇▇▇▇▇
▇▇▇▇▇▇▇▇▇*
-----------------------------------------------------------------------------------------------------------
15 Years 12 Years 9 Years 6 Years 3 Years Same as 3 Years
Less Than Less Than Less Than Less Than Less Than First More Than
First First First First First First
-----------------------------------------------------------------------------------------------------------------------------
50 $3.02 $3.08 $3.14 $3.20 $3.26 $3.32 $3.36
55 3.14 3.21 3.29 3.37 3.44 3.52 3.58
60 3.30 3.39 3.48 3.58 3.68 3.79 3.86
65 3.49 3.61 3.73 3.86 4.00 4.14 4.24
70 3.74 3.89 4.06 4.24 4.42 4.60 4.74
-----------------------------------------------------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A.
-----------------------------------------------------------------------------------------------------------------------------
Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company.
TB890 Page 19
VARIABLE PAYMENT OPTIONS
BASED ON ASSUMED INVESTMENT RETURN
The amounts shown in these tables are the initial payment amounts based on
a 5.0% Assumed Investment Return for each $1,000 of the proceeds.
-----------------------------------------------------------------------------------------------------------------------------------
Option 3-V, Table II Option 3-V, Table III Option 3-V, Table IV
-----------------------------------------------------------------------------------------------------------------------------------
Monthly Installment for Life Monthly Installment for Life Monthly Installment for Life
No Period Certain 10 Years Certain With Emergency Cash
-----------------------------------------------------------------------------------------------------------------------------------
Age* Male Female Unisex Male Female Unisex Male Female Unisex
50 $ 5.07 $ 4.93 $ 4.98 $ 5.04 $ 4.92 $ 4.95 $ 4.83 $ 4.76 $ 4.78
51 5.13 4.99 5.03 5.09 4.96 5.00 4.87 4.80 4.82
52 5.19 5.04 5.08 5.15 5.01 5.05 4.92 4.84 4.86
53 5.26 5.10 5.14 5.21 5.07 5.11 4.96 4.88 4.91
54 5.33 5.16 5.21 5.27 5.12 5.17 5.01 4.93 4.95
55 5.40 5.22 5.27 5.34 5.18 5.23 5.06 4.98 5.00
56 5.48 5.29 5.35 5.41 5.25 5.30 5.12 5.03 5.05
57 5.57 5.36 5.42 5.49 5.32 5.37 5.18 5.08 5.11
58 5.66 5.44 5.50 5.57 5.39 5.44 5.24 5.14 5.17
59 5.75 5.52 5.59 5.66 5.47 5.52 5.31 5.20 5.23
60 5.85 5.61 5.68 5.75 5.55 5.61 5.37 5.26 5.29
61 5.97 5.70 5.78 5.85 5.63 5.70 5.45 5.33 5.37
62 6.09 5.81 5.89 5.95 5.72 5.79 5.53 5.40 5.44
63 6.21 5.91 6.00 6.06 5.82 5.89 5.61 5.48 5.52
64 6.35 6.03 6.13 6.17 5.92 6.00 5.70 5.56 5.60
65 6.50 6.16 6.26 6.29 6.03 6.11 5.79 5.65 5.69
66 6.66 6.29 6.40 6.42 6.15 6.23 5.89 5.75 5.79
67 6.83 6.43 6.55 6.55 6.27 6.36 6.00 5.85 5.89
68 7.01 6.59 6.71 6.69 6.40 6.49 6.11 5.96 6.00
69 7.21 6.76 6.89 6.83 6.54 6.63 6.23 6.07 6.12
70 7.41 6.94 7.08 6.98 6.69 6.77 6.36 6.20 6.25
71 7.63 7.14 7.28 7.13 6.84 6.93 6.49 6.33 6.38
72 7.87 7.35 7.50 7.28 7.00 7.09 6.63 6.46 6.52
73 8.12 7.58 7.74 7.45 7.17 7.25 6.78 6.62 6.66
74 8.39 7.83 8.00 7.61 7.34 7.42 6.94 6.78 6.83
75 8.68 8.11 8.28 7.78 7.52 7.60 7.11 6.95 7.00
76 8.99 8.40 8.58 7.95 7.71 7.78 7.29 7.13 7.18
77 9.32 8.72 8.90 8.12 7.90 7.97 7.47 7.33 7.36
78 9.68 9.07 9.25 8.29 8.09 8.16 7.68 7.52 7.57
79 10.06 9.45 9.63 8.47 8.29 8.34 7.88 7.74 7.79
80 10.47 9.85 10.04 8.64 8.48 8.53 8.11 7.98 8.01
81 10.91 10.30 10.48 8.80 8.67 8.71 8.34 8.23 8.26
82 11.38 10.78 10.96 8.97 8.86 8.89 8.60 8.48 8.53
83 11.88 11.30 11.47 9.12 9.04 9.06 8.84 8.75 8.77
84 12.42 11.87 12.03 9.27 9.21 9.23 9.09 9.01 9.05
85 12.99 12.48 12.63 9.41 9.37 9.38 9.35 9.31 9.32
86 13.60 13.13 13.27 9.54 9.51 9.52 9.67 9.60 9.61
87 14.26 13.84 13.96 9.67 9.65 9.65 9.96 9.90 9.91
88 14.95 14.59 14.70 9.78 9.77 9.77 10.28 10.27 10.27
89 15.69 15.39 15.48 9.89 9.88 9.88 10.61 10.61 10.61
90 16.47 16.23 16.30 9.98 9.98 9.98 10.97 10.97 10.97
91 17.29 17.10 17.16 10.07 10.07 10.07 11.36 11.36 11.36
92 18.16 18.01 18.05 10.15 10.15 10.15 11.86 11.85 11.85
93 19.07 18.95 18.98 10.22 10.22 10.22 12.33 12.32 12.32
94 20.05 19.92 19.96 10.28 10.28 10.28 12.94 12.93 12.93
95 21.09 20.94 20.99 10.34 10.33 10.33 13.47 13.45 13.46
-----------------------------------------------------------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A.
Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company.
H994 Page 20
Option 5V, Table V
Monthly Installment For Joint and Full Survivor
-------------------------------------------------------------------------------------------
Age of Age of Female Annuitant*
-------------------------------------------------------------------------------
Male 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years
Less Than Less Than Less Than Less Than Less Than Male More ▇▇▇▇
▇▇▇▇▇▇▇▇▇* Male Male Male Male Male Male
-------------------------------------------------------------------------------------------
50 $4.37 $4.42 $4.46 $4.51 $4.56 $4.62 $4.67
55 4.48 4.54 4.60 4.67 4.74 4.81 4.88
60 4.62 4.70 4.79 4.88 4.98 5.08 5.18
65 4.81 4.92 5.04 5.17 5.31 5.46 5.61
70 5.07 5.23 5.40 5.59 5.79 6.00 6.22
-------------------------------------------------------------------------------------------
Monthly Installment For Unisex Joint and Full Survivor
-------------------------------------------------------------------------------------------
Age of Age of Joint Annuitant*
-------------------------------------------------------------------------------
First 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years
Less Than Less Than Less Than Less Than Less Than First More ▇▇▇▇
▇▇▇▇▇▇▇▇▇* First First First First First First
-------------------------------------------------------------------------------------------
50 $4.38 $4.42 $4.47 $4.51 $4.56 $4.61 $4.66
55 4.48 4.54 4.60 4.67 4.73 4.80 4.87
60 4.63 4.70 4.79 4.88 4.97 5.07 5.16
65 4.82 4.93 5.05 5.17 5.30 5.44 5.57
70 5.09 5.24 5.41 5.59 5.78 5.97 6.16
-------------------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A
-------------------------------------------------------------------------------------------
Option 5V, Table VI
Monthly Installment For Joint and Full Survivor (Life with Emergency Cash)
-------------------------------------------------------------------------------------------
Age of Age of Female Annuitant*
-------------------------------------------------------------------------------
Male 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years
Less Than Less Than Less Than Less Than Less Than Male More ▇▇▇▇
▇▇▇▇▇▇▇▇▇* Male Male Male Male Male Male
-------------------------------------------------------------------------------------------
50 $4.34 $4.38 $4.42 $4.47 $4.51 $4.57 $4.61
55 4.43 4.48 4.54 4.60 4.67 4.74 4.79
60 4.55 4.62 4.70 4.78 4.88 4.97 5.05
65 4.71 4.80 4.91 5.03 5.16 5.30 5.41
70 4.92 5.05 5.21 5.38 5.56 5.76 5.91
-------------------------------------------------------------------------------------------
Monthly Installment For Unisex Joint and Full Survivor (Life with emergency Cash)
------------------ ------------------------------------------------------------------------
Age of Age of Joint Annuitant*
-------------------------------------------------------------------------------
First 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years
Less Than Less Than Less Than Less Than Less Than First More ▇▇▇▇
▇▇▇▇▇▇▇▇▇* First First First First First First
011----------------------------------------------------------------------------------------
50 $4.34 $4.38 $4.42 $4.47 $4.51 $4.56 $4.60
55 4.43 4.48 4.54 4.60 4.67 4.73 4.78
60 4.55 4.62 4.70 4.78 4.87 4.96 5.03
65 4.71 4.81 4.92 5.03 5.16 5.29 5.38
70 4.93 5.07 5.22 5.38 5.56 5.74 5.87
-------------------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A
-------------------------------------------------------------------------------------------
Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company.
J994 Page 21
SECTION 11 - GENERAL PROVISIONS
THE CONTRACT
The entire contract consists of this contract, and endorsements, if any.
MODIFICATION OF CONTRACT
No change in this contract is valid unless made in writing by us and approved by
one of our officers. No Registered Representative has authority to change or
waive any provision of Your contract.
TAX QUALIFICATION
This contract is intended to qualify as an annuity contract for federal income
tax purposes. The provisions of this contract are to be interpreted to maintain
such qualification, notwithstanding any other provisions to the contrary. To
maintain such tax qualification, we reserve the right to amend this contract to
reflect any clarifications that may be needed or are appropriate to maintain
such tax qualification or to conform this contract to any applicable changes in
the tax qualification requirements. We will send You a copy in the event of any
such amendment. If You refuse such an amendment it must be by giving us written
notice, and Your refusal may result in adverse tax consequences.
NON-PARTICIPATING
This contract will not share in our surplus earnings.
AGE OR SEX CORRECTIONS
If the age or sex of the Annuitant has been misstated, the benefits will be
those, which the premiums paid, would have purchased for the correct age and
sex. If required by law to ignore differences in the sex of the Annuitant, the
annuity payments will be determined using the unisex factors in Section 10.
Any underpayment made by us will be paid with the next payment. Any overpayment
made by us will be deducted from future payments. Any underpayment or
overpayment, will include interest at 5% per year, from the date of the wrong
payment to the date of the adjustment.
INCONTESTABILITY
This contract shall be incontestable from the Contract Date.
EVIDENCE OF SURVIVAL
We have the right to require satisfactory evidence that a person was alive if a
payment is based on that person being alive. No payment will be made until we
receive the evidence.
SETTLEMENT
Any payment by us under this contract is payable at our Home Office.
RIGHTS OF OWNER
The owner may, while the Annuitant is living:
1. Assign this contract.
2. Surrender the contract to us.
3. Amend or modify the contract with our consent.
4. Receive annuity payments or name a Payee to receive the payments.
5. Exercise, receive and enjoy every other right and benefit contained in
the contract.
The use of these rights may be subject to the consent of any assignee or
irrevocable beneficiary; and of the spouse in a community or marital property
state.
Unless we have been notified of a community or marital property interest in this
contract, we will rely on our good faith belief that no such interest exists and
will assume no responsibility for inquiry.
CHANGE OF OWNERSHIP
In the case of a non-tax-qualified annuity, You can change the owner of this
contract, from yourself to a new owner, in a notice You sign which gives us the
facts that we need. When this change takes effect, all rights of ownership in
this contract will pass to the new owner.
A change of owner will not be effective until it is recorded in our records.
After it has been so recorded, the change will take effect as of the date You
signed the notice. However, if the Annuitant dies before the notice has been so
recorded, it will not be effective as to those proceeds we have paid before the
change was recorded in our records.
We may require that the change be endorsed in the contract. Changing the owner
does not change the beneficiary or the Annuitant.
A change of ownership may result in adverse tax consequences.
ANNUITY COMMENCEMENT DATE
The Annuity Commencement Date is the date annuity payments begin. This date may
not be later than the last day of the contract month starting after the
Annuitant attains age 85, except as expressly allowed by us (within state
restrictions), but in no event later than the last day of the contract month
following the month in which the Annuitant attains age 95. You may change the
Annuity Commencement Date at any time before the Annuity Commencement Date by
giving us 30 days' written notice.
R142 Page 22
SECTION 11 - CONTINUED
ASSIGNMENT
(a) In the case of a non tax-qualified annuity, this Contract may be assigned.
The assignment must be in writing and filed with us.
(b) We assume no responsibility for the validity of any assignment. Any claim
made under an assignment shall be subject to proof of interest and the
extent of the assignment.
(c) This contract may be applied for and issued to qualify as a tax-qualified
annuity under certain sections of the Internal Revenue Code. Ownership of
this contract is then restricted so that it will comply with provisions of
the Internal Revenue Code.
Assignment of this contract may result in adverse tax consequences.
BENEFICIARY
Death proceeds, when payable in accordance with Section 9, are payable to the
designated beneficiary or beneficiaries. Such beneficiary(ies) must be named and
may be changed without consent (unless irrevocably designated or required by
law) by notifying us in writing on a form acceptable to us. The change will take
effect upon the date You sign it, whether or not You are living when we receive
it. The notice must have been postmarked (or show other evidence of delivery
that is acceptable to us) on or before the date of death. Your most recent
change of beneficiary notice will replace any prior beneficiary designations. No
change will apply to any payment we made before the written notice was received.
If an irrevocable beneficiary dies, You may designate a new beneficiary.
You may direct that the beneficiary shall not have the right to withdraw, assign
or commute any sum payable under an option. In the absence of such election or
direction, the beneficiary may change the manner of payment or make an election
of any option.
If any primary or contingent beneficiary dies before the Annuitant, that
beneficiary's interest in this contract ends with that beneficiary's death. Only
those beneficiaries living at the time of the Annuitant's death will be eligible
to receive their share of the death proceeds. In the event no primary or
contingent beneficiaries have been named and all primary beneficiaries have died
before the death proceeds become payable, the owner(s) will become the
beneficiary(ies) unless elected otherwise in accordance with Section 9. If both
primary and contingent beneficiaries have been named, payment will be made to
the named primary beneficiaries living at the time the death proceeds become
payable. If there is more than one beneficiary and You failed to specify their
interest, they will share equally. Payment will be made to the named contingent
beneficiary(ies) only, if all primary beneficiaries have died before the death
proceeds become payable. If any primary beneficiary is alive at the time the
death proceeds become payable, but dies before receiving their payment, their
share will be paid to their estate.
PROTECTION OF PROCEEDS
Unless You so direct by filing written notice with us, no beneficiary may assign
any payments under this contract before the same are due. To the extent
permitted by law, no payments under this contract will be subject to the claims
of creditors of any beneficiary.
DEFERMENT
We will pay any Partial Withdrawals or Surrender proceeds from the Separate
Account within 7 days after we receive all requirements that we need. However,
it may happen that the New York Stock Exchange is closed for trading (other than
the usual weekend or holiday closings), or the Securities and Exchange
Commission restricts trading or determines that an emergency exists. If so, it
may not be practical for us to determine the investment experience of the
Separate Account. In that case, we may defer transfers among the Subaccounts and
to the Fixed Account, and determination or payment of Partial Withdrawals or
Surrender proceeds.
When permitted by law, we may defer paying any Partial Withdrawals or Surrender
proceeds from the Fixed Account for up to 6 months from the date we receive Your
request. If the owner dies after the request is received, but before the request
is processed, the request will be processed before the death proceeds are
determined. Interest will be paid on any amount deferred for 30 days or more.
This rate will be the Fixed Account Guaranteed Minimum Effective Annual Interest
Rate shown on Page 3, unless otherwise required by law.
REPORTS TO OWNER
We will give You an annual report at least once each Contract Year. This report
will show the number and value of the accumulation units held in each of the
Subaccounts as well as the value of the Fixed Account. It will also give You the
Death Benefit, Cash Value, and any other facts required by law or regulation.
R142 Page 23
Home Office: Transamerica Occidental Life
Transamerica ▇▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇ +Insurance Company
[LOGO] Occicental Life Cedar Rapids, IA 52499
A Stock Company
INDEX
Page
Account Value ................................. 4
Accumulation Units ............................ 9
Age or Sex Corrections ........................ 22
Annuity Commencement Date ..................... 22
Annuity Payments .............................. 14
Adjusted Account Value ........................ 4
Assignment .................................... 23
Beneficiary ................................... 23
Cash Value .................................... 5
Contract ...................................... 22
Contract Data Page ............................ 3
Death Proceeds ................................ 12
Definitions ................................... 2
Dollar Cost Averaging Option .................. 11
Evidence of Survival .......................... 22
Excess Interest Adjustment .................... 5
Fixed Account ................................. 10
Guaranteed Minimum Death Benefit .............. 12
Guaranteed Return of Fixed Account
Premium Payments .......................... 8
Guaranteed Periods ............................ 10
Incontestability .............................. 22
Modification of Contract ...................... 22
Non-participating ............................. 22
Option to Change Annuity Commencement Date .... 22
Partial Withdrawals ........................... 6
Payee ......................................... 15
Payment of Premiums ........................... 4
Payment Option Tables ......................... 18, 19, 20, 21
Proof of Age .................................. 5
Protection of Proceeds ........................ 3
Right to Cancel ............................... 1
Rights of Owner ............................... 2
Separate Account .............................. 8
Service Charge ................................ 4
Settlement .................................... 2
Surrender Charges ............................. 8
Transfers ..................................... 10
Flexible Premium Deferred Variable Annuity
Income Payable At Annuity Commencement Date
Benefits Based On The Performance Of The Separate Account Are
Variable And Are Not Guaranteed As To Dollar Amount (See Sections 6 and 10C)
Non-Participating
Y734