Exhibit (4)(a)
▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇ LIFE INSURANCE COMPANY
Final
05-02-02 Home Office: Little Rock, Arkansas
Service Center: P. O. Box 44222
Jacksonville, Florida 32231-4222
▇▇▇▇▇▇▇ ▇▇▇▇▇ LIFE INSURANCE COMPANY will make periodic annuity payments for the
life of the Annuitant or as otherwise provided in this Contract. Payments will
be made to the Owner starting on the Annuity Date.
This is a legal Contract between you and us. PLEASE READ THE CONTRACT CAREFULLY.
EXCEPT FOR FIXED ANNUITY PAYMENTS, VALUES PROVIDED BY THIS CONTRACT ARE BASED ON
THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT
GUARANTEED AS TO FIXED-DOLLAR AMOUNT.
TEN DAY RIGHT TO REVIEW CONTRACT: You may cancel this Contract within ten days
after you receive it. Simply return or mail it to us or your Financial Advisor.
We will refund the greater of the Contract Value or all of your Premiums.
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TABLE OF CONTENTS
SECTION PAGE
Definitions.......................................................... 2
Contract Schedule.................................................... 3
1. General Provisions............................................... 4
2. Premiums......................................................... 6
3. The Separate Account............................................. 6
4. Charges and Deductions........................................... 7
5. Transfers........................................................ 8
6. Withdrawals...................................................... 8
7. Payment at Death................................................. 8
8. Annuity Provisions............................................... 9
9. Annuity Options..................................................10
10. Annuity Option Tables............................................12
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▇▇▇▇▇▇▇ ▇▇▇▇▇ Life Insurance Company is a stock life insurance company.
/s/ ▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇▇▇ /s/ ▇▇▇▇ ▇. ▇▇▇▇▇
President Secretary
Individual Variable Annuity Contract
Flexible Premiums - Nonparticipating
DEFINITIONS
1. ACCUMULATION UNIT: A unit of measure used to compute the value of your
interest in a subaccount of the Separate Account prior to the Annuity Date.
2. ANNUITANT: Annuity payments may depend upon the continuation of a person's
life or persons' lives. That person is called the Annuitant.
3. ANNUITY DATE: The date on which annuity payments are scheduled to begin.
4. ATTAINED AGE: The age of a person on the Contract Date plus the number of
full contract years since the Contract Date.
5. BENEFICIARY: The person(s) designated by you to receive payment upon the
death of an Owner prior to the Annuity Date.
6. COMPANY: ▇▇▇▇▇▇▇ ▇▇▇▇▇ Life Insurance Company. Also referred to as "we"
or "us."
7. CONTRACT ANNIVERSARY: The yearly anniversary of the Contract Date.
8. CONTRACT DATE: The effective date of the Contract as shown on the
Contract Schedule. This is usually the business day we receive your initial
premium at our Service Center.
9. CONTRACT VALUE: The value of your interest in the Separate Account.
10. CONTRACT YEAR: The period from the Contract Date to the first Contract
Anniversary, and thereafter, the period from one Contract Anniversary to
the next Contract Anniversary.
11. DUE PROOF OF DEATH: A certified copy of the death certificate, Beneficiary
Statement and any additional paperwork necessary to process a death claim.
12. FUND: An investment portfolio of an open-end management investment company
or unit investment trust in which a subaccount may invest.
13. INDIVIDUAL RETIREMENT ACCOUNT OR ANNUITY ("IRA"): A retirement arrangement
meeting the requirements of Section 408 of the Internal Revenue Code.
14. NONQUALIFIED CONTRACT: A retirement arrangement plan other than a qualified
plan described under Section 401, 403, 408, 408A, 457 or any similar
provisions of the Internal Revenue Code.
15. OWNER: The person or persons entitled to exercise all rights under the
Contract. In this Contract, "you" means Owner.
16. PREMIUMS: The money you pay into this Contract.
17. SEPARATE ACCOUNT: This Contract is funded by a separate account of the
Company. The separate account has multiple subaccounts, which may invest
in shares or units of an underlying Fund. The separate account and the
subaccounts currently available with this Contract are identified in the
Contract Schedule.
18. SURRENDER VALUE: The amount payable upon surrender of the Contract. It is
equal to the Contract Value less any Contingent Deferred Sales Charge and
any other charges which are collected upon a full withdrawal.
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CONTRACT SCHEDULE -----------
IRA Annuity
FINAL
05/06/02
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▇▇▇▇▇▇▇ ▇▇▇▇▇ LIFE INSURANCE COMPANY Contract Number: [%999999999]
Service Center: Contract Date: [October 1, 2001]
P.O. Box 44222 Issue Date: [October 2, 2001]
Jacksonville, FL 32231-4222 Financial Advisor:
▇-▇▇▇-▇▇▇-▇▇▇▇ [▇▇▇ ▇▇▇▇▇▇]
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OWNER INFORMATION ANNUITANT INFORMATION
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Name: [▇▇▇▇ ▇ PUBLIC] Name: [▇▇▇▇ ▇ ▇▇▇▇▇▇]
Age: [65] Age: [70] Sex: [M]
Address: [▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇] Joint Annuitant: [▇▇▇▇ ▇ PUBLIC]
[ANYWHERE, USA 77777] Age: [ ] Sex: [ ]
Annuity Date: [January 1, 2020]
Maximum Owner Age: 90 Maximum Annuitant Age: 90
Maximum Annuitization Age: 95
Beneficiary: [SURVIVING SPOUSE]
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CONTRACT INFORMATION
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CONTRACT TYPE: FLEXIBLE PREMIUM INDIVIDUAL VARIABLE ANNUITY
MINIMUM ADDITIONAL PREMIUM: $50
SEPARATE ACCOUNT: The ▇▇▇▇▇▇▇ ▇▇▇▇▇ Life Variable Annuity Separate Account D
(The "Separate Account")
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FEES AND CHARGES
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ASSET-BASED INSURANCE CHARGE: 1.30%
TRANSFER CHARGE: We reserve the right to charge $25 for each transfer in excess
of 12 transfers during a Contract Year.
CONTRACT FEE: $40 at the end of each Contract Year (and on full withdrawal) if
the greater of premiums less withdrawals or Contract Value is less than
$50,000.
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CONTRACT SCHEDULE (CONTINUED)
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CONTINGENT DEFERRED SALES CHARGE
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Applies to each withdrawn premium. Premiums are assumed to be withdrawn on a
"first-in, first-out" (FIFO) basis.
Years Elapsed Charge As a Percent of
Since Premium Payment Premium Withdrawn
--------------------- -----------------
less than 1 7%
1 6%
2 5%
3 4%
4 3%
5 2%
6 1%
7+ 0%
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FUND ALLOCATIONS
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MAXIMUM NUMBER OF SUBACCOUNTS: [18]
INITIAL PREMIUM: $25,000.00. For the first 14 days following the Contract
Date all premiums will be allocated to the [ML Ready Asset Trust].
SUBACCOUNTS AND ALLOCATION AFTER 14 DAYS FOLLOWING THE CONTRACT DATE:
[100%] [AIM Constellation] [100%] [MFS Core Growth] [100%] [PIMCO Total Return]
[100%] [AIM Premier Equity] [100%] [MFS Mid Cap Growth] [100%] [▇▇▇▇▇▇ Growth Income]
[100%] [Alliance Growth & Inc] [100%] [MFS Research Intl] [100%] [▇▇▇▇▇▇ Intl Growth]
[100%] [Alliance Prem Growth] [100%] [ML Basic Value] [100%] [▇▇▇▇▇▇ Voyager]
[100%] [Am Century Equity Inc] [100%] [▇▇ ▇▇▇▇ Core Bond] [100%] [▇▇▇▇▇▇▇▇ ▇▇ Cap Value]
[100%] [American Funds Bond] [100%] [ML Fundamental Growth] [100%] [▇▇▇▇▇▇▇▇▇ Foreign]
[100%] [American Funds Growth] [100%] [ML Global Allocation] [100%] [▇▇▇▇▇▇▇▇▇ Growth]
[100%] [American Funds Income] [100%] [ML Ready Asset Trust] [100%] [▇▇▇ ▇▇▇▇▇▇ Aggrss
[100%] [Amer Funds Invst Co] [100%] [ML SP 500 Index] Grow]
[100%] [▇▇▇▇▇ NY Venture] [100%] [ML Small Cap Value] [100%] [▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇]
[100%] [Delaware Trend] [100%] [ML US Govt. Mortgage] [100%] [▇▇▇ ▇▇▇▇▇▇ Equity Inc]
[100%] [Fidelity Adv Equity Gro] [100%] [▇▇▇▇▇▇▇▇▇▇▇ Global] [100%] [Fund Name]
[100%] [Fidelity Adv Mid Cap Gro] [100%] [Oppen Main St. Grow Inc] [100%] [Fund Name]
[100%] [Fidelity Adv Overseas] [100%] [Oppen Quest Oppty]
[100%] [Lord ▇▇▇▇▇▇ Bond Debntr] [100%] [PIMCO Renaissance]
[100%] [Lord ▇▇▇▇▇▇ Mid Cap Val] [100%] [PIMCO Small Cap Value]
100% TOTAL
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WITHDRAWALS
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MINIMUM WITHDRAWAL AMOUNT: $100
MINIMUM REMAINING CONTRACT VALUE AFTER WITHDRAWAL: $5,000
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TRANSFERS
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MINIMUM TRANSFER AMOUNT: $100
MAXIMUM NUMBER OF TRANSFERS WITHOUT TRANSFER CHARGE: 12 per Contract Year
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GUARANTEED MINIMUM DEATH BENEFIT
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[Maximum Anniversary Value - OR - Premiums Compounded at 5% - OR - Return of
Premium]
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CONTRACT SCHEDULE (CONTINUED)
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GUARANTEED MINIMUM INCOME BENEFIT (GMIB) RIDER (GOLD(SM) BENEFIT RIDER)
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MAXIMUM AGE FOR GMIB RIDER: 75
FIRST EXERCISE ANNIVERSARY DATE: [October 1, 2011]
The 10th Contract Anniversary.
LAST EXERCISE ANNIVERSARY DATE: [October 1, 2021]
The Contract Anniversary on or following the older ▇▇▇▇▇▇▇▇▇'s 85th birthday.
LAST EXERCISE DATE: [October 31, 2021]
The 30th day following the Last Exercise Anniversary Date.
EXERCISE PERIOD: You may exercise GMIB on or during the 30-day period following each
Contract Anniversary beginning with the First Exercise Anniversary Date and
ending with the Last Exercise Anniversary Date.
ANNUITY OPTIONS AVAILABLE ON EXERCISE OF GMIB:
Life Annuity
Joint and Survivor Life Annuity
Life Annuity with Payments Guaranteed for 10 Years
Joint and Survivor Life Annuity with Payments Guaranteed for 10 Years
BENEFIT BASE RATE: [5.0%]
BENEFIT BASE LIMITATION DATE: [October 1, 2016]
The Contract Anniversary on or following the older Annuitant's 80th birthday.
GMIB FEE PERCENTAGE: [0.40% annually]
GMIB FEE: Deducted from the Contract Value on the last business day of each calendar
quarter and upon termination of the GMIB Rider. The amount deducted will be
the sum of the GMIB Fees for each month during that calendar quarter. Each
monthly GMIB Fee is determined on the last business day of each month and
upon termination of the GMIB Rider as follows:
(i) determine the GMIB Benefit Base on that date;
(ii) multiply this amount by the GMIB Fee Percentage;
(iii) divide by 12
The GMIB Fee will be reduced proportionally for any month in which the
GMIB Rider:
(a) terminates prior to the last business day of that month; or
(b) was not in effect as of the last business day of the prior month.
This fee is withdrawn from each subaccount in the same proportion that the
value of each subaccount bears to the Contract Value on the date the fee is
withdrawn.
PREMIUM LIMITATION:
The sum of premiums paid under all contracts with a GMIB Rider having the
same oldest Annuitant may not exceed $2,000,000 without prior approval.
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THIS SECTION INTENTIONALLY LEFT BLANK
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NOTE: If the Guaranteed Minimum Income Benefit has not been selected, print text
as shown in this box rather than the one immediately above.
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1. GENERAL PROVISIONS
1.1 BENEFICIARY: The Beneficiary is shown in the Contract Schedule. You may
change the Beneficiary while you are alive.
You may name a beneficiary irrevocably. If you do so, you can later
change the beneficiary only with the beneficiary's written consent.
If a beneficiary does not survive you, the estate or heirs of such
beneficiary have no rights under this Contract. However, if a
beneficiary survives you but dies before the Contract Value is
distributed, the estate or heirs of such beneficiary are entitled to the
death benefit that would otherwise have been paid to such beneficiary.
If no beneficiary survives you, payment of the death benefit will be
made to your estate.
1.2 OWNERSHIP OF CONTRACT: Unless another Owner is named by the purchaser,
the purchaser is the Owner. Upon notice to us you may assign the
Contract to a new Owner. The assignment terminates all prior beneficiary
designations. When the Contract is issued or the Owner is changed, the
age of the Owner (or older co-owner or Annuitant, if applicable) must be
less than the Maximum Owner Age shown in the Contract Schedule.
Only spouses may be co-owners. The beneficiary of the co-owner spouses
must be the surviving spouse. Ownership rights must be exercised by the
co-owners jointly. Co-owners are deemed to be joint tenants with right
of survivorship unless they indicate otherwise.
1.3 ANNUITANT: When an annuity option is elected, the amount payable as of
the Annuity Date is based on the age (and sex, where permissible) of the
Annuitant, the annuity option selected, and the Contract Value.
The Annuitant may be changed at any time prior to the Annuity Date. A
change of Annuitant by a non-natural owner will be treated as the death
of an Owner. When the Contract is issued or a new Annuitant is named,
the age of the Annuitant (or the older joint annuitant, if applicable)
must be less than the Maximum Annuitant Age shown in the Contract
Schedule.
1.4 NOTICES, CHANGES AND CHOICES: To be effective, all notices, changes and
choices you may make under this Contract must be in writing, signed and
received by us at our Service Center, except that transfers and premium
allocations may be made by telephone by you or your representative if
authorized by you in writing. If acceptable to us, notices, changes, and
choices relating to beneficiaries, ownership, Annuitants, and Annuity
Date will take effect as of the date signed unless we have already acted
in reliance on the prior status. We are not responsible for their
validity.
1.5 RESTRICTIONS ON IRAS: If this Contract is issued as or as part of an IRA
or 403(b) Contract, it may not be assigned, pledged, or transferred
unless permitted by law.
1.6 MISSTATEMENT OF AGE OR SEX: If the age of the Owner (or co-owner, if
applicable) is misstated, any death benefit payable under this Contract
will be adjusted to reflect the correct age.
If the age or sex of the Annuitant (or joint annuitant, if applicable)
is misstated, annuity payments will be adjusted to reflect the correct
age(s) and sex(es). Any amount we have overpaid as a result of such
misstatement will be deducted from the next payments made by us under
this Contract. Interest on the overpayment will be charged at the rate
of 6% per year. Any amount we have underpaid will be paid in full with
the next payment made by us under this Contract. We will pay interest on
the underpayment at the rate of 6% per year.
1.7 PROOF OF AGE, SEX, OR SURVIVAL: We may require satisfactory proof of
age, sex, or survival of any person on whose continued life any payment
under this Contract depends.
1.8 INCONTESTABILITY: We will not contest this Contract.
- 4 -
1.9 THE CONTRACT: This Contract, and any endorsements or riders are the
entire Contract. It is issued in consideration of the payment of the
Initial Premium.
Only our President, a Vice President, Secretary, or Assistant Secretary
may change the Contract. Any change must be in writing.
At any time we may make such changes in this Contract as required to
make it conform with any law, regulation, or ruling issued by a
government agency.
1.10 NONPARTICIPATING: This Contract is nonparticipating. It does not share
in our surplus.
1.11 DATES: Contract years and anniversaries are measured from the Contract
Date.
1.12 CONTRACT PAYMENTS: All sums payable to or by us are payable at our
Service Center. We may require return of this Contract prior to making
payment. Paid-up annuity benefits, Contract withdrawal values and death
benefits will not be less than the minimum required by the laws of the
state in which the Contract is delivered.
1.13 PROTECTION OF PROCEEDS: Payments under this Contract may not be assigned
by the payee prior to their due dates. To the extent allowed by law,
payments are not subject to legal process for debts of a payee.
1.14 PERIODIC REPORTS: At least once a year prior to the Annuity Date we will
furnish you with a report for your Contract. It will show the current
number of Accumulation Units, the value per Accumulation Unit and the
Contract Value.
1.15 PAYMENTS UNDER THE CONTRACT: Payment generally will be made within seven
days of our receipt of a completed request, but we may defer payment if:
(a) the New York Stock Exchange is closed;
(b) trading on the New York Stock Exchange is restricted;
(c) an emergency exists such that it is not reasonably practical to
dispose of securities in the Separate Account or to determine the
value of its assets;
(d) the Securities and Exchange Commission by order so permits for the
protection of security holders; or
(e) payment is derived from a check used to pay a Premium which has not
cleared through the banking system.
Conditions (b), (c) and (d) will be decided by or in accordance with
rules of the Securities and Exchange Commission. Transfers also may be
deferred upon the occurrence of any of the events described above.
1.16 TAX QUALIFICATION: This Contract is intended to qualify as an annuity
contract for federal income tax purposes. To that end, the provisions of
this Contract are to be interpreted to ensure or maintain such tax
qualification, notwithstanding any other provision to the contrary.
Distributions under this Contract shall be made in a time and manner
necessary to maintain such qualification under the applicable provisions
of the Internal Revenue Code including, in the case of an owner who is a
non-natural person, the requirement to distribute the entire interest in
the Contract upon any change of the Annuitant. For this purpose, the
entire interest in the Contract is the Contract Value less any
applicable charges. We reserve the right to amend this Contract to
reflect any clarifications that may be needed or are appropriate to
maintain such qualification or to conform this Contract to any
applicable changes in the tax qualification requirements.
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2. PREMIUMS
2.1 ADDITIONAL PREMIUMS: The Minimum Additional Premium is shown on the
Contract Schedule. Premiums may be paid at any time prior to the Annuity
Date without prior notice to us. We reserve the right to refuse to
accept a Premium.
2.2 PREMIUM ALLOCATION: Your Premiums will be allocated to the subaccounts
of the Separate Account, as shown in the Contract Schedule. If you do
not give us allocation instructions with subsequent Premiums, we will
allocate those Premiums according to the allocation instructions last
received from you.
3. THE SEPARATE ACCOUNT
3.1 THE SEPARATE ACCOUNT: The Separate Account is identified in the Contract
Schedule. It is a separate investment account of ▇▇▇▇▇▇▇ ▇▇▇▇▇ Life
Insurance Company. With respect to the Separate Account, income, gains,
and losses, whether or not realized, from assets allocated to the
Separate Account are credited to or charged against the Separate Account
without regard to other income, gains, or losses of the Company. Assets
allocated to the Separate Account remain our property but are separate
from our general account and any other separate accounts we may have.
Separate Account assets, to the extent equal to the Separate Account's
reserves and other liabilities, may not be charged with liabilities from
any other business we conduct. We reserve the right to transfer any
excess to our general account.
3.2 SUBACCOUNTS: Current subaccounts are shown in the Contract Schedule. We
reserve the right to limit the number of subaccounts in which you may
invest to the number shown in the Contract Schedule.
3.3 CHANGES TO THE SEPARATE ACCOUNT: We may make additional subaccounts
available. We reserve the right, subject to obtaining any necessary
regulatory approvals, to close or eliminate subaccounts; to substitute a
new portfolio for the portfolio in which a subaccount invests; to
deregister the Separate Account under the Investment Company Act of 1940
(the "1940 Act"); to make any changes required by the 1940 Act; to
operate the Separate Account as a unit investment trust, a managed
investment company under the 1940 Act or any other form permitted by
law; to transfer all or a portion of the assets of a subaccount or
Separate Account to another subaccount or Separate Account pursuant to a
combination or otherwise; and to create a new Separate Account.
3.4 NUMBER OF ACCUMULATION UNITS: For each subaccount the number of your
Accumulation Units is the sum of:
Each Premium or transfer allocated to the subaccount
Divided by
The value of an Accumulation Unit for that subaccount for the
valuation period in which we received the Premium or processed
the transfer.
The number of Accumulation Units will be adjusted for transfers from
each subaccount, withdrawals and charges. Adjustments will be made as of
the valuation period in which the transaction is effective.
3.5 VALUE OF EACH ACCUMULATION UNIT: For each subaccount, the value of an
Accumulation Unit was arbitrarily set at $10 when the subaccount was
established. The value may increase or decrease from one valuation
period to the next. For any valuation period the value is:
- 6 -
The value of an Accumulation Unit for the last prior valuation
period
Multiplied by
The Net Investment Factor for that subaccount for the current
valuation period.
3.6 NET INVESTMENT FACTOR: This is an index used to measure the investment
performance of a subaccount from one valuation period to the next. For
any subaccount, we determine the Net Investment Factor by dividing the
value of the assets of the subaccount for that valuation period by the
value of the assets of the subaccount for the preceding valuation
period. We subtract from that result the daily equivalent of the
asset-based insurance charge for the valuation period. We also take
reinvestment of dividends and capital gains into account when we
determine the Net Investment Factor.
We may adjust the Net Investment Factor to make provision for any change
in tax law that requires us to pay tax on earnings in the Separate
Account and any charge that may be assessed against the Separate Account
for assessments or federal premium taxes or federal, state or local
excise, profits or income taxes measured by or attributable to the
receipt of Premiums.
3.7 VALUATION PERIOD: This is the interval from one determination of the net
asset value of a subaccount to the next. Net asset values are determined
as of the close of regular trading on each day the New York Stock
Exchange is open.
4. CHARGES AND DEDUCTIONS
4.1 CONTRACT FEE: A Contract fee may be deducted from the Contract Value on
or prior to the Annuity Date. The amount of this fee and circumstances
under which it will be imposed are shown in the Contract Schedule.
4.2 ASSET-BASED INSURANCE CHARGE: The asset-based insurance charge is made
to compensate us for our expenses for administration of the Separate
Account, for issue and administration of the Contract, for providing a
guaranteed minimum death benefit, and our risks. The maximum charge
equals, on an annual basis, the percentage shown in the Contract
Schedule. This charge is deducted daily from the net asset value of the
subaccounts.
4.3 CONTINGENT DEFERRED SALES CHARGE: A Contingent Deferred Sales Charge may
be deducted on withdrawals prior to the Annuity Date. The amount of this
charge and how it is calculated are shown in the Contract Schedule.
4.4 TAXES, FEES AND ASSESSMENTS: Any charges made by us attributable to
premium taxes imposed by a state or other government will be deducted at
the Annuity Date, except in those jurisdictions that do not allow us to
reduce our current taxable premium income by the amount of any
withdrawal or death benefit. In those jurisdictions, we will also deduct
a charge for those taxes on any withdrawal or death benefit paid under
the Contract. We may also deduct a charge for assessments or federal
premium taxes or federal, state, or local excise, profits, or income
taxes measured by or attributable to the receipt of Premiums. We also
reserve the right to deduct from the Separate Account any taxes imposed
on the Separate Account.
4.5 PAYMENT OF DEDUCTIONS: The asset-based insurance charge will be computed
and deducted from each subaccount for each day the Contract is in force.
The Transfer Charge described in Section 5.1 will be deducted pro rata
from the subaccounts from which Contract Value is being transferred.
Other applicable charges will be deducted from each subaccount of the
Separate Account in the ratio of your interest in each subaccount to
your Contract Value. However, if you request a partial withdrawal from
specific subaccounts, any Contingent Deferred Sales Charge attributable
to such withdrawal will also be deducted from those subaccounts in the
same proportion as the withdrawal.
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5. TRANSFERS
5.1 TRANSFERS AMONG SUBACCOUNTS: You may transfer all or part of your
Contract Value among the subaccounts. Your request will be processed as
of the end of the valuation period during which your request is received
in good order. The number of transfers allowed each contract year
without charge is shown in the Contract Schedule. We reserve the right
to charge for each additional transfer as shown in the Contract
Schedule. The minimum amount which may be transferred from any
subaccount in any transaction is shown in the Contract Schedule.
An excessive number of transfers, including short-term "market timing"
transfers, may adversely affect the performance of the underlying
portfolio in which a subaccount invests. If, in our sole opinion, a
pattern of an excessive number of transfers develops for a Contract, we
reserve the right not to process a transfer request. We also reserve the
right not to process a transfer request when the sale or purchase of
shares or units of an underlying portfolio is not reasonably practicable
due to actions taken or limitations imposed by the underlying fund.
6. WITHDRAWALS
6.1 WITHDRAWALS: You may withdraw all or part of your Contract Value. Your
request will be processed as of the end of the valuation period during
which your request is received in good order. A Contingent Deferred
Sales Charge may apply to partial or full withdrawals (see Section 4.3).
Notice must be received by us prior to the Annuity Date. The minimum
amount of each withdrawal, and the Contract Value that must remain after
a withdrawal, are shown in the Contract Schedule. For a full withdrawal,
upon surrender of this Contract to our Service Center, we will pay you
the Surrender Value.
6.2 PAYMENT OF WITHDRAWALS: Unless you notify us otherwise, partial
withdrawals will be deducted from each subaccount in the ratio of your
Contract Value in each subaccount to the Contract Value. Withdrawals
will be based on values for the valuation period in which the notice
(and Contract if required) is received at our Service Center.
7. PAYMENT AT DEATH
7.1 DEATH OF OWNER
(including an Annuitant who is also an Owner)
7.1.1 DEATH PRIOR TO ANNUITY DATE: If an Owner dies prior to the Annuity Date,
we will pay the Beneficiary the death benefit specified below in a lump
sum or, if requested, under an Annuity Option under Section 7.1.3. If
the Owner is a non-natural person, then the Annuitant rather than the
Owner will be used to determine the death benefit. The death benefit is
determined as of the date we receive Due Proof of Death of the Owner at
our Service Center.
The death benefit is equal to the greater of:
(i) the Premiums paid into the Contract less "adjusted" withdrawals
from the Contract;
or
(ii) the Contract Value.
Each "adjusted" withdrawal equals the amount withdrawn multiplied by (i)
divided by (ii) (both determined immediately prior to the withdrawal).
If we have not received the Beneficiary's instructions for making
payment within 60 days following our receipt of the Owner's certified
death certificate, Due Proof of Death will be deemed to have been
received by us on the 60th day, and payment will be made in a lump sum.
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7.1.2 CONTRACT CONTINUATION OPTION: If the surviving spouse of the deceased
Owner is the Beneficiary, such spouse may choose to continue this
Contract. The spouse shall become the "new" Owner and the Beneficiary
until a new beneficiary is named. If the death benefit which would have
been paid to the surviving spouse is greater than the Contract Value as
of the date we determine the death benefit, we will increase the
Contract Value of the continued Contract to equal the death benefit we
would have paid to the surviving spouse. The amount of the increase will
be allocated to each subaccount based upon the ratio of your interest in
each subaccount to the Contract Value immediately prior to the increase.
7.1.3 ANNUITY OPTION: If the Beneficiary is the surviving spouse of the
deceased Owner, he or she may choose to receive payments under any of
the Annuity Options of this Contract. For any other beneficiary, only
those options are available that provide for full payment of such
Owner's interest in the Contract:
(a) within five years of the date of such Owner's death;
(b) over the lifetime of such beneficiary of this Contract; or
(c) over a period that does not exceed the life expectancy, as
defined by Internal Revenue Service regulations, of such
beneficiary of this Contract.
Subparagraphs (b) and (c) apply only to individuals, and such payments
must start within one year of the date of such Owner's death. For IRAs,
any annuity option chosen must meet the requirements of the Internal
Revenue Code.
7.1.4 DEATH AFTER ANNUITY DATE: See Section 9.9.
7.2 DEATH OF ANNUITANT WHO IS NOT AN OWNER
7.2.1 If the Annuitant dies prior to the Annuity Date and the Annuitant is not
an Owner, the Owner, provided the Owner is a natural person, may
designate a new Annuitant. If one is not designated, the Owner will
become the Annuitant. If the Owner is a non-natural person, the death of
the Annuitant shall be treated as the death of an Owner.
8. ANNUITY PROVISIONS
8.1 ANNUITY DATE: The Annuity Date may be no earlier than the first Contract
Anniversary nor any later than the date the Annuitant would reach the
Maximum Annuitization Age shown in the Contract Schedule. If you have
not chosen an Annuity Date, it will be the date the Annuitant would
reach the Maximum Annuitization Age shown in the Contract Schedule. For
an IRA, if you have not chosen an Annuity Date, it will be the date the
Annuitant reaches age 70 1/2. You may change the Annuity Date prior to
the Annuity Date.
8.2 AMOUNT OF ANNUITY PAYMENTS: Charges made by us for premium taxes and any
other charges collected upon annuitization will be deducted from your
Contract Value at the Annuity Date. The remaining value will be
transferred to our general account and applied to the Annuity Option you
select, at our then current annuity payout rates, which will be
furnished on request. They will not be less favorable than those shown
in the annuity tables in this Contract. The tables show the minimum
guaranteed amount of each monthly payment for each $1,000 so applied,
according to the sex (where permissible) and age at the Annuity Date of
the Annuitant.
8.3 ANNUITY OPTIONS: If you have not chosen an Annuity Option described in
Section 9, Option 4 will apply with a 10-year guarantee period. You may
change options prior to the Annuity Date. An option not set forth in the
Contract may be chosen if acceptable to us.
- 9 -
8.4 MINIMUM ANNUITY PAYMENT: If the Contract Value to be applied at the
Annuity Date is less than $5,000, we may pay such amount in a lump sum.
If any payment would be less than $50, we may change the frequency so
payments are at least $50 each.
9. ANNUITY OPTIONS
9.1 OPTION 1 - PAYMENTS OF A FIXED AMOUNT: Equal payments in the amount
chosen will be made until the amount of your Contract Value transferred
to our general account adjusted for interest credited is exhausted. The
term over which such payments are made must be at least five years.
9.2 OPTION 2 - PAYMENTS FOR A FIXED PERIOD: Payments will be made for the
period chosen. The period must be at least 5 years.
9.3 OPTION 3 - LIFE ANNUITY: Payments will be made for the life of the
Annuitant. Payments will cease with the last payment due prior to the
Annuitant's death.
9.4 OPTION 4 - LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 5, 10, 15 OR 20
YEARS: Payments will be made for the guaranteed period chosen (5, 10, 15
or 20 years) and as long thereafter as the Annuitant lives.
9.5 OPTION 5 - LIFE ANNUITY WITH GUARANTEED RETURN OF CONTRACT VALUE:
Payments will be made until the sum of the annuity payments equals the
amount of your Contract Value transferred to our general account at the
Annuity Date, and as long thereafter as the Annuitant lives.
9.6 OPTION 6 - JOINT AND SURVIVOR LIFE ANNUITY: Payments will be made during
the lifetimes of the Annuitant and a designated second person. The
amount of such payments will not change by reason of the first death of
a joint Annuitant.
9.7 OPTION 7 - JOINT AND SURVIVOR LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR
5, 10, 15 OR 20 YEARS: Payments will be made for the guaranteed period
chosen (5, 10, 15 or 20 years) and as long thereafter as either of the
joint Annuitants lives.
9.8 OPTION 8 - IRA: This option is available only for IRAs. Annuity payments
may be based on (a) the life expectancy of the Annuitant, (b) the joint
life expectancy of the Annuitant and his or her spouse, or (c) the life
expectancy of the surviving spouse if the Annuitant dies before the
Annuity Date. Payments will be made annually. Each annual payment will
be equal to the remaining value on that January 1, divided by the
applicable current life expectancy, as defined by Internal Revenue
Service regulations. Each subsequent payment will be made on the
anniversary of the Annuity Date. Interest will be credited at our
current rate for this option. On the death of the measuring life or
lives prior to full distribution of the remaining value, the remaining
value will be paid to the Beneficiary in a lump sum.
9.9 DEATH OF ANNUITANT: On the death of an Annuitant who is not an Owner
while guaranteed amounts remain unpaid under options 1, 2, 4, 5 or 7,
the Owner may choose either:
(a) to have payments continue for the amount or period guaranteed;
or
(b) to receive the present value of the remaining guaranteed
payments in a lump sum.
If an Owner who is also the Annuitant dies while guaranteed amounts
remain unpaid, the present value may be paid in a lump sum to the
Beneficiary, if the Beneficiary so elects.
Present values will be computed at the interest rate that was used to
compute the amount of the initial annuity payment.
- 10 -
9.10 PAYMENT: Except for Option 8, monthly payments will be made beginning on
the Annuity Date, but prior to the Annuity Date you may choose a less
frequent payment interval. The amount of each payment on an annual,
semiannual, or quarterly basis will not be less than the monthly payment
computed from the annuity tables in this Contract multiplied by the
appropriate factor.
- 11 -
10. ANNUITY OPTION TABLES
The following tables are based on the 1983 Table "a" projected forward to 2000
for Individual Annuity Valuation with interest at 3%.
MINIMUM GUARANTEED MONTHLY ANNUITY PAYMENT FOR EACH $1,000 APPLIED UNDER OPTION
OPTION 2 (PAYMENTS FOR A FIXED PERIOD)
----------------------------------------------------------------------------------------------
YEARS EACH YEARS EACH YEARS EACH YEARS EACH
PAYABLE PAYMENT PAYABLE PAYMENT PAYABLE PAYMENT PAYABLE PAYMENT
----------------------------------------------------------------------------------------------
5 17.91 9 10.53 13 7.71 17 6.23
6 15.14 10 9.61 14 7.26 18 5.96
7 13.16 11 8.86 15 6.87 19 5.73
8 11.68 12 8.24 16 6.53 20 5.51
----------------------------------------------------------------------------------------------
OPTION 3 (LIFE ANNUITY), OPTION 4 (LIFE ANNUITY WITH 10 OR 20 YEARS GUARANTEED)
AND OPTION 5 (RETURN OF CONTRACT VALUE GUARANTEED)
--------------------------------------------------------------------------------------------------------------------------------
(*)ADJUSTED LIFE 10 YEARS 20 YEARS RETURN OF (*)ADJUSTED LIFE 10 YEARS 20 YEARS RETURN OF
MALE AGE ANNUITY GUARANTEE GUARANTEE CONTRACT VALUE FEMALE AGE ANNUITY GUARANTEE GUARANTEE CONTRACT VALUE
--------------------------------------------------------------------------------------------------------------------------------
56 4.42 4.37 4.20 4.21 56 4.12 4.10 4.01 4.00
57 4.51 4.45 4.27 4.28 57 4.20 4.17 4.07 4.06
58 4.60 4.54 4.33 4.35 58 4.28 4.25 4.13 4.13
59 4.70 4.63 4.39 4.43 59 4.36 4.33 4.19 4.20
60 4.80 4.73 4.46 4.51 60 4.45 4.41 4.26 4.27
61 4.92 4.83 4.52 4.60 61 4.55 4.50 4.33 4.35
62 5.04 4.93 4.59 4.68 62 4.65 4.59 4.40 4.43
63 5.17 5.05 4.65 4.78 63 4.76 4.69 4.47 4.52
64 5.30 5.16 4.72 4.88 64 4.87 4.80 4.54 4.61
65 5.45 5.29 4.78 4.98 65 5.00 4.91 4.61 4.70
66 5.61 5.42 4.85 5.09 66 5.13 5.03 4.68 4.80
67 5.77 5.55 4.91 5.20 67 5.27 5.15 4.76 4.91
68 5.95 5.69 4.97 5.32 68 5.42 5.29 4.83 5.02
69 6.14 5.84 5.03 5.45 69 5.58 5.42 4.90 5.14
70 6.34 5.99 5.08 5.58 70 5.75 5.57 4.97 5.27
71 6.55 6.14 5.13 5.72 71 5.94 5.73 5.03 5.40
72 6.78 6.30 5.18 5.86 72 6.14 5.89 5.09 5.54
73 7.02 6.46 5.23 6.02 73 6.36 6.06 5.15 5.69
74 7.28 6.63 5.27 6.18 74 6.60 6.23 5.21 5.85
75 7.55 6.80 5.31 6.34 75 6.86 6.42 5.25 6.02
76 7.84 6.97 5.34 6.52 76 7.13 6.61 5.30 6.20
77 8.16 7.15 5.37 6.71 77 7.43 6.80 5.34 6.39
78 8.49 7.32 5.40 6.90 78 7.75 7.00 5.37 6.59
79 8.85 7.50 5.42 7.11 79 8.10 7.20 5.40 6.80
80 9.24 7.67 5.44 7.32 80 8.47 7.40 5.43 7.02
81 9.65 7.84 5.46 7.55 81 8.87 7.60 5.45 7.26
82 10.09 8.01 5.47 7.79 82 9.31 7.79 5.47 7.51
83 10.55 8.17 5.49 8.04 83 9.79 7.99 5.48 7.77
84 11.05 8.32 5.49 8.31 84 10.31 8.17 5.49 8.05
85 11.58 8.47 5.50 8.59 85 10.87 8.35 5.50 8.36
--------------------------------------------------------------------------------------------------------------------------------
OPTION 6 (JOINT AND SURVIVOR LIFE ANNUITY)
---------------------------------------------------------------------------------------------------------------------------
(*)ADJUSTED (*)ADJUSTED MALE AGE (*)ADJUSTED
FEMALE FEMALE
AGE 50 55 60 65 70 75 80 85 AGE
---------------------------------------------------------------------------------------------------------------------------
50 3.46 3.54 3.60 3.65 3.69 3.71 3.72 3.73 50
55 3.58 3.70 3.80 3.88 3.94 3.98 4.01 4.03 55
60 3.68 3.85 4.00 4.13 4.24 4.32 4.37 4.40 60
65 3.77 3.98 4.20 4.40 4.59 4.73 4.83 4.90 65
70 3.84 4.09 4.38 4.67 4.96 5.21 5.41 5.55 70
75 3.89 4.18 4.52 4.92 5.34 5.74 6.10 6.38 75
80 3.92 4.24 4.63 5.11 5.67 6.26 6.85 7.37 80
85 3.95 4.28 4.71 5.25 5.93 6.72 7.58 8.45 85
---------------------------------------------------------------------------------------------------------------------------
Information for ages or Annuity Options not shown will be furnished on request.
(*)"Adjusted Age" is the actual age on the Annuity Date reduced by one year for
each 10 full years between January 1, 2000 and the Annuity Date. For example:
--------------------------------------------------------
ANNUITY DATE ADJUSTED AGE
--------------------------------------------------------
Before 2010 Actual Age
--------------------------------------------------------
2010 to 2019 Subtract 1 year from actual age
--------------------------------------------------------
2020 to 2029 Subtract 2 years from actual age
--------------------------------------------------------
2030 to 2039 Subtract 3 years from actual age
--------------------------------------------------------
2040 to 2049 Subtract 4 years from actual age
--------------------------------------------------------
- 12 -
================================================================================
SUPPLEMENTAL CONTRACT SCHEDULE -----------
IRA
Final as of
05-06-2002
VERSION A
-----------
▇▇▇▇▇▇▇ ▇▇▇▇▇ LIFE INSURANCE COMPANY Contract Number: [%999999999]
Service Center: Contract Date: [October 1, 2001]
P.O. Box 44222 Issue Date: [October 2, 2001]
Jacksonville, FL 32231-4222 Financial Advisor:
▇-▇▇▇-▇▇▇-▇▇▇▇ [▇▇▇ ▇▇▇▇▇▇]
--------------------------------------------------------------------------------
CONTRACT INFORMATION
Owner Name: [▇▇▇▇ ▇ ▇▇▇▇▇▇] Annuitant: [▇▇▇▇ ▇ ▇▇▇▇▇▇]
Joint Annuitant: [▇▇▇▇ ▇ PUBLIC]
Address: [▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇]
[▇▇▇▇▇▇▇▇, ▇▇▇ 77777]
Beneficiary: [▇▇▇▇ ▇ PUBLIC]
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
GUARANTEED MINIMUM INCOME BENEFIT (GMIB) RIDER (GOLD(SM) BENEFIT RIDER)
--------------------------------------------------------------------------------
CHANGE OF ANNUITANT EFFECTIVE DATE: [September 99, 9999]
BENEFIT BASE LIMITATION DATE: [October 1, 2016]
The Contract Anniversary on or following the oldest Annuitant's 80th birthday, or the
Change of Annuitant Effective Date, if earlier.
FIRST EXERCISE ANNIVERSARY DATE: [October 1, 2011]
LAST EXERCISE ANNIVERSARY DATE: [October 1, 2021]
The Contract Anniversary on or following the oldest Annuitant's 85th birthday.
LAST EXERCISE DATE: [October 31, 2021]
The 30th day following the Last Exercise Anniversary Date.
EXERCISE PERIOD: You may exercise GMIB on or during the 30-day period following each Contract
Anniversary beginning with the First Exercise Anniversary Date and ending with the
Last Exercise Anniversary Date.
--------------------------------------------------------------------------------
--------------------------------------
Print this supplemental schedule page
only if either Benefit Base Limitation
Date or Last Exercise Anniversary
Date changes due to a change of
Annuitant.
--------------------------------------
================================================================================