FIRST METLIFE INVESTORS INSURANCE COMPANY
[▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇
▇▇▇ ▇▇▇▇, ▇▇▇ ▇▇▇▇ ▇▇▇▇▇]
FIRST METLIFE INVESTORS INSURANCE COMPANY (referred to as "we, us and our") will
make Annuity Payments as described in this Contract beginning on the Annuity
Date.
This Contract is issued in return for the payment of the Purchase Payment.
RIGHT TO RETURN CONTRACT
This Contract may be returned for any reason within 10 days after you receive it
by mailing or delivering the Contract to either us or the agent who sold it.
Return of this Contract by mail is effective on being postmarked, properly
addressed and postage prepaid. We will promptly refund your Account Value as of
the Business Day we receive your Contract. Your Account Value may be more or
less than your Purchase Payment.
With the combined annual Asset-Based Insurance Charges of 1.55%, the smallest
rate of investment return required to ensure that the dollar amount of variable
annuity payments does not decrease, is 4.55% for variable annuity options based
on an assumed interest rate (AIR) of 3.00%.
Signed for the Company.
/s/ ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ Secretary /s/ ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ President
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INDIVIDUAL SINGLE PURCHASE PAYMENT
DEFERRED VARIABLE ANNUITY CONTRACT
NONPARTICIPATING
READ YOUR CONTRACT CAREFULLY
ANNUITY PAYMENTS, DEATH BENEFITS, WITHDRAWAL VALUES AND ANY OTHER CONTRACT VALUE
PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE
SEPARATE ACCOUNT, ARE VARIABLE, MAY INCREASE OR DECREASE IN ACCORDANCE WITH
FLUCTUATIONS IN THE NET INVESTMENT FACTOR, AS APPLICABLE, AND ARE NOT GUARANTEED
AS TO DOLLAR AMOUNT, UNLESS OTHERWISE SPECIFIED.
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TABLE OF CONTENTS
Page
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Contract Schedule........................................................ 3
Definitions.............................................................. 4
General Provisions....................................................... 4
Annuitant, Ownership, Assignment Provisions.............................. 5
Beneficiary Provisions................................................... 5
Purchase Payment Provisions.............................................. 6
Account Value Provision.................................................. 6
Separate Account Provisions.............................................. 6
Transfer Provisions...................................................... 7
Death Benefit Provisions................................................. 7
Withdrawal Provisions.................................................... 8
Annuity Provisions....................................................... 8
Suspension or Deferral of Payments or Transfers from the
Separate Account...................................................... 10
Reserves, Values and Benefits............................................ 10
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DEFINITIONS
ACCOUNT VALUE
The sum of your interests in the Subaccounts of the Separate Account.
ACCUMULATION UNIT
A unit of measure used to calculate the Account Value in a Subaccount of the
Separate Account during the Accumulation Period.
ACCUMULATION PERIOD
The period prior to the Annuity Date.
ANNUITANT
The natural person(s) on whose life Annuity Payments are based. You may change
the Annuitant at any time prior to the Annuity Date unless an Owner is not a
natural person. Any reference to Annuitant shall also include any Joint
Annuitant under an Annuity Option. The Annuitant and Owner do not have to be the
same person.
ANNUITY PAYMENTS
The series of payments made to the Owner or other named payee after the Annuity
Date under the Annuity Option elected.
ANNUITY DATE
The date on which Annuity Payments begin. The Annuity Date is shown on the
Contract Schedule.
ANNUITY PERIOD
The period starting on the Annuity Date during which Annuity Payments are
payable.
ANNUITY SERVICE OFFICE
The office indicated on the Contract Schedule to which notices and requests must
be sent, or as otherwise directed by Notice from us. All sums payable by us
under the Contract are payable through the Annuity Service Office.
ANNUITY UNIT
A unit of measure used to calculate Variable Annuity Payments after the Annuity
Date.
ATTAINED AGE
The age of any Owner or Annuitant on his/her last birthday.
BENEFICIARY
The person(s) or entity(ies) you name to receive a death benefit payable under
this Contract upon the death of the Owner or a Joint Owner, or in certain,
circumstances, an Annuitant.
BUSINESS DAY
Each day that the New York Stock Exchange is open for business. The Separate
Account will be valued each Business Day. A Business Day ends as of the close of
regular trading on the New York Stock Exchange.
COMPANY
First MetLife Investors Insurance Company.
CONTRACT ANNIVERSARY
An anniversary of the Issue Date of this Contract.
CONTRACT YEAR
A one-year period starting on the Issue Date and on each Contract Anniversary
thereafter.
FIXED ANNUITY PAYMENTS
A series of payments made by us during the Annuity Period which we guarantee as
to dollar amount. Fixed Annuity payments are made out of our General Account.
GENERAL ACCOUNT
All of our assets other than those in any segregated asset account.
INVESTMENT OPTIONS
The investment choices within the Separate Account available under the Contract.
ISSUE DATE
The date this Contract was issued. The Issue Date is shown on the Contract
Schedule.
JOINT OWNER
If there is more than one Owner, each Owner shall be a Joint Owner of the
Contract.
NOTICE
Any form of communication providing information we need, either in signed
writing or another manner that we approve in advance. All Notices to us must be
sent to our Annuity Service Office and received in good order. To be effective
for a Business Day, a Notice must be received in good order prior to the end of
that Business Day.
OWNER
The person(s) or entity(ies) entitled to the ownership rights under this
Contract. If Joint Owners are named, all references to Owner shall mean Joint
Owners. (Referred to as "you or yours.")
PURCHASE PAYMENT
The amount paid to us under this Contract as consideration for the benefits it
provides, less any Premium and Other Taxes deducted upon receipt of the Purchase
Payment.
SEPARATE ACCOUNT
A segregated asset account of the Company designated on the Contract Schedule.
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SUBACCOUNT
Separate Account assets are divided into Subaccounts. Assets of each Subaccount
will be invested in shares of an Investment Option.
VARIABLE ANNUITY PAYMENTS
A series of payments made by us during the Annuity Period which vary in amount
with the investment experience of each applicable Subaccount.
WITHDRAWAL VALUE
The Account Value less any applicable withdrawal charge, less any Premium and
Other Taxes, and less any Account Fee.
GENERAL PROVISIONS
THE CONTRACT -- The entire contract consists of this Contract, any riders or
endorsements attached to this Contract, and a copy of the application, if one is
attached to this Contract when issued. This Contract must be returned to us
prior to the payment of any benefit unless otherwise waived by us. Prior to any
payment of a death claim, due proof of death must be submitted to us.
INCONTESTABILITY
We will not contest the validity of this Contract at any time following the
Issue Date.
NON-PARTICIPATING
This Contract will not share in any distribution by us of dividends.
MISSTATEMENT OF AGE OR SEX
We may require proof of age or sex of the Annuitant before making any Annuity
Payments under this Contract which are measured by the Annuitant's life. If the
age or sex of the Annuitant has been misstated, the amount payable will be the
amount that the Account Value would have provided at the correct age or sex.
Once Annuity Payments have begun, any underpayments will be made up in one sum
with the next Annuity Payment. Any overpayments will be deducted from future
Annuity Payments until the total is repaid.
PROTECTION OF PROCEEDS
No Beneficiary may commute, encumber, alienate or assign any payments under this
Contract before they are due. To the extent permitted by law, no payments will
be subject to the debts, contracts or engagements of any payee or to any
judicial process to levy upon or attach the same for payment thereof.
REPORTS
At least once each calendar year we will furnish you with a report showing the
Account Value and any other information as may be required by law. We will send
you confirmations of certain transactions. Reports and confirmations will be
sent to your last known address. You will have 60 days from the date you receive
your report or confirmation to inform us of any errors in the report or
confirmation, otherwise the report or confirmation will be deemed to be final
and correct.
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PREMIUM AND OTHER TAXES
Any taxes paid by us to any governmental entity relating to this Contract will
be deducted from the Purchase Payment or Account Value when incurred. We will,
at our sole discretion, determine when taxes relate to the Contract, including
when they have resulted from: the investment experience of the Separate Account;
receipt by us of the Purchase Payment; or commencement of Annuity Payments. We
may, at our sole discretion, pay taxes when due and deduct that amount from the
Account Value at a later date. Payment at an earlier date does not waive any
right we may have to deduct amounts at a later date. We will deduct any
withholding taxes required by applicable law.
EVIDENCE OF SURVIVAL
We may require satisfactory evidence of the continued survival of any person(s)
on whose life Annuity Payments are based. We reserve the right to discontinue
Annuity Payments until satisfactory proof of continued survival is received.
MODIFICATION OF CONTRACT
This Contract may be modified by us in order to maintain compliance with
applicable state and federal law. This Contract may be changed or altered only
in writing signed by our President or our Secretary.
ANNUITANT, OWNERSHIP,
ASSIGNMENT PROVISIONS
OWNER
You, as the Owner, have all the interest and rights under this Contract. The
Owner is the person designated as such on the Issue Date, unless changed.
You may change the Owner at any time. A change of Owner will automatically
revoke any prior designation of Owner. A request for change must be:
1. by Notice; and
2. received by us at the Annuity Service Office.
The change will become effective as of the date the Notice is signed. A new
designation of Owner will not apply to any payment made or action taken by us
prior to the time the new designation was recorded at our Annuity Service
Office. Any change of Owner is subject to our underwriting rules in effect at
the time of the request.
JOINT OWNER
A Contract may be owned by Joint Owners, limited to two natural persons. Joint
Owners have equal ownership rights and must both authorize any exercising of
those ownership rights unless otherwise allowed by us. Upon the death of either
Owner, the surviving Joint Owner will be deemed to be the primary Beneficiary.
ANNUITANT
The Annuitant is the person on whose life Annuity Payments are based. The
Annuitant is the person designated by you as of the Issue Date, unless changed
prior to the Annuity Date. The Annuitant may not be changed in a Contract which
is owned by a non-natural person. Any change of Annuitant is subject to our
underwriting rules in effect at the time of the request.
ASSIGNMENT
You may assign your rights under this Contract. We will not be bound by any
assignment until Notice of the assignment is recorded by us. We are not
responsible for the validity of any assignment. We will not be liable for any
payment or other settlement made by us before we record the Notice of the
assignment.
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BENEFICIARY PROVISIONS
BENEFICIARY
The Beneficiary designation in effect on the Issue Date will remain in effect,
unless changed. Unless you provide otherwise, the death benefit will be paid in
equal shares or all to the Beneficiary(ies) as follows:
1. to the primary Beneficiary(ies) who survive you (or if the Owner is not a
natural person, the Annuitant's death); or if there are none, then
2. to the contingent Beneficiary(ies) who survive you (or if the Owner is not
a natural person, the Annuitant's death); or if there are none, then
3. to your estate.
If Joint Owners have been designated, unless you inform us otherwise, the
surviving Joint Owner will be treated as the primary Beneficiary. Any other
Beneficiary designation will be treated as a contingent Beneficiary unless
otherwise indicated in a Notice to us.
CHANGE OF BENEFICIARY
Subject to the rights of any irrevocable Beneficiary, you may change the primary
Beneficiary or contingent Beneficiary. A change may be made by filing a Notice
with us. The change will take effect as of the date the Notice is signed. We
will not be liable for any payment made or action taken before we record the
change.
PURCHASE PAYMENT PROVISIONS
PURCHASE PAYMENT
The Purchase Payment is due on the Issue Date and is shown on the Contract
Schedule.
ALLOCATION OF PURCHASE PAYMENT
The allocation of the Purchase Payment is made in accordance with your selection
made at the Issue Date. Allocation of the Purchase Payment is subject to the
Allocation Requirements set forth on the Contract Schedule. If there are Joint
Owners, unless we are instructed to the contrary, allocation instructions will
be accepted from either one of the Joint Owners.
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ACCOUNT VALUE PROVISION
ACCOUNT VALUE
Your Account Value for any Business Day is the sum of your interests in the
Subaccounts of the Separate Account as of such Business Day.
The portion of your Account Value in a Subaccount is determined by multiplying
the number of Accumulation Units allocated to the Contract for the Subaccount by
the Accumulation Unit Value.
ACCOUNT FEE
We will deduct an Account Fee from your Account Value as set forth on the
Contract Schedule.
SEPARATE ACCOUNT PROVISIONS
THE SEPARATE ACCOUNT
The Separate Account is designated on the Contract Schedule and consists of
assets, which are kept separate from our General Account assets and all of our
other segregated asset accounts. The assets of the Separate Account, equal to
reserves and other liabilities of your Contract and those of other owners who
have an interest in the Separate Account, will not be charged with liabilities
arising out of any other business we may do.
The Separate Account assets are divided into Subaccounts. The assets of each
Subaccount are allocated to an Investment Option.
INVESTMENTS OF THE SEPARATE ACCOUNT
The Purchase Payment applied to the Separate Account is allocated to the
Subaccounts of the Separate Account. We may, from time to time, add additional
Investment Options. You may be permitted to transfer all or a portion of your
Account Value to the additional Investment Option(s). However, the right to make
any transfer will be limited by any terms and conditions in effect at the time
of transfer.
If the shares of any of the Investment Options become unavailable for investment
by the Separate Account, or we deem further investment in these shares
inappropriate, we may prohibit or otherwise limit further purchase of such
shares or substitute shares of another Investment Option for shares already
purchased under this Contract, subject to obtaining any necessary regulatory
approvals.
CHANGE IN OPERATION
We reserve the right to transfer assets of the Separate Account to another
account, and to modify the structure or operation of the Separate Account,
subject to obtaining any necessary regulatory approvals. If we do so, we
guarantee that such modification will not affect your Account Value.
VALUATION OF ASSETS
Assets of the Separate Account are valued at their fair market value in
accordance with our procedures.
ACCUMULATION UNIT
Accumulation Units shall be used to account for all amounts allocated to or
withdrawn from a Subaccount of the Separate Account as a result of the Purchase
Payment, withdrawals, transfers, or fees and charges. We will determine the
number of Accumulation Units of a Subaccount purchased or cancelled. This is
done by dividing the amount allocated to (or the amount withdrawn from) the
Subaccount, by the dollar value of one Accumulation Unit of the Subaccount as of
the end of the Business Day during which the Notice for the transaction is
received at the Annuity Service Office.
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ACCUMULATION UNIT VALUE
The initial Accumulation Unit Value for each Subaccount was set by us.
Subsequent Accumulation Unit values for each Subaccount are determined by
multiplying the Accumulation Unit Value for the immediately preceding Business
Day by the Net Investment Factor of the Subaccount for the current Business Day.
The Accumulation Unit Value may increase or decrease from Business Day to
Business Day.
NET INVESTMENT FACTOR
The Net Investment Factor for each Subaccount is determined by dividing A by B
and multiplying by (1-C) where:
A is (i) the net asset value per share of the Investment Option held by the
Subaccount at the end of the current Business Day; plus
(ii) any dividend or capital gains per share declared on behalf of such
Investment Option that has an ex-dividend date as of the current
Business Day.
B is the net asset value per share of the Investment Option held by the
Subaccount for the immediately preceding Business Day.
C is (i) the Separate Account Product Charges which are shown on the Contract
Schedule for each day since the last Business Day. The daily charge
is equal to the annual Separate Account Product Charges divided by
365; plus
(ii) a charge factor, if any, for any taxes or any tax reserve we have
established as a result of the operation of this Subaccount.
PRODUCT CHARGES
We deduct Product Charges from the Separate Account and Account Value as shown
on the Contract Schedule.
TRANSFER PROVISIONS
You may make certain transfers of your Account Value subject to the provisions
set forth below. You may elect to make these transfers by telephone or other
means acceptable to us. However, to elect this option you must first provide us
with a Notice in a form that we may require. If there are Joint Owners, unless
we are instructed to the contrary, transfer instructions will be accepted from
either one of the Joint Owners. We will use reasonable procedures to confirm
that instructions are genuine. Neither we nor our Annuity Service Office will be
liable for any transfers made in accordance with your instructions. All
transfers made on the same Business Day will be treated as one transfer. A
transfer will be made as of the end of a Business Day when we receive a Notice
containing all the required information necessary to process the request.
TRANSFERS DURING THE ACCUMULATION PERIOD
During the Accumulation Period, you may ask us to transfer your Account Value
from one Subaccount to another, subject to the following:
1. the maximum number of transfers per Contract Year is shown on the Contract
Schedule;
2. we reserve the right to assess a transfer fee if the number of transfers
exceeds the maximum number of permissible free transfers shown on the
Contract Schedule;
3. the minimum and maximum amounts which may be transferred are shown on the
Contract Schedule;
4. your right to make transfers is subject to limitations or modification by
us if we determine, in our sole opinion, that the exercise of the right by
one or more owners with interests in the Subaccount is, or would be, to the
disadvantage of other owners. Restrictions may be applied in any manner
reasonably designed to prevent any use of the transfer right that is
considered by us to be to the disadvantage of other owners. A limitation or
modification could be applied to transfers to, or from, one or more of the
Subaccounts and could include, but is not limited to:
a. the requirement of a minimum time period between each transfer;
b. not accepting a transfer request from an agent acting under a
power of attorney on behalf of more than one owner;
c. limiting the dollar amount that may be transferred between the
Subaccounts by an owner at any one time;
d. requiring that a written transfer request be provided to us,
signed by an owner;
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5. to the extent permitted by applicable law, during times of drastic economic
or market conditions, we may suspend the transfer privilege temporarily
without notice and treat transfer requests based on their separate
components (a redemption order with a simultaneous request for purchase of
another Subaccount). In such a case, the redemption order would be
processed at the source Subaccount's next determined Accumulation Unit
Value. However, the purchase into the new Subaccount would be effective at
the next determined Accumulation Unit Value for the new Subaccount only
after we receive the proceeds from the source Subaccount, or we otherwise
receive cash on behalf of the source Subaccount;
6. transfers do not change any pre-scheduled transfers.
TRANSFERS DURING THE ANNUITY PERIOD
Transfers made during the Annuity Period are subject to the following:
1. the maximum number of transfers between Subaccounts is shown on the
Contract Schedule;
2. you may not make a transfer from the General Account to the Separate
Account;
3. transfers among Subaccounts will be made by converting the number of
Annuity Units being transferred to the number of Annuity Units of the
Subaccount to which the transfer is made, so that the next Annuity Payment
if it were made at that time would be the same amount that it would have
been without the transfer. Thereafter, Annuity Payments will reflect
changes in the value of the new Annuity Units; and
4. you may make a transfer from the Separate Account to the General Account.
The amount transferred to the General Account from a Subaccount of the
Separate Account will be equal to the product of "(a)" multiplied by "(b)"
multiplied by "(c)", where (a) is the number of Annuity Units representing
your interest in the Subaccount per Annuity Payment; (b) is the Annuity
Unit value for the Subaccount; and (c) is the present value of $1.00 per
payment period for the remaining annuity benefit period based on the
Attained Age of the Annuitant at time of transfer, and calculated using the
same actuarial basis as the Variable Annuity rates applied on the Annuity
Date for the Annuity Option elected. ▇▇▇▇▇▇▇ transferred to the General
Account will be applied under the Annuity Option elected at the Attained
Age of the Annuitant at the time of the transfer using the Fixed Annuity
Option Table. If at the time of transfer, the then current Fixed Annuity
Option rates applicable to this class of contracts provide a greater
payment, the greater payment will be made. All amounts and Annuity Unit
values will be determined as of the end of the Business Day on which we
receive a Notice.
DEATH BENEFIT PROVISIONS
DEATH OF OWNER DURING THE ACCUMULATION PERIOD
During the Accumulation Period, the death benefit will be paid to your
Beneficiary(ies) upon your death, or upon the first death of a Joint Owner.
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD
The death benefit is the Account Value determined as of the end of the Business
Day on which we have received both due proof of death and an election for the
payment method. The death benefit amount in the Separate Account remains in the
Separate Account until distribution begins. From the time the death benefit is
determined until complete distribution is made, the amount in the Separate
Account will continue to be subject to investment risk. This risk is borne by
the Beneficiary.
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD
A Beneficiary must elect the death benefit to be paid under one of the options
below (unless the Owner has previously made such election) in the event of the
death of an Owner during the Accumulation Period. In addition, if the
Beneficiary is the spouse of the Owner, he or she may elect to continue the
Contract in his or her own name and exercise all the Owner's rights under the
Contract. The death benefit options available under the Contract are:
OPTION 1 -- lump sum payment of the death benefit; or
OPTION 2 -- the payment of the entire death benefit within five (5) years of the
date of the death of the Owner or the first Joint Owner to die; or
OPTION 3 -- payment of the death benefit under an Annuity Option over the
lifetime of the Beneficiary or over a period not extending beyond the life
expectancy of the Beneficiary with distribution beginning within one year of the
date of death of the Owner or the first Joint Owner to die.
Any portion of the death benefit not applied under Option 3 within one (1) year
of the date of the Owner's or Joint Owner's death must be distributed within
five (5) years of the date of death.
If a lump sum payment is requested, the amount will be paid within seven (7)
days of receipt of proof of death and the election, unless the Suspension or
Deferral of Payments Provision is in effect.
Payment to the Beneficiary, other than in a lump sum, may only be elected during
the sixty (60) day period beginning with the date of receipt of proof of death.
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DEATH OF OWNER DURING THE ANNUITY PERIOD
If the Owner or a Joint Owner, who is not the Annuitant, dies during the Annuity
Period, any remaining payments under the Annuity Option elected will continue at
least as rapidly as under the method of distribution in effect at the time of
the Owner's death. Upon the death of the Owner or a Joint Owner during the
Annuity Period, the Beneficiary becomes the Owner.
DEATH OF ANNUITANT
Upon the death of an ▇▇▇▇▇▇▇▇▇, who is not the Owner or Joint Owner, during the
Accumulation Period, the Owner automatically becomes the Annuitant. The Owner
may select a new Annuitant if the Owner does not want to be the Annuitant. Any
new Annuitant designation will be subject to the Company's underwriting rules
then in effect. However, if the Owner is a non-natural person, the death of the
primary Annuitant will be treated as the death of the Owner.
Upon the death of the Annuitant during the Annuity Period, the death benefit, if
any, will be as specified in the Annuity Option elected. Death benefits will be
paid at least as rapidly as under the method of distribution in effect at the
Annuitant's death.
PAYMENT OF DEATH BENEFIT
We will require due proof of death before any death benefit is paid. Due proof
of death will be:
1. a certified death certificate;
2. a certified decree of a court of competent jurisdiction as to the finding
of death;
3. a written statement by a licensed medical doctor who attended the deceased;
or
4. any other proof satisfactory to us.
Any death benefit will be paid in accordance with applicable law or regulations
governing death benefit payments.
In all events, this Contract will be continued and administered in accordance
with Section 72 (s) of the Internal Revenue Code, as amended.
WITHDRAWAL PROVISIONS
WITHDRAWALS
Prior to the Annuity Date, you may, upon Notice to us, make a total or partial
withdrawal of the Withdrawal Value. A withdrawal will result in the cancellation
of Accumulation Units from each applicable Subaccount of the Separate Account in
the ratio that the Account Value in the Subaccount bears to the total Account
Value. You must specify in a Notice to us from which Subaccount(s) values are to
be withdrawn if other than the above method is desired. We will pay the amount
of any withdrawal within seven (7) days of receipt of the Notice in good order
unless the Suspension or Deferral of Payments or Transfers from the Separate
Account provision is in effect.
Each partial withdrawal must be for an amount which is not less than the minimum
shown on the Contract schedule or, if smaller, the remaining Withdrawal Value.
If the withdrawal would result in the Account Value being less than the Minimum
Withdrawal Value which must remain in the Contract after a Partial Withdrawal as
shown on the Contract schedule we will treat the withdrawal request as a request
for a full withdrawal.
WITHDRAWAL CHARGE
Upon withdrawal of all or a portion of the Account Value, a Withdrawal Charge as
set forth on the Contract schedule may be assessed. Under certain circumstances,
described on the Contract schedule, a withdrawal may be made without the
imposition of a Withdrawal Charge.
For a partial withdrawal, the Withdrawal Charge will be deducted from the
remaining Account Value, if sufficient, or from the amount withdrawn.
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ANNUITY PROVISIONS
ANNUITY DATE
The Annuity Date is shown on the Contract Schedule. Prior to the Annuity Date,
you may, subject to the Annuity Requirements set forth on the Contract Schedule,
change the Annuity Date upon thirty (30) days prior Notice to us.
ELECTION OF ANNUITY OPTION
The Annuity Option is elected by you. If no Annuity Option is elected, Option 2
- Life Annuity with Ten (10) Years of Annuity Payments Guaranteed will
automatically be applied. Upon thirty (30) days Notice prior to the Annuity Date
you may change the Annuity Option.
ANNUITY OPTIONS
You may elect to receive Annuity Payments monthly, quarterly, semi-annually or
annually. The following Annuity Options, or any other Annuity Option acceptable
to you and us, may be elected:
OPTION 1 -- LIFE ANNUITY
We will make Annuity Payments, payable at the frequency elected, during the
lifetime of the Annuitant and terminating with the last payment due prior to the
Annuitant's death.
OPTION 2 -- LIFE ANNUITY WITH 10 YEARS OF ANNUITY PAYMENTS GUARANTEED
We will make Annuity Payments, payable at the frequency elected, during the
lifetime of the Annuitant with a guarantee that if at the Annuitant's death
there have been less than 10 years of Annuity Payments made as selected, Annuity
Payments will continue for the remainder of the Guaranteed Period. You may elect
to have the present value of the guaranteed Variable Annuity Payments remaining,
as of the date due proof of the Annuitant's death is received at our Annuity
Service Office, commuted at the Assumed Investment Return selected. We will
require the return of this Contract and proof of death prior to the payment of
any commuted values.
OPTION 3 -- JOINT AND LAST SURVIVOR ANNUITY
We will make Annuity Payments, payable at the frequency elected, during the
joint lifetime of the Annuitant and the Joint Annuitant. Upon the death of
either the Annuitant or Joint Annuitant, Annuity Payments will continue to be
paid during the remaining lifetime of the survivor. Annuity Payments cease with
the final Annuity Payment due prior to the last survivor's death.
OPTION 4 -- JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEARS OF ANNUITY PAYMENTS
GUARANTEED
We will make Annuity Payments, payable at the frequency elected, during the
joint lifetime of the Annuitant and the Joint Annuitant. Upon the death of
either the Annuitant or Joint Annuitant, Annuity Payments will continue to be
paid during the remaining lifetime of the survivor. If at the last death of the
Annuitant and the Joint Annuitant, there have been less than 10 years of Annuity
Payments made as selected, Annuity Payments will continue to be made for the
remainder of the Guaranteed Period. You may elect to have the present value of
the guaranteed Variable Annuity Payments remaining, as of the date due proof of
the Annuitant's death is received at our Annuity Service Office, commuted at the
Assumed Investment Return selected. We will require the return of this Contract
and proof of death prior to the payment of any commuted values.
ANNUITY
You can elect to have the Annuity Option payable as Fixed Annuity Payments or
Variable Annuity Payments or a combination. Fixed Annuity Payments are
guaranteed as to dollar amount. Variable Annuity Payments will reflect the
investment experience of the Separate Account in accordance with the allocation
of the Account Value to the Subaccounts. Unless another payee is designated, you
will be the payee of the Annuity Payments.
The Adjusted Account Value will be applied to the applicable Fixed and/or
Variable Annuity Tables to determine your first Annuity Payment. The Adjusted
Account Value is determined on the Annuity Calculation Date which is a Business
Day no more than five Business Days prior to the Annuity Date. The Adjusted
Account Value is the Account Value, less any Premium and Other Taxes or other
applicable taxes and less the Account Fee. The amount of the first payment for
each $1,000 of Adjusted Account Value is shown in the Annuity Tables.
FIXED ANNUITY
Fixed Annuity Payments are based upon the Annuity Option elected, the
Annuitant's Attained Age and sex, and the appropriate Fixed Annuity Option
Table. If, as of the Annuity Calculation Date, the then-current Fixed Annuity
Option rates applicable to this class of contracts provide an Annuity Payment
greater than that which is guaranteed under the same Annuity Option under this
Contract, then the greater payment will be made.
6410 (11/05)
VARIABLE ANNUITY
Variable Annuity Payments are not predetermined as to dollar amount; and will
increase or decrease in proportion to the amount that the Net Investment Factor
exceeds the Assumed Investment Return selected.
The dollar amount of the first Variable Annuity Payment is determined as
follows. The first Variable Annuity Payment will be based upon the Annuity
Option elected, the Annuitant's Attained Age and sex, and the appropriate
Variable Annuity Option Table. If, as of the Annuity Calculation Date, the then
current Variable Annuity Option rates applicable to this class of Contracts
provide a first Annuity Payment greater than that which is guaranteed under the
same Annuity Option under this Contract, the greater payment will be made.
The dollar amount of Variable Annuity Payments for each applicable Subaccount
after the first payment is determined as follows:
1. the dollar amount of the first Variable Annuity Payment is divided by the
value of an Annuity Unit for each applicable Subaccount as of the Annuity
Calculation Date. This establishes the number of Annuity Units for each
monthly payment. The number of Annuity Units for each applicable Subaccount
remains fixed during the Annuity Period, unless you transfer values from
the Subaccount to another Subaccount;
2. the fixed number of Annuity Units per payment in each Subaccount is
multiplied by the Annuity Unit value for that Subaccount for the Business
Day for which the Annuity Payment is being calculated. This result is the
dollar amount of the payment for each applicable Subaccount, less any
Account Fee.
The total dollar amount of each Variable Annuity Payment is the sum of all
Subaccount Variable Annuity Payments.
ANNUITY UNIT
The initial Annuity Unit Value for each Subaccount of the Separate Account was
set by us.
The subsequent Annuity Unit value for each Subaccount is determined by
multiplying the Annuity Unit value for the immediately preceding Business Day by
the Net Investment Factor for the Subaccount for the current Business Day and
multiplying the result by a factor for each day since the last Business Day
which offsets the Assumed Investment Return used to develop the Variable Annuity
Tables. You select the Assumed Investment Return (which must be acceptable to
us) to be used at the time this Contract is issued. Upon thirty (30) days
Notice, prior to the Annuity Date, you may change the selected Assumed
Investment Return. If you do not select an Assumed Investment Return, the
Assumed Investment Return will be the one shown in the Annuity Requirements on
the Contract Schedule.
FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS
Annuity Payments will be paid as monthly installments or at any frequency
acceptable to you and us. The Adjusted Account Value on the Annuity Calculation
Date is applied to the Annuity Table for the Annuity Option elected. If the
amount of the Adjusted Account Value to be applied under an Annuity Option is
less than $5,000, we reserve the right to make one lump sum payment in lieu of
Annuity Payments. If the amount of any Annuity Payment would be or becomes less
than $100, we may reduce the frequency of payments to an interval which will
result in each payment being at least $100.
ANNUITY PAYMENT GUARANTEE
We guarantee that the dollar amount of each Variable Annuity Payment after the
first Annuity Payment will not be affected by variations in actual mortality
experience or expenses, but only by investment experience. The amount of each
Fixed Annuity Payment will not change.
BASIS OF PAYMENTS
The Annuity Tables are based on the tables defined under the Annuity
Requirements set forth on the Contract Schedule.
6410 (11/05)
SUSPENSION OR DEFERRAL OF PAYMENTS OR TRANSFERS FROM THE SEPARATE ACCOUNT
We reserve the right to suspend or postpone payments for a withdrawal or
transfer for any period when:
1. the New York Stock Exchange is closed (other than customary weekend and
holiday closings);
2. trading on the New York Stock Exchange is restricted;
3. an emergency exists as a result of which disposal of securities held in the
Separate Account is not reasonably practicable or it is not reasonably
practicable to determine the value of the Separate Account's net assets; or
4. during any other period when the Securities and Exchange Commission, by
order, so permits for the protection of the Owner.
The applicable rules and regulations of the Securities and Exchange Commission
will govern as to whether the conditions described in (2) and (3) exist.
RESERVES, VALUES AND BENEFITS
All reserves are greater than, or equal to, those required by statute. Any
values and death benefits that may be available under this Contract are not less
than the minimum benefits required by any law of the state in which this
Contract is delivered.
6410 (11/05)
FIXED ANNUITY TABLES AND VARIABLE ANNUITY TABLES
AMOUNT OF FIRST MONTHLY PAYMENT
PER $1000 OF CONTRACT VALUE
Annuitant Only
Option 1: Life Annuity
----------------------------
Attained Age
of Annuitant Male Female
----------------------------
55 3.95 3.72
60 4.30 4.01
65 4.75 4.40
70 5.37 4.92
75 6.24 5.64
80 7.43 6.68
85 9.08 8.22
Option 2: Life Annuity with 10 Years of Annuity Payments Guaranteed
----------------------------
Attained Age
of Annuitant Male Female
----------------------------
55 3.93 3.71
60 4.26 3.99
65 4.68 4.36
70 5.23 4.84
75 5.92 5.47
80 6.73 6.29
85 7.61 7.26
Annuitant and Joint Annuitant
Option 3: Joint and Last Survivor Life Annuity
Age of Female Joint Annuitant
------------------------------------------------------------------
Attained Age 10 Years 5 Years Same 5 Years 10 Years
of Male ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Younger Age Older Older
------------------------------------------------------------------
55 3.21 3.33 3.44 3.56 3.66
60 3.37 3.52 3.67 3.81 3.94
65 3.58 3.77 3.96 4.15 4.33
70 3.84 4.09 4.35 4.61 4.85
75 4.19 4.53 4.89 5.25 5.58
80 4.66 5.13 5.64 6.15 6.59
85 5.31 5.98 6.71 7.42 8.02
Option 4: Joint and Last Survivor Annuity with 10 Years of Annuity Payments
Guaranteed
Age of Female Joint Annuitant
------------------------------------------------------------------
Attained Age 10 Years 5 Years Same 5 Years 10 Years
of Male ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Younger Age Older Older
------------------------------------------------------------------
55 3.21 3.33 3.44 3.55 3.66
60 3.37 3.52 3.67 3.81 3.94
65 3.58 3.76 3.96 4.15 4.32
70 3.84 4.09 4.35 4.60 4.83
75 4.19 4.52 4.87 5.22 5.51
80 4.65 5.10 5.58 6.03 6.38
85 5.27 5.88 6.50 7.02 7.35
Monthly installments for ages not shown will be furnished on request.
6410 (11/05)
INDIVIDUAL SINGLE PURCHASE PAYMENT
DEFERRED VARIABLE ANNUITY CONTRACT
NONPARTICIPATING
▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇
▇▇▇▇▇ ▇▇▇
P.O. Box 25130
Wilmington, DE 19899
6410 (11/05)
