EXHIBIT 4.a
FIRST SUNAMERICA LIFE INSURANCE COMPANY
A STOCK COMPANY NEW YORK, NEW YORK
CONTRACT NUMBER [P9999999999]
OWNER [▇▇▇▇ ▇▇▇]
EXECUTIVE OFFICE ANNUITY SERVICE CENTER
▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇ ▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇▇
▇▇▇ ▇▇▇▇, ▇▇▇ ▇▇▇▇ ▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇
FIRST SUNAMERICA LIFE INSURANCE COMPANY ("We", "Us", the "Company", or "First
SunAmerica") agrees to provide benefits to the Owner in accordance with the
provisions set forth in this Contract and in consideration of the Application
and Purchase Payments We receive.
THE VALUE OF AMOUNTS ALLOCATED TO THE SEPARATE ACCOUNT DURING THE ACCUMULATION
AND ANNUITY PERIODS IS NOT GUARANTEED, AND WILL INCREASE OR DECREASE BASED UPON
THE INVESTMENT EXPERIENCE OF THE VARIABLE PORTFOLIOS YOU CHOOSE.
THE SEPARATE ACCOUNT CHARGE IS CHARGED AGAINST THE ASSETS OF THE SEPARATE
ACCOUNT. THIS CHARGE INCLUDES FEES FOR MORTALITY AND EXPENSE RISK AND THE
DISTRIBUTION EXPENSE. ON AN ANNUALIZED BASIS THE CHARGE EQUALS 1.65%. THESE
CHARGES ARE ASSESSED, ON A SIMPLE INTEREST BASIS, AS A PERCENTAGE OF THE AVERAGE
DAILY ENDING VALUE OF THE ASSETS ATTRIBUTABLE TO THE ACCUMULATION UNITS OF THE
VARIABLE PORTFOLIOS TO WHICH YOUR CONTRACT VALUE IS ALLOCATED. THE DAILY CHARGE
IS 1/365TH OF THE ANNUALIZED CHARGE. THUS, THE SMALLEST ANNUAL EFFECTIVE RATE OF
THE INVESTMENT RETURN THAT WOULD HAVE TO BE EARNED ON ASSETS OF THE SEPARATE
ACCOUNT SO THAT THE DOLLAR AMOUNT OF VARIABLE ANNUITY PAYMENTS WILL NOT DECREASE
IS 5.22%, COMPOUNDED DAILY. THE CONTRACT'S RATE OF RETURN IS BASED ON COMPOUND
INTEREST.
RIGHT TO EXAMINE - IF, WITHIN 10 DAYS OF RECEIPT OF THIS CONTRACT (60 DAYS IF
THE CONTRACT REPLACED ANY OTHER LIFE INSURANCE OR ANNUITY CONTRACT(S)) YOU ARE
NOT SATISFIED WITH IT, YOU MAY RETURN THIS CONTRACT TO OUR ANNUITY SERVICE
CENTER OR TO THE AGENT THROUGH WHOM THE CONTRACT WAS PURCHASED. THE COMPANY WILL
REFUND THE PURCHASE PAYMENT OR THE CONTRACT VALUE REDUCED BY THE LESSER OF: (A)
THE VALUE OF ALL PAYMENT ENHANCEMENT(S) AS OF THE DATE ON WHICH WE RECEIVE YOUR
REQUEST TO CANCEL YOUR CONTRACT; OR (B) THE AMOUNT OF ALL PAYMENT ENHANCEMENT(S)
WE ALLOCATED TO YOUR CONTRACT VALUE, WHICHEVER IS GREATER, COMPUTED AS OF THE
BUSINESS DAY DURING WHICH WE RECEIVE THE CONTRACT. UPON SUCH REFUND, THE
CONTRACT SHALL BE VOID.
G-097R (3/07)
For Individual Retirement Annuities, or if a refund of the Purchase Payment(s)
is otherwise required We reserve the right to allocate your Purchase Payment(s)
to the Cash Management Portfolio until the end of the Right To Examine period.
Thereafter, allocations will be made as selected by You on Your Application.
With 30 days advance notice, we may cease offering Fixed Account Guarantee
Period Options and/or Dollar Cost Averaging Options if market conditions are
such that we are not able to credit the Minimum Guarantee Rate shown on the
Contract Data Page.
THIS IS A LEGAL DOCUMENT. READ IT CAREFULLY.
/s/ ▇▇▇ ▇. ▇▇▇▇▇▇▇
----------------------------------------
▇▇▇ ▇. ▇▇▇▇▇▇▇
President
INDIVIDUAL FIXED AND
VARIABLE ANNUITY CONTRACT
Nonparticipating
1
TABLE OF CONTENTS
CONTRACT DATA PAGE.................................................... PAGE 3
DEFINITIONS........................................................... PAGE 4
PURCHASE PAYMENT PROVISIONS........................................... PAGE 7
PAYMENT ENHANCEMENT PROVISIONS........................................ PAGE 8
ACCUMULATION PROVISIONS............................................... PAGE 8
CHARGES AND DEDUCTIONS................................................ PAGE 9
TRANSFER PROVISIONS................................................... PAGE 10
WITHDRAWAL PROVISIONS................................................. PAGE 10
DEATH PROVISIONS...................................................... PAGE 11
ANNUITY PROVISIONS.................................................... PAGE 15
GENERAL PROVISIONS.................................................... PAGE 16
ANNUITY PAYMENT OPTIONS .............................................. PAGE 19
FIXED ANNUITY PAYMENT OPTIONS TABLE................................... PAGE 20
VARIABLE ANNUITY PAYMENT OPTIONS TABLE................................ PAGE 23
2
CONTRACT DATA PAGE
CONTRACT NUMBER: [P9999999999] ANNUITY SERVICE CENTER:
P. O. ▇▇▇ ▇▇▇▇▇
▇▇▇ ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇
OWNER: [▇▇▇▇ ▇▇▇] AGE AT ISSUE: [35]
ANNUITANT: [▇▇▇▇ ▇▇▇] INITIAL PURCHASE PAYMENT: [$25,000.00]
SPECIFIED ANNUITY DATE: [April 15, 2034] CONTRACT DATE: [June 7, 2007]
LATEST ANNUITY DATE: [June 7, 2067] CURRENT INTEREST RATE FOR FIXED ACCOUNT OPTIONS:
BENEFICIARY: As named by You 1 Year Guarantee Period: [1.50%]
6-Month DCA Account: [1.50%]
SEPARATE ACCOUNT: 12-Month DCA Account: [1.50%]
[FS VARIABLE ANNUITY ACCOUNT FIVE]
MINIMUM GUARANTEE RATE FOR FIXED ACCOUNT
SEPARATE ACCOUNT CHARGE: 1.65% OPTIONS: [1.0% - 3.0%]
Of the above percentage, the charge for
Guaranteed death benefit risk is 0.10% With 30 days advance notice, we may cease offering
the Fixed Account Options, Fixed Account Guarantee
PAYMENT ENHANCEMENT RATE: [2%] * Period Options and/or Dollar Cost Averaging Account
* Due to economic conditions, the Options if market conditions are such that we are not
Payment Enhancement Rate may be able to credit the Minimum Guarantee Rate shown on
greater or less than The rate shown this page.
above.
TRANSFER FEE:
Current: [$25.00]. Maximum: $25.00
Waived for systematic transfers ANNUAL CONTRACT MAINTENANCE FEE:
(i.e. DCA) and for the first 15 Current: [$35.00] Maximum: $50.00
transfers in any Contract Year.
WITHDRAWAL CHARGE SCHEDULE:
Number of Contribution Years Elapsed
From the Date any Purchase Payment is Withdrawal Charge as a
allocated to the Contract and to the Percentage of Withdrawn
Date of Withdrawal Purchase Payment
---------------------------------------- -------------------------------------
0 9%
1 8%
2 8%
3 7%
4 7%
5 6%
6 5%
7 4%
8 3%
9+ 0%
OPTIONAL ELECTIONS: OPTIONAL ELECTION DETAILS:
Maximum Anniversary Value See attached Endorsement FSE-6191-2
FOR INQUIRIES
CALL ▇-▇▇▇-▇▇▇-▇▇▇▇
3
DEFINITIONS
Defined in this section are some of the words and phrases used in this Contract.
These terms are capitalized when used in the Contract with the meaning set forth
below.
ACCUMULATION UNIT
A unit of measurement used to compute the Contract Value in a Variable Portfolio
before to the Annuity Date.
AGE
Age as of last birthday.
ANNUITANT
The natural person(s) whose life (lives) is (are) used to determine the annuity
benefits under the Contract. If the Contract is in force and the Annuitant(s) is
(are) alive on the Annuity Date, We will begin payments to the Payee. This
Contract cannot have Joint Annuitants if it is issued in connection with a
tax-qualified retirement plan.
ANNUITY DATE
The date on which annuity payments ("income payments") to the Payee begin. This
date cannot be later than the Latest Annuity Date.
ANNUITY SERVICE CENTER
The address as specified on the Contract Data Page.
ANNUITY UNIT
A unit of measurement determined on or after the Annuity Date used to compute
annuity payments from the Variable Portfolio(s).
BENEFICIARY
The Beneficiary You name at issue to receive the death benefit under this
Contract upon your death. You may later change Your Beneficiary in a written
request to Us at Our Annuity Service Center.
CONTINUATION DATE
The date on which We receive, at Our Annuity Service Center: (a) the Spousal
Beneficiary's written request to continue the Contract, and (b) Due Proof of
Death of the Owner. If We receive (a) and (b) on different dates, the
Continuation Date will be the later date.
CONTRACT DATE
The date Your Contract is issued, as shown on the Contract Data Page. It is the
date from which Contract Years and anniversaries are measured.
CONTRACT VALUE
The sum of: (1) Your share of the Variable Portfolios' Accumulation Unit Values,
and (2) the value of amounts if any, allocated to any available Fixed Account
Options.
CONTRACT YEAR
One year starting from the Contract Date in one calendar year and ending on the
day preceding the anniversary of such date in the succeeding calendar year.
4
CONTRIBUTION YEAR
The one year period starting from the date a Purchase Payment is made in one
calendar year and ending on the day preceding the anniversary of such date in
the following calendar years.
DEATH BENEFIT ADJUSTMENT
Any increase or reduction to the amount of the death benefit payable to account
for Purchase Payment and/or Withdrawal activity after a specified point in time
which will equal (a), (b), or (c), whichever is applicable, as follows:
(a) Where only Purchase Payments are received after the specified point in
time, the dollar value of the Purchase Payments will be added to the
death benefit payable; or
(b) Where only Withdrawals are made after the specified point in time, the
Withdrawal will reduce the death benefit payable in the same
proportion that the Contract Value was reduced at the time of the
Withdrawal; or
(c) Where Purchase Payments have been received and Withdrawals made after
the specified point in time, the death benefit amount payable will be
adjusted by Purchase Payment(s) received after a specified point in
time, reduced by any Withdrawal, made after that specified point in
time in the same proportion that the Contract Value was reduced at the
time of the Withdrawal.
DOLLAR COST AVERAGING (DCA)
An optional program under which You authorize the systematic transfer of
specified amounts or percentages from any source account to any target account.
FIXED ACCOUNT OPTIONS
The investment options, if available under this Contract, which become part of
the Company's general asset account and are credited with a fixed rate of
interest declared by the Company. The general asset account contains all the
assets of the Company except for the Separate Account and other segregated asset
accounts. The amount You have in any Fixed Account Option at a given time is a
result of Purchase Payment(s) You have allocated to it or any part of Your
Contract Value You have transferred to it.
FIXED ANNUITIZATION
A series of periodic income payments of predetermined amounts that do not vary
with investment experience. Such payments are made from the Company's general
asset account. This Contract provides several fixed annuity payment options.
GUARANTEE PERIOD
The period for which interest is credited to amounts allocated to any available
Fixed Account Options. We determine in Our sole discretion the periods, if any,
that will be offered.
IRC
The Internal Revenue Code of 1986, as it may be amended or superseded.
JOINT OWNER
Any person named as Joint Owner on the Application and listed on the Contract
Data Page, unless subsequently changed. The Joint Owner, if any, possesses an
undivided interest in this Contract in conjunction with the Owner. All
references within this Contract to Owner will also apply to the Joint Owner.
5
LATEST ANNUITY DATE
The later of the Owner's 90th birthday or ten years after the Contract Date. If
the Owner is a non-natural person, the Latest Annuity Date is the later of the
Annuitant's 90th birthday or ten years after the Contract Date.
NET PURCHASE PAYMENT
The sum of all Purchase Payment(s), reduced for each Withdrawal in the same
proportion that the Contract Value is reduced by such Withdrawal.
NYSE
New York Stock Exchange.
OWNER
The person or entity named in the Contract who is entitled to exercise all
rights and privileges of ownership under the Contract. Owner means both Joint
Owners, if applicable.
PAYEE
The person receiving payment of annuity benefits under this Contract.
PAYMENT ENHANCEMENT
Amounts allocated to Your Contract Value by Us prior to Your 86th birthday.
Payment Enhancements are not considered Purchase Payments.
PAYMENT ENHANCEMENT RATE
The percentage applied to each Purchase Payment to calculate the Payment
Enhancement.
PURCHASE PAYMENTS
Payments in U.S. currency made by or on behalf of the Owner to the Company to
fund the Contract.
REQUIRED DOCUMENTATION
Is: (a) Due Proof of Death that the Owner or the Spousal Beneficiary died before
the Annuity Date; and, (b) an election form specifying the payment options and
(c) any other documentation We may require.
SEPARATE ACCOUNT
A segregated asset account named on the Contract Data Page. The Separate Account
consists of several Variable Portfolios, each investing in shares of the
Underlying Fund(s) of the trust(s). The assets of the Separate Account are not
commingled with the general assets and liabilities of the Company. The value of
amounts allocated to the Variable Portfolios of the Separate Account is not
guaranteed.
SPECIFIED ANNUITY DATE
The anticipated Annuity Date specified by You on the Application and as shown on
the Contract Data Page. You may change this date in writing before the Annuity
Date, but in no event can the date be later than the Latest Annuity Date. If
this date is not specified, it will be the Latest Annuity Date.
SPOUSAL BENEFICIARY
The original deceased Owner's surviving spouse who is designated as the primary
Beneficiary at the time of the Owner's death and may continue the Contract as
the Owner on the Continuation Date.
6
SUBSEQUENT PURCHASE PAYMENTS
Purchase Payments made after the initial Purchase Payment.
TOTAL INVESTED AMOUNT
The sum of all Purchase Payments less amounts previously withdrawn that incurred
a Withdrawal Charge, less Purchase Payments withdrawn that are no longer subject
to a Withdrawal Charge.
UNDERLYING FUND
The variable investment options in which the corresponding Variable Portfolio(s)
invest.
VARIABLE ANNUITIZATION
A series of periodic income payments which vary in amount according to the
investment experience of one or more Variable Portfolios, as selected by You.
This Contract provides several variable annuity payment options.
VARIABLE PORTFOLIO
One or more divisions of the Separate Account which provides for the variable
investment options available under this Contract. Each Variable Portfolio has
its own investment objective and is invested in the Underlying Fund(s) of the
trusts. A Variable Portfolio is not chargeable with liabilities arising out of
any other Variable Portfolio. The available Variable Portfolios are shown on the
Application. Additional Variable Portfolios may become available in the future.
The Variable Portfolios may also be referred to as a Variable Subaccount and/or
Subaccount.
WE, OUR, US, THE COMPANY
First SunAmerica Life Insurance Company.
WITHDRAWAL(S)
Amount(s) withdrawn from the Contract Value including any charges and fees
applicable to each such withdrawal.
YOU, YOUR
The Owner.
PURCHASE PAYMENT PROVISIONS
PURCHASE PAYMENTS
Purchase Payments are flexible. This means that, subject to Company disclosed
restrictions, You may change the amounts, frequency and/or timing of Purchase
Payments. Purchase Payments can be made at any time after the Contract Date, but
before the older Owner's 86th birthday. With instructions from You, Purchase
Payments will be allocated to the Variable Portfolio(s) and/or Fixed Account
Option(s), if available. The minimum Purchase Payment that may be allocated to a
Variable Portfolio or available Fixed Account Option under the Contract is $100.
Subject to prior Company approval, the maximum of all Purchase Payments made to
the Contract may not exceed $1,000,000.
DOLLAR COST AVERAGING PROGRAM
To facilitate a dollar cost averaging program, a source account and target
account(s) must be identified. Subject to Company disclosed restrictions, a
source account can be any available 1-year fixed account, available fixed
accounts designed to facilitate Dollar Cost Averaging (DCA Fixed Accounts) or a
Variable Portfolio. The target account must be a Variable Portfolio. Any portion
of a Purchase Payment
7
allocated to any available DCA Fixed Account Options must be transferred out to
the Variable Portfolio(s) within the specified DCA Fixed Account period. Upon
termination of a DCA program using the DCA Fixed Account as a source account,
any amounts remaining in the DCA Fixed Account will be transferred to the target
allocation(s) for the program being terminated. If money remains in a DCA Fixed
Account at the time of annuitization, that amount will be applied towards a
Fixed Annuitization. The unit values credited and applied to your Contract are
determined on the date of transfer. The minimum amount that may be allocated to
the 6-month DCA Fixed Account Option is $600. The minimum amount that may be
allocated to the 12-month DCA Fixed Account Option is $1,200. If market
conditions exist such that we are not able to credit at least the Minimum
Guarantee Rate for Fixed Account Options shown on the Contract Data Page, we
reserve the right to cease offering DCA Fixed Account Options. We will notify
you 30 days before the end of a Fixed Account Option if we exercise this right.
The DCA Fixed Accounts are not available if the Optional Payment Enhancement
Endorsement has been elected.
CHANGES TO VARIABLE PORTFOLIO OFFERINGS
If the shares of an Underlying Fund should no longer be available for investment
by the Separate Account, then We may substitute shares of another Underlying
Fund, for shares already purchased, or to be purchased in the future. At any
given time, some Variable Portfolios may not be available for receipt of
Purchase Payment(s) or transfers. Substitutions of securities will be carried
out in accordance with any applicable state and/or federal laws or regulations.
PAYMENT ENHANCEMENT PROVISIONS
We will allocate Payment Enhancements to available Variable Portfolio(s) and/or
Fixed Account Option(s) in the same proportion as each corresponding Purchase
Payment.
Payment Enhancements for Subsequent Purchase Payment(s) will be determined by
the Payment Enhancement Rate in effect at the time Your Subsequent Purchase
Payment is received by Us. We will send You a confirmation of the Payment
Enhancement allocated to Your Contract Value.
ACCUMULATION PROVISIONS
Prior to the Annuity Date, the Contract Value is the sum of the Separate Account
Accumulation Value and the Fixed Account Accumulation Value, if any. If Your
Contract Value falls below $2,500, subject to applicable state and federal laws,
rules and regulations, we may terminate Your Contract and send you the remaining
dollar amount.
SEPARATE ACCOUNT ACCUMULATION VALUE
The Separate Account Accumulation Value under the Contract is the sum of the
Accumulation Unit Values held in the Variable Portfolios for You.
NUMBER OF ACCUMULATION UNITS
Your Contract is credited with Accumulation Units of the Separate Account when
amounts are allocated to the Variable Portfolio(s). For that portion of each
Purchase Payment and/or transfer amount allocated to a Variable Portfolio, the
number of Accumulation Units credited is equal:
The sum of each Purchase Payment and/or transfer amount allocated to the
Variable Portfolio reduced by premium taxes, if any:
Divided by
8
The Accumulation Unit Value for that Variable Portfolio for the NYSE business
day in which the Purchase Payment or transfer amount is received.
The number of Accumulation Units will be reduced for Withdrawals of Contract
Value, annuitizations, amounts transferred out of a Variable Portfolio, the
Contract Maintenance Fee and applicable charges for optional features as set
forth in endorsements to this Contract. Any reduction to the Contract Value will
be made as of the NYSE business day in which We receive all requirements for the
transaction, as appropriate.
ACCUMULATION UNIT VALUE (AUV)
The AUV of a Variable Portfolio for any NYSE business day is calculated by
subtracting (2) from (1) and dividing the result by (3) where:
(1) is the total value at the end of the given NYSE business day of the assets
attributable to the Variable Portfolio minus any applicable liabilities
other than those owed to the Contractholders;
(2) is the amount equal to the daily Separate Account Charge plus the daily
charge for any optional features that impose a daily charge;
(3) is the number of Accumulation Units outstanding at the end of the given
NYSE business day.
FIXED ACCOUNT ACCUMULATION VALUE
The Fixed Account Accumulation Value, if any, shall be the sum of all monies
allocated or transferred to the Fixed Account Option(s), if available, reduced
by any applicable premium taxes, plus all interest credited on the Fixed Account
Option(s) during the period that You have Contract Value allocated to the Fixed
Account Options. This amount shall be adjusted for Withdrawals, annuitizations,
transfers, and the deduction of the Contract Maintenance Fee and applicable
charges for elected features as set forth in endorsements to this Contract. The
Fixed Account Accumulation Value will not be less than the minimum values
required by law in the State of New York.
FIXED ACCOUNT GUARANTEE PERIOD OPTIONS AND INTEREST CREDITING
The portion of Your Contract Value within the Fixed Account, if any, is credited
with interest at rates guaranteed by Us for the Guarantee Period(s) selected.
Interest is credited on a daily basis at the then applicable effective interest
rate for the applicable Guarantee Period. You may select from one or more
Guarantee Periods which We may offer at any particular time. We reserve the
right at any time to add Guarantee Periods. We also reserve the right to cease
offering Guarantee Periods if market conditions are such that we are not able to
credit the Minimum Guarantee Rate for Fixed Account Options shown on the
Contract Data Page. We will notify you 30 days before the end of a Guarantee
Period if we exercise this right. If You have allocated any part of Your initial
Purchase Payment to a Guarantee Period, the amount allocated, as well as the
duration of the Guarantee Period is shown on the Application as completed by
You. The interest rate applicable to an allocation of Purchase Payment or
transfer of Contract Value to a Guarantee Period is the rate in effect for that
Guarantee Period at the time of the allocation or transfer. If You have
allocated or transferred amounts at different times to the Fixed Account, each
allocation or transfer may have a unique effective interest rate associated with
that amount. We guarantee the effective annual rate of interest for the Fixed
Account, including any of the Guarantee Periods will not be less the Minimum
Guarantee Rate as mandated by Your state, and shown on the Contract Data Page.
The minimum guarantee rate under Your Contract as referenced on the Contract
Data Page is at least equal to the lesser of: (a) 3% per annum; or (b) the
three-month average value of the five-year Constant Maturity Treasury Rate
reported by the Federal Reserve, rounded up to the nearest 1/4th of 1%, for the
second, third and fourth month preceding the first day of the calendar quarter
during which the Contract is issued, reduced by 1.25% and where the resulting
interest rate is not less than 1%.
9
CHARGES AND DEDUCTIONS
We will deduct the following charges from the Contract:
CONTRACT MAINTENANCE FEE
The charge as shown on the Contract Data Page will be deducted on each Contract
anniversary before to the Annuity Date. It will also be deducted when the
Contract Value is withdrawn in full if the Withdrawal is not on the Contract
anniversary. We also reserve the right to waive the fee for Contracts with a
value of $50,000.00 or greater on the Contract anniversary.
WITHDRAWAL CHARGE
The charge, as shown on the Contract Data Page, if any, may be deducted upon
Withdrawal of any portion of the Contract Value. See the Contract Data Page.
SEPARATE ACCOUNT CHARGE
This charge, as shown on the Contract Data Page, on an annualized basis equals a
percentage of the average daily ending value of the assets attributable to the
Accumulation Units of the Variable Portfolio(s) to which the Contract is
allocated. This charge compensates Us for mortality and expense risks, and
distribution expenses associated with the Contract. We subtract this charge
daily.
TRANSFER PROVISIONS
Subject to applicable restrictions, You may transfer all of part of Your
Contract Value amont the Variable Portfolios and/or available Fixed Account
Options (unless otherwise noted). The minimum amount that can be transferred is
$100 and the amount that can remain in a Variable Portfolio or available Fixed
Account Option is $500. We reserve the right to charge a fee, as shown on the
Contract Data Page, for transfers if the number of transfers exceeds a limit of
fifteen (15) in any Contract Year. Automatic asset rebalancing and/or transfers
arising out of the DCA program are not counted against the 15 allowable free
transfers. We further reserve the right to restrict Your transfer privileges,
including but not limited to possible termination of those privileges in our
sole discretion.
Furthermore, the Underlying Funds, may have their own transfer policies that are
applicable to this Contract as a result of investment in the Variable
Portfolios. These policies likewise may include termination of Your transfer
privileges and/or penalty fees resulting from transfer activity that is defined
as excessive according to the Underlying Funds' policies.
TRANSFERS OF ACCUMULATION UNITS BETWEEN VARIABLE PORTFOLIOS AND FIXED ACCOUNTS
Before the Annuity Date, transfers are subject to certain restrictions. You may
transfer all or a portion of Your Contract Value from one Variable Portfolio to
another Variable Portfolio(s) or any available Fixed Account Option(s), other
than the DCA Account Options. You may also transfer from any available Fixed
Account Option(s) to the Variable Portfolio(s) and/or any available Fixed
Account Option(s) of the Contract. A transfer will result in the redemption of
Accumulation Units in a Variable Portfolio and the purchase of Accumulation
Units in the other Variable Portfolio. Transfers will be effected at the end of
the NYSE business day in which We receive Your completed request for the
transfer.
10
TRANSFERS OF ANNUITY UNITS BETWEEN VARIABLE PORTFOLIOS
On and after the Annuity Date, transfers into and out of any available Fixed
Account Option(s) are not allowed. You may transfer all or a portion of Your
Contract Value from one Variable Portfolio to another Variable Portfolio(s). A
transfer will result in the redemption of Annuity Units in a Variable Portfolio
and the purchase of Annuity Units in the other Variable Portfolio. Transfers
will be effected for the last NYSE business day of the month in which We receive
Your request for the transfer.
WITHDRAWAL PROVISIONS
On or before the Annuity Date and while You are living, You may withdraw all or
part of Your Contract Value under this Contract by informing Us at Our Annuity
Service Center, subject to the requirement that the amount remaining after
withdrawal must be at least $2,500. For a full withdrawal, this Contract must be
returned to Our Annuity Service Center. The minimum amount that can be withdrawn
is $1,000, subject to the minimums set forth by the laws of the State of New
York.
Unless You tell Us otherwise in writing, Withdrawals will be deducted from the
Contract Value in proportion to their allocation among any available Fixed
Account Options and the Variable Portfolios. Withdrawals will be based on values
for the NYSE business day in which the request for withdrawal and the Contract
(in the case of a full withdrawal), are received at Our Annuity Service Center.
Unless the SUSPENSION OF PAYMENTS or DEFERMENT OF PAYMENTS sections are in
effect, payment of withdrawals will be made within seven calendar days.
WITHDRAWAL CHARGE
Withdrawals of all or a portion of the Contract Value may be subject to a
Withdrawal Charge as shown on the Contract Data Page. The Withdrawal Charge
percentage applied to any withdrawal will depend on how long the Purchase
Payment to which the withdrawal is attributed has been in the Contract. No
Withdrawal Charge is deducted on an amount which is considered a Penalty-Free
Withdrawal or a Purchase Payment no longer subject to a Withdrawal Charge.
For the purpose of determining the Withdrawal Charge, a Withdrawal will be
attributed to amounts in the following order: (1) penalty-free earnings in the
Contract; (2) Purchase Payments no longer subject to the Withdrawal Charge and
not yet withdrawn; (3) any remaining Penalty-Free Withdrawal amount (except in
the case of a full Withdrawal); and (4) Purchase Payments subject to a
Withdrawal Charge. Purchase Payments, when withdrawn, are assumed to be
withdrawn on a first-in-first-out (FIFO) basis. You will not receive the benefit
of a Penalty-Free Withdrawal in case of a full surrender.
The Withdrawal Charge will be assessed against the Variable Portfolio(s) and the
available Fixed Account Option(s) in the same proportion as the remaining
Contract Value is allocated unless You request that the Withdrawal come from a
particular Variable Portfolio or available Fixed Account Option. After a
Withdrawal is taken, the remaining Contract Value must be sufficient to cover
any Withdrawal Charge remaining upon full Withdrawal of the Contract.
PENALTY-FREE WITHDRAWALS
On any day before the Annuity Date, You may make a Withdrawal of up to the
Penalty-Free Withdrawal amount for that day without incurring a Withdrawal
Charge. Any portion of the Penalty-Free Withdrawal made in excess of the
penalty-free earnings in the Contract is considered to be a Withdrawal of future
penalty-free earnings and is therefore not a withdrawal of the Total Invested
Amount. On any day, penalty-free earnings in the Contract are calculated as the
Contract Value at the end of that day less the Total Invested Amount.
11
During the first Contract Year, the maximum Penalty-Free Withdrawal amount is
equal to the penalty-free earnings in the Contract as of the date of Withdrawal.
Alternatively, during the first Contract Year, You may make Withdrawals of the
Penalty-Free Withdrawal amount through the Systematic Withdrawal Program. The
maximum Penalty-Free Withdrawal amount as of any systematic withdrawal date is
10% of the Total Invested Amount less any Withdrawals already made during the
Contract Year.
After the first Contract Year, the maximum Penalty-Free Withdrawal amount as of
the date of the Withdrawal is the greater of:
(a) penalty-free earnings in the Contract as of that date; or
(b) 10% of the Total Invested Amount, less any withdrawals already made during
the year.
Although amounts withdrawn free of a Withdrawal Charge reduce Contract Value,
they do not reduce the Total Invested Amount for purposes of calculating the
Withdrawal Charge or for the purposes of calculating penalty-free earnings in
the Contract. As a result, You will not receive the benefit of a Penalty-Free
Withdrawal in a full Withdrawal.
SYSTEMATIC WITHDRAWAL PROGRAM
Prior to the Annuity Date, You may elect to participate in a Systematic
Withdrawal Program by informing Us at Our Annuity Service Center. The Systematic
Withdrawal Program allows You to make automatic withdrawals from Your Contract
monthly, quarterly, semiannually or annually. The minimum systematic withdrawal
amount is $100, provided that the amount remaining after withdrawal is $500. Any
amount withdrawn through the Systematic Withdrawal Program may be subject to a
Withdrawal Charge as discussed in the WITHDRAWAL CHARGE and PENALTY-FREE
WITHDRAWALS provisions. You may terminate Your participation in the Systematic
Withdrawal Program at any time by sending Us a written request. We reserve the
right to modify, suspend or terminate the Systematic Withdrawal Program at any
time.
Systematic withdrawals will be deducted first from the Penalty-Free Withdrawal
amount available each Contract Year.
DEATH PROVISIONS
Notwithstanding any provision of this Contract to the contrary, all payments of
benefits under this Contract will be made in a manner that satisfies the
requirements of IRC Section 72(s), as amended from time to time, and complies
with requirements set forth by the laws of the State of New York. If the
Contract is owned by a trust or other non-natural person, We will treat the
death of any Annuitant as the death of the "Primary Annuitant" and as the death
of any Owner.
DUE PROOF OF DEATH
Due Proof of Death means:
1. a certified copy of a death certificate; or
2. a certified copy of a decree of a court of competent jurisdiction
as to the finding of death; or
3. a written statement by a medical doctor who attended the deceased
Owner at the time of death; or
12
4. any other proof satisfactory to Us.
DEATH OF OWNER BEFORE THE ANNUITY DATE
We will pay a death benefit to the Beneficiary upon Our receiving all Required
Documentation at Our Annuity Service Center. Unless You have previously
designated a payment option on behalf of the Beneficiary, the Beneficiary must
select one of the following options:
1. Immediately collect the death benefit in a lump sum payment. If a
lump sum payment is elected, payment will be in accordance with
any applicable laws and regulations governing payments on death;
or
2. Collect the death benefit in the form of one of the Annuity
Payment Options. If an Annuity Payment Option is desired, an
option must be elected within 60 days of Our receipt of: (a) Due
Proof of Death of the Owner; (b) an election form specifying the
payment option and (c) any other documentation We may require.
The payments must be over the life of the Beneficiary or over a
period not extending beyond the life expectancy of the
Beneficiary. Payments under this option must begin within one
year after the Owner's death, otherwise, the death benefit will
be paid in accordance with option 1 above; or
3. If eligible, continue the Contract as the Spousal Beneficiary. On
the Continuation Date, We will contribute to the Contract any
amount by which the death benefit exceeds the Contract Value,
calculated as of the Owner's date of death. This amount is not
considered a Purchase Payment except in the calculation of
certain death benefits upon the death of the Spousal Beneficiary.
If this option is elected, no death benefit is paid.
Upon the Spousal Beneficiary's death, the entire interest of the Contract must
be distributed immediately under option 1 or 2 as provided under DEATH OF OWNER
BEFORE THE ANNUITY DATE.
AMOUNT OF DEATH BENEFIT
If the Owner was age 80 or younger on the Contract Date, upon Our receipt of all
Required Documentation at Our Annuity Service Center, We will calculate the
death benefit and it will be the greater of:
(1) The Contract Value as of the later of: (a) the date of death of the
Owner; and (b) the NYSE business day during which We receive all
Required Documentation at Our Annuity Service Center; or
(2) Net Purchase Payment(s) received prior to the Owner's 86th birthday.
NOTE: In declining market environments, the death benefit payable may be
less than the Net Purchase Payments received.
SPOUSAL BENEFICIARY CONTINUATION
If the Spousal Beneficiary was age 80 or younger on the Continuation Date upon
Our receipt of all Required Documentation at Our Annuity Service Center, We will
calculate the death benefit and it will be the greater of:
(1) The Contract Value as of the later of: (a) the date of death of the
Spousal Beneficiary; and (b) the NYSE business day during which We
receive all Required Documentation at Our Annuity Service Center; or
13
(2) The Contract Value on the Continuation Date, and a Death Benefit
Adjustment for Purchase Payment(s) received after the Continuation
Date but prior to the Spousal Beneficiary's 86th birthday and/or
Withdrawals taken after the Continuation Date.
If the Spousal Beneficiary was age 81 or older on the Continuation Date, the
death benefit will be the Contract Value as of the later of: (a) the date of
death of the Spousal Beneficiary and (b) the NYSE business day during which We
receive all Required Documentation at Our Annuity Service Center.
The death benefit payable will accrue interest at Our current rate from the date
of death to the date the death benefit is distributed.
In any event, the entire interest in the Contract will be distributed within
five years from the date of Owner's death.
DEATH OF OWNER OR ANNUITANT ON OR AFTER THE ANNUITY DATE
If any Owner or Annuitant dies on or after the Annuity Date and before the
entire interest in the Contract has been distributed, We will pay the remaining
portion of the annuity payout to the Beneficiary upon Our receipt of Required
Documentation. For further information pertaining to death of the Annuitant, see
ANNUITY PAYMENT OPTIONS.
BENEFICIARY
The Beneficiary is selected by the Owner. While the Owner is living and before
the Annuity Date, the Owner may change the Beneficiary by written notice in a
form satisfactory to Us. A change in Beneficiary will take effect on the date
the notice is signed by the Owner, subject to any action we have taken before
receipt of such notice. If two or more persons are named as Beneficiaries under
the Contract, those surviving the Owner will share equally unless otherwise
stated; and each must elect to receive their respective portions of the death
benefit according to the options listed under DEATH OF OWNER BEFORE THE ANNUITY
DATE. If the Annuitant survives the Owner, and there are no surviving
Beneficiaries, the Annuitant will be deemed the Beneficiary.
Joint Owners, if applicable, shall be each other's primary Beneficiary. Joint
Annuitants, if any, when the Owner is a non-natural person, shall be each
other's primary Beneficiary. Any other Beneficiary designation will be treated
as a contingent Beneficiary.
If the Owner is also the Annuitant and dies before the Annuity Date, with no
surviving Beneficiaries, upon Our receipt of all Required Documentation We will
pay the death benefit, and We will pay the death benefit to the estate of the
Owner in accordance with option 1, under DEATH OF OWNER BEFORE THE ANNUITY DATE.
14
ANNUITY PROVISIONS
ANNUITY DATE
You specify an anticipated Annuity Date on the Application as shown on the
Contract Data Page. You may change the Annuity Date at any time at least seven
days before to the Annuity Date, by written notice to Us at Our Annuity Service
Center. The Annuity Date must always be the first day of the calendar month and
must be at least thirteen (13) months after the Contract Date, but not beyond
the Latest Annuity Date. If no Annuity Date is specified on the Application, the
Annuity Date will be the Latest Annuity Date.
PAYMENTS TO OWNER
Unless You request otherwise, We will make annuity payments to You. If You want
the annuity payments to be made to some other Payee, We will make such payments
subject to receipt of a written request filed at the Annuity Service Center no
later than thirty (30) days before the due date of the first annuity payment.
All payments will comply with the laws of the State of New York.
Any such request is subject to the rights of any assignee. No payments available
to or being paid to the Payee while the Annuitant is alive can be transferred,
commuted, anticipated or encumbered.
BETTERMENT OF RATES
The amount of the Owner's monthly payment will be at least equal to the monthly
payment produced by the application of an amount equal to the Contract Value of
this Contract to purchase any single consideration immediate annuity contract
offered by the Company at the same time to the same class of annuitants. We are
not currently offering any single premium immediate annuity contracts.
AMOUNT OF FIXED ANNUITY PAYMENTS
The amount of each fixed annuity payment will be determined by applying the
portion of the Contract Value allocated by You for Fixed Annuitization, less any
applicable premium taxes, to the annuity table applicable to the fixed annuity
payment option chosen. In no event will the Fixed Annuitization be changed once
it begins.
AMOUNT OF VARIABLE ANNUITY PAYMENTS
(a) FIRST VARIABLE ANNUITY PAYMENT: The dollar amount of the first Variable
Annuitization payment will be determined by applying the portion of the
Contract Value allocated to the Variable Portfolio(s), less any applicable
premium taxes, to rates which are at least equal to the annuity rates based
upon the annuity table applicable to the variable annuity payment option
chosen. If the Contract Value is allocated to more than one Variable
Portfolio, the value of Your interest in each Variable Portfolio is applied
separately to the variable annuity payment option table to determine the
amount of the first annuity payment attributable to each Variable
Portfolio.
(b) NUMBER OF VARIABLE ANNUITY UNITS: The number of Annuity Units for each
applicable Variable Portfolio is the amount of the first annuity payment
attributable to that Variable Portfolio divided by the value of the
applicable Annuity Unit for that Variable Portfolio as of the Annuity Date.
The number will not change as a result of investment experience.
(c) VALUE OF EACH VARIABLE ANNUITY UNIT: The value of an Annuity Unit may
increase or decrease from one month to the next. For any month, the value
of an Annuity Unit of a particular Variable Portfolio is the value of that
Annuity Unit as of the last NYSE business day of the preceding month,
multiplied by the Net Investment Factor for that Variable Portfolio for the
last NYSE business day of the current month.
15
The Net Investment Factor for any Variable Portfolio for a certain month is
determined by dividing (1) by (2) and multiplying by (3) where:
(1) is the Annuity Unit Value of the Variable Portfolio determined as
of the last business day at the end of that month,
(2) is the Annuity Unit Value of the Variable Portfolio determined as
of the last business day at the end of the preceding month., and
(3) is a factor that neutralizes the assumed investment rate of 3.5%
per annum upon which the annuity payment tables are based. The
monthly factor that neutralizes the assumed investment rate of
3.5% per annum is: 1/1.035(1/12)=0.99713732.
(d) SUBSEQUENT VARIABLE ANNUITY PAYMENTS: After the first Variable
Annuitization payment future payments will vary in amount according to the
investment performance of the applicable Variable Portfolio(s) to which
Your Purchase Payments are allocated. The amount may change from month to
month. The amount of each subsequent payment for each Variable Portfolio
is :
The number of Annuity Units for each Variable Portfolio as determined for the
first annuity payment
Multiplied by
The value of an Annuity Unit for that Variable Portfolio at the end of the month
immediately preceding the month in which payment is due.
We guarantee that the amount of each Variable Annuitization payment will not be
affected by variations in expenses or mortality experience.
GENERAL PROVISIONS
ENTIRE CONTRACT
The Entire Contract between You and Us consists of this Contract, the
Application completed by You and attached to this Contract, and any attached
endorsement(s) or rider(s). An agent cannot change the terms or conditions of
this Contract. Any change must be in writing and approved by Us. Only Our
President, Secretary, or one of Our Vice-Presidents can give Our approval.
CHANGE OF ANNUITANT
If the Owner is an individual, the Owner may change the Annuitant(s) at any time
prior to the Annuity Date. To make a change, the Owner must send a written
notice to Us at least 30 days before the Annuity Date. The change will become
effective on the date the notice is signed by the Owner, subject to any action
We have taken before receipt of such notice. If the Owner is a non-natural
person, the Owner may not change the Annuitant.
DEATH OF ANNUITANT
If the Owner is a natural person, the Owner and Annuitant are different, and the
Annuitant dies before the Annuity Date, the Owner becomes the Annuitant until
the Owner elects a new Annuitant. If there are Joint Annuitants, upon the death
of any Annuitant before the Annuity Date, the Owner may elect a new Joint
Annuitant. However, if the Owner is a non-natural person, We will treat the
death of any Annuitant as the death of the "Primary Annuitant" and as the death
of the Owner, as explained in the DEATH PROVISIONS.
16
MISSTATEMENT OF AGE OR SEX
If the Age or sex of any Annuitant has been misstated, future annuity payments
will be adjusted using the correct Age and sex, according to Our rates in effect
on the date that annuity payments were determined. Any overpayment, plus
interest at the rate of 4% per year, will be deducted from the next payment(s)
due. Any underpayment, plus interest at the rate of 4% per year, will be paid in
full with the next payment due.
With respect to Contract issue Age and other age driven features in the
Contract, should We discover a misstatement of Age, We reserve the right to
fully pursue Our remedies including possible termination of the Contract and/or
revocation of any Age driven benefits.
PROOF OF AGE, SEX, OR SURVIVAL
We may require satisfactory proof of correct Age or sex at any time. If any
payment under this Contract depends on the Annuitant being alive, We may require
satisfactory proof of survival.
DEFERMENT OF PAYMENTS
We may defer making payments from the available Fixed Account Options for up to
six (6) months. Interest, subject to state requirements, will be credited during
the deferral period.
SUSPENSION OF PAYMENTS
We may suspend or postpone any payments from the Variable Portfolios if any of
the following occur:
(a) the NYSE is closed;
(b) trading on the NYSE is restricted;
(c) an emergency exists such that it is not reasonably practical to dispose of
securities in the Variable Portfolios or to determine the value of its
assets; or
(d) the Securities and Exchange Commission, by order, so permits for the
protection of Owners. Conditions in (b) and (c) will be decided by or in
accordance with rules of the Securities and Exchange Commission.
CONFORMITY WITH STATE LAWS
The provisions of this Contract will be interpreted by the laws of the State of
New York, the state in which this Contract is delivered. Any provision which, on
the Contract Date, is in conflict with the law of such state is amended to
conform to the minimum requirements of such law.
CHANGES IN LAW
If the laws governing this Contract or the taxation of benefits under the
Contract change, We will amend this Contract, subject to New York Insurance
Department approval, to comply with any changes.
ASSIGNMENT
You may assign this Contract before the Annuity Date, but We will not be bound
by an assignment unless the request for assignment is signed by You and received
by Us. Your rights and those of any other person referred to in this Contract
will be subject to the assignment. Certain assignments may be taxable. We do not
assume any responsibility for the validity or tax consequences of any
assignment. We reserve the right to not recognize assignments if it changes the
risk profile of the Owner of the Contract as determined in Our sole discretion.
CLAIMS OF CREDITORS
To the extent permitted by law, no right or proceeds payable under this Contract
will be subject to claims of creditors or legal process.
17
PREMIUM TAXES OR OTHER TAXES
We may deduct from Your Contract Value any premium tax or other taxes payable to
a state or other government entity, if applicable. Should We advance any amount
so due, We are not waiving any right to collect such amount at a later date. We
will deduct any withholding taxes required by applicable law.
WRITTEN NOTICE
Any notice We send to You will be sent to Your address shown in the Application
unless You request otherwise. Any written request or notice to Us must be sent
to Our Annuity Service Center, as specified on the Contract Data Page.
PERIODIC REPORTS
At least once during each Contract Year, We will send You a statement of the
account activity of the Contract. The statement will include all transactions
which have occurred during the accounting period shown on the statement.
INCONTESTABILITY
This Contract shall be incontestable after it has been in force for a period of
two years from the Contract Date during Your lifetime or during the lifetimes of
each of the persons who are required to provide Us with information concerning
their age, sex and identity. The incontestability of this Contract applies to
any statements You make, except as otherwise stated in the Misstatement of Age
or Sex provision. Accurate statements as to Your age, sex and identity are
required as a condition of issuing this Contract.
NONPARTICIPATING
This Contract does not share in Our surplus.
WAIVER
Our waiver of any of the terms and conditions under this Contract will not be
deemed to constitute waiver of the right to enforce strict compliance.
18
ANNUITY PAYMENT OPTIONS
During the Annuitant's life, upon written election and the return of this
Contract to Us at Our Annuity Service Center, the Contract Value may be applied
to provide one of the following options or any annuity payment option that is
mutually agreeable. After one year from the Contract Date, and before to the
Annuity Date, You can choose one of the options described below. If no option
has been selected by the Annuity Date, You will automatically receive Option 4
below, with payments for 10 years guaranteed.
OPTIONS 1 & 1V - LIFE ANNUITY, LIFETIME PAYMENTS GUARANTEED
Payments payable to a Payee during the lifetime of the Annuitant. No further
payments are payable after the death of the Annuitant.
OPTIONS 2 & 2V - JOINT AND SURVIVOR LIFE ANNUITY
Payments payable to the Payee during the lifetime of the Annuitant and during
the lifetime of a designated second person. No further payments are payable
after the deaths of both the Annuitant and the designated second person.
OPTIONS 3 & 3V - JOINT AND SURVIVOR LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 10
YEARS
Payments are payable to the Payee during the lifetime of the Annuitant and
during the lifetime of a designated second person. If, at the death of the
survivor, payments have been made for less than 10 years, the remaining
guaranteed annuity payments will be continued to the Beneficiary.
OPTIONS 4 & 4V - LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 10 OR 20 YEARS
Payments payable to the Payee during the lifetime of the Annuitant. If, at the
death of the Annuitant, payments have been made for less than the 10 or 20
years, as selected at the time of annuitization, the remaining guaranteed
annuity payments will be continued to the Beneficiary.
OPTIONS 5 & 5V - FIXED PAYMENTS FOR A SPECIFIED PERIOD CERTAIN
Payments payable to the Payee for any specified period of time for [5] years or
more, but not exceeding [30] years, as selected at the time of annuitization.
The selection must be made for full twelve month periods. In the event of death
of the Annuitant, any remaining annuity payments will be continued to the
Beneficiary. If Variable Annuity Payments are elected under this Annuity Payment
Option, any remaining guaranteed Variable Annuity payments may be redeemed for a
discounted value determined by Us. Any applicable Withdrawal Charges will be
deducted from the discounted value as if You fully surrendered Your Contract.
19
FIXED ANNUITY PAYMENT OPTIONS TABLE
BASIS OF COMPUTATION
The actuarial basis for the Table of Annuity Rates is the Annuity 2000 Mortality
Table with a guaranteed interest rate of [1.50%], with quinquennial age
setbacks. For every five years that the Contract has been in effect at the time
of annuitization, the Annuitant's age will be set back by one year to determine
the applicable factors. The Fixed Annuity Payment Options Table does not include
any applicable premium tax.
OPTIONS 1 & 4 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
OPTION 4 OPTION 4
LIFE ANNUITY LIFE ANNUITY
OPTION 1 (W/120 PAYMENTS (W/240 PAYMENTS
LIFE ANNUITY GUARANTEED) GUARANTEED)
AGE OF -------------- --------------- ---------------
ANNUITANT MALE FEMALE MALE FEMALE MALE FEMALE
--------- ----- ------ ---- ------ ---- ------
55 3.68 3.38 3.64 3.35 3.48 3.27
56 3.77 3.46 3.73 3.43 3.55 3.34
57 3.87 3.54 3.82 3.51 3.62 3.40
58 3.98 3.63 3.92 3.60 3.69 3.47
59 4.09 3.73 4.02 3.69 3.76 3.54
60 4.21 3.83 4.13 3.78 3.83 3.62
61 4.34 3.93 4.24 3.89 3.90 3.69
62 4.47 4.05 4.36 3.99 3.97 3.77
63 4.62 4.17 4.49 4.10 4.04 3.84
64 4.77 4.30 4.62 4.22 4.10 3.92
65 4.93 4.44 4.76 4.35 4.17 4.00
66 5.11 4.58 4.90 4.48 4.24 4.07
67 5.30 4.74 5.05 4.62 4.30 4.15
68 5.49 4.91 5.20 4.76 4.36 4.22
69 5.71 5.09 5.36 4.92 4.41 4.29
70 5.93 5.29 5.53 5.08 4.47 4.36
71 6.17 5.50 5.70 5.25 4.51 4.42
72 6.43 5.73 5.87 5.43 4.56 4.48
73 6.70 5.98 6.05 5.62 4.60 4.53
74 6.99 6.24 6.23 5.81 4.63 4.58
75 7.31 6.53 6.41 6.01 4.67 4.62
76 7.64 6.84 6.59 6.21 4.69 4.65
77 8.00 7.18 6.78 6.41 4.72 4.69
78 8.38 7.55 6.96 6.62 4.74 4.71
79 8.79 7.94 7.13 6.83 4.75 4.74
80 9.23 8.37 7.31 7.03 4.77 4.75
81 9.70 8.84 7.47 7.23 4.78 4.77
82 10.20 9.34 7.63 7.42 4.79 4.78
83 10.73 9.88 7.78 7.60 4.80 4.79
84 11.30 10.47 7.93 7.77 4.80 4.80
85 11.90 11.10 8.06 7.93 4.81 4.80
20
OPTION 2 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
JOINT & 100% SURVIVOR LIFE ANNUITY
AGE OF AGE OF FEMALE ANNUITANT
MALE ----------------------------------------------
ANNUITANT 55 60 65 70 75 80 85
--------- ---- ---- ---- ---- ---- ---- ----
55 3.01 3.18 3.33 3.45 3.54 3.60 3.64
60 3.12 3.36 3.59 3.78 3.94 4.05 4.12
65 3.21 3.51 3.83 4.13 4.40 4.61 4.75
70 3.27 3.63 4.03 4.46 4.89 5.26 5.53
75 3.32 3.70 4.18 4.74 5.35 5.95 6.45
80 3.34 3.76 4.29 4.95 5.75 6.62 7.45
85 3.36 3.79 4.35 5.09 6.05 7.20 8.44
OPTION 3 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT & 100% SURVIVOR LIFE ANNUITY (W/120 PAYMENTS GUARANTEED)
AGE OF AGE OF FEMALE ANNUITANT
MALE ----------------------------------------------
ANNUITANT 55 60 65 70 75 80 85
--------- ---- ---- ---- ---- ---- ---- ----
55 3.01 3.18 3.33 3.45 3.53 3.59 3.62
60 3.12 3.36 3.58 3.78 3.93 4.03 4.09
65 3.21 3.51 3.82 4.12 4.38 4.56 4.67
70 3.27 3.62 4.02 4.44 4.84 5.16 5.36
75 3.31 3.70 4.16 4.70 5.26 5.76 6.11
80 3.33 3.74 4.25 4.88 5.59 6.28 6.80
85 3.35 3.77 4.31 4.99 5.81 6.66 7.35
OPTION 3 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT & 100% SURVIVOR LIFE ANNUITY (W/240 PAYMENTS GUARANTEED)
AGE OF AGE OF FEMALE ANNUITANT
MALE ----------------------------------------------
ANNUITANT 55 60 65 70 75 80 85
--------- ---- ---- ---- ---- ---- ---- ----
55 3.00 3.16 3.30 3.39 3.45 3.47 3.48
60 3.11 3.33 3.53 3.68 3.77 3.81 3.82
65 3.18 3.46 3.72 3.94 4.08 4.15 4.17
70 3.23 3.54 3.86 4.14 4.33 4.43 4.46
75 3.26 3.59 3.94 4.27 4.50 4.62 4.66
80 3.27 3.61 3.98 4.33 4.58 4.71 4.76
85 3.27 3.62 3.99 4.35 4.61 4.75 4.80
21
OPTION 5 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
FIXED PAYMENT FOR SPECIFIED PERIOD
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
5 17.28
6 14.51
7 12.53
8 11.04
9 9.89
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
10 8.96
11 8.21
12 7.58
13 7.05
14 6.59
15 6.20
16 5.85
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
17 5.55
18 5.27
19 5.03
20 4.81
21 4.62
22 4.44
23 4.28
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
24 4.13
25 3.99
26 3.86
27 3.75
28 3.64
29 3.54
30 3.44
22
VARIABLE ANNUITY PAYMENT OPTIONS TABLE
BASIS OF COMPUTATION
The actuarial basis for the Table of Annuity Rates is the Annuity 2000 Mortality
Table with an effective annual Assumed Investment Rate of 3.50%, with
quinquennial age setbacks. For every five years that the Contract has been in
effect at the time of annuitization, the Annuitant's age will be set back by one
year to determine the applicable factors. The Variable Annuity Payment Options
Table does not include any applicable premium tax.
OPTIONS 1V& 4V - TABLE OF MONTHLY INSTALLMENTS PER $1,000
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
OPTION 4V OPTION 4V
LIFE ANNUITY LIFE ANNUITY
(W/120 (W/240
OPTION 1V PAYMENTS PAYMENTS
LIFE ANNUITY GUARANTEED) GUARANTEED)
AGE OF -------------- ------------- -------------
ANNUITANT MALE FEMALE MALE FEMALE MALE FEMALE
--------- ----- ------ ---- ------ ---- ------
55 4.80 4.48 4.74 4.45 4.54 4.34
56 4.89 4.56 4.82 4.52 4.60 4.40
57 4.99 4.64 4.91 4.60 4.67 4.46
58 5.09 4.73 5.01 4.68 4.73 4.53
59 5.21 4.82 5.11 4.77 4.79 4.59
60 5.33 4.92 5.21 4.86 4.86 4.66
61 5.45 5.03 5.32 4.96 4.92 4.73
62 5.59 5.14 5.44 5.06 4.98 4.80
63 5.73 5.26 5.56 5.17 5.05 4.87
64 5.89 5.39 5.69 5.29 5.11 4.94
65 6.06 5.53 5.83 5.41 5.17 5.01
66 6.24 5.68 5.97 5.54 5.23 5.08
67 6.43 5.84 6.11 5.67 5.29 5.14
68 6.63 6.01 6.26 5.82 5.34 5.21
69 6.84 6.19 6.42 5.97 5.39 5.28
70 7.07 6.39 6.57 6.12 5.44 5.34
71 7.32 6.60 6.74 6.29 5.48 5.39
72 7.58 6.84 6.91 6.46 5.52 5.45
73 7.86 7.09 7.08 6.64 5.56 5.49
74 8.16 7.36 7.25 6.83 5.59 5.54
75 8.47 7.65 7.42 7.02 5.62 5.57
76 8.82 7.97 7.59 7.22 5.64 5.61
77 9.18 8.31 7.77 7.41 5.67 5.64
78 9.57 8.69 7.94 7.61 5.68 5.66
79 9.99 9.09 8.11 7.81 5.70 5.68
80 10.43 9.53 8.27 8.00 5.71 5.70
81 10.91 10.00 8.43 8.19 5.72 5.71
82 11.42 10.51 8.58 8.38 5.73 5.72
83 11.96 11.07 8.72 8.55 5.74 5.73
84 12.53 11.67 8.85 8.71 5.74 5.74
85 13.15 12.31 8.98 8.86 5.75 5.74
23
OPTION 2V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
JOINT & 100% SURVIVOR LIFE ANNUITY
AGE OF AGE OF FEMALE ANNUITANT
MALE ----------------------------------------------
ANNUITANT 55 60 65 70 75 80 85
--------- ---- --- ---- ---- ---- ---- ----
55 4.09 4.25 4.40 4.52 4.62 4.69 4.74
60 4.20 4.42 4.64 4.84 5.00 5.13 5.21
65 4.29 4.56 4.87 5.17 5.45 5.67 5.83
70 4.35 4.68 5.07 5.49 5.92 6.30 6.60
75 4.40 4.77 5.23 5.78 6.38 6.99 7.50
80 4.43 4.83 5.34 6.00 6.79 7.66 8.50
85 4.45 4.87 5.42 6.15 7.10 8.25 9.49
OPTION 3V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT AND 100% SURVIVOR LIFE ANNUITY (W/120 PAYMENTS GUARANTEED)
AGE OF AGE OF FEMALE ANNUITANT
MALE ----------------------------------------------
ANNUITANT 55 60 65 70 75 80 85
--------- ---- ---- ---- ---- ---- ---- ----
55 4.08 4.25 4.40 4.52 4.61 4.68 4.71
60 4.19 4.41 4.63 4.83 4.99 5.10 5.16
65 4.28 4.56 4.86 5.15 5.41 5.61 5.73
70 4.35 4.68 5.05 5.46 5.86 6.18 6.40
75 4.39 4.76 5.20 5.72 6.27 6.76 7.11
80 4.42 4.81 5.30 5.91 6.60 7.26 7.77
85 4.44 4.84 5.36 6.03 6.82 7.63 8.29
OPTION 3V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT AND 100% SURVIVOR LIFE ANNUITY (W/240 PAYMENTS GUARANTEED)
AGE OF AGE OF FEMALE ANNUITANT
MALE ----------------------------------------------
ANNUITANT 55 60 65 70 75 80 85
--------- ---- ---- ---- ---- ---- ---- ----
55 4.07 4.22 4.36 4.45 4.51 4.53 4.54
60 4.17 4.38 4.56 4.71 4.80 4.84 4.85
65 4.25 4.50 4.74 4.95 5.08 5.14 5.17
70 4.30 4.58 4.88 5.14 5.31 5.40 5.43
75 4.32 4.63 4.96 5.25 5.46 5.57 5.61
80 4.34 4.65 4.99 5.31 5.54 5.66 5.70
85 4.34 4.66 5.00 5.33 5.57 5.69 5.74
24
OPTION 5V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
PAYMENTS FOR A SPECIFIED PERIOD
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
5 17.28
6 14.51
7 12.53
8 11.04
9 9.89
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
10 8.96
11 8.21
12 7.58
13 7.05
14 6.59
15 6.20
16 5.85
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
17 5.55
18 5.27
19 5.03
20 4.81
21 4.62
22 4.44
23 4.28
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
24 4.13
25 3.99
26 3.86
27 3.75
28 3.64
29 3.54
30 3.44
25
FIRST SUNAMERICA LIFE INSURANCE COMPANY
A STOCK COMPANY NEW YORK, NEW YORK
INDIVIDUAL FIXED AND
VARIABLE ANNUITY CONTRACT
Nonparticipating
26