READ YOUR CONTRACT CAREFULLY
Exhibit 4(a)
Pacific Life & Annuity Company
[700 Xxxxxxx Xxxxxx Xxxxx
Xxxxxxx Xxxxx, XX 00000
(000) 000-0000]
[700 Xxxxxxx Xxxxxx Xxxxx
Xxxxxxx Xxxxx, XX 00000
(000) 000-0000]
READ YOUR CONTRACT CAREFULLY
This is a legal contract between you (the “Owner”) and Pacific Life & Annuity Company, a stock
company (hereinafter referred to as “we”, “us”, “our” and the “Company”).
We agree to pay the benefits provided under this Contract, subject to its provisions.
We have issued this Contract in consideration of the application and payment of the Initial
Purchase Payment.
BENEFITS AND VALUES PROVIDED BY THIS CONTRACT ARE BASED UPON THE EXPERIENCE OF THE SEPARATE ACCOUNT
AND ARE VARIABLE. THESE AMOUNTS MAY INCREASE OR DECREASE IN VALUE BASED ON INVESTMENT RESULTS, AND
ARE NOT GUARANTEED AS TO A DOLLAR AMOUNT. THE DETAILS OF THE VARIABLE PROVISIONS BEGIN ON PAGE 10.
Right to Cancel – You may return this Contract within ten (10) days after you receive it. To do
so, mail it to us at our Service Center or to the agent who sold it to you (the “date of
surrender”). No withdrawal charge will be imposed and we will refund the Contract Value as of the
date of surrender, including any fees or charges for premium taxes and/or other taxes that were
deducted from Purchase Payments and/or the Contract Value.
Signed for the Company at Newport Beach, California to be effective as of the Contract Date.
PACIFIC LIFE & ANNUITY COMPANY
Chairman and Chief Executive Officer | Secretary |
The smallest gross annual rate of return needed for the dollar amount of the variable annuity
payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and all
product fees and charges. The fees and charges would include the Mortality and Expense Risk charge
of 1.15% and the Administrative Fee of 0.15%. Thus, the total gross annual rate of return would
need to be at least 5.30% (net of fund level expenses).
Pursuant to Section 3 of the federal Defense of Marriage Act (“DOMA”), same-sex marriages currently
are not recognized for purposes of federal law. Therefore, the favorable income-deferral options
afforded by federal tax law to an opposite-sex spouse under Internal Revenue Code sections 72(s)
and 401(a)(9) are currently NOT available to a same-sex spouse. Same-sex spouses who own or are
considering the purchase of annuity products that provide benefits based upon status as a spouse
should consult a tax advisor. To the extent that an annuity contract or certificate accords to
spouses other rights or benefits that are not affected by DOMA, same-sex spouses remain entitled to
such rights or benefits to the same extent as any annuity holder’s spouse.
INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT
Investment Experience Reflected in Benefits
Variable Accumulation Before Annuity Date
Withdrawal Charges Waived in Specific Instances
Annuities Payable in Variable and Fixed Dollar Amounts
Death Benefit Proceeds Payable Before Annuity Date
Non-Participating – No Dividends are Payable
Investment Experience Reflected in Benefits
Variable Accumulation Before Annuity Date
Withdrawal Charges Waived in Specific Instances
Annuities Payable in Variable and Fixed Dollar Amounts
Death Benefit Proceeds Payable Before Annuity Date
Non-Participating – No Dividends are Payable
10-2180
TABLE OF CONTENTS
PAGE | ||||
CONTRACT SPECIFICATIONS |
3 | |||
DEFINITION OF TERMS |
4 | |||
GENERAL PROVISIONS |
7 | |||
PURCHASE PAYMENTS Initial Purchase Payment |
9 | |||
Additional Purchase Payments |
9 | |||
Purchase Payment Allocation |
9 | |||
Allocations During the Right to Cancel
Period |
9 | |||
Minimum Investment Option Value |
9 | |||
VARIABLE INVESTMENT OPTIONS Variable Investment Options |
10 | |||
Separate Account |
10 | |||
CONTRACT VALUES Contract Value |
11 | |||
Variable Account Value |
11 | |||
Subaccount Value |
11 | |||
Subaccount Unit Value |
11 | |||
Net Investment Factor |
11 | |||
Loan Account Value |
12 | |||
Persistency Credit |
12 | |||
CHARGES, FEES AND DEDUCTIONS Administrative Fee |
13 | |||
Mortality and Expense Risk Charge
(“Risk Charge”) |
13 | |||
Annual Fee |
13 | |||
Premium Taxes |
13 | |||
Other Taxes |
13 | |||
Withdrawal Charge |
13 | |||
Amount of Withdrawal Charge |
14 | |||
Free Withdrawals |
14 | |||
Earnings |
14 | |||
TRANSFER PROVISIONS Transfers |
15 | |||
Transfer Limitations and Restrictions |
15 | |||
WITHDRAWAL PROVISIONS Withdrawals |
16 | |||
Minimum Xxxxxxxxxx Xxxxxx |
00 | |||
Xxxx Xxxxxxxxxx |
16 | |||
Amount Available for Withdrawal |
16 | |||
DEATH BENEFIT PROVISIONS Death Benefit |
17 | |||
Death Benefit Amount |
17 | |||
Death of Annuitant |
17 | |||
Death of Owner |
17 | |||
Death of Owner Distribution Rules |
18 | |||
BENEFICIARY PROVISIONS Designation of Beneficiary |
19 | |||
Adding or Changing Your Beneficiary |
19 | |||
ANNUITY PROVISIONS Choice of Annuity Date |
20 | |||
Default Annuity Option |
20 | |||
Application of Contract Value |
20 | |||
Your Selections |
20 | |||
Fixed and Variable Annuities |
21 | |||
Amount of Payments |
21 | |||
Fixed Annuity Payments |
21 | |||
Conversion to Current Rates |
21 | |||
Variable Annuity Payments – Subaccount
Annuity Units |
21 | |||
Subsequent Variable Payments |
21 | |||
Annuity Unit Value |
22 | |||
Periodic Payments |
22 | |||
ANNUITY OPTIONS Option 1 – Life Only |
23 | |||
Option 2 – Life with Period Certain |
23 | |||
Option 3 – Joint and Survivor Life |
23 | |||
Option 4 – Period Certain Only |
23 | |||
ANNUITY OPTION TABLES Applicability of Rates |
24 | |||
Basis of Computations |
24 | |||
Rates Not Shown |
24 |
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2
CONTRACT SPECIFICATIONS
Contract Data
Contract Number:
|
[VA99999999] | Contract Date: | [01-01-2009] | |||
Contract Type:
|
[Non-Qualified] | Initial Purchase Payment: | [$500,000] | |||
Minimum Purchase Payment Amount:
|
[$10,000] | Maximum Purchase Payment Amount: | [$1,000,000] | |||
Owner(s):
|
[Xxxx Xxx] [Xxxx Xxx] |
|||||
Annuitant(s):
|
[Xxxx Xxx] [Xxxx Xxx] |
Annuitant’s Age: | [35] [35] |
|||
Annuity Date:
|
[01-01-2027] | Annuitant’s Sex: | [Male] [Female] |
Fees & Charges
M&E Risk Charge: |
1.15 | % | ||
Administrative Fee: |
0.15 | % | ||
Annual Fee: |
$ | 30.00 | * |
* | Waived if Net Contract Value is $50,000 or more |
Withdrawal Charges
Age of Purchase | ||||
Payment in | ||||
Contract Years | Withdrawal Charge % | |||
1 |
7 | % | ||
2 |
7 | % | ||
3 |
6 | % | ||
4 |
6 | % | ||
5 |
5 | % | ||
6 |
3 | % | ||
7 |
1 | % | ||
8 and Later |
0 | % |
Optional Riders
Name | Annual Charge % | Maximum Annual Charge % | ||||||
[Stepped-Up Death Benefit Rider |
0.20%] | 0.20 | % | |||||
[Guaranteed Withdrawal Benefit III-B Rider
(also known as the Automatic Income Builder) |
1.05%] | 1.50 | % | |||||
[Core Withdrawal Benefit II-A Rider |
0.65%] | 1.20 | % |
For a complete description of the charges, fees and deductions shown above and other applicable
fees and charges, refer to the Charges, Fees and Deductions section of the Contract or the Annual
Charge provision of the Optional Rider(s) shown above, if applicable.
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3
Investment Options
[Small-Cap Growth]
|
[International Large-Cap] | [Real Estate] | ||
[International Value]
|
[Small-Cap Value] | [Small-Cap Equity] | ||
[International Small-Cap]
|
[Main Street Core] | [Diversified Bond] | ||
[Mid-Cap Value]
|
[Emerging Markets] | [Capital Appreciation V.I. Fund] | ||
[Equity Index]
|
[Cash Management] | [Mutual Global Discovery Securities Fund] | ||
[Small-Cap Index]
|
[High Yield Bond] | [Xxxxxxxxx Global Bond Securities Fund] | ||
[Dividend Growth]
|
[Managed Bond] | [International Core Equity Portfolio] | ||
[Large-Cap Value]
|
[Inflation Managed] | [Total Return Fund] | ||
[Short Duration Bond]
|
[Large-Cap Growth] | [Growth Stock Series] | ||
[Growth LT]
|
[Xxxxxxxx] | [Value Series Fund] | ||
[Focused 30]
|
[Mid-Cap Growth] | |||
[Mid-Cap Equity] |
[AllianceBernstein VPS Balanced Wealth Strategy]
[BlackRock Global Allocation V.I. Fund]
[Franklin Xxxxxxxxx VIP Founding Funds]
[GE Investments Total Return Fund]
[Invesco V.I. Global Multi-Asset Fund]
[Pacific Dynamix – Conservative Growth]
[Pacific Dynamix – Moderate Growth]
[Pacific Dynamix – Growth]
[PIMCO Global Multi-Asset Portfolio]
[Invesco Xxx Xxxxxx V.I. Global Tactical Asset Allocation Fund]
[BlackRock Global Allocation V.I. Fund]
[Franklin Xxxxxxxxx VIP Founding Funds]
[GE Investments Total Return Fund]
[Invesco V.I. Global Multi-Asset Fund]
[Pacific Dynamix – Conservative Growth]
[Pacific Dynamix – Moderate Growth]
[Pacific Dynamix – Growth]
[PIMCO Global Multi-Asset Portfolio]
[Invesco Xxx Xxxxxx V.I. Global Tactical Asset Allocation Fund]
DCA Plus Fixed Option Guarantee Terms and Rates
6 Mos. |
[4.00%] | * | ||
12 Mos. |
[3.00%] | * |
* | Minimum Guaranteed Interest Rate is 3.00% per year. |
Service Center
Send Forms and written requests to:
|
Send Payments to: | |
Pacific Life & Annuity Company [P.O. Xxx 0000 Xxxxx, Xxxxxxxx 00000-0000] |
Pacific Life & Annuity Company [P.O. Xxx 0000 Xxxxx, Xxxxxxxx 00000-0000] |
Toll-Free Number for Contract Owners: [0-000-000-0000 (between 6 a.m. — 5 p.m., Pacific Time)]
Toll-Free Number for Registered Representatives: [0-000-000-0000 (between 6 a.m. — 5 p.m., Pacific]
Time)
Please use our toll-free number to present inquiries or obtain information about your coverage and
for us to provide assistance in resolving complaints.
10-2180
3A
DEFINITION OF TERMS
Account Value – The amount of the Contract Value allocated to any one of the Investment
Options.
Add-In Amount – The amount added by us, if applicable, to the Contract Value on the Notice Date to
set the Contract Value equal to the death benefit proceeds that would have been payable to the
spouse as the deemed Beneficiary/designated recipient of the death benefit.
Age – The Owner’s or Annuitant’s age, as applicable, at his or her last birthday.
Annuitant – The person you name on whose life annuity payments may be determined. An Annuitant’s
life may also be used to determine certain increases in death benefits and to determine the Annuity
Date. If you designate Joint Annuitants or a Contingent Annuitant, “Annuitant” means the sole
surviving Annuitant, unless otherwise stated. If the Contract is owned by a Non-Natural Owner, you
may not designate a Joint or Contingent Annuitant. Any named Annuitant, Joint Annuitant, or
Contingent Annuitant must be under Age 86 as of the Contract Date. If the Contract is a
Non-Qualified Contract, you cannot change the Annuitant or change or add a Joint Annuitant. If the
Contract is a Qualified Contract, you may add a Joint Annuitant only on the Annuity Date.
Annuity Date (“Annuity Start Date”) – The date shown in the Contract Specifications, or the date
you later elect, if any, for the start of annuity payments if the Annuitant is still living and the
Contract is in force; or if earlier, the date that annuity payments actually begin.
Annuity Options – Income options available for a series of payments after the Annuity Date.
Beneficiary – The person you name who may receive any death benefit proceeds or any remaining
annuity benefits in accordance with the provisions of this Contract.
Business Day – Any day on which the value of an amount invested in a Subaccount is required to be
determined by applicable law which currently includes each day that both the New York Stock
Exchange is open for trading and our administrative offices are open. If any transaction or event
under this Contract is scheduled to occur on a day that does not exist in a given calendar period,
or on a day that is not a Business Day, such transaction or event will be deemed to occur on the
next following Business Day, unless otherwise stated.
Calendar Year – A one-year period beginning January 1 and ending December 31.
Code – The Internal Revenue Code of 1986, as amended.
Contingent Annuitant – The person, if any, you select to become the Annuitant if the Annuitant dies
before the Annuity Date. You may add or change the Contingent Annuitant prior to the Annuity Date
provided the Contingent Annuitant is not the sole surviving Annuitant. Any Contingent Annuitant you
name must be under Age 86 as of the Contract Date. If you add or change a Contingent Annuitant
after the Contract is issued, any newly-named or added Contingent Annuitant must be under Age 86 at
the time of such change or addition. If the Contract is owned by a Non-Natural Owner, you may not
designate a Contingent Annuitant.
Contingent Beneficiary – The person, if any, you select to become the Beneficiary if the
Beneficiary dies.
Contract Anniversary – The same date, in each subsequent year, as the Contract Date.
Contract Date – The date we issued this Contract, as shown in the Contract Specifications. Contract
Years, Contract Anniversaries, Contract Semiannual Periods, Contract Quarters and Contract Months
are measured from the Contract Date.
Contract Debt – As of the end of any Business Day, the principal amount you have outstanding on any
loan under this Contract, plus any accrued and unpaid interest.
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Contract Value – As of the end of any Business Day, the Contract Value is equal to the sum of the
Variable Account Value plus any Loan Account Value.
General Account – The General Account consists of our assets, other than those assets allocated to
Separate Account A or to any of our other separate accounts.
Investment Option – A Variable Account offered under the Contract.
Loan Account Value – The amount, including any interest accrued, held in the Loan Account to secure
any Contract Debt.
Net Contract Value – The Contract Value less any Contract Debt.
Non-Natural Owner – A corporation or other entity that is not a (natural) person.
Non-Qualified Contract – A Contract other than a Qualified Contract.
Notice Date – The day on which we receive, in a form satisfactory to us, proof of death and
instructions satisfactory to us regarding payment of death benefit proceeds.
Owner – The person(s) who has (have) all rights under this Contract. If the Contract names two
Owners, Owner means both Owners (“Joint Owners”). Any named Owner must be under Age 86 as of the
Contract Date. If the Contract allows you to change or add Owners after the Contract is issued, any
newly-named or added Owners, including Joint Owners, must be under Age 86 at the time of such
change or addition.
Primary Annuitant – The individual that is named in the Contract, the events in the life of whom
are of primary importance in affecting the timing or amount of the payout under the Contract.
Purchase Payment – An amount paid to us, by or on behalf of an Owner, as consideration for the
benefits provided under this Contract.
Qualified Contract – A Contract that qualifies under the Code as an individual retirement annuity
(“XXX”) or a Contract purchased under a Qualified Plan that qualifies for special tax treatment
under the Code.
Qualified Plan – A retirement plan that receives favorable tax treatment under Section 401, 403,
408, or 408A of the Code.
SEC – Securities and Exchange Commission.
Separate Account or Separate Account A – The Company’s Separate Account, registered as a unit
investment trust under the Investment Company Act of 1940, as amended (“1940 Act”).
Service Center – Our mailing address shown in the Contract Specifications. We will notify you of
any change in our mailing address.
Subaccount – An investment division of the Separate Account. Each Subaccount, (a “Variable
Investment Option” or “Variable Account”) invests its assets in a separate series or class of
shares of a designated investment company.
Subaccount Annuity Unit (“Annuity Units”) – Annuity Units are used to measure variation in variable
annuity payments. The amount of each variable annuity payment (after the first payment) will vary
with the value and number of the Annuity Units in each Subaccount.
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Subaccount Unit – Subaccount Units are used to measure the Variable Account Value in that
Subaccount.
Unit Value – The value of a Subaccount Unit (“Subaccount Unit Value”) or Subaccount Annuity Unit
(“Subaccount Annuity Unit Value”). The Unit Value of any Subaccount is subject to change on any
Business Day. The fluctuations in value reflect investment results and daily deductions for the
mortality and expense risk charge and administrative fee. Changes in Subaccount Annuity Unit Values
also reflect an additional adjustment factor that corrects for an assumed investment return. The
Unit Value of a Subaccount Unit and of a Subaccount Annuity Unit are determined each Business Day.
Variable Account (“Variable Investment Option”) – A Subaccount of the Separate Account or any
separate account of ours which is available under the Contract in which the assets of the Company
are segregated from the assets in our General Account and from the assets in our other separate
accounts.
Variable Account Value (“Subaccount Value”) – The aggregate amount of the Contract Value allocated
to the Variable Accounts.
You and Your – The person or persons named as Owner(s) in the Contract Specifications. If there are
Joint Owners, you and your mean both Joint Owners.
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6
GENERAL PROVISIONS
Report to Owner(s) – At least once per year prior to the Annuity Date, we will provide you with
a report that will show the beginning and ending dates of the current report period, the Contract
Value at the beginning and end of the report period, the Full Withdrawal Value at the end of the
report period, and the transactions (i.e., Purchase Payments received, loan repayments, if
applicable, transfers, withdrawals, additional amounts credited and/or charges and/or fees incurred
since the last report) and any other information that may be required. After the Annuity Date, we
will provide you with any information that may be required. Additional status reports are
available upon request at no charge.
Payments, Instructions and Requests – Unless this Contract provides otherwise, all Purchase
Payments, loan repayments (if applicable), instructions and requests must be received in a form
satisfactory to us at our Service Center. Any subsequent Purchase Payments, loan repayments (if
applicable) and requests for loans (if applicable), transfers or withdrawals received by us on any
Business Day usually will be processed the same Business Day, unless the transaction or event is
scheduled to occur on another day.
Generally, all other instructions and requests normally will be effective as of the end of the
Business Day following the day such instructions and requests are received, in a form satisfactory
to us, unless the transaction or event is scheduled to occur on another day. We may require that
you provide signature guarantees or other safeguards for any instruction, request or other document
you may send to our Service Center. You acknowledge and agree that we will not be liable for any
loss, liability, cost or expense of any kind or character for acting on instructions or requests
submitted to us that we reasonably believe to be genuine.
Any change in Owner, if permitted under the Contract, will be effective, unless otherwise specified
by the Owner, on the date such change is signed, subject to any payments made or actions taken by
us prior to our receipt of the notice.
Entire Contract – This Contract, the attached application and any attached riders and endorsements,
constitute the entire Contract, and supersede any and all prior agreements, whether oral or
written, about the terms of this Contract and the application. All statements made by or by the
authority of the applicant in the application are representations and not warranties.
Contract Modifications – Modifications to this Contract or any waiver of our rights or requirements
under this Contract can only be made if in writing by an authorized officer of the Company. This
Contract is intended to qualify as an annuity contract for federal income tax purposes. In
addition, if this Contract is a Qualified Contract, this Contract is intended to qualify as part of
a Qualified Plan. To that end, the provisions of this Contract are to be interpreted and
administered to ensure or maintain such tax qualification, notwithstanding any other provisions to
the contrary. Subject to any required regulatory approval, we may modify this Contract without the
Owner’s consent and/or our administrative procedures to reflect any clarifications that may be
needed or are appropriate to maintain its tax qualification or to conform this Contract to any
applicable changes in the tax qualification requirements.
Basis of Values – A detailed statement showing how values are determined has been filed with the
New York State Insurance Department. All values and reserves are at least equal to those required
by the laws of the state of New York.
Minimum Benefits – The benefits provided under this contract are not less than the minimum benefits
required by New York. Such benefits may be altered by increases and/or decreases in the investment
performance of the variable Investment Options, loans and loan repayments, and partial or full
withdrawals as described in the applicable sections of this Contract.
Claims of Creditors – The Contract Value and other benefits under this Contract are exempt from the
claims of creditors to the extent permitted by law.
Removal of Beneficiary or Contingent Annuitant – You may remove a Beneficiary or Contingent
Annuitant from this Contract by providing written instructions satisfactory to us to our Service
Center. Any change in Beneficiary or Contingent Annuitant will be effective on the date such change
is signed, subject to any payments made or actions taken by us prior to our receipt of the notice.
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7
Ownership – This Contract belongs to the Owner. The Owner is entitled to exercise all rights
available under this Contract. If this Contract names two Owners, both Owners must join in any
request to exercise these rights. The Owner may exercise these rights without the consent of the
Beneficiary or any other person, except as otherwise required by law. If your Contract is
Non-Qualified, you may change Contract ownership at any time while the Annuitant is living and
prior to your Annuity Date. Any change in Owner will be effective on the date such change is
signed, subject to any payments made or actions taken by us prior to our receipt of the notice.
Assignment – You may assign all rights and benefits under this Contract before the Annuity Date.
The assignment must be in writing in a form satisfactory to us. The assignment is effective on the
date the notice of assignment is signed, subject to any payments made or actions taken by us prior
to our receipt of the notice. We are not responsible for the validity of any assignment. If the
Contract has been absolutely assigned, the assignee becomes the Owner. You should consult with your
tax adviser to determine the tax consequences of an assignment before taking any action.
Delay of Payments – Generally, we will pay any amounts due from the Contract within seven (7) days
after our receipt of the request, in a form satisfactory to us. Payments or transfers to or from a
Variable Account may be delayed after our receipt of the request under certain circumstances. These
include:
• | a closing of the New York Stock Exchange other than on a regular holiday or weekend; |
• | a trading restriction by the SEC; or |
• | an emergency declared by the SEC. |
We may delay payments or transfers from our General Account (which would include payment of the
withdrawal proceeds and loans) for up to six (6) months after the requested effective date of the
transaction. Any amount delayed, so long as it is held under the General Account, will earn
interest at a minimum annual rate of 3%.
If you make any Purchase Payment by check, other than a cashier’s check, we may delay making
payments to you until your check has cleared.
Incontestability – After this Contract has been issued, we will not contest the validity of this
Contract other than for statements relating to age, sex or identity.
Misstatement of Age and/or Sex – We may require proof of the Annuitant’s or Owner’s Age and/or sex
before any payments associated with the death benefit proceeds are made. If the Age and/or sex of
the Annuitant or Owner is incorrectly stated, we will base any such payment associated with the
death benefit proceeds on the Annuitant’s or Owner’s correct Age and/or sex.
We may require proof of the Annuitant’s Age and/or sex before starting annuity payments. If the Age
and/or sex (or both) of the Annuitant is incorrectly stated, we will correct the amount payable,
based upon the Annuitant’s correct Age and/or sex, if applicable. If we make the correction after
annuity payments have started and we have made overpayments, we will deduct the amount of the
overpayment, with interest at 3% per year, from any payments due then or later. If we have made
underpayments, we will add the amount, with interest at 3% per year, of the underpayments to the
next payment we make after we receive proof of the correct Age and/or sex.
Proof of Life or Death – Before we make a payment, we have the right to require proof of the life
or death of any person on whose life or death determines whether, to whom, or how much we must pay
any benefits under this Contract.
Withholding Taxes – We reserve the right to withhold from all payments made or deemed made under
this Contract, any taxes required to be withheld by applicable federal or state law, unless the
Owner or payee elects otherwise pursuant to applicable withholding rules.
Non-Participating – This Contract is classified as a non-participating contract. It does not
participate in our surplus, and therefore no dividends are payable.
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PURCHASE PAYMENTS
Initial Purchase Payment – This Contract will not be in force until we receive at our Service
Center the initial Purchase Payment. The initial Purchase Payment is shown in the Contract.
Additional Purchase Payments – You may make additional Purchase Payments at any time before the
Annuity Date, while the Annuitant is living and this Contract is in force. Each additional Purchase
Payment must be at least $250 for Non-Qualified Contracts and $50 for Qualified Contracts. A single
Purchase Payment or the aggregate of all Purchase Payments may not exceed the Maximum Purchase
Payment amount shown in the Contract Specifications without our approval.
Purchase Payments are payable in U.S. dollars at our Service Center. Checks should be made payable
to Pacific Life & Annuity Company. If you make Purchase Payments by check other than a cashier’s
check, withdrawal payments and any refund under the Right to Cancel provision may be delayed until
your check has cleared.
Purchase Payment Allocation – Prior to the Annuity Date, you may allocate all or part of your
Purchase Payments to one or more of the Investment Options available under this Contract. The
Investment Options available on the Contract Date are shown in the Contract Specifications.
You may change the Purchase Payment allocation by providing us with instructions in a form
satisfactory to us. We will allocate any Purchase Payment according to your most recent allocation
instructions. We may reject any instruction or Purchase Payment if your instructions are not clear
and we cannot determine your allocation instructions.
Allocations During the Right to Cancel Period – We will allocate the initial Purchase Payment in
accordance with your most recent allocation instructions.
Minimum Investment Option Value – We reserve the right to require that, as a result of any
allocation to an Investment Option, any transfer, or any withdrawal, the remaining Account Value in
any Investment Option must be at least $500.
We also reserve the right to transfer any remaining Account Value that does not meet such minimum
amount to your other Investment Options on a pro rata basis relative to your most recent allocation
instructions for those Investment Options.
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VARIABLE INVESTMENT OPTIONS
Variable Investment Options – The Variable Investment Options consist of Subaccounts of the
Separate Account. The available Subaccounts as of the Contract Date are shown in the Contract
Specifications.
Separate Account – We established and maintain the Separate Account under the laws of the state of
Arizona. Any income, gains or losses (whether or not realized) from the assets of each Variable
Account are credited or charged against such Variable Account without regard to our other income,
gains or losses. Assets may be put in our Separate Account to support this Contract and other
variable annuity contracts. Assets may be put in our Separate Account for other purposes, but not
to support contracts other than variable annuity contracts. The assets of our Separate Account are
our property. We will maintain in each Separate Account assets with a value at least equal to the
amounts accumulated in accordance with the applicable agreements with respect to such Separate
Account and the reserves for annuities in the course of payment that vary with the investment
experience of such Separate Account. The portion of the Separate Account assets equal to the
reserves and other Contract liabilities with respect to each Variable Account will not be
chargeable with liabilities arising out of any other business we conduct. We may transfer assets of
a separate account in excess of the reserves and other liabilities with respect to its Variable
Accounts to another separate account or to our General Account. All obligations arising under the
Contract are our general corporate obligations. We do not hold ourselves out to be trustees of the
Separate Account assets.
We reserve the right, subject to compliance with the law then in effect, and after any required
regulatory approval, to:
• | cease offering any Subaccount; |
• | add or change designated investment companies or their portfolios, or other investment vehicles; |
• | add, delete or make substitutions for the securities and other assets that are held or purchased by the Separate Account or any Variable Account; |
• | permit conversion or exchanges between portfolios and/or classes of contracts on the basis of Owners’ requests; |
• | add, remove or combine Variable Accounts; |
• | combine the assets of any Variable Account with any of our other Separate Accounts or of any of our affiliates; |
• | register or deregister Separate Account A or any Variable Account under the 1940 Act; |
• | operate any Variable Account as a managed investment company under the 1940 Act, or any other form permitted by law; |
• | run any Variable Account under the direction of a committee, board, or other group; |
• | restrict or eliminate any voting rights of Owners with respect to any Variable Account or other persons who have voting rights as to any Variable Account; |
• | make any changes required by the 1940 Act or other federal securities laws; |
• | make any changes necessary to maintain the status of the Contracts as annuities under the Code; |
• | make other changes required under federal or state law relating to annuities; |
• | suspend or discontinue sale of the Contracts; and |
• | comply with applicable law. |
If any of these changes result in a material change in the underlying investments of a Variable
Account, we will notify you of such change.
We will not change the investment policy of the Separate Account without following the filing and
other procedures of the Insurance Superintendent of the State of New York. Unless required by law
or regulation, an investment policy may not be changed without our consent.
From time to time we may make other Investment Options available to you. Any new Investment Option
may invest in portfolios of the designated investment company, other designated investment
companies or their portfolios, or in other investment vehicles. New Investment Options will be made
available to existing Owners at our discretion. We will provide you with written notice of all
material details, including investment objectives and charges. We will comply with the filing or
other procedures established by applicable state insurance regulators, to the extent required by
applicable law.
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CONTRACT VALUES
Contract Value – The Contract Value on any Business Day is the sum of:
• | the Variable Account Value; plus |
• | the Loan Account Value. |
We generally determine values on each day that the New York Stock Exchange is open, provided our
administrative offices are also open on that day.
Variable Account Value – The Variable Account Value on any Business Day is the sum of the
Subaccount Values on that day.
Subaccount Value – Each Subaccount Value on any Business Day is equal to the number of Subaccount
Units in that Subaccount multiplied by the Unit Value of the Subaccount on that day.
We credit the Subaccount with Subaccount Units as a result of any:
• | Purchase Payments received by us, reduced by any applicable premium taxes and/or other taxes, and allocated to that Subaccount; |
• | transfers to that Subaccount, including transfers from the Loan Account; and |
• | additional amounts allocated to that Subaccount. |
We debit the Subaccount with Subaccount Units as a result of any:
• | transfers from that Subaccount, including transfers to the Loan Account; |
• | withdrawals, including any applicable withdrawal charges; |
• | amounts applied to provide for annuity payments; |
• | annual fees; |
• | annual charges for expenses relating to optional benefit riders attached to the Contract; and |
• | charges for premium taxes and/or other taxes. |
The number of Subaccount Units we credit to, or debit from, a Subaccount in connection with a
transaction is equal to the amount of the transaction applicable to that Subaccount divided by that
Subaccount’s Unit Value at the end of the valuation period that includes that day. The number of
Subaccount Units in a Subaccount will change only if we credit or debit Subaccount Units for the
transactions specified above. The number of Subaccount Units will not change because of subsequent
changes in the Subaccount Unit Value.
Subaccount Unit Value – The initial Unit Value of each Subaccount was $10 on the Business Day the
Subaccount began operations. At the end of each subsequent Business Day, the Unit Value for each
Subaccount is equal to (Y) times (Z), where:
(Y) | is the Unit Value for that Subaccount as of the end of the prior Business Day; and |
(Z) | is the Net Investment Factor for that Subaccount for the period (a “valuation period”) between the prior Business Day and that Business Day. |
Net Investment Factor – Each Subaccount’s Net Investment Factor for any valuation period is equal
to (A / B) – C, where:
(A) | equals: |
(a) | the net asset value per share of the corresponding portfolio shares held by the Subaccount as of the end of that valuation period; plus |
(b) | the per share amount of any dividend or capital gain distributions made during that valuation period on the portfolio shares held by the Subaccount; plus or minus |
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(c) | any per share charge or credit for any income taxes, other taxes, or amounts set aside during that valuation period as a reserve for any income and/or any other taxes for which we determine to have resulted from the operations of the Subaccount or Contract, and/or any taxes attributable, directly or indirectly, to Purchase Payments; |
(B) | is the net asset value per share of the portfolio shares held by the Subaccount as of the end of the prior valuation period; and |
(C) | is a factor that we assess against the Subaccount’s net assets held by each Subaccount for the mortality and expense risk charge and the administrative fee during that valuation period. |
Loan Account Value – For Qualified Contracts that permit loans, the Loan Account Value as of the
end of any Business Day is the Loan Account Value on the prior Business Day, increased by any:
• | interest; plus |
• | Contract Value loaned on that day; |
and decreased by any:
• | loan principal repaid; plus |
• | earned interest transferred from the Loan Account on that day. |
Persistency Credit – Beginning on the eighth (8th) Contract Anniversary prior to
annuitization, and on every Contract Anniversary thereafter that is prior to the Annuity Date, we
will add to the Contract Value an amount equal to 0.55% multiplied by the Contract Value for that
Contract Anniversary. The Persistency Credit will be allocated among Investment Options on a pro
rata basis.
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CHARGES, FEES AND DEDUCTIONS
Administrative Fee – We charge an administrative fee against the assets held in the Variable
Investment Option(s). This fee is assessed daily at the annual rate which is shown in the Contract
Specifications. This fee is guaranteed not to increase.
Mortality and Expense Risk Charge (“Risk Charge”) – We impose a Risk Charge against the assets held
in the Variable Investment Option(s). This charge is assessed daily at the annual rate which is
shown in the Contract Specifications. The Risk Charge compensates us for the risks we assume that
mortality and expenses will vary from those we assumed. This charge is guaranteed not to increase.
Annual Fee – We charge an annual fee against the Contract Value on each Contract Anniversary prior
to the Annuity Date, and at the time you withdraw the entire Net Contract Value (on a prorated
basis for the current Contract Year). The annual fee is shown in the Contract Specifications.
This fee is guaranteed not to increase. The annual fee is waived if, on any Contract Anniversary
prior to the Annuity Date, or at the time you make a full withdrawal, the Net Contract Value is
$50,000 or more on that day.
We will not impose the annual fee on amounts applied to provide an annuity or on payment of the
death benefit proceeds.
Premium Taxes – From the Contract Value, we will deduct a charge for any taxes we pay that are
attributable to Purchase Payments or withdrawals. Such taxes may include, but are not limited to:
any federal, state or local premium or retaliatory taxes; and any federal, state or local income,
excise, business or any other type of tax (or component thereof), measured by or based upon,
directly or indirectly, the amount of Purchase Payments we receive from you. We will normally
deduct this charge upon annuitization. However, we may impose this charge on any withdrawal, at
the time any death benefit is paid, when the taxes are incurred or when we pay the taxes. We will
base this charge on the Contract Value, the amount of the transaction, the aggregate amount of
Purchase Payments we receive under the Contract; or any other amount that, in our sole discretion,
we deem appropriately reimburses us for premium taxes paid on this Contract.
Other Taxes – We reserve the right to charge the Separate Account and/or deduct from the Contract
Value a charge for any federal, state or local taxes we pay that are or become attributable to the
Separate Account or Contract, including, but not limited to, income taxes attributable to our
operation of the Separate Account or to our operations with respect to the Contract, or taxes
attributable, directly or indirectly, to Purchase Payments or payments we make under this Contract.
Withdrawal Charge – Purchase Payments are subject to a withdrawal charge which is shown in the
Contract Specifications. This charge may apply to amounts withdrawn under the Contract prior to the
Annuity Date, depending on the length of time each Purchase Payment has been allocated to the
Contract and on the amount withdrawn.
We will not apply the withdrawal charge on:
• | distributions resulting from the death of the first Owner or the sole surviving Annuitant before the Annuity Date, except as provided under the Death of Owner provision for certain Non-Natural Owners; |
• | if the Contract Value is applied to provide an annuity option from us; |
• | withdrawals after 90 days from the Contract Date if the Owner or Annuitant has been confined to an accredited nursing home for 60 days, and was not confined to the nursing home on the Contract Date. Confinement period for which you seek the waiver must begin after the Contract Date; |
• | withdrawals to meet required minimum distributions for Qualified Contracts as they apply to amounts held under the Contract; |
• | withdrawals after the first Contract Anniversary, if the Owner or Annuitant has been diagnosed as having a medically determinable condition that results in a life expectancy of twelve (12) months or less and we are provided with medical evidence satisfactory to us; or |
• | withdrawals as defined under the “Free Withdrawals” section below. |
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Amount of Withdrawal Charge – The amount of a withdrawal charge depends on how long the Purchase
Payments are held under this Contract. Each Purchase Payment you make is considered to have a
certain “age,” depending on the length of time since that Purchase Payment was effective.
A Purchase Payment is “age one” from the day it was effective until the next Contract Anniversary
and increases in “age” on that and each succeeding Contract Anniversary. When you withdraw an
amount, the “age” of any Purchase Payment you withdraw determines the level of withdrawal charge as
shown in the Contract Specifications.
For purposes of calculating the withdrawal charge, we assume that amounts withdrawn will be applied
to Purchase Payments first and in the order the Purchase Payments were received. The withdrawal
charge will be deducted proportionately from each Investment Option selected for withdrawal.
Free Withdrawals – During a Contract Year, you may withdraw free of withdrawal charges amounts up
to the sum of your earnings plus your “Eligible Purchase Payments”. Eligible Purchase Payments
include 10% of all Purchase Payments that have an “age” of less than eight (8) years, plus 100% of
all remaining Purchase Payments that have an “age” of eight (8) years or more.
Any portion of your Eligible Purchase Payments not withdrawn during a Contract Year may not be
carried over to the next Contract Year.
Earnings – For the purposes of calculating the withdrawal charge as of the end of any Business Day,
earnings equal the Contract Value less the aggregate Purchase Payments that are reduced by
withdrawals of prior Purchase Payments.
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TRANSFER PROVISIONS
Transfers – You may, on or before the Annuity Date and subject to the requirements, limitations
and restrictions described in this section, transfer all or part of the Contract Value, less any
Loan Account Value, in any Investment Option among other Investment Options, while the Annuitant is
living and the Contract is in force. Your transfer request must specify:
(a) | the Investment Option (the “source account”) from which the transfer is to be made. You may choose one or more Investment Options as your source account(s). Your source account may not also be a target account; |
(b) | the amount of the transfer. The amount of the transfer may be specified as a dollar amount or a percentage of the source Account Value. If you select more than one source account, the amount of the transfer from each source account must be at least the lesser of $250 or the full source Account Value; and |
(c) | the Investment Option (the “target account”) to receive the transferred amount. You may choose one or more Investment Options as your target account(s). If you select more than one target account, your request must specify how the transferred amounts are to be allocated among the target accounts. Your source account may not also be a target account. |
Transfers among Investment Options will normally be effective as of the end of the Business Day the
transfer request, in a form satisfactory to us, is received at our Service Center.
Transfer Limitations and Restrictions – The following limitations and restrictions apply to
transfers among Investment Options:
(a) | Transfers are allowed thirty (30) days after the Contract Date. |
(b) | Transfers are limited to twenty-five (25) transfers during each Calendar Year and only two (2) per month, into or out, that affect any international Investment Options. For the purpose of applying this limitation, transfers that occur on the same day are considered one transfer and transfers that occur as a result of any systematic transfer option are excluded from the maximum twenty-five (25) transfers per Calendar Year limitation. |
(c) | Transfers to or from an Investment Option cannot be made until the eighth (8th) calendar day (provided that day is a Business Day) from the last day of the most recent transfer to or from that Investment Option. The day of the most recent transfer is considered as the first (1st) calendar day for purposes of meeting this requirement. Transfers that occur as a result of any systematic transfer option are excluded from this requirement. |
(d) | If a transfer reduces the remaining Account Value in any Investment Option immediately after such transfer to an amount less than $500, we reserve the right to transfer such remaining Account Value to your other Investment Options on a pro rata basis relative to your most recent allocation instructions. |
(e) | We further reserve the right to restrict, in our sole discretion and without prior notice, transfers initiated by a market timing organization or individual or other party authorized to give transfer instructions on behalf of multiple Contract Owners. Such restrictions could include: |
(i) | not accepting transfer instructions from an individual or entity acting on behalf of more than one Contract Owner; and |
(ii) | not accepting preauthorized transfer forms from market timers or other entities acting on behalf of more than one Contract Owner at a time. |
(f) | We further reserve the right to modify the limits described in subparagraphs (a) through (e) above or to impose, without prior notice, other limitations and restrictions on transfers or exchanges that we determine, in our sole discretion, will disadvantage or potentially hurt the rights or interests of other Contract Owners or to comply with any applicable federal or state laws, rules and regulations. |
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WITHDRAWAL PROVISIONS
Withdrawals – You may, on or before the Annuity Date and subject to the requirements,
limitations and restrictions described in this section, withdraw all or a portion of the amount
available under this Contract, while the Annuitant is living and the Contract is in force.
However, no withdrawals are allowed within thirty (30) days of the Contract Date.
You may specify that the withdrawal be taken from a specific Investment Option or pro rata from all
Investment Options. If your request does not specify the Investment Option from which the
withdrawal is to be made, the withdrawal will be taken pro rata from all Investment Options
relative to the Account Value in each option.
Withdrawals will normally be effective as of the end of the Business Day the withdrawal request, in
a form satisfactory to us, is received at our Service Center.
Minimum Withdrawal Amount – The minimum amount that may be withdrawn is $500. If the withdrawal
reduces the Account Value in any Investment Option to an amount less than $500, we reserve the
right, with prior written notice, to transfer such remaining Account Value to your other Investment
Options on a pro rata basis relative to your most recent allocation instructions.
If the withdrawal reduces the Net Contract Value to an amount less than $1,000, we may terminate
this Contract and pay you the withdrawal proceeds (see Full Withdrawal provision). We will not
terminate the Contract if you own an optional rider and a withdrawal reduces the Net Contract Value
to an amount less than $1,000. Payment of the withdrawal proceeds will end this Contract and we
will have no further obligations under the Contract.
Full Withdrawal – You may, on or before the Annuity Date, make a full withdrawal under this
Contract for its withdrawal proceeds, while the Annuitant is living and the Contract is in force.
A full withdrawal will terminate the Contract. We will require the return of this Contract or a
signed Lost Contract Affidavit with your request. Your request for a full withdrawal will normally
be effective as of the end of the Business Day such request, in a form satisfactory to us, is
received at our Service Center. Payment of the withdrawal proceeds will end this Contract and we
will have no further obligations under the Contract.
Amount Available for Withdrawal – The amount available for withdrawal is the Net Contract Value as
of the end of the Business Day on which the withdrawal request is effective, less any:
• | Withdrawal charges; |
• | charges for expenses relating to optional riders attached to the Contract; |
• | charges for annual fees; and |
• | charges for premium taxes and/or other taxes. |
The amount we send you (the “withdrawal proceeds”) will also reflect any required or requested
federal and/or state income tax withholding.
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DEATH BENEFIT PROVISIONS
Death Benefit – A death benefit will be payable only if the sole surviving Annuitant or any
Owner dies before the Annuity Date and while this Contract is in force.
The proceeds of any death benefit will be payable upon receipt of, in a form satisfactory to us,
proof of death and instructions regarding payment of the death benefit proceeds (the “Notice
Date”). Such proceeds will equal the Death Benefit Amount reduced by any:
• | Contract Debt; and |
• | charges for premium taxes and/or other taxes, if proceeds are used to purchase an Annuity Option. |
These proceeds may be payable in a lump sum, as periodic payments under an Annuity Option available
under this Contract, towards the purchase of any other Annuity Option we then offer, or in
accordance with the Code (see Death of Owner Distribution Rules).
If there are multiple Beneficiaries, the Death Benefit Amount will be calculated when we first
receive proof of death and instructions, in proper form, from any Beneficiary. Any Death Benefit
Amount still remaining to be paid to any other Beneficiary will fluctuate with the performance of
the underlying Investment Options.
Death Benefit Amount – The Death Benefit Amount as of any Business Day prior to the Annuity Date is
equal to the greater of:
(a) | the Contract Value as of that day; or |
(b) | the aggregate Purchase Payments reduced by an amount for each withdrawal that has occurred, which is calculated by multiplying the aggregate Purchase Payments received prior to each withdrawal by the ratio of the amount of the withdrawal, including any withdrawal charge, to the Contract Value immediately prior to the withdrawal. |
Death of Annuitant – If the Annuitant dies before the Owner and before the Annuity Date, the death
benefit proceeds will be equal to the Death Benefit Amount as of the Notice Date. Unless there is a
surviving Joint Annuitant or Contingent Annuitant, we will pay the death benefit proceeds to the
first person among the following who is (1) living; or (2) an entity entitled to receive the death
benefit proceeds; following the death of the sole surviving Annuitant:
(a) | the Owner; |
(b) | the Joint Owner; |
(c) | the Beneficiary; or |
(d) | the Contingent Beneficiary. |
If none are living (or if there is no entity entitled to receive the death benefit proceeds), we
will pay the death benefit proceeds to the Owner’s estate.
If an Annuitant dies and there is a surviving Joint Annuitant, the surviving Joint Annuitant
becomes the Annuitant and no death benefit will be paid. If there is no surviving Joint Annuitant
and there is a Contingent Annuitant, the Contingent Annuitant becomes the Annuitant and no death
benefit will be paid.
If you are the Annuitant and you die, we will determine the amount of any death benefit and to whom
it will be paid under this Death of Annuitant provision. If the Contract is issued as a
Non-Qualified Contract, we will distribute any death benefit proceeds under the Death of Owner
Distribution Rules provision.
Death of Owner – If you are not the Annuitant and you die before the Annuitant and before the
Annuity Date, the death benefit proceeds will be equal to the Death Benefit Amount as of the Notice
Date.
If you die while the Annuitant is living and prior to the Annuity Date, we will pay the death
benefit proceeds to the first among the following who is (1) living; or (2) an entity entitled to
receive the death benefit proceeds:
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(a) | the Joint Owner; |
(b) | the Beneficiary; or |
(c) | the Contingent Beneficiary. |
If none are living (or if there is no entity entitled to receive the death benefit proceeds), we
will pay the death benefit proceeds to your estate.
If you are a Non-Natural Owner of a Contract other than a Contract issued under a Qualified Plan as
defined in Section 401 or 403 of the Code, the Primary Annuitant will be treated as the Owner of
the Contract for purposes of the Death of Owner Distribution Rules.
Death of Owner Distribution Rules – The following rules will determine when a distribution must be
made under this Contract. These rules do not affect our determination of the amount of death
benefit proceeds payable or distribution proceeds. If there is more than one Owner, these rules
apply on the date on which the first of these Joint Owners die.
If the Owner dies before the Annuity Date, the designated recipient of the death benefit proceeds
may elect to receive the death benefit proceeds:
• | in a lump sum payment; |
• | within five (5) years following the Owner’s death; or |
• | in the form of an annuity for life or over a period that does not exceed the life expectancy of the designated recipient, with annuity payments that start within one (1) year after the Owner’s death. |
Unless otherwise required by law, an election to receive an annuity (in lieu of a lump sum payment)
must be made within such time frames as we may prescribe from time to time, or the lump sum payment
option will be deemed elected. We will consider that deemed election as our receipt of
instructions regarding payment of the death benefit proceeds.
The Owner may designate that the Beneficiary is to receive the death benefit proceeds either
through an annuity for life or over a period that does not exceed the life expectancy of the
Beneficiary. Such designation must be made in writing in a form acceptable to us, and may only be
revoked by the Owner in writing in a form acceptable to us. Upon death of the Owner, the
Beneficiary cannot revoke or modify any designation made by the Owner on how the death benefit
proceeds are to be paid.
If the spouse of the deceased Owner is the sole surviving Beneficiary, or is the sole surviving
Joint Owner, and has an unrestricted right to receive the death benefit proceeds in a lump sum, the
spouse may continue this Contract as Owner rather than receive the death benefit proceeds, provided
that we receive instructions to continue the Contract within such time frames as we may prescribe
from time to time.
On the Notice Date, if the surviving spouse has elected to continue the Contract, we will set the
Contract Value equal to the death benefit proceeds that would have been payable to the spouse as
the deemed Beneficiary/designated recipient of the death benefit. The amount that the Death
Benefit Amount exceeds the Contract Value will be added to the Contract Value in the form of the
Add-In Amount on the Notice Date. The Add-In Amount will be allocated among Investment Options in
accordance with the current allocation instructions for the Contract and will be considered
earnings. There will not be an adjustment to the Contract Value if the Contract Value is equal to
the death benefit proceeds as of the Notice Date.
If the Owner dies on or after the Annuity Date, but payments have not yet been completed, then
distributions of the remaining amounts payable under this Contract must be made at least as rapidly
as the rate that was being used at the date of the Owner’s death. All of the Owner’s rights
granted by the Contract will be assumed by the first person among the following who is (1) living;
or (2) an entity entitled to assume the Owner’s rights granted by the contract:
(a) | the Joint Owner; |
(b) | the Beneficiary; or |
(c) | the Contingent Beneficiary. |
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If none are living (or if there is no entity entitled to assume the Owner’s rights granted by the
Contract), all of the Owner’s rights granted by the Contract will be assumed by the Owner’s estate.
In any event, the death benefit proceeds will be paid in accordance with Section 72(s) of the Code.
These Death of Owner Distribution Rules do not apply to Qualified Contracts issued under Qualified
Plans as defined in Section 401, 403, 408 or 408A of the Code or to an annuity that is a qualified
funding asset as defined in Code Section 130(d) (but without regard to whether there is a qualified
assignment).
BENEFICIARY PROVISIONS
Designation of Beneficiary – The Beneficiary is the person you name who may receive any death
benefit proceeds, or any remaining annuity payments after the Annuity Date, if the Annuitant or
Owner dies. The Owner can name more than one Beneficiary. Multiple Beneficiaries will share the
death benefit proceeds (or any remaining annuity payments) equally, unless otherwise specified. If
any Beneficiary predeceases the Annuitant or Owner, that Beneficiary’s interest will go to any
other Beneficiaries named, according to their respective interests, unless otherwise specified. If
you leave no surviving Beneficiary, your estate may receive the death benefit proceeds.
If the Beneficiary is a trustee, we will neither be responsible for verifying a trustee’s right to
receive any death benefit proceeds, nor for how the trustee disposes of any death benefit proceeds.
If before payment of any death benefit proceeds, we receive proper notice that the trust has been
revoked or is not in effect, then any death benefit proceeds payable will be paid to the Contingent
Beneficiary, if living; if not to the Owner’s estate.
Adding or Changing Your Beneficiary – You may add, change, or remove any Beneficiary, subject to
the terms of any assignment, at any time prior to the death of the Annuitant or Owner, by providing
us with a request in a form satisfactory to us. Qualified Contracts may have additional
restrictions on naming and changing Beneficiaries. Any change or addition will take effect on the
date the notice of change is signed by the Owner, subject to any payments made or actions taken by
us prior to our receipt of the notice.
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ANNUITY PROVISIONS
Choice of Annuity Date – Unless otherwise changed as provided below, the Annuity Date is shown
in the Contract Specifications. If you did not select an Annuity Date in the application for this
contract, and you have a Non-Qualified Contract, your Annuity Date will be the later of the
Annuitant’s 90th birthday or the tenth (10th) Contract Anniversary. If there
are Joint Annuitants, the Annuity Date will be based on the younger Annuitant’s birthday. If you
did not select an Annuity Date in the application for this Contract and you have a Qualified
Contract, distribution at an earlier age may be required.
The Annuity Date may be changed by providing proper notice to us at least ten (10) Business Days
prior to the current Annuity Date or new Annuity Date, whichever is earlier, subject to any
applicable state law or the Code.
The new Annuity Date may not be earlier than the first Contract Anniversary and must occur on or
before the later of the Annuitant’s 90th birthday or the tenth (10th) Contract
Anniversary, or earlier, as required by any applicable state law or the Code. If there are Joint
Annuitants, the Annuity Date will be based on the younger Annuitant’s birthday. You should consult
with your Qualified Plan administrator before you elect an Annuity Date.
Default Annuity Option – For all Non-Qualified Contracts and those Qualified Contracts where the
Annuitant is not married, the Annuity Option will be a fixed annuity Life with a Period Certain of
Ten (10) Years. If this is a Qualified Contract and you are married, the Annuity Option will be a
fixed annuity Joint and Survivor Life, with survivor payments of 100%, and your spouse will
automatically be named as the secondary Annuitant.
The Annuity Option may be changed by providing proper notice to us at least ten (10) Business Days
prior to the current Annuity Date, to any other Annuity Option contained in this Contract or
allowed by us.
Unless otherwise specified or changed, we will make annuity payments based on our most frequent
payment schedule that results in an initial annuity payment of at least $20. The payment frequency
may be changed by providing proper notice to us at least ten (10) Business Days prior to the
current Annuity Date.
Subject to our minimum requirements, the Net Contract Value less any charges for premium taxes
and/or other taxes will be converted to a fixed annuity payout option on the Annuity Date.
Application of Contract Value – Prior to the Annuity Date, you may elect to convert all or part of
the Net Contract Value less any charge for premium taxes and/or other taxes, to any currently
offered Annuity Option. The aggregate net amount you convert must be at least $2,000 or an amount
that would provide an income of at least $20 per month; otherwise, we reserve the right to
terminate this Contract and pay such aggregate net amount in a single sum.
Subject to the Withdrawal Provisions, you may also elect a full withdrawal in lieu of annuity
payments under an Annuity Option. Before we make any full withdrawal, we require return of this
Contract (or a signed Lost Contract Affidavit) to us.
If you convert only a portion of the Net Contract Value on the Annuity Date, you may, at that time,
elect not to have the remainder of the Net Contract Value distributed, but instead to continue the
Contract with that remaining Contract Value. This option may or may not be available, or may be
available only for certain types of Contracts. If this option is available and you elect it, you
would choose a second Annuity Date for such Contract Value. All references in this Contract to the
Annuity Start Date (or Annuity Date) would, with regard to such Contract Value, be deemed to refer
to that second Annuity Date. The second Annuity Date may not be after the Annuitant’s
90th birthday or the tenth (10th) Contract Anniversary. You should consult
with your tax adviser for more information if you desire this option.
Your Selections – Prior to the Annuity Date, you may make three selections about the annuity
payments. First, you may choose whether you want those payments to be a fixed-dollar amount or a
variable-dollar amount, or both. Second, you may choose the form of annuity payments (Annuity
Option). Third, you may choose to have annuity payments made monthly, quarterly, semiannually, or
annually.
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The first annuity payment will be sent on the day following the Annuity Date. If the amount of the
first annuity payment is less than $20 a month, we reserve the right to offer a less frequent mode
of payment so that each payment is at least $20. If there is no mode of payment so that each
payment is at least $20, we may terminate the Contract and pay you the Net Contract Value.
Once annuity payments begin, no changes can be made to either the Annuity Option or the basis on
which such payments are made (a fixed annuity basis or variable annuity basis), no additional
purchase payments will be accepted and no withdrawals will be allowed.
Fixed and Variable Annuities – You may choose a fixed annuity (with fixed-dollar payments), a
variable annuity (with variable-dollar payments), or you may choose a combination of both. If you
select a variable annuity, you may choose any Subaccounts for the annuity. If you select a variable
annuity, on the Annuity Date, we will convert that portion of the Net Contract Value as it is
currently allocated among the Subaccount(s). We will apply the net amount you convert to a fixed
annuity and/or a variable annuity (and in this instance, to each Subaccount), based on the relative
Account Value in each Investment Option on the Annuity Date. Any net amount you convert to a fixed
annuity will be held in our General Account.
Each periodic payment under the fixed annuity will be equal to the amount of the first fixed
annuity payment (unless you elect a joint and survivor life annuity with reduced survivor
payments). The amount of each variable annuity periodic payment will vary with the investment
results of the Subaccount(s) you select. After the Annuity Date, you may exchange the Annuity Units
in any Subaccount(s) for Annuity Units in any other Subaccount(s) up to four (4) times in any
twelve (12) month period. We reserve the right to limit the Subaccounts available, to change the
number and frequency of exchanges with prior notice and to change the number of Subaccounts you may
choose.
Amount of Payments – The first annuity payment amount depends on the Annuity Option, payment
frequency, and whether you select a fixed annuity and/or a variable annuity. If you do not choose
the Period Certain Only Option, the amount will depend on the Age of the Annuitant(s), the Annuity
Date, and the sex of the Annuitant(s), unless unisex factors apply.
Fixed Annuity Payments – The minimum guaranteed income purchased per $1,000 of the net amount
applied to a fixed annuity is based on an annual interest rate of 3% and the 1983a Mortality Table
with the ages set back ten (10) years.
Conversion to Current Rates – Annuity payments will be based on the greater of:
* | our current income factors in effect for this Contract on the Annuity Date; or |
* | our guaranteed income factors set forth in this Contract. |
The dollar amount of any payments after the first annuity payment is specified during the annuity
payment period according to the provisions of the elected Annuity Option.
Variable Annuity Payments – Subaccount Annuity Units. For each Subaccount, we divide the amount
of the initial variable annuity payment from each Subaccount by the Annuity Unit Value for that
Subaccount (the “Annuity Unit Value”) on the Annuity Date, to obtain the number of Annuity Units
for that Subaccount. The number of Annuity Units in each Subaccount will not change unless
exchanges of Annuity Units are made (or if the Joint and Survivor Annuity Option is elected and the
Primary Annuitant dies first), but the Annuity Unit Value of those Annuity Units will vary.
Neither expenses actually incurred other than taxes on the investment return, nor mortality
actually experienced shall adversely affect the dollar amount of variable annuity payments to any
payee for whom variable annuity payments have commenced.
Subsequent Variable Payments – The amount of each subsequent variable annuity payment will be the
sum of the amounts payable based on the Annuity Units in each Subaccount. To determine the amount
payable for each Subaccount, we multiply the number of Annuity Units in that Subaccount by their
Annuity Unit Value on the day in each payment period that corresponds to the Annuity Date.
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21
Annuity Unit Value – The initial Annuity Unit Value for each Subaccount was arbitrarily set at $10
on the Business Day the Subaccount began operations. At the end of each subsequent Business Day,
the Annuity Unit Value for each Subaccount is equal to (A x B) x C, where:
A - is the Subaccount’s Annuity Unit Value for that Subaccount as of the end of the prior Business Day;
B - is the Net Investment Factor for that Subaccount for that valuation period; and
C - is an interest factor to offset the effect of the assumed investment return which is built into the Annuity Option Tables.
We generally calculate the Annuity Unit Value of each Subaccount on each day the New York Stock
Exchange is open, provided our administrative offices are also open that day.
We guarantee that the amount of each subsequent annuity payment will not be affected by variations
in our expenses or in mortality experience.
Periodic Payments – The first payment under the Annuity Options will be determined on the Annuity
Date and will be made on the day following the Annuity Date.
For a Beneficiary entitled to a death benefit due to the death of the Annuitant, the first payment
will be made on the first day of the calendar month, or earlier at our option, next following the
day we receive due proof of the Annuitant’s death and instructions regarding payment, (called the
“Payment Start Date”), and such other documentation as we may require. Subsequent payments will be
determined on the day in each payment period that corresponds to the Payment Start Date and will be
made on the following day.
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22
ANNUITY OPTIONS
The following Annuity Options are available under this Contract. Additional options may become
available in the future:
Option 1 – Life Only: Periodic payments are made to the designated payee during the Annuitant’s
lifetime. Payments stop when the Annuitant dies.
Option 2 – Life with Period Certain: Periodic payments are made to the designated payee during the
Annuitant’s lifetime, with payments guaranteed for a specified period. You may choose to have
payments guaranteed five (5) through thirty (30) years (in full years only). If the Annuitant dies
before the guaranteed payments are completed, we will pay the remainder of the guaranteed payments
to the first person among the following who is (1) living; or (2) an entity entitled to receive the
remainder of guaranteed payments:
(a) | the Owner; |
(b) | the Joint Owner; |
(c) | the Beneficiary; or |
(d) | the Contingent Beneficiary. |
If none are living (or if there is no entity entitled to receive the remainder of the guaranteed
payments) we will pay the remainder of the guaranteed payments to the Owner’s estate.
If the Annuitant dies after all of the payments under the period certain have been paid, payments
will stop when the Annuitant dies.
Additionally, if variable payments are elected under this option, you may redeem all remaining
guaranteed variable payments after the Annuity Date. The amount available upon such redemption
would be the present value of any remaining guaranteed variable payments at the assumed investment
return as shown in the Basis of Computation provision.
Option 3 – Joint and Survivor Life: Periodic payments are made to the designated payee during the
lifetime of the Primary Annuitant. After the death of the Primary Annuitant, periodic payments are
based on the life of the secondary Annuitant named in the election if and so long as such secondary
Annuitant lives. Payments made based on the life of the secondary Annuitant may be in installments
equal to 50%, 66-2/3% or 100% (as specified in the election) of the original payment amount payable
during the lifetime of the Primary Annuitant. If you elect a reduced payment based on the life of
the secondary Annuitant, fixed annuity payments will be equal to 50% or 66-2/3% of the original
fixed payment payable during the lifetime of the Primary Annuitant. Variable annuity payments will
be determined using 50% or 66-2/3%, as applicable, of the number of Annuity Units for each
Subaccount credited to the Contract. Payments stop when both Annuitants have died.
Option 4 – Period Certain Only: Periodic payments are made to the designated payee during the
Annuitant’s lifetime, with payments guaranteed for a specified period. You may choose to have
payments guaranteed five (5) through thirty (30) years (in full years only). If the Annuitant dies
before the guaranteed payments are completed, we will pay the remainder of the guaranteed payments
to the first person among the following who is (1) living; or (2) an entity entitled to receive the
remainder of the guaranteed payments:
(a) | the Owner; |
(b) | the Joint Owner; |
(c) | the Beneficiary; or |
(d) | the Contingent Beneficiary. |
If none are living (or if there is no entity entitled to receive the remainder of the guaranteed
payments) we will pay the remainder of the guaranteed payments to the Owner’s estate.
Additionally, if variable payments are elected under this option, you may redeem all remaining
guaranteed variable payments after the Annuity Date. The amount available upon such redemption
would be the present value of any remaining guaranteed variable payments at the assumed investment
return as shown in the Basis of Computation provision.
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ANNUITY OPTION TABLES
Applicability of Rates – For the fixed Annuity Option, the Annuity Option Tables contained in
the following pages illustrate the minimum guaranteed monthly income purchased per $1,000 of the
net amount applied.
The tables also illustrate the minimum rates for the first monthly variable annuity payment per
$1,000 of the net amount applied to the variable annuity payment option. Subsequent payments may be
higher or lower than the first payment, based on the investment performance of the Subaccount(s)
you elect and whether you exchange Subaccount Annuity Units.
For some Qualified Plans and in some states, the use of sex-distinct income factors are prohibited.
For those Qualified Plans, we use blended unisex income factors for life payment options for both
male and female Annuitants.
Basis of Computations – The actuarial basis for the fixed Annuity Option Tables is the 1983a
Annuity Mortality Table with the ages set back ten (10) years with interest at an annual rate of
3%. The rates for variable annuity payments are based on an assumed investment return of 4% per
year and the 1983a Annuity Mortality Table with the ages set back ten (10) years.
A setback of ten (10) years indicates we will assume an age of ten (10) years younger than the
actual attained age when calculating the annuitization factor. For example, a 65 year old will
have an annuitization factor calculated based on the tabular mortality of a 55 year old, and
progress forward a year at a time. The table of annuitization factors included with this contract
already reflects a ten (10) year age setback.
Rates Not Shown – We will provide rates for any payment frequency, interest rate, age or sex,
combinations thereof, and/or payout percentage for any Annuity Option, if applicable, that we offer
if they are not shown in the tables.
Annuity benefits will not be less than those that would have been provided by the application of an
amount to purchase any single consideration immediate annuity offered by us at the time annuity
payments commence to the same class annuitant. The amount shall be the greater of the withdrawal
proceeds or 95% of what the withdrawal proceeds would be if there were no withdrawal proceeds.
10-2180
24
OPTIONS 1 AND 2
LIFE ONLY OR LIFE WITH GUARANTEED PERIOD CERTAIN OF 10 AND 20 YEARS
LIFE ONLY OR LIFE WITH GUARANTEED PERIOD CERTAIN OF 10 AND 20 YEARS
Fixed Annuity Rates
Male at 3% | Female at 3% | Unisex at 3% | ||||||||||||||||||||||||||||||||||||||
Life with | Life with | Life with | ||||||||||||||||||||||||||||||||||||||
Guaranteed | Guaranteed | Guaranteed | ||||||||||||||||||||||||||||||||||||||
Life | Period Certain | Life | Period Certain | Life | Period Certain | |||||||||||||||||||||||||||||||||||
Age | Only | 10 Yr. | 20 Yr. | Only | 10 Yr. | 20 Yr. | Only | 10 Yr. | 20 Yr. | |||||||||||||||||||||||||||||||
30 | 3.04 | 3.03 | 3.03 | 2.93 | 2.93 | 2.93 | 2.99 | 2.98 | 2.98 | |||||||||||||||||||||||||||||||
35 | 3.14 | 3.14 | 3.13 | 3.02 | 3.02 | 3.01 | 3.08 | 3.08 | 3.07 | |||||||||||||||||||||||||||||||
40 | 3.28 | 3.27 | 3.26 | 3.13 | 3.12 | 3.12 | 3.20 | 3.20 | 3.19 | |||||||||||||||||||||||||||||||
45 | 3.44 | 3.44 | 3.41 | 3.26 | 3.26 | 3.24 | 3.35 | 3.35 | 3.33 | |||||||||||||||||||||||||||||||
50 | 3.66 | 3.64 | 3.60 | 3.42 | 3.42 | 3.40 | 3.54 | 3.54 | 3.50 | |||||||||||||||||||||||||||||||
55 | 3.93 | 3.90 | 3.82 | 3.63 | 3.63 | 3.59 | 3.78 | 3.77 | 3.71 | |||||||||||||||||||||||||||||||
60 | 4.27 | 4.22 | 4.08 | 3.90 | 3.89 | 3.82 | 4.09 | 4.06 | 3.96 | |||||||||||||||||||||||||||||||
65 | 4.70 | 4.62 | 4.39 | 4.25 | 4.22 | 4.11 | 4.48 | 4.43 | 4.25 | |||||||||||||||||||||||||||||||
70 | 5.28 | 5.14 | 4.71 | 4.72 | 4.66 | 4.44 | 5.00 | 4.90 | 4.58 | |||||||||||||||||||||||||||||||
75 | 6.10 | 5.81 | 5.02 | 5.35 | 5.22 | 4.79 | 5.73 | 5.52 | 4.92 | |||||||||||||||||||||||||||||||
80 | 7.23 | 6.61 | 5.27 | 6.25 | 5.96 | 5.12 | 6.74 | 6.30 | 5.20 | |||||||||||||||||||||||||||||||
85 | 8.82 | 7.49 | 5.42 | 7.56 | 6.89 | 5.35 | 8.18 | 7.20 | 5.39 | |||||||||||||||||||||||||||||||
90 | 11.06 | 8.33 | 5.49 | 9.53 | 7.89 | 5.47 | 10.28 | 8.12 | 5.48 | |||||||||||||||||||||||||||||||
95 | 14.16 | 8.97 | 5.51 | 12.48 | 8.74 | 5.50 | 13.30 | 8.86 | 5.51 |
Variable Annuity Rates
Male at 4% | Female at 4% | Unisex at 4% | ||||||||||||||||||||||||||||||||||||||
Life with | Life with | Life with | ||||||||||||||||||||||||||||||||||||||
Guaranteed | Guaranteed | Guaranteed | ||||||||||||||||||||||||||||||||||||||
Life | Period Certain | Life | Period Certain | Life | Period Certain | |||||||||||||||||||||||||||||||||||
Age | Only | 10 Yr. | 20 Yr. | Only | 10 Yr. | 20 Yr. | Only | 10 Yr. | 20 Yr. | |||||||||||||||||||||||||||||||
30 | 3.69 | 3.69 | 3.68 | 3.60 | 3.59 | 3.59 | 3.64 | 3.64 | 3.64 | |||||||||||||||||||||||||||||||
35 | 3.79 | 3.78 | 3.77 | 3.67 | 3.67 | 3.66 | 3.73 | 3.73 | 3.72 | |||||||||||||||||||||||||||||||
40 | 3.91 | 3.90 | 3.88 | 3.77 | 3.76 | 3.75 | 3.84 | 3.83 | 3.82 | |||||||||||||||||||||||||||||||
45 | 4.06 | 4.06 | 4.02 | 3.89 | 3.88 | 3.87 | 3.98 | 3.97 | 3.95 | |||||||||||||||||||||||||||||||
50 | 4.27 | 4.25 | 4.20 | 4.04 | 4.03 | 4.01 | 4.16 | 4.15 | 4.11 | |||||||||||||||||||||||||||||||
55 | 4.53 | 4.50 | 4.40 | 4.24 | 4.23 | 4.18 | 4.39 | 4.37 | 4.30 | |||||||||||||||||||||||||||||||
60 | 4.86 | 4.81 | 4.65 | 4.50 | 4.47 | 4.40 | 4.68 | 4.64 | 4.53 | |||||||||||||||||||||||||||||||
65 | 5.29 | 5.20 | 4.94 | 4.84 | 4.86 | 4.67 | 5.06 | 5.00 | 4.81 | |||||||||||||||||||||||||||||||
70 | 5.86 | 5.70 | 5.24 | 5.29 | 5.22 | 4.98 | 5.58 | 5.47 | 5.12 | |||||||||||||||||||||||||||||||
75 | 6.68 | 6.35 | 5.54 | 5.92 | 5.77 | 5.32 | 6.30 | 6.07 | 5.44 | |||||||||||||||||||||||||||||||
80 | 7.82 | 7.14 | 5.77 | 6.81 | 6.50 | 5.63 | 7.31 | 6.83 | 5.71 | |||||||||||||||||||||||||||||||
85 | 9.41 | 8.00 | 5.91 | 8.14 | 7.40 | 5.85 | 8.77 | 7.72 | 5.89 | |||||||||||||||||||||||||||||||
90 | 11.68 | 8.81 | 5.98 | 10.12 | 8.38 | 5.96 | 10.88 | 8.61 | 5.97 | |||||||||||||||||||||||||||||||
95 | 14.79 | 9.43 | 6.00 | 13.08 | 9.21 | 6.00 | 13.92 | 9.33 | 6.00 |
10-2180
25
OPTION 3 — JOINT AND 50% SURVIVOR LIFE
Primary Annuitant
Male Age
Male Age
60 | 65 | 70 | 75 | 80 | 85 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Female | 3% | 4% | 3% | 4% | 3% | 4% | 3% | 4% | 3% | 4% | 3% | 4% | |||||||||||||||||||||||||||||||||||||||||||||
Age | Fixed | Variable | Fixed | Variable | Fixed | Variable | Fixed | Variable | Fixed | Variable | Fixed | Variable | |||||||||||||||||||||||||||||||||||||||||||||
60 | 3.91 | 4.50 | 4.13 | 4.72 | 4.39 | 4.98 | 4.69 | 5.30 | 5.02 | 5.65 | 5.38 | 6.05 | |||||||||||||||||||||||||||||||||||||||||||||
65 | 3.99 | 4.58 | 4.25 | 4.83 | 4.54 | 5.13 | 4.88 | 5.48 | 5.26 | 5.88 | 5.67 | 6.32 | |||||||||||||||||||||||||||||||||||||||||||||
70 | 4.06 | 4.65 | 4.36 | 4.93 | 4.70 | 5.27 | 5.10 | 5.68 | 5.55 | 6.14 | 6.03 | 6.65 | |||||||||||||||||||||||||||||||||||||||||||||
75 | 4.12 | 4.71 | 4.46 | 5.03 | 4.85 | 5.42 | 5.32 | 5.89 | 5.86 | 6.44 | 6.45 | 7.05 | |||||||||||||||||||||||||||||||||||||||||||||
80 | 4.17 | 4.75 | 4.54 | 5.11 | 4.98 | 5.55 | 5.54 | 6.10 | 6.18 | 6.75 | 6.91 | 7.49 | |||||||||||||||||||||||||||||||||||||||||||||
85 | 4.21 | 4.79 | 4.60 | 5.17 | 5.09 | 5.66 | 5.72 | 6.28 | 6.49 | 7.05 | 7.40 | 7.96 |
Primary Annuitant
Unisex Age
Unisex Age
60 | 65 | 70 | 75 | 80 | 85 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Unisex | 3% | 4% | 3% | 4% | 3% | 4% | 3% | 4% | 3% | 4% | 3% | 4% | |||||||||||||||||||||||||||||||||||||||||||||
Age | Fixed | Variable | Fixed | Variable | Fixed | Variable | Fixed | Variable | Fixed | Variable | Fixed | Variable | |||||||||||||||||||||||||||||||||||||||||||||
60 | 3.84 | 4.43 | 4.07 | 4.66 | 4.34 | 4.93 | 4.65 | 5.24 | 5.00 | 5.61 | 5.39 | 6.03 | |||||||||||||||||||||||||||||||||||||||||||||
65 | 3.90 | 4.49 | 4.17 | 4.75 | 4.47 | 5.05 | 4.83 | 5.41 | 5.23 | 5.83 | 5.68 | 6.31 | |||||||||||||||||||||||||||||||||||||||||||||
70 | 3.96 | 4.54 | 4.25 | 4.83 | 4.60 | 5.17 | 5.02 | 5.59 | 5.49 | 6.07 | 6.03 | 6.63 | |||||||||||||||||||||||||||||||||||||||||||||
75 | 4.00 | 4.58 | 4.32 | 4.90 | 4.72 | 5.28 | 5.20 | 5.76 | 5.76 | 6.33 | 6.41 | 6.99 | |||||||||||||||||||||||||||||||||||||||||||||
80 | 4.03 | 4.62 | 4.38 | 4.95 | 4.81 | 5.38 | 5.36 | 5.92 | 6.02 | 6.58 | 6.81 | 7.38 | |||||||||||||||||||||||||||||||||||||||||||||
85 | 4.05 | 4.64 | 4.42 | 4.99 | 4.88 | 5.45 | 5.49 | 6.05 | 6.25 | 6.81 | 7.20 | 7.76 |
OPTION 3 — JOINT AND 66 2/3% SURVIVOR LIFE
Primary Annuitant
Male Age
Male Age
60 | 65 | 70 | 75 | 80 | 85 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Female | 3% | 4% | 3% | 4% | 3% | 4% | 3% | 4% | 3% | 4% | 3% | 4% | |||||||||||||||||||||||||||||||||||||||||||||
Age | Fixed | Variable | Fixed | Variable | Fixed | Variable | Fixed | Variable | Fixed | Variable | Fixed | Variable | |||||||||||||||||||||||||||||||||||||||||||||
60 | 3.80 | 4.39 | 3.97 | 4.56 | 4.16 | 4.75 | 4.35 | 4.95 | 4.55 | 5.17 | 4.76 | 5.40 | |||||||||||||||||||||||||||||||||||||||||||||
65 | 3.90 | 4.49 | 4.12 | 4.69 | 4.34 | 4.92 | 4.58 | 5.17 | 4.83 | 5.43 | 5.07 | 5.70 | |||||||||||||||||||||||||||||||||||||||||||||
70 | 4.00 | 4.58 | 4.25 | 4.83 | 4.53 | 5.10 | 4.84 | 5.41 | 5.15 | 5.73 | 5.46 | 6.06 | |||||||||||||||||||||||||||||||||||||||||||||
75 | 4.08 | 4.66 | 4.38 | 4.95 | 4.72 | 5.28 | 5.11 | 5.67 | 5.51 | 6.08 | 5.92 | 6.50 | |||||||||||||||||||||||||||||||||||||||||||||
80 | 4.14 | 4.72 | 4.48 | 5.05 | 4.89 | 5.45 | 5.37 | 5.92 | 5.90 | 6.45 | 6.45 | 7.01 | |||||||||||||||||||||||||||||||||||||||||||||
85 | 4.19 | 4.77 | 4.56 | 5.13 | 5.03 | 5.59 | 5.61 | 6.16 | 6.28 | 6.83 | 7.02 | 7.58 |
OPTION 3 — JOINT AND 100% SURVIVOR LIFE
Primary Annuitant
Male Age
Male Age
60 | 65 | 70 | 75 | 80 | 85 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Female | 3% | 4% | 3% | 4% | 3% | 4% | 3% | 4% | 3% | 4% | 3% | 4% | |||||||||||||||||||||||||||||||||||||||||||||
Age | Fixed | Variable | Fixed | Variable | Fixed | Variable | Fixed | Variable | Fixed | Variable | Fixed | Variable | |||||||||||||||||||||||||||||||||||||||||||||
60 | 3.60 | 4.19 | 3.69 | 4.27 | 3.76 | 4.34 | 3.81 | 4.39 | 3.84 | 4.43 | 3.87 | 4.45 | |||||||||||||||||||||||||||||||||||||||||||||
65 | 3.75 | 4.32 | 3.88 | 4.45 | 3.99 | 4.55 | 4.07 | 4.64 | 4.14 | 4.71 | 4.18 | 4.76 | |||||||||||||||||||||||||||||||||||||||||||||
70 | 3.88 | 4.45 | 4.06 | 4.62 | 4.24 | 4.79 | 4.38 | 4.94 | 4.50 | 5.06 | 4.58 | 5.14 | |||||||||||||||||||||||||||||||||||||||||||||
75 | 3.99 | 4.56 | 4.23 | 4.79 | 4.49 | 5.03 | 4.72 | 5.27 | 4.93 | 5.47 | 5.08 | 5.63 | |||||||||||||||||||||||||||||||||||||||||||||
80 | 4.08 | 4.65 | 4.38 | 4.94 | 4.72 | 5.27 | 5.07 | 5.61 | 5.40 | 5.94 | 5.68 | 6.22 | |||||||||||||||||||||||||||||||||||||||||||||
85 | 4.15 | 4.73 | 4.50 | 5.06 | 4.91 | 5.46 | 5.39 | 5.93 | 5.89 | 6.43 | 6.37 | 6.90 |
10-2180
26
OPTION 4 — PERIOD CERTAIN ONLY
Monthly Income
3% | 4% | |||||||||||
Years | Fixed | Variable | ||||||||||
5 | 17.90 | 18.32 | ||||||||||
6 | 15.13 | 15.56 | ||||||||||
7 | 13.16 | 13.59 | ||||||||||
8 | 11.68 | 12.12 | ||||||||||
9 | 10.53 | 10.97 | ||||||||||
10 | 9.61 | 10.06 | ||||||||||
11 | 8.86 | 9.31 | ||||||||||
12 | 8.24 | 8.69 | ||||||||||
13 | 7.71 | 8.17 | ||||||||||
14 | 7.26 | 7.72 | ||||||||||
15 | 6.87 | 7.34 | ||||||||||
16 | 6.53 | 7.00 | ||||||||||
17 | 6.23 | 6.71 | ||||||||||
18 | 5.96 | 6.44 | ||||||||||
19 | 5.73 | 6.21 | ||||||||||
20 | 5.51 | 6.00 | ||||||||||
21 | 5.32 | 5.81 | ||||||||||
22 | 5.15 | 5.64 | ||||||||||
23 | 4.99 | 5.49 | ||||||||||
24 | 4.84 | 5.35 | ||||||||||
25 | 4.71 | 5.22 | ||||||||||
26 | 4.59 | 5.10 | ||||||||||
27 | 4.47 | 5.00 | ||||||||||
28 | 4.37 | 4.90 | ||||||||||
29 | 4.27 | 4.80 | ||||||||||
30 | 4.18 | 4.72 |
10-2180
27
Pacific Life & Annuity Company • 000 Xxxxxxx Xxxxxx Xxxxx • Xxxxxxx Xxxxx, XX 00000
INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT
Investment Experience Reflected in Benefits
Variable Accumulation Before Annuity Date
Withdrawal Charges Waived in Specific Instances
Variable and Fixed Annuity Payments After Annuity Date
Death Benefit Proceeds Payable Before Annuity Date
Non-Participating – No Dividends are Payable
Investment Experience Reflected in Benefits
Variable Accumulation Before Annuity Date
Withdrawal Charges Waived in Specific Instances
Variable and Fixed Annuity Payments After Annuity Date
Death Benefit Proceeds Payable Before Annuity Date
Non-Participating – No Dividends are Payable