RIGHT TO EXAMINE CONTRACT. This Contract may be returned for cancellation within days after the date it is received by the Owner. It may be delivered or mailed to the Company or to any agent of the Company, along with a written request for cancellation. This Contract shall then be canceled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date this Contract is delivered or mailed to the Company, along with the request for cancellation. This Contract is issued in consideration of the application for this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contract. Vice President Chairman, President and Chief Executive Officer AMOUNTS HELD IN CONNECTION WITH THIS CONTRACT MAY BE HELD IN THE COMPANY’S GENERAL ACCOUNT AND/OR THE COMPANY’S SEPARATE ACCOUNT THAT THE COMPANY MAINTAINS IN CONNECTION WITH THIS CONTRACT AND CERTAIN OTHER CONTRACTS. THE AMOUNTS HELD IN THE SEPARATE ACCOUNT ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNTS AND SHALL INCREASE OR DECREASE IN VALUE BASED UPON THE INVESTMENT RESULTS OF THE SEPARATE ACCOUNT. A DESCRIPTION OF THE SEPARATE ACCOUNT APPEARS IN THE ACCOUNTS SECTION OF THIS CONTRACT. A DESCRIPTION OF THE CHARGES DEDUCTED FROM THE AMOUNTS HELD IN THE SEPARATE ACCOUNT APPEARS IN THE DEFINITION OF ADMINISTRATIVE CHARGES IN THE DEFINITIONS SECTION OF THIS CONTRACT. THIS IS A PARTICIPATING CONTRACT. IRA-2004 This page left blank intentionally. IRA-2004 Table of Contents SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Date 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 Change of Allocations 8 SECTION 4 - ACCOUNTS 9 Accounts 9 General Account 9 Separate Account 9 Account Value 9 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account 10 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 Withdrawals and Transfers 10 Amount of Withdrawal or Transfer 10 Requests for Withdrawal or Transfer 10 Postponement of Withdrawals or Transfers 11 SECTION 6 - BENEFITS 11 Annuity Benefit 11 Amount of Annuity Benefit 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continuation 12 Death Benefit Settlement Options 13 SECTION 7 - DISTRIBUTIONS 14 SECTION 8 - BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - GENERAL PROVISIONS 17 Adjustments to Current Rate of Interest and Expense Charges 17 Contract 17 Evidence of Survival 17 Incontestability 17 Misstatements of Age 17 Non-Alienation of Benefits 17 Non-Assignment of Contract 18 Non-Waiver 18 Notices 18 Participating Contract 18 Dividends 18 Payment of Benefits 18 Reports 18 Severability of Provisions 18 Termination of Contract 18 SECTION 10 - TABLE OF RATES 19 SECTION 11 - LIST OF ACCOUNTS AND FUNDS 20 SECTION 1 - SPECIFICATIONS OWNER/ANNUITANT: Xxxxxxx Xxxxxx CONTRACT NUMBER: Traditional 00-000000-0 EFFECTIVE DATE: Month Day, YYYY DATE OF ISSUE: Month Day, YYYY STATE OF DELIVERY: Generic TYPE OF CHARGE AMOUNT OF CHARGE ADMINISTRATIVE CHARGES: SEPARATE ACCOUNT CHARGE Maximum of 2% annually of the net assets in each Investment Fund. CONTRACT CHARGE A monthly contract charge of $2.00 for administrative expenses, except the monthly charge shall not exceed 1/12 of 1% of the Account Value. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% and shall apply from the Effective Date until the first December 31st following the Effective Date. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafter. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00%. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20%.
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RIGHT TO EXAMINE CONTRACT. This Contract Within 10 days after this contract is first received (60 days after its receipt for a contract issued in replacement of another contract), it may be returned cancelled for cancellation within days after any reason without penalty (e.g., no withdrawal charges will be deducted) by delivering or mailing it to our Servicing Office. Upon cancellation, the date it is received by Company will return any premium payments paid under the Owner. It may be delivered or mailed Fixed Account of the contract and/or the value of any payments made to the Company or Variable Account on the appropriate Valuation Date as follows: if the contract is personally delivered to any agent of the Company's Servicing Office or authorized representative, along with a written request for cancellation. This Contract shall then be canceled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall such Valuation Date will be the date this Contract of delivery. If the contract is delivered or mailed to the Company's Servicing Office, along with such Valuation Date will be the request for cancellationdate the contract is mailed. This Contract The contract is governed by the laws of the State of New York; it is issued in and accepted subject to the terms set forth on this page and on the following pages which are made a part of this contract. In consideration of the application for it, and the Premium Payment(s) as provided this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract contract is executed by the Company at as of its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this ContractIssue. Vice President Chairman/s/ Xxxxxx X. Xxxxxxx PRESIDENT PAYMENTS AND VALUES BASED ON THE FIXED ACCOUNT ARE SUBJECT TO A MARKET VALUE ADJUSTMENT FORMULA, President and Chief Executive Officer THE OPERATION OF WHICH MAY RESULT IN UPWARD OR DOWNWARD ADJUSTMENTS IN AMOUNTS HELD IN CONNECTION WITH PAYABLE TO THE OWNER, INCLUDING WITHDRAWALS AND TRANSFERS. PAYMENTS MADE FROM THE FIXED ACCOUNT PURSUANT TO AN ELECTION WHICH BECOMES EFFECTIVE AT THE END OF A GUARANTEED PERIOD AND PAYMENTS MADE UNDER THE "ANNUITY BENEFIT" PROVISIONS AND UNDER THE "PENALTY-FREE ANNUITIZATION" PROVISION ARE NOT SUBJECT TO THE MARKET VALUE ADJUSTMENT. PAYMENTS MADE UNDER THE "DEATH BENEFIT" PROVISIONS ARE NOT SUBJECT TO ANY MARKET VALUE ADJUSTMENT. ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT MAY BE HELD IN WHEN BASED ON INVESTMENT EXPERIENCE OF THE COMPANY’S GENERAL VARIABLE ACCOUNT AND/OR THE COMPANY’S SEPARATE ACCOUNT THAT THE COMPANY MAINTAINS IN CONNECTION WITH THIS CONTRACT ARE VARIABLE AND CERTAIN OTHER CONTRACTS. THE AMOUNTS HELD IN THE SEPARATE ACCOUNT ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNTS AND SHALL INCREASE OR DECREASE IN VALUE BASED UPON AMOUNT. WITH THE CONTRACT ASSET CHARGES OF 1.40%, THE SMALLEST ANNUAL RATE OF INVESTMENT RESULTS OF RETURN WHICH WOULD HAVE TO BE EARNED ON THE SEPARATE ACCOUNT. A DESCRIPTION ASSETS OF THE SEPARATE ACCOUNT APPEARS IN SO THAT THE ACCOUNTS SECTION OF THIS CONTRACT. A DESCRIPTION OF THE CHARGES DEDUCTED FROM THE AMOUNTS HELD IN THE SEPARATE ACCOUNT APPEARS IN THE DEFINITION OF ADMINISTRATIVE CHARGES IN THE DEFINITIONS SECTION OF THIS CONTRACT. THIS IS A PARTICIPATING CONTRACT. IRA-2004 This page left blank intentionally. IRA-2004 Table of Contents SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Date 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 Change of Allocations 8 SECTION 4 - ACCOUNTS 9 Accounts 9 General Account 9 Separate Account 9 Account Value 9 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account 10 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 Withdrawals and Transfers 10 Amount of Withdrawal or Transfer 10 Requests for Withdrawal or Transfer 10 Postponement of Withdrawals or Transfers 11 SECTION 6 - BENEFITS 11 Annuity Benefit 11 Amount of Annuity Benefit 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continuation 12 Death Benefit Settlement Options 13 SECTION 7 - DISTRIBUTIONS 14 SECTION 8 - BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - GENERAL PROVISIONS 17 Adjustments to Current Rate of Interest and Expense Charges 17 Contract 17 Evidence of Survival 17 Incontestability 17 Misstatements of Age 17 Non-Alienation of Benefits 17 Non-Assignment of Contract 18 Non-Waiver 18 Notices 18 Participating Contract 18 Dividends 18 Payment of Benefits 18 Reports 18 Severability of Provisions 18 Termination of Contract 18 SECTION 10 - TABLE OF RATES 19 SECTION 11 - LIST OF ACCOUNTS AND FUNDS 20 SECTION 1 - SPECIFICATIONS OWNER/ANNUITANT: Xxxxxxx Xxxxxx CONTRACT NUMBER: Traditional 00-000000-0 EFFECTIVE DATE: Month Day, YYYY DATE OF ISSUE: Month Day, YYYY STATE OF DELIVERY: Generic TYPE OF CHARGE DOLLAR AMOUNT OF CHARGE ADMINISTRATIVE CHARGES: SEPARATE ACCOUNT CHARGE Maximum of 2% annually of the net assets in each Investment Fund. CONTRACT CHARGE A monthly contract charge of $2.00 for administrative expenses, except the monthly charge shall not exceed 1/12 of 1% of the Account Value. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% and shall apply from the Effective Date until the first December 31st following the Effective Date. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafter. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00%. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20VARIABLE ANNUITY PAYMENTS WILL NOT DECREASE IS 5.40%.
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RIGHT TO EXAMINE CONTRACT. This Contract contract may be returned for cancellation within 10 days after the date it is received by the Owneryou. It may be delivered or mailed to the Company or to any agent of the Company, along with a written request for cancellation. This Contract shall contract will then be canceled cancelled as of the Date of Issue and the Company shall will refund to the Owner you an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the date of surrender date of all contributions allocated to any Investment FundAccount associated with an Investment Fund of the Separate Account. For purposes the purpose of this paragraph onlyprovision, the date of surrender date shall will be the date this Contract contract is delivered or mailed to the Company, along with the request Company for cancellation. This Contract The contract is issued in consideration of the application for this Contract contract and payment of the first contribution (premium)required contribution. Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall The contract will take effect on the Effective Date shown in below. This page and the Specifications Section following pages are a part of this Contractcontract. All benefits payable are subject to the provisions of this contract. This Contract contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contractcontract. /s/ Xxxxx Xxxxx /s/ Xxxxxx X. Xxxxx Vice President Chairman, President and & Chief Executive Officer AMOUNTS ASSETS HELD IN CONNECTION WITH THIS CONTRACT MAY BE HELD IN THE COMPANY’S GENERAL ACCOUNT AND/OR THE COMPANY’S SEPARATE ACCOUNT THAT THE COMPANY MAINTAINS IN CONNECTION WITH THIS CONTRACT AND CERTAIN OTHER CONTRACTS. THE AMOUNTS HELD IN ASSETS OF THE SEPARATE ACCOUNT ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNTS AND SHALL WILL INCREASE OR DECREASE IN VALUE BASED UPON THE INVESTMENT RESULTS OF THE SEPARATE ACCOUNT. A DESCRIPTION OF THE SEPARATE ACCOUNT APPEARS IS DESCRIBED IN THE ACCOUNTS SECTION PROVISION OF THIS CONTRACT. A CONTRACT ENTITLED “DESCRIPTION OF ACCOUNTS”. DEATH BENEFIT PAYABLE UPON YOUR DEATH BEFORE THE CHARGES DEDUCTED FROM THE AMOUNTS HELD IN THE SEPARATE ACCOUNT APPEARS IN THE DEFINITION OF ADMINISTRATIVE CHARGES IN THE DEFINITIONS SECTION OF THIS CONTRACTANNUITY COMMENCEMENT DATE. THIS IS A PARTICIPATING CONTRACT. IRA-2004 ANNUITANT AND OWNER: (Herein called “you” and “your”) CONTRACT NUMBER: STATE OF DELIVERY: EFFECTIVE DATE: DATE OF ISSUE: This page left blank intentionally. IRA-2004 intentionally Table of Contents SECTION 1 - CONTRACT SPECIFICATIONS 5 SECTION 2 - DEFINITION BENEFIT PROVISIONS 5 Account Value MONTHLY ANNUITY BENEFITS 5 Administrative Charges AMOUNT OF ANNUITY BENEFIT 5 Annuitant ANNUITY COMMENCEMENT DATE 5 Annuity Commencement Date REQUIRED BEGINNING DATE 5 VALID TRANSACTION DATE 6 Beneficiary DISTRIBUTIONS 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice TERMINATION OF THIS CONTRACT 7 Owner 7 Required Distribution Date 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions CONTRIBUTIONS 7 Allocation of Contributions ALLOCATION OF CONTRIBUTIONS 8 Change of Allocations ALLOCATIONS 8 SECTION 4 - CHANGE OF ALLOCATIONS 8 ACCUMULATION VALUE 8 ACCUMULATION VALUE 8 DESCRIPTION OF ACCOUNTS 9 Accounts TYPES OF ACCOUNTS 9 General Account 9 Separate Account 9 Account Value 9 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account GENERAL ACCOUNT 10 SECTION 5 - SEPARATE ACCOUNT 10 ACCUMULATION UNITS 12 ACCUMULATION UNIT VALUE 12 ACCUMULATION UNIT VALUE CHANGE FACTOR 12 VALUATION DAY AND VALUATION PERIOD 12 CHANGES TO SEPARATE ACCOUNT 12 VALUATION OF ASSETS 12 STATEMENT OF ACCOUNTS 13 CHARGES 13 TYPES AND AMOUNTS OF CHARGES 13 CHANGE IN THE AMOUNT OF CHARGES 13 SPECIFIED PAYMENTS OPTIONS 14 ELECTION OF SPECIFIED PAYMENTS OPTION 14 PAYMENT OF SPECIFIED AMOUNT 14 WITHDRAWALS AND TRANSFERS 10 Withdrawals and Transfers 10 Amount of Withdrawal or Transfer 10 Requests for Withdrawal or Transfer 10 Postponement of Withdrawals or Transfers 11 SECTION 6 - BENEFITS 11 Annuity Benefit 11 Amount of Annuity Benefit 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continuation 12 Death Benefit Settlement Options 13 SECTION 7 - DISTRIBUTIONS 14 SECTION 8 - WITHDRAWALS AND TRANSFERS 14 WITHDRAWALS 14 TRANSFERS 15 AMOUNT OF WITHDRAWAL OR TRANSFER 15 REQUESTS 15 POSTPONEMENT OF PAYMENTS, WITHDRAWALS OR TRANSFERS 15 ANNUITY OPTIONS 15 ELECTION OF FORM OF ANNUITY 15 BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - CHANGE OF BENEFICIARY 17 FIXED AMOUNT OPTION 17 FIXED AMOUNT OPTION 17 GENERAL PROVISIONS 17 Adjustments to Current Rate of Interest and Expense Charges THE CONTRACT 17 Contract INCONTESTABILITY 17 Evidence of Survival 17 Incontestability 17 Misstatements of Age 17 NonMISSTATEMENTS OF AGE 18 ASSIGNMENT 18 CHANGES TO THIS CONTRACT 18 SURVIVAL OF PAYEE 18 CLAIMS OF CREDITORS 18 CORRESPONDENCE 18 PARTICIPATING CONTRACT 18 DIVIDENDS 18 REQUIRED INFORMATION 18 NON-Alienation of Benefits 17 Non-Assignment of Contract 18 Non-Waiver 18 Notices 18 Participating Contract 18 Dividends 18 Payment of Benefits 18 Reports 18 Severability of Provisions 18 Termination of Contract 18 SECTION 10 - WAIVER 19 TABLE OF RATES 19 SECTION 11 - LIST OF ACCOUNTS AND FUNDS 20 SECTION 1 - SPECIFICATIONS OWNER/ANNUITANT: Xxxxxxx Xxxxxx CONTRACT NUMBER: Traditional 00-000000-0 EFFECTIVE DATE: Month Day, YYYY DATE OF ISSUE: Month Day, YYYY STATE OF DELIVERY: Generic TYPE OF CHARGE AMOUNT OF CHARGE ADMINISTRATIVE CHARGES: SEPARATE ACCOUNT CHARGE Maximum of 2% annually of the net assets in each Investment Fund. CONTRACT CHARGE A monthly contract charge of $2.00 for administrative expenses, except the monthly charge shall not exceed 1/12 of 1% of the Account Value. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% and shall apply from the Effective Date until the first December 31st following the Effective Date. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafter. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00%. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20%.20
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RIGHT TO EXAMINE CONTRACT. This Contract may be returned for cancellation within [10] days after the date it is received by the Owner. It may be delivered or mailed to the Company or to any agent of the Company, along with a written request for cancellation. This Contract shall then be canceled cancelled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; , plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date this Contract is delivered or mailed to the Company, along with the request for cancellation. This Contract is issued in consideration of the application for this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is made, subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contract. Vice President Chairman, President and Chief Executive Officer AMOUNTS HELD IN CONNECTION WITH THIS CONTRACT MAY BE HELD IN THE COMPANY’S GENERAL ACCOUNT AND/OR THE COMPANY’S SEPARATE ACCOUNT THAT THE COMPANY MAINTAINS IN CONNECTION WITH THIS CONTRACT AND CERTAIN OTHER CONTRACTS. THE AMOUNTS HELD IN THE SEPARATE ACCOUNT ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNTS AND SHALL INCREASE OR DECREASE IN VALUE BASED UPON THE INVESTMENT RESULTS OF THE SEPARATE ACCOUNT. A DESCRIPTION OF THE SEPARATE ACCOUNT APPEARS IN THE ACCOUNTS SECTION OF THIS CONTRACT. A DESCRIPTION OF THE CHARGES DEDUCTED FROM THE AMOUNTS HELD IN THE SEPARATE ACCOUNT APPEARS IN THE DEFINITION OF ADMINISTRATIVE CHARGES IN THE DEFINITIONS SECTION OF THIS CONTRACT. THIS IS A PARTICIPATING CONTRACT. IRA-2004 INHER XXX-2010 This page left blank intentionallyintentionally blank. IRA-2004 INHER XXX-2010 Table of Contents SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION DEFINITIONS 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 5 Code 6 Commuted Value 5 Contract 6 Contract Charge 6 Current Rate of Interest 6 Date of Issue 6 Designated Beneficiary 6 Effective Date 6 Eligible Rollover Distribution 6 Guaranteed Rate of Interest 6 Home Office XXX 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Beginning Date 7 Retirement Plan 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States 0 Xxxxxxxxxx Xxxxxxxxxx Xxxxxxx 0 Xxxxxx Xxxxxx Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 Change of Allocations 8 SECTION 4 - ACCOUNTS 9 8 Accounts 9 8 General Account 9 8 Separate Account 9 8 Account Value 9 8 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account 10 9 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 Withdrawals and Transfers 10 Amount of Withdrawal or Transfer 10 Requests for Withdrawal or Transfer 10 Postponement of Withdrawals or Transfers 11 10 SECTION 6 - BENEFITS DISTRIBUTIONS 10 Rules for Distribution 10 Distribution Methods 11 Annuity Benefit 11 Amount of Annuity Benefit 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continuation 12 Death Benefit Settlement Options 13 SECTION 7 - DISTRIBUTIONS 14 DESIGNATED BENEFICIARY 12 SECTION 8 - BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - GENERAL PROVISIONS 17 12 Adjustments to Current Rate of Interest and Expense Charges 17 12 Contract 17 12 Evidence of Survival 17 12 Overpayments 13 Incontestability 17 Misstatements of Age 17 13 Non-Alienation of Benefits 17 13 Non-Assignment of Contract 18 13 Non-Waiver 18 13 Notices 18 13 Participating Contract 18 13 Dividends 18 13 Payment of Benefits 18 13 Reports 18 14 Severability of Provisions 18 14 Termination of Contract 18 14 SECTION 10 - TABLE OF RATES 19 SECTION 11 9 - LIST OF ACCOUNTS AND FUNDS 20 14 SECTION 1 - SPECIFICATIONS OWNER/ANNUITANT: Xxxxxxx Xxxxxx [Xxxx Xxx], beneficiary of [Xxxx Xxxxx] CONTRACT NUMBER: Traditional 00-000000-0 EFFECTIVE DATE: Month Day, YYYY DATE OF ISSUE: Month Day, YYYY STATE OF DELIVERY: Generic DECEASED: DATE OF DEATH: TYPE OF CHARGE AMOUNT OF CHARGE ADMINISTRATIVE CHARGES: SEPARATE ACCOUNT CHARGE Maximum of [2% %] annually of the net assets in each Investment Fund. CONTRACT CHARGE A monthly contract charge of [$2.00 2.50] for administrative expenses[, except the monthly charge shall not exceed 1/12 of 1% of the Account Value]. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% [2%] and shall apply from the Effective Date until the first December 31st following the Effective Date. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafter. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00[3%]. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20%[1.20]%.
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RIGHT TO EXAMINE CONTRACT. This Contract may be returned for cancellation within days after the date it is received by the Owner. It may be delivered or mailed to the Company or to any agent of the Company, along with a written request for cancellation. This Contract shall then be canceled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date this Contract is delivered or mailed to the Company, along with the request for cancellation. This Contract is issued in consideration of the application for this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contract. Vice President Chairman, President and Chief Executive Officer AMOUNTS HELD IN CONNECTION WITH THIS CONTRACT MAY BE HELD IN THE COMPANY’S GENERAL ACCOUNT AND/OR THE COMPANY’S SEPARATE ACCOUNT THAT THE COMPANY MAINTAINS IN CONNECTION WITH THIS CONTRACT AND CERTAIN OTHER CONTRACTS. THE AMOUNTS HELD IN THE SEPARATE ACCOUNT ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNTS AND SHALL INCREASE OR DECREASE IN VALUE BASED UPON THE INVESTMENT RESULTS OF THE SEPARATE ACCOUNT. A DESCRIPTION OF THE SEPARATE ACCOUNT APPEARS IN THE ACCOUNTS SECTION OF THIS CONTRACT. A DESCRIPTION OF THE CHARGES DEDUCTED FROM THE AMOUNTS HELD IN THE SEPARATE ACCOUNT APPEARS IN THE DEFINITION OF ADMINISTRATIVE CHARGES IN THE DEFINITIONS SECTION OF THIS CONTRACT. THIS IS A PARTICIPATING CONTRACT. IRA-2004 This page left blank intentionally. IRA-2004 Table of Contents SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Date XXXX XXX 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 9 Change of Allocations 8 9 SECTION 4 - ACCOUNTS 9 Accounts 9 General Account 9 Separate Account 9 Account Value 9 10 Accumulation Units 9 10 Accumulation Unit Value 9 10 Accumulation Unit Value Change Factor 9 10 Changes To Separate Account 10 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 11 Withdrawals and Transfers 10 11 Amount of Withdrawal or Transfer 10 11 Requests for Withdrawal or Transfer 10 11 Postponement of Withdrawals or Transfers 11 SECTION 6 - BENEFITS 11 Annuity Benefit 11 Amount of Annuity Benefit 11 12 Annuity Options 11 12 Specified Payments Option 12 13 Death Benefit 12 13 Spousal Continuation 12 13 Death Benefit Settlement Options 13 SECTION 7 - DISTRIBUTIONS 14 SECTION 8 - BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - GENERAL PROVISIONS 17 16 Adjustments to Current Rate of Interest and Expense Charges 17 16 Contract 17 16 Evidence of Survival 17 16 Incontestability 17 Misstatements of Age 17 Non-Alienation of Benefits 17 Non-Assignment of Contract 18 17 Non-Waiver 18 17 Notices 18 17 Participating Contract 18 17 Dividends 18 17 Payment of Benefits 18 17 Reports 18 Severability of Provisions 18 Termination of Contract 18 SECTION 10 - TABLE OF RATES 19 18 SECTION 11 - LIST OF ACCOUNTS AND FUNDS 20 SECTION 1 - SPECIFICATIONS OWNER/ANNUITANT: Xxxxxxx Xxxxxx Xxxx CONTRACT NUMBER: Traditional 00-000000-0 EFFECTIVE DATE: Month Day, YYYY DATE OF ISSUE: Month Day, YYYY STATE OF DELIVERY: Generic TYPE OF CHARGE AMOUNT OF CHARGE ADMINISTRATIVE CHARGES: SEPARATE ACCOUNT CHARGE Maximum of 2% annually of the net assets in each Investment Fund. CONTRACT CHARGE A monthly contract charge of $2.00 for administrative expenses, except the monthly charge shall not exceed 1/12 of 1% of the Account Value. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% and shall apply from the Effective Date until the first December 31st following the Effective Date. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafter. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00%. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20%.
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RIGHT TO EXAMINE CONTRACT. This Contract may be returned for cancellation within days after the date it is received by the Owner. It may be delivered or mailed to the Company or to any agent of the Company, along with a written request for cancellation. This Contract shall then be canceled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date this Contract is delivered or mailed to the Company, along with the request for cancellation. This Contract is issued in consideration of the application for this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contract. Vice President Chairman, President and Chief Executive Officer AMOUNTS HELD IN CONNECTION WITH THIS CONTRACT MAY BE HELD IN THE COMPANY’S GENERAL ACCOUNT AND/OR THE COMPANY’S SEPARATE ACCOUNT THAT THE COMPANY MAINTAINS IN CONNECTION WITH THIS CONTRACT AND CERTAIN OTHER CONTRACTS. THE AMOUNTS HELD IN THE SEPARATE ACCOUNT ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNTS AND SHALL INCREASE OR DECREASE IN VALUE BASED UPON THE INVESTMENT RESULTS OF THE SEPARATE ACCOUNT. A DESCRIPTION OF THE SEPARATE ACCOUNT APPEARS IN THE ACCOUNTS SECTION OF THIS CONTRACT. A DESCRIPTION OF THE CHARGES DEDUCTED FROM THE AMOUNTS HELD IN THE SEPARATE ACCOUNT APPEARS IN THE DEFINITION OF ADMINISTRATIVE CHARGES IN THE DEFINITIONS SECTION OF THIS CONTRACT. THIS IS A PARTICIPATING CONTRACT. IRA-2004 This page left blank intentionally. IRA-2004 Table of Contents SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Employer 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Date 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 Change of Allocations 8 SECTION 4 - ACCOUNTS 9 8 Accounts 9 8 General Account 9 8 Separate Account 9 8 Account Value 9 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account 10 9 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 Withdrawals and Transfers 10 Amount of Withdrawal or Transfer 10 Requests for Withdrawal or Transfer 10 Postponement of Withdrawals or Transfers 11 10 SECTION 6 - BENEFITS 11 Annuity Benefit 11 Amount of Annuity Benefit 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continuation 12 Death Benefit Settlement Options 13 12 SECTION 7 - DISTRIBUTIONS 14 SECTION 8 - BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - GENERAL PROVISIONS 17 Adjustments to Current Rate of Interest and Expense Charges 17 Contract 17 Evidence of Survival 17 Incontestability 17 Misstatements of Age 17 Non-Alienation of Benefits 17 Non-Assignment of Contract 18 17 Non-Waiver 18 17 Notices 18 Participating Contract 18 Dividends 18 Payment of Benefits 18 Reports 18 Report to Employer 18 Severability of Provisions 18 Termination of Contract 18 SECTION 10 - TABLE OF RATES 19 SECTION 11 - LIST OF ACCOUNTS AND FUNDS 20 SECTION 1 - SPECIFICATIONS OWNER/ANNUITANT: Xxxxxxx Xxxxxx Simple CONTRACT NUMBER: Traditional 00-000000-0 EFFECTIVE DATE: Month Day, YYYY DATE OF ISSUE: Month Day, YYYY STATE OF DELIVERY: Generic TYPE OF CHARGE AMOUNT OF CHARGE ADMINISTRATIVE CHARGES: SEPARATE ACCOUNT CHARGE Maximum of 2% annually of the net assets in each Investment Fund. CONTRACT CHARGE A monthly contract charge of $2.00 for administrative expenses, except the monthly charge shall not exceed 1/12 of 1% of the Account Value. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% and shall apply from the Effective Date until the first December 31st following the Effective Date. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafter. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00%. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20%.
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RIGHT TO EXAMINE CONTRACT. This Contract may be returned for cancellation within Within 10 days after the date it is received by the Owner. It may be delivered or mailed to the Company or to any agent of the Company, along with a written request for cancellation. This Contract shall then be canceled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date this Contract is delivered first received, it may be cancelled for any reason without penalty (e.g., no withdrawal charges will be deducted) by delivering or mailed mailing it to the Companyrepresentative through whom it was purchased, along with or to our Servicing Office. When the request for cancellationContract is received at the Servicing Office, the Company will return the value of the Variable Account and/or the value of the Fixed Account of the Contract as of the date of cancellation where permitted by law. This If this Contract is issued in as an IRA, then the entire amount of Premium Payments made shall be returned. The contract is governed by the laws of the State of New York; it is issued and accepted subject to the terms set forth on this page and on the following pages which are made a part of this contract. In consideration of the application for it, and the Premium Payment(s) as provided this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract contract is executed by the Company at as of its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this ContractIssue. Vice President Chairman/s/ Xxxxxx X. Xxxxxxx PRESIDENT PAYMENTS AND VALUES BASED ON THE FIXED ACCOUNT ARE SUBJECT TO A MARKET VALUE ADJUSTMENT FORMULA, President and Chief Executive Officer THE OPERATION OF WHICH MAY RESULT IN UPWARD OR DOWNWARD ADJUSTMENTS IN AMOUNTS HELD IN CONNECTION WITH PAYABLE TO THE OWNER, INCLUDING WITHDRAWALS AND TRANSFERS. PAYMENTS MADE FROM THE FIXED ACCOUNT PURSUANT TO AN ELECTION WHICH BECOMES EFFECTIVE AT THE END OF A GUARANTEED PERIOD AND PAYMENTS MADE UNDER THE "ANNUITY BENEFIT" PROVISIONS AND UNDER THE "PENALTY-FREE ANNUITIZATION" PROVISION ARE NOT SUBJECT TO THE MARKET VALUE ADJUSTMENT. PAYMENTS MADE UNDER THE "DEATH BENEFIT" PROVISIONS ARE NOT SUBJECT TO ANY MARKET VALUE ADJUSTMENT. ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT MAY BE HELD IN WHEN BASED ON INVESTMENT EXPERIENCE OF THE COMPANY’S GENERAL VARIABLE ACCOUNT AND/OR THE COMPANY’S SEPARATE ACCOUNT THAT THE COMPANY MAINTAINS IN CONNECTION WITH THIS CONTRACT ARE VARIABLE AND CERTAIN OTHER CONTRACTS. THE AMOUNTS HELD IN THE SEPARATE ACCOUNT ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNTS AND SHALL INCREASE OR DECREASE IN VALUE BASED UPON AMOUNT. WITH THE CONTRACT ASSET CHARGES OF 1.40%, THE SMALLEST ANNUAL RATE OF INVESTMENT RESULTS OF RETURN WHICH WOULD HAVE TO BE EARNED ON THE SEPARATE ACCOUNT. A DESCRIPTION ASSETS OF THE SEPARATE ACCOUNT APPEARS IN SO THAT THE ACCOUNTS SECTION OF THIS CONTRACT. A DESCRIPTION OF THE CHARGES DEDUCTED FROM THE AMOUNTS HELD IN THE SEPARATE ACCOUNT APPEARS IN THE DEFINITION OF ADMINISTRATIVE CHARGES IN THE DEFINITIONS SECTION OF THIS CONTRACT. THIS IS A PARTICIPATING CONTRACT. IRA-2004 This page left blank intentionally. IRA-2004 Table of Contents SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Date 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 Change of Allocations 8 SECTION 4 - ACCOUNTS 9 Accounts 9 General Account 9 Separate Account 9 Account Value 9 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account 10 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 Withdrawals and Transfers 10 Amount of Withdrawal or Transfer 10 Requests for Withdrawal or Transfer 10 Postponement of Withdrawals or Transfers 11 SECTION 6 - BENEFITS 11 Annuity Benefit 11 Amount of Annuity Benefit 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continuation 12 Death Benefit Settlement Options 13 SECTION 7 - DISTRIBUTIONS 14 SECTION 8 - BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - GENERAL PROVISIONS 17 Adjustments to Current Rate of Interest and Expense Charges 17 Contract 17 Evidence of Survival 17 Incontestability 17 Misstatements of Age 17 Non-Alienation of Benefits 17 Non-Assignment of Contract 18 Non-Waiver 18 Notices 18 Participating Contract 18 Dividends 18 Payment of Benefits 18 Reports 18 Severability of Provisions 18 Termination of Contract 18 SECTION 10 - TABLE OF RATES 19 SECTION 11 - LIST OF ACCOUNTS AND FUNDS 20 SECTION 1 - SPECIFICATIONS OWNER/ANNUITANT: Xxxxxxx Xxxxxx CONTRACT NUMBER: Traditional 00-000000-0 EFFECTIVE DATE: Month Day, YYYY DATE OF ISSUE: Month Day, YYYY STATE OF DELIVERY: Generic TYPE OF CHARGE DOLLAR AMOUNT OF CHARGE ADMINISTRATIVE CHARGES: SEPARATE ACCOUNT CHARGE Maximum of 2% annually of the net assets in each Investment Fund. CONTRACT CHARGE A monthly contract charge of $2.00 for administrative expenses, except the monthly charge shall not exceed 1/12 of 1% of the Account Value. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% and shall apply from the Effective Date until the first December 31st following the Effective Date. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafter. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00%. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20VARIABLE ANNUITY PAYMENTS WILL NOT DECREASE IS 5.40%.
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