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XXXX XXXXXXX LIFE INSURANCE COMPANY OF NEW YORK [XXXX XXXXXXX LOGO]
OVERNIGHT MAILING ADDRESS: ANNUITY SERVICE OFFICE: HOME OFFICE
[000 Xxxxxxxxx Xxxxx [P.O. Box 9505 [000 Xxxxxx Xxxx Xxxxx, 0xx Xxxxx
Xxxxxxxxxx, XX 00000-0000] Xxxxxxxxxx, XX 00000-9505] Valhalla, NY 10595]
[0-000-000-0000]
THIS IS A LEGAL CONTRACT - READ IT CAREFULLY.
WE AGREE to pay the benefits of this Certificate in accordance with its terms.
THIS CERTIFICATE is issued in consideration of the Payment.
Xxxx Xxxxxxx Life Insurance Company of New York will provide a guaranteed annual
amount for withdrawal beginning on the Lifetime Income Date and continuing for
the life of the Annuitant and any co-Annuitant. We will pay an annuity benefit
beginning on the Annuity Commencement Date to the Annuitant, if living, unless
otherwise directed by the Owner, in accordance with the Annuity Payments section
of this Certificate. If the Annuitant dies while this Certificate is in effect
prior the Annuity Commencement Date, we will pay the Certificate Value to the
Beneficiary upon receipt of all required claim forms and proof of death of the
Annuitant at the Annuity Service Office.
The smallest annual rate of investment return which is required to be earned on
the assets of the Separate Account so that the dollar amount of variable Annuity
Payments will not decrease is [3.62%]. Explicit annual charges against the
assets of the Separate Account are as follows:
Certificate Asset Fee Charge: no greater than [0.60%]
TEN DAY RIGHT TO REVIEW
YOU MAY CANCEL THE CERTIFICATE BY RETURNING IT TO OUR ANNUITY SERVICE OFFICE OR
REGISTERED REPRESENTATIVE WHO SOLD IT YOU AT ANY TIME WITHIN 10 DAYS AFTER
RECEIPT OF THE CERTIFICATE. DURING THE FIRST 7 DAYS OF THIS 10 DAY PERIOD, WE
WILL RETURN THE GREATER OF (I) THE CERTIFICATE VALUE COMPUTED AT THE END OF THE
VALUATION PERIOD DURING WHICH THE CERTIFICATE IS DELIVERED TO US OR (II) AN
AMOUNT EQUAL TO THE PAYMENT. AFTER 7 DAYS, WE WILL PAY THE CERTIFICATE VALUE
COMPUTED AT THE END OF THE VALUATION PERIOD DURING WHICH THE CERTIFICATE IS
DELIVERED TO US. WE WILL PAY THE REFUND AMOUNT TO THE OWNER WITHIN 7 DAYS OF
RECEIPT OF THE CERTIFICATE BY US.
ANNUITY PAYMENTS, DEATH BENEFITS, SURRENDER VALUES AND OTHER VALUES PROVIDED BY
THIS CERTIFICATE WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT
ARE VARIABLE, MAY INCREASE OR DECREASE IN ACCORDANCE WITH THE FLUCTUATIONS IN
THE INVESTMENT RESULTS, AS APPLICABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR
AMOUNT.
DETAILS OF VARIABLE ACCOUNT PROVISIONS ON PAGE 6.1
SIGNED FOR THE COMPANY at its Home Office, Valhalla, New York, on the
Certificate Date.
/s/ Xxxxx X. Xxxxxxxxx /s/ Xxxxxxx Xxxxx
------------------------------- --------------------------------------
President Secretary
GROUP SINGLE PAYMENT DEFERRED VARIABLE ANNUITY
GUARANTEED LIFETIME WITHDRAWAL BENEFIT
NON-PARTICIPATING
VENTURE.202.10-CERT-NY NY
INTRODUCTION
This is a group single payment deferred variable annuity certificate. This
Certificate provides that, prior to the Annuity Commencement Date, the
Certificate Value will accumulate on a variable basis. Subject to the provisions
of the Certificate, you may take withdrawals and transfer amounts among the
Investment Options. If you limit withdrawals to the amounts described in the
Lifetime Income Benefit section, we guarantee that the Lifetime Income Amount
will be available for withdrawal each Certificate Year after the Lifetime Income
Date and during the life of the Annuitant and any co-Annuitant. After the
Annuity Commencement Date, Annuity Payments may be either fixed or variable, or
a combination of fixed and variable.
The Certificate Value will vary with the investment performance of your
Investment Options.
If you select Annuity Payments on a variable basis, the payment amount will vary
with the investment performance of the Variable Account.
You must allocate the Payment among one or more Investment Options. The
Investment Options are identified on the Specifications Page.
TABLE OF CONTENTS PAGE
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SPECIFICATIONS PAGES S.1
PART 1 - DEFINITIONS 1.1
PART 2 - GENERAL PROVISIONS 2.1
PART 3 - OWNER, BENEFICIARY 3.1
PART 4 - PAYMENT 4.1
PART 5 - FEES AND DEDUCTIONS 5.1
PART 6 - VARIABLE ACCOUNT PROVISIONS 6.1
PART 7 - TRANSFERS 7.1
PART 8 - WITHDRAWAL PROVISIONS 8.1
PART 9 - LIFETIME INCOME BENEFIT 9.1
PART 10 - DISTRIBUTIONS DURING ANNUITANT'S LIFE 10.1
PART 11 - DISTRIBUTIONS AFTER ANNUITANT'S DEATH 11.1
PART 12 - ANNUITY PAYMENTS 12.1
PART 13 - ANNUITY OPTIONS 13.1
PART 1 DEFINITIONS
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WE AND YOU "We", "us" and "our" means the Company."You" or "your"
means the Owner of this Certificate.
ACCUMULATION UNIT A unit of measure that is used to calculate the value
of the Variable Account of this Certificate before the
Annuity Commencement Date.
ANNUITANT A person whose age and life is used to determine
eligibility for the Lifetime Income Benefit and the
amount and duration of Annuity Payments involving life
contingencies. The Annuitant is as designated on the
Specifications Page, unless changed.
ANNUITY COMMENCEMENT The date Annuity Payments begin. It is the date
DATE selected by you and specified on the Specifications
Page, unless changed. Annuity Payments may not be
scheduled under the Certificate to begin earlier than
12 months from the Certificate Date. This date may not
be later than the Maturity Date.
ANNUITY OPTION The method selected by you for Annuity Payments made by
us.
ANNUITY PAYMENT(S) Payment(s) by us to you, in accordance with the Annuity
Option elected under the terms of this Certificate.
ANNUITY SERVICE OFFICE Any office designated by us for the receipt of Payment
and processing of Owner requests.
ANNUITY UNIT A unit of measure that is used after the Annuity
Commencement Date to calculate variable Annuity
Payments.
BENEFICIARY The person, persons or entity to whom certain benefits
are payable following the death of the Annuitant. For
purposes of the Internal Revenue Code, the "designated
beneficiary" under the Certificate shall be the
individual who is entitled to receive the amounts
payable on death of an Owner, or if any Owner is not an
individual, on any change in, or death of, an
Annuitant.
BENEFIT BASE The Benefit Base is the total amount used for the sole
purpose of calculating guaranteed lifetime withdrawals.
The Benefit Base is not used in calculating the
Certificate Value or any other guaranteed benefits. The
Benefit Base cannot be withdrawn in a lump sum.
CO-ANNUITANT The second person whose age and life may be used to
determine eligibility for the Lifetime Income Benefit.
The co-Annuitant is designated on the Specifications
Page, unless changed. Only the spouse of the Annuitant
is eligible to be a co-Annuitant.
COMPANY The insurance company named on the first page of this
Certificate (or any successor insurance company named
by endorsement to this Certificate) that will pay
benefits in accordance with this Certificate.
CERTIFICATE ANNIVERSARY The annual anniversary of the Certificate beginning
twelve months from the Certificate Date and each year
thereafter.
CERTIFICATE DATE The date of issue of this Certificate as designated on
the Specifications Page.
CERTIFICATE VALUE The total of your Investment Account Values.
CERTIFICATE YEAR The period of time measured twelve consecutive months
from the Certificate Date or any Certificate
Anniversary thereafter.
CONTINGENT BENEFICIARY The person, persons or entity who becomes entitled to
receive the Certificate proceeds if all Beneficiaries
die before the Owner dies.
1.1
ENDORSEMENT An Endorsement modifies the certificate to which it is
attached. Endorsements must be signed by an officer of
the Company in order to be effective.
FIXED ANNUITY An Annuity Option with payments which are predetermined
and guaranteed as to dollar amount.
GENERAL ACCOUNT All the assets of the Company other than assets in
Separate Accounts.
INTERNAL REVENUE CODE The Internal Revenue Code of 1986, as amended from time
(IRC) to time, and any successor statute of similar purposes.
INVESTMENT ACCOUNT VALUE The value of your investment in an Investment Option.
INVESTMENT OPTIONS The investment choices available to you. The Investment
Options available under this Certificate are shown on
the Specifications Page. When you select an Investment
Option, we allocate your Certificate Value to a
Sub-Account of the Variable Account that invests in a
corresponding Portfolio.
LIFETIME INCOME AMOUNT The Lifetime Income Amount is the amount that is
(LIA) guaranteed to be available for withdrawal each
Certificate Year after the Lifetime Income Date and
during the life of the Annuitant and any co-Annuitant
while this Certificate is in effect. The LIA reduces
to zero upon the death of the last to die of the
Annuitant and any co-Annuitant.
LIFETIME INCOME DATE The Lifetime Income Date is the date on which the
initial LIA is calculated.
LIFETIME INCOME The percentage used to determine your Lifetime Income
PERCENTAGE Amount.
MATURITY DATE The latest date on which annuity benefits may commence.
It is the date specified on the Specifications Page,
unless changed. The maximum Maturity Date will be the
later of age 90 or the end of the 10th Certificate
Year. Any extension of the Maturity Date will be
subject to the laws and regulations then in effect and
our prior approval.
NET PAYMENT The Payment less the amount of premium tax, if any,
deducted from the Payment.
OWNER The person, persons or entity entitled to the ownership
rights under this Certificate. The Owner is as
designated on the Specifications Page, unless changed.
PAYMENT An amount paid to us by you as consideration for the
benefits provided by this Certificate.
PORTFOLIO The investment choices available to the Variable
Account.
QUALIFIED CERTIFICATES Certificates issued under Qualified Plans.
QUALIFIED PLANS Retirement plans which receive favorable tax treatment
under sections 401, 403, 408 or 457, of the Internal
Revenue Code of 1986, as amended.
RIDER A Rider provides an optional benefit, which may result
in an additional charge to the Certificate. A Rider
supplements the certificate to which it is attached.
Riders must be signed by an officer of the Company in
order to be effective.
SEPARATE ACCOUNT A segregated account of the Company that is not
commingled with our general assets and obligations.
SUB-ACCOUNT(S) The Variable Account is divided into Sub-Accounts. Each
Sub-Account is invested in shares of a different
Portfolio.
SURRENDER VALUE The Certificate Value on any Valuation Date, less, if
applicable, any certificate fees, any rider charges,
and any deduction for premium taxes or similar taxes.
VALUATION DATE Any date on which the New York Stock Exchange is open
for business and the net asset value of a Portfolio is
determined.
1.2
VALUATION PERIOD Any period from one Valuation Date to the next,
measured from the time on each such date that the net
asset value of each Portfolio is determined.
VARIABLE ACCOUNT The Company's Separate Account as shown on the
Specifications Page.
VARIABLE ANNUITY An Annuity Option with payments which: (1) are not
predetermined or guaranteed as to dollar amount; and
(2) vary in relation to the investment experience of
one or more specified variable Investment Options.
WITHDRAWAL AMOUNT The amount deducted from the Certificate Value when you
request a withdrawal. This amount is the total of the
amount paid to you plus the following, if applicable:
any certificate fees, any rider charges, any deduction
for premium taxes or similar taxes, and any income
taxes resulting from the withdrawal and withheld by us.
The Withdrawal Amount may not exceed the Certificate
Value.
1.3
PART 2 GENERAL PROVISIONS
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ENTIRE CONTRACT The entire contract consists of the group contract,
this Certificate, Endorsements and Riders, if any, and
the application(s), if one is attached to the group
contract or this Certificate.
The benefits and values available under this
Certificate are not less than the minimum required by
any statute of the state in which this Certificate is
delivered. We have filed a detailed statement of the
method used to calculate the benefits and values with
the Department of Insurance in the state in which this
Certificate is delivered, if required by law.
MODIFICATION Only the President, a Vice President, or the Secretary
of the Company has authority to agree on our behalf to
any alteration of the Certificate or to any waiver of
our rights or requirements. The change or waiver must
be in writing. We will not change or modify this
Certificate without prior approval by the New York
Superintendent of Insurance. No change that reduces
benefits will be made without your written consent.
We may make any amendments as may be necessary to
comply with the applicable provisions of the IRC and
regulations thereunder as in effect from time to time.
Any such amendment will be subject to any necessary
regulatory approvals and, where required, approval of
the Owner. We will send you a copy of any amendment. We
will not be responsible for any adverse tax
consequences resulting from the Owner's rejection of
any such amendment.
CHANGE IN ANNUITY Prior to the Annuity Commencement Date, an Owner may
COMMENCEMENT DATE request in writing a change of the Annuity Commencement
Date. Any extension of the Annuity Commencement Date
beyond the Maturity Date will be subject to our prior
approval and any applicable law or regulation then in
effect.
ASSIGNMENT This Certificate is subject to assignment restrictions
for Federal Income Tax purposes. It is established for
the exclusive benefit of the Annuitant and his or her
Beneficiaries. It shall not be sold, assigned,
discounted, or pledged as collateral for a loan or as
security for the performance of an obligation or for
any other purpose, to any person other than us.
CLAIMS OF CREDITORS All benefits and payments under this Certificate shall
be exempt from the claims of creditors to the extent
permitted by law.
MISSTATEMENT AND PROOF We may require proof of age, sex or survival of any
OF AGE, SEX OR SURVIVAL person upon whose age, sex or survival any Lifetime
Income Benefit, Annuity Payments or other benefits
provided by this Certificate or any Rider attached
thereto depend. If the age or sex of the Annuitant or
any co-Annuitant has been misstated, the benefits will
be those which would have been provided for the correct
age and sex. If we have made incorrect benefit
payments, we will immediately pay the amount of any
underpayment adjusted with interest at 3% per annum. We
will deduct the amount of any overpayment from future
benefit payments without adjustment for interest.
ADDITION, DELETION OR We reserve the right, subject to prior approval of the
SUBSTITUTION OF New York Superintendent of Insurance and in compliance
INVESTMENT OPTIONS with applicable law, to make additions to, deletions
from, or substitutions for the Portfolio shares that
are held by the Variable Account or that the Variable
Account may purchase. We reserve the right to eliminate
the shares of any of the eligible Portfolios and to
substitute shares of another Portfolio. We will not
substitute any shares attributable to your interest in
a Sub-Account without notice to you and prior approval
of the Securities and Exchange Commission to the extent
required by the Investment Company Act of 1940. Nothing
contained herein shall prevent the Variable Account
from purchasing other securities for other series or
classes of certificates, or from effecting a conversion
between shares of another open-end investment company.
2.1
We reserve the right, subject to prior approval of the
New York Superintendent of Insurance and in compliance
with applicable law, to establish additional
Sub-Accounts which would invest in shares of a new
Portfolio. We also reserve the right to eliminate
existing Sub-Accounts, to combine Sub-Accounts or to
transfer assets in a Sub-Account to another Separate
Account established by us or an affiliated company. In
the event of any such substitution or change, we may,
by appropriate endorsement, make such changes in this
and other Certificates as may be necessary or
appropriate to reflect such substitutions or change. If
deemed by us to be in the best interests of persons
having voting rights under the Certificates, the
Variable Account may be operated as a management
company under the Investment Company Act of 1940 or it
may be de-registered under such Act in the event such
registration is no longer required.
NON-PARTICIPATING Your Certificate is non-participating and will not
share in our profits or surplus earnings. We will pay
no dividends on your Certificate.
REPORTS We will send you periodic reports, at least once each
Certificate Year after the first, containing the value
of each investment account and the Certificate Value.
The report will include the number of Accumulation
Units credited to each variable investment account, the
Accumulation Unit value for each and the dollar value
of each Accumulation Unit no more than 4 months prior
to the date of the mailing of the report. We will
provide such information concerning required minimum
distributions as is prescribed by the Commissioner of
Internal Revenue.
INSULATION The portion of the assets of the Variable Account equal
to the reserves and other certificate liabilities with
respect to such account are not chargeable with
liabilities arising out of any other business we may
conduct. Moreover, the income, gains and losses,
realized or unrealized, from assets allocated to the
Variable Account shall be credited to or charged
against such account without regard to our other
income, gains or losses.
SEPARATE ACCOUNT ASSETS We will maintain, in the Separate Account, assets with
a value at least equal to the amounts accumulated in
accordance with the terms of the applicable agreements
with respect to the Separate Account, and the reserves
for annuities, in the course of payment that vary with
the investment experience of the Separate Account.
CURRENCY AND PLACE OF All payments made to or by us shall be made in the
PAYMENTS lawful currency of the United States of America at the
Annuity Service Office or elsewhere if we consent.
NOTICES AND ELECTIONS All notices and elections you make under this
Certificate must be in writing, signed by you and
received by us at the Annuity Service Office. All
notices, requests and elections will be effective when
signed. We will not be liable for any payments made or
actions taken before the notice or election is received
by us.
GOVERNING LAW This Certificate will be governed by the laws of the
jurisdiction indicated on the Specifications Page.
CERTIFICATE CONTINUATION If the Group IRA Single Payment Deferred Variable
UPON CONTRACT Annuity Contract under which this Certificate is issued
TERMINATION terminates, this Certificate shall continue in
accordance with its terms.
2.2
PART 3 OWNER, BENEFICIARY
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OWNER The Owner must be one natural person who is the sole
Owner of the Certificate and the Annuitant, or a Trust
established for the exclusive benefit of the Annuitant
or his or her Beneficiaries. The Certificate is
established for the exclusive benefit of the Annuitant
or his or her Beneficiaries.
BENEFICIARY The Beneficiary is as designated on the Specifications
Page, unless changed. However, if there is a
co-Annuitant, that person will be treated as the
Beneficiary upon death of the Annuitant. If no such
Beneficiary is living, the Beneficiary is the
Contingent Beneficiary. If no Beneficiary or Contingent
Beneficiary is living, the Beneficiary is the estate of
the deceased Annuitant.
CHANGE OF OWNER, Except as permitted under the "Death Before Maturity
ANNUITANT, BENEFICIARY Date" provision, and otherwise permitted under
applicable federal tax law, neither the Owner nor the
Annuitant may be changed. The co-Annuitant may be
removed from the Certificate, but no change or addition
of co-Annuitant is permitted prior to the Annuity
Commencement Date. Only the spouse of the Annuitant is
eligible to be named as a co-Annuitant.
Subject to the right of an irrevocable Beneficiary, you
may change the Beneficiary by written request in a form
acceptable to us and which is received at our Annuity
Service Office. Any change must be approved by us. If
approved, any change of Beneficiary will take effect on
the date the request is signed. We will not be liable
for any payments or actions we take before the change
is approved.
3.1
PART 4 PAYMENT
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GENERAL The Certificate is not effective until Payment is
received by us at our Annuity Service Office or such
other place designated by us. The Certificate will be
purchased with a single payment.
ALLOCATION OF NET When we receive the Payment, the Net Payment will be
PAYMENT allocated among Investment Options in accordance with
the allocation percentages you elected as shown on the
Specifications Page.
4.1
PART 5 FEES AND DEDUCTIONS
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CERTIFICATE ASSET FEE To compensate us for assuming certain administration
expenses, expense risks and mortality risks, we deduct
from each variable Investment Option a fee each
Valuation Period at an annual rate set forth on the
Specifications Page. A portion of this Asset Fee may
also be used to reimburse us for distribution expenses.
This fee is reflected in the Net Investment Factor used
to determine the value of Accumulation Units and
Annuity Units of the Certificate.
LIFETIME INCOME BENEFIT To compensate us for assuming risks associated with the
FEE Lifetime Income Benefit, we charge an annual Lifetime
Income Benefit Fee. The Lifetime Income Benefit Fee is
deducted on each Certificate Anniversary. This fee is
withdrawn from each Investment Option in the same
proportion that the Investment Account Value of each
Investment Option bears to the Certificate Value. The
amount of the fee is equal to the Lifetime Income
Benefit Fee percentage, shown on the Specifications
Page, multiplied by the Benefit Base as of the prior
Certificate Anniversary.
The Lifetime Income Benefit Fee will not be deducted
during the Settlement Phase. The fee will not be
deducted after the Maturity Date if an Annuity Option
has commenced.
The initial Lifetime Income Benefit Fee percentage is
shown on the Specifications Page. We reserve the right
to increase the Lifetime Income Benefit Fee percentage
if we determine an increase is required. If the fee is
increased you will receive a 30-day advance notice of
the increase and given the opportunity to terminate the
Lifetime Income Benefit. If you elect to terminate this
benefit you will need to provide a written request in a
form acceptable to us.
In such a situation, the percentage will never exceed
the Maximum Lifetime Income Benefit Fee percentage,
shown on the Specifications Page.
TAXES We reserve the right to charge certain taxes against
your Payment (either at the time of payment or
liquidation), Certificate Value, payment of death
benefit, withdrawals, or Annuity Payments, as
appropriate. Such taxes may include premium taxes or
other taxes levied by any government entity which we,
in our sole discretion, determine have resulted from
the establishment or maintenance of the Variable
Account, or from the receipt by us of the Payment, or
from the issuance of this Certificate, or from the
commencement or continuance of Annuity Payments under
this Certificate.
5.1
PART 6 VARIABLE ACCOUNT PROVISIONS
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INVESTMENT ACCOUNT VALUE The Investment Account Value of an Investment
Option is determined by multiplying (a) times (b)
where:
(a) equals the number of Accumulation
Units credited to the Investment Option;
and
(b) equals the appropriate Accumulation
Unit Value.
ACCUMULATION UNITS We will credit the Net Payment to your Investment
Options in the form of Accumulation Units. The
number of Accumulation Units we will credit to
each Investment Option will be determined by
dividing the Net Payment allocated to that
Investment Option by the Accumulation Unit Value
for that Investment Option.
Accumulation Units will be adjusted for any
transfers and will be canceled on payment of a
death benefit, withdrawal, maturity or assessment
of certain charges based on their value for the
Valuation Period in which such transaction occurs.
ACCUMULATION UNIT VALUE We will determine the Accumulation Unit Value for
a particular Investment Option for any Valuation
Period by multiplying the Accumulation Unit Value
for the immediately preceding Valuation Period by
the net investment factor for the corresponding
Sub-Account for the Valuation Period for which the
value is being determined. The Accumulation Unit
Value may increase, decrease or remain the same
from one Valuation Period to the next.
NET INVESTMENT FACTOR The net investment factor is an index that
measures the investment performance of a
Sub-Account from one Valuation Period to the next.
The net investment factor for any Valuation Period
is determined by dividing (a) by (b) and
subtracting (c) from the result where:
(a) is the net result of:
1) the net asset value per share
of a Portfolio share held in the
Sub-Account determined as of the
end of the current Valuation
Period, plus
2) the per share amount of any
dividend or capital gain
distributions made by the Portfolio
on shares held in the Sub-Account
if the ex-dividend date occurs
during the current Valuation
Period, and
(b) is the net asset value per share of
a Portfolio share held in the Sub-
Account determined as of the end of the
immediately preceding Valuation Period,
and
(c) is the Certificate Asset Fee shown
on the Specifications Page.
The net investment factor may be greater or less
than, or equal to, one.
6.1
PART 7 TRANSFERS
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TRANSFERS BEFORE MATURITY
DATE Before the Maturity Date or the Annuity
Commencement Date, if earlier, you may transfer
amounts among Investment Options of the
Certificate. Amounts will be canceled from the
Investment Options from which amounts are
transferred and credited to the Investment Options
to which amounts are transferred. We will effect
such transfers so that the Certificate Value on
the date of transfer will not be affected by the
transfer.
TRANSFERS ON OR AFTER
MATURITY DATE Once variable Annuity Payments have begun, you may
transfer all or part of the investment upon which
your variable Annuity Payments are based from one
Investment Option to another. To do this, we will
convert variable Annuity Units you hold in the
Investment Option from which you are transferring
to variable Annuity Units of the Investment Option
to which you are transferring. We will determine
the number of Annuity Units to transfer so that if
the next Annuity Payment were made at that time,
it would be the same amount that it would have
been without the transfer. You must give us notice
at least 30 days before the due date of the first
variable Annuity Payment to which the transfer
will apply. Transfer charges and limitations are
identified on the Specifications Page.
After the Annuity Commencement Date, transfers
will not be allowed from a fixed to a variable
Annuity Option, or from a variable to a fixed
Annuity Option.
DEFERRAL, MODIFICATION OR
TERMINATION OF TRANSFER
PRIVILEGE We reserve the right to defer, modify or terminate
the transfer privilege at any time that we are
unable to purchase or redeem shares of the
Portfolios. Transfer charges and limitations are
identified on the Specifications Page and in the
"Suspension of Payments" provision in the
Withdrawals Provisions section.
7.1
PART 8 WITHDRAWAL PROVISIONS
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PAYMENTS OF WITHDRAWALS You may withdraw part or all of the Surrender
Value, at any time before the earlier of the death
of the Annuitant, the Annuity Commencement Date or
the Maturity Date, by sending us a written
request. We will pay all withdrawals within seven
days of receipt at the Annuity Service Office
subject to postponement in certain circumstances,
as specified below.
SUSPENSION OF PAYMENTS We may defer the right of withdrawal from, or
postpone the date of payments from, the variable
Investment Options for any period when: (1) the
New York Stock Exchange is closed (other than
customary weekend and holiday closings); (2)
trading on the New York Stock Exchange is
restricted; (3) an emergency exists as a result of
which disposal of securities held in the Variable
Account is not reasonably practicable or it is not
reasonably practicable to determine the value of
the Variable Account's net assets; or (4) the
Securities and Exchange Commission, by order, so
permits for the protection of security holders;
provided that applicable rules and regulations of
the Securities and Exchange Commission shall
govern as to whether the conditions described in
(2) and (3) exist.
TOTAL WITHDRAWAL Upon receipt of your request to withdraw the
entire Certificate Value, we will terminate the
Certificate and pay you the Surrender Value.
At the time of the total withdrawal, we will
deduct the total amount of the Annual Certificate
Fee from the Certificate Value in determining the
Surrender Value. We will also deduct a pro rata
share of the Lifetime Income Benefit Fee. A pro
rata share of the fee is equal to the Lifetime
Income Benefit Fee percentage, shown on the
Specifications Page, multiplied by the Benefit
Base, and then multiplied by the number of days
that have elapsed since the previous Certificate
Anniversary and divided by 365. For purposes of
determining the Lifetime Income Benefit Fee, a
total withdrawal will be deemed to have been taken
on the date the death benefit is determined and
once an Annuity Option has been elected.
PARTIAL WITHDRAWAL If you request to withdraw an amount less than the
Surrender Value, we will pay you the amount
requested and deduct the Withdrawal Amount from
the Certificate Value. Unless you specify the
amount to be withdrawn from each Investment
Option, the Withdrawal Amount will be withdrawn
from each Investment Option on a pro rata basis.
Any withdrawals prior to the Lifetime Income Date,
or withdrawals after the Lifetime Income Date that
exceed the Lifetime Income Amount, may reduce the
Lifetime Income Benefit.
FREQUENCY OF PARTIAL
WITHDRAWALS You may make as many partial withdrawals as you
wish.
8.1
PART 9 LIFETIME INCOME BENEFIT
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GENERAL This benefit guarantees that each Certificate Year
after the Lifetime Income Date and during the life
of the Annuitant and any co-Annuitant you may take
withdrawals up to an amount equal to the Lifetime
Income Amount (LIA), even if your Certificate
Value reduces to zero. The LIA is described below
in the "Lifetime Income Amount (LIA)" provision.
The Lifetime Income Date is the Certificate
Anniversary on or after the later of (a) the date
the younger of the Annuitant or any co-Annuitant
reaches the Lifetime Income Age or (b) the Minimum
Holding Period Expiration date as shown on the
Specifications Page.
BENEFIT BASE - INITIAL AND
MAXIMUM The initial Benefit Base equals the greater of the
Payment or the Benefit Base Percentage multiplied
by the Transferred Benefit Base. The Benefit Base
is available only for the purpose of the Lifetime
Income Benefit. It can not be withdrawn as a lump
sum. The Benefit Base shall not exceed the Maximum
Benefit Base amount shown on the Specifications
Page.
BENEFIT BASE - IMPACT OF
BENEFIT ENHANCEMENT On the first Certificate Anniversary and each
Certificate Anniversary on and prior to the first
withdrawal after the Lifetime Income Date, we will
determine a Benefit Enhancement amount and apply
it to the Benefit Base, provided no withdrawals
are taken during the previous Certificate Year.
The Benefit Enhancement amount is equal to the
Benefit Enhancement Percentage multiplied by the
Benefit Base as of the beginning of the previous
Certificate Year.
The Benefit Enhancement Percentage is shown on the
Specifications Page.
BENEFIT BASE - IMPACT OF
STEP-UP At the time of the first withdrawal on or after
the Lifetime Income Date, if the Certificate Value
on the Certificate Anniversary prior to that
withdrawal on or after the Lifetime Income Date is
greater than the Benefit Base including any
Benefit Enhancement we will automatically Step-Up
the Benefit Base to the greater amount.
9.1
BENEFIT BASE - IMPACT OF
WITHDRAWALS Prior to the Lifetime Income Date, the Benefit
Base will decrease as a result of any withdrawals.
The amount deducted in connection with the
withdrawal will be equal to the greater of the
following:
(a) An amount equal to A multiplied by
(B divided by C) where:
A equals the amount of the
withdrawal,
B equals the Benefit Base prior
to the withdrawal,
C equals the Certificate Value
prior to the withdrawal, or
(b) The amount of the withdrawal.
Beginning on the Lifetime Income Date, the Benefit
Base will not reduce if total withdrawals during a
Certificate Year are less than or equal to the
LIA.
If a withdrawal after the Lifetime Income Date
causes total withdrawals during a Certificate Year
to exceed the LIA or if total withdrawals during a
Certificate Year already exceeded the LIA, then
the Benefit Base will be decreased as a result of
the withdrawal. The amount deducted in connection
with the withdrawal will be equal to the greater
of the following:
(a) An amount equal to A multiplied by
(B divided by C) where:
A equals the amount of the
withdrawal,
B equals the Benefit Base prior
to the withdrawal,
C equals the Certificate Value
prior to the withdrawal, or
(b) The amount of the withdrawal.
See "Examples of Excess Withdrawal" below.
Notwithstanding the discussion above, the Benefit
Base will not be reduced when all withdrawals
during the Certificate Year and after the Lifetime
Income Date are Life Expectancy Distributions
elected under an automatic distribution program,
provided by us, even if such Life Expectancy
Distributions exceed the LIA for the Certificate
year. (See the "Life Expectancy Distributions"
provision.)
LIFETIME INCOME AMOUNT (XXX) The initial LIA will be determined at the time of
the first withdrawal on or after the Lifetime
Income Date. The initial LIA is equal to the
Lifetime Income Percentage shown on the
Specifications Page multiplied by the Benefit Base
on the date of that withdrawal.
Each time the Benefit Base is changed after the
Lifetime Income Date, then the new LIA will equal
the Lifetime Income Percentage shown on the
Specifications Page multiplied by the new Benefit
Base.
9.2
EXAMPLES OF EXCESS
WITHDRAWAL The following examples illustrate the effect of an
excess withdrawal on the Benefit Base and LIA.
Before Withdrawal After Withdrawal
Ex, Benefit Benefit
# CV Base LIA Withdrawal CV Base A LIA
1 $25,000 $40,000 $1,800 $2,000 $23,000 $36,800 B $1,656.00 B
2 $60,000 $40,000 $1,800 $2,000 $58,000 $38,000 C $1,710.00 C
----------
(A) Benefit Base is reduced on a pro-rata basis, or by the amount of the
withdrawal if greater, for withdrawals during the Certificate Year.
(B) In Example #1, Benefit Base = $36,800 ($40,000 X $2,000/$25,000 = $3,200.
Since $3,200 is greater than $2,000 the Benefit Base is reduced by $3,200.
$40,000 minus $3,200 = $36,800); LIA = Lifetime Income Percentage
multiplied by $36,800 If Lifetime Income Percentage is equal to 4.5%, then
LIA .045 x $36,800= $1,656.00
(C) In Example #2, Benefit Base = $38,000 ($40,000 X $2,000/$60,000 = $1,333.
Since $2,000 is greater than $1,333 the Benefit Base is reduced by $ 2,000.
$40,000 minus $2,000= $38,000); LIA = Lifetime Income Percentage multiplied
by $38,000. If Lifetime Income Percentage is equal to 4.5%, then LIA .045 x
$38,000= $ 1,710.00
LIFE EXPECTANCY
DISTRIBUTIONS For purposes of this benefit, Life Expectancy
Distributions are distributions within a calendar
year that:
(a) are part of a series of
substantially equal periodic payments
over the Annuitant's Life Expectancy
(or, if applicable, the joint Life
Expectancy of the Annuitant and the
Annuitant's spouse); and are paid to the
Owner as required or contemplated by
Code Section 401(a)(9), Section
408(b)(3), or Section 408A(c), as the
case may be ("Qualified Death Benefit
Stretch Distributions" and "Required
Minimum Distributions"); and
(b) are the Certificate's proportional
share of all such distributions as
determined by the Company and based on
the Company's understanding of the Code.
For purposes of this "Life Expectancy
Distributions" provision, references to Owner or
Annuitant also include the Beneficiary, as
applicable.
We reserve the right to make any
changes necessary to comply with the Code and
Treasury Regulations.
SETTLEMENT PHASE The Certificate will enter its Settlement Phase if
the Certificate Value reduces to zero, withdrawals
during the Certificate Year do not exceed the LIA,
and the Benefit Base is still greater than zero.
When the Certificate enters its Settlement Phase
the Lifetime Income Benefit will continue, however
all other rights and benefits under the
Certificate, including death benefits, will
terminate.
You will automatically receive settlement payments
equal to the LIA each Certificate Year of the
Settlement Phase during the life of the Annuitant
and any co-Annuitant. If the Settlement Phase is
entered prior to the Lifetime Income Date, then
settlement payments will begin on or after the
Lifetime Income Date. The settlement payments will
be paid no less frequently than annually. You may
choose among the frequencies that we make
available at the time settlement payments begin.
The Lifetime Income Benefit Fee will not be
deducted during the Settlement Phase.
If the last of the Annuitant and any co-Annuitant
dies during the Settlement Phase, then the
Lifetime Income Benefit terminates and no
additional settlement payments will be paid.
9.3
PART 10 DISTRIBUTIONS DURING ANNUITANT'S LIFE
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GENERAL Notwithstanding any provision of this Certificate
to the contrary, the distribution of the
Annuitant's interest in the Certificate shall be
made in accordance with the requirements of IRC
Sections 401(a)(9) and 408(b)(3) and the
regulations thereunder, the provisions of which
are herein incorporated by reference. If
distributions are not made in the form of an
annuity on an irrevocable basis (except for
acceleration), then distribution of the interest
in the Certificate, as described below, must
satisfy the requirements of IRC Section 408(a)(6)
and the regulations thereunder, rather than this
Part and paragraphs (b) and (c) of Part 11 of this
Certificate. The required minimum distribution for
this Certificate may be withdrawn from another
Individual Retirement Account in accordance with
Q&A-9 of Section 1.408-8 of the Income Tax
Regulations.
There is no required distribution during the life
of the Annuitant if this Certificate is issued as
a Xxxx XXX as indicated in the Type of Certificate
on the Specifications Page.
INTEREST IN THE CERTIFICATE Unless otherwise provided under applicable federal
tax law, the "interest" in the Certificate
includes the amount of any outstanding rollover,
transfer, and recharacterization under Q&As-7 and
-8 of Section 1.408-8 of the Income Tax
Regulations. Also, prior to the date that Annuity
Payments commence on an irrevocable basis (except
for acceleration), the "interest" in the
Certificate includes the actuarial value of any
other benefits provided under the Certificate,
such as guaranteed death benefits or the Lifetime
Income Benefit.
REQUIRED BEGINNING DATE The "required beginning date" means April 1 of the
calendar year following the calendar year in which
the Annuitant attains age 70 1/2, or such later
date provided by applicable tax law.
DISTRIBUTIONS Unless otherwise permitted under applicable
federal tax law, the entire interest will commence
to be distributed no later than the required
beginning date over (i) the life of the Annuitant
or the lives of the Annuitant and his or her
designated Beneficiary (within the meaning of IRC
Section 401(a)(9)), or (ii) a period certain not
extending beyond the life expectancy of the
Annuitant, or joint life and last survivor
expectancy of the Annuitant and his or her
designated Beneficiary.
If the interest in the Certificate is to be
distributed over a period greater than one year,
the amount to be distributed by December 31 of
each year (including the year in which the
required beginning date occurs) shall be
determined in accordance with the requirements of
IRC Section 401(a)(9) and the regulations
thereunder. Payments must be made in periodic
payments at intervals of no longer than one year.
Unless otherwise provided by applicable federal
tax law, payments must be either nonincreasing or
they may increase only as provided in Q&As-1 and
-4 of Section 1.401(a)(9)-6 of the Income Tax
Regulations. In addition, any distribution must
satisfy the incidental benefit requirements
specified in Q&A-2 of Section 1.401(a)(9)-6.
The distribution periods described above cannot
exceed the periods specified in Section
1.401(a)(9)-6 of the Income Tax Regulations
(except as otherwise provided by applicable
federal tax law).
If Annuity Payments commence on or before the
required beginning date, the first required
payment can be made as late as the required
beginning date and must be the payment that is
required for one payment interval. The second
payment need not be made until the end of the next
payment interval.
10.1
PART 11 DISTRIBUTIONS AFTER ANNUITANT'S DEATH
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DEATH BENEFIT BEFORE
MATURITY DATE Death benefit distributions prior to the Maturity
Date are governed by Internal Revenue Code Section
72(s). Pursuant to Section 72(s) any reference in
this DEATH BENEFIT section to "spouse" means a
spouse as defined in Section 3 of the federal
Defense of Marriage Act ("DOMA"). Therefore, a
same-sex partner is not a "spouse" for purposes of
the distribution provisions of this section.
If the Annuitant dies prior to the Maturity Date
or Annuity Commencement Date, if earlier, the
interest in the Certificate will be distributed to
the Beneficiary as follows. Written notice and
proof of death and all required claim forms must
be received at the Company's Annuity Service
Office prior to any distribution.
The Certificate Value may be withdrawn by the
Beneficiary in one sum immediately, in which case
the Certificate will terminate. If the Certificate
Value is not taken in one sum immediately, the
Certificate will continue subject to the following
provisions:
(a) The Beneficiary becomes the Owner.
(b) If the Beneficiary is not the
deceased Annuitant's spouse, the
Lifetime Income Benefit will no longer
be available and the entire interest in
the Certificate must be distributed
under one of the following options:
(i) the entire interest in
the Certificate must be
distributed over the life of
the Beneficiary, or over a
period not extending beyond the
life expectancy of the
Beneficiary, with distributions
beginning by the end of the
calendar year following the
calendar year of the
Annuitant's death; or
(ii) the entire interest in
the Certificate must be
distributed by the end of the
calendar year containing the
fifth anniversary of the
Annuitant's Death; or
(iii) the entire interest in
the Certificate must be
distributed as Annuity Payments
under one of the options
described in the Annuity
Options section.
An irrevocable election of the method of
distribution must be made no later than
the end of the calendar year immediately
following the calendar year in which the
Annuitant died. If no election is made,
the interest in the Certificate will be
distributed as described in (ii) above.
The life expectancy of the Beneficiary
is determined using the age of the
Beneficiary as of his or her birthday in
the year following the year of the
Annuitant's death.
If the Beneficiary dies before the
distributions required by (i) or (ii)
are complete, the entire remaining
Certificate Value must be distributed at
least as rapidly as under the
distribution option chosen.
11.1
(c) The following options apply if the
sole Beneficiary is the Annuitant's
spouse.
If the sole Beneficiary is the deceased
Xxxxxxxxx's spouse and is the
co-Annuitant, the surviving spouse may
elect to continue the Certificate as the
new Owner/Annuitant and the Lifetime
Income Benefit will be available during
the life of the surviving spouse.
If the sole Beneficiary is the deceased
Xxxxxxxxx's spouse, but is not the
co-Annuitant, the surviving spouse may
elect to continue the Certificate as the
new Owner/Annuitant but the Lifetime
Income Benefit will no longer be
available.
The surviving spouse may name a new
Beneficiary (and, if no Beneficiary is
so named, the surviving spouse's estate
will be the Beneficiary).
The spouse may also elect distributions
under one of the following options:
(i) the entire interest in
the Certificate may be
distributed over the life of
the Beneficiary, or over a
period not extending beyond the
life expectancy of the
Beneficiary, with distributions
beginning by the end of the
calendar year following the
calendar year of the
Annuitant's death (or by the
end of the calendar year in
which the Annuitant would have
attained age 70 1/2, if later)
; or
(ii) the entire interest in
the Certificate may be
distributed by the end of the
calendar year containing the
fifth anniversary of the
Annuitant's Death; or
(iii) as Annuity Payments
under one of the options
described in the Annuity
Options section.
11.2
Such election must be made no later than the
earlier of the date distributions are
scheduled to begin under (i) above or
December 31 of the year containing the fifth
anniversary of the Annuitant's death. If no
election is made, the entire interest in the
Certificate will be distributed as described
in (ii) above.
If the surviving spouse dies before required
distributions commence, the remaining
interest will be distributed, starting by the
end of the calendar year following the
calendar year of the spouse's death, over the
designated Beneficiary's life expectancy
determined using the Beneficiary's ages as of
his or her birthday in the year following the
death of the spouse. If elected, the interest
may be distributed as described in (ii)
above.
If there is no Beneficiary, the entire interest in
the Certificate will be distributed by the end of
the calendar year containing the fifth anniversary
of the Annuitant's Death.
Life expectancies are determined using the Single
Life Table in Q&A-1 of Section 1.401(a)(9)-9 of the
Income Tax Regulations. If distributions are made to
a surviving spouse as the sole designated
Beneficiary, such spouse's life expectancy for a
year is the number in the Single Life Table
corresponding to such spouse's age in the year. In
all other cases, remaining life expectancy for a
year is the number in the Single Life Table
corresponding to the Beneficiary's age in the year
distributions must begin, reduced by 1 for each
subsequent year.
We will permit the Owner to limit the option(s)
offered to any named Beneficiary, if the Owner
provides written notice to the Company prior to
death and the desired option(s) is one provided for
in this Certificate and it satisfies the applicable
requirements of IRC Sections 401(a)(9) and 408(b)(3)
and the regulations thereunder.
If the Annuitant dies after required distributions
commence, the remaining portion of his or her
interest in the Certificate, if any, will be
distributed at least as rapidly as under the
distribution option chosen.
If there is more than one Beneficiary, the foregoing
provisions will independently apply to each
Beneficiary, to the extent of that Beneficiary's
share.
DEATH BENEFIT ON OR AFTER
MATURITY DATE If Annuity Payments have been selected based on an
Annuity Option providing for payments for a
guaranteed period, and the Annuitant dies on or
after the Annuity Commencement Date, we will make
the remaining guaranteed payments to the
Beneficiary. Any remaining payments will be made at
least as rapidly as under the method of distribution
being used as of the date of the Annuitant's death.
If no Beneficiary is living, we will commute any
unpaid guaranteed payments to a single sum (on the
basis of the interest rate used in determining the
payments) and pay that single sum to the estate of
the last to die of the Annuitant and the
Beneficiary.
PROOF OF DEATH We will require proof of death upon the death of the
Annuitant or the Owner. Proof of death is one of the
following received at the Annuity Service Office:
(a) A certified copy of a death
certificate.
(b) A certified copy of a decree of a
court of competent jurisdiction as to
the finding of death.
(c) Any other proof satisfactory to us.
11.3
PART 12 ANNUITY PAYMENTS
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GENERAL Benefits payable under this Certificate may be
applied in accordance with one or more of the
Annuity Options described below, subject to any
restrictions of Internal Revenue Code sections
401(a)(9) and 408(b)(3). If guaranteed payments are
to be made, the period over which the guaranteed
payments are made may not exceed the period
permitted under Section 1.401(a)(9)-6 of the Income
Tax Regulations. Once Annuity Payments commence, the
Annuity Option may not be changed. The "Life 5-Year
Certain" Annuity Option described under Part 13,
Option 1 is the default Annuity Option unless you
request another option prior to the Annuity
Commencement Date or unless otherwise required by
the Internal Revenue Code. If you are receiving
distributions that comply with the minimum
distribution requirements of the Internal Revenue
Code, you do not need to annuitize the Certificate
Value.
We will send you information about Annuity Options
before the Annuity Commencement Date. If by the
Maturity Date, you do not choose an Annuity Option,
make a total withdrawal of the Surrender Value, or
ask us to change the Maturity Date, we will
automatically pay you Annuity Payments under the
Annuity Option shown on the Specifications Page and
the Annuity Commencement Date is considered to be
the Maturity Date. You can change the Annuity Option
at any time before Annuity Payments commence.
You may select a Fixed or Variable Annuity. We will
provide variable Annuity Payments unless otherwise
elected. Once Annuity Payments commence, the Annuity
Option may not be changed.
The method used to calculate the amount of the
initial and subsequent Annuity Payments is described
below.
If the monthly income is less than $20, we may pay
the greater of the Certificate Value or the commuted
value of the Lifetime Income Benefit in one lump sum
on the Maturity Date, or the Annuity Commencement
Date if earlier.
12.1
VARIABLE ANNUITY PAYMENTS We will determine the amount of the first
variable Annuity Payment by applying the
portion of the Certificate Value used to
effect a Variable Annuity (minus any
applicable premium taxes) to the Annuity
Option elected based on the mortality table
and assumed interest rate shown on the
Specifications Page. We will provide a table
of the annuity factors upon request. If the
current rates in use by us on the Annuity
Commencement Date are more favorable to you,
we will use the current rates. The portion of
the Certificate Value used to effect a
Variable Annuity will be measured as of a
date not more than 10 business days prior to
the Annuity Commencement Date.
Subsequent payments will be based on the
investment performance of the Investment
Options you elected. The amount of each
subsequent variable Annuity Payment is
determined by multiplying the number of
Annuity Units credited for each Investment
Option you elect by the appropriate Annuity
Unit value on each subsequent determination
date, which is a uniformly applied date not
more than 10 business days before the payment
is due. The number of Annuity Units is
determined by dividing the portion of the
first payment allocated to an Investment
Option by the Annuity Unit value for that
Investment Option determined as of the same
date that the Certificate Value used to
effect Annuity Payments was determined. The
portion of the first payment allocated to an
investment Option will be determined in the
same proportion that the Investment Account
Value of each Investment Option bears to the
Certificate Value used to effect the Variable
Annuity, unless you elect a different
allocation.
Variable Annuity Payments, at the time of
their commencement, will not be less than
those that would be provided by the
application of the Certificate Value to
purchase any single consideration immediate
annuity, offered by the Company at the time,
to the same class of annuitants. Since no
such annuity currently exists, we will apply
rates that are reasonable in relation to the
market single premium immediate annuity
rates.
MORTALITY AND EXPENSE
GUARANTEE We guarantee that the dollar amount of each
variable Annuity Payment will not be affected
by changes in mortality and expense
experience.
ANNUITY UNIT VALUE The value of an Annuity Unit for each
Investment Option for any Valuation Period is
determined as follows:
(a) The net investment factor for the
corresponding Sub-Account for the
Valuation Period for which the
Annuity Unit value is being
calculated is multiplied by the
value of the Annuity Unit for the
preceding Valuation Period; and
(b) The result is adjusted to
compensate for the interest rate
used to determine the first
variable Annuity Payment.
The dollar value of Annuity Units may
increase, decrease or remain the same from
one Valuation Period to the next.
FIXED ANNUITY PAYMENTS We will determine the amount of each fixed
Annuity Payment by applying the portion of
the Certificate Value used to effect a Fixed
Annuity measured as of a date not more than
10 business days prior to the Annuity
Commencement Date (minus any applicable
premium taxes) to the Annuity Option elected
based on the mortality table and interest
rate shown on the Specifications Page.
Fixed Annuity Payments, at the time of their
commencement, will not be less than those
that would be provided by the application of
the Certificate Value to purchase any single
consideration immediate annuity, offered by
the Company at the time, to the same class of
annuitants.
We guarantee the dollar amount of fixed
Annuity Payments.
12.2
PART 13 ANNUITY OPTIONS
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DESCRIPTION OF ANNUITY
OPTIONS Option 1: Life Annuity
Life 5-Year Certain. We will make Annuity
Payments for 5 years and after that during
the lifetime of the Annuitant. No payments
are due after the death of the Annuitant or,
if later, the end of the 5-year period.
Option 2: Joint Life Annuity
Joint Life 5-Year Certain. We will make
Annuity Payments for 5 years and after that
during the joint lifetime of the Annuitant
and co-Annuitant. No payments are due after
the death of both the Annuitant and
co-Annuitant or, if later, the end of the
5-year period.
Option 3: Fixed Life Annuity
Life Annuity with Cash Refund: This option is
available if only one of the Annuitant or
co-Annuitant is living at the Annuity
Commencement Date. We will make payments
during the lifetime of the Annuitant or
co-Annuitant. After the death of the
Annuitant or co-Annuitant, we will pay the
Beneficiary a lump sum amount equal to the
excess, if any, of the Certificate Value at
the election of this option over the sum of
the Annuity Payments made under this option.
This option is available on or after the
later of the Annuitant's 90th birthday or the
tenth Certificate Anniversary.
The annual amount of the Annuity Payments
will equal the greater of:
(a) the Lifetime Income Amount, or
(b) the annual amount determined
by applying the Certificate Value
to a Cash Refund Annuity Option
based on the Mortality Table and
Fixed Annuity Payment Interest Rate
listed on the Specifications Page.
Option 4: Fixed Joint Life Annuity
Joint Life Annuity with Cash Refund: This
option is available if both the Annuitant and
co-Annuitant are living at the Annuity
Commencement Date. We will make payments
during the lifetime of the Annuitant and
co-Annuitant. After the death of both the
Annuitant and co-Annuitant, we will pay the
Beneficiary a lump sum amount equal to the
excess, if any, of the Certificate Value at
the election of this option over the sum of
the Annuity Payments made under this option.
This option is available only if the
co-Annuitant is the co-Annuitant listed on
the Specifications Page at issue of the
Certificate. This option may be elected on or
after the earlier of the Annuitant's or
co-Annuitant's 90th birthday or the tenth
Certificate Anniversary, if later.
The annual amount of the Annuity Payments
will equal the greater of:
(a) the Lifetime Income Amount, or
(b) the annual amount determined
by applying the Certificate Value
to a Joint Life Cash Refund Annuity
Option based on the Mortality Table
and Fixed Annuity Payment Interest
Rate listed on the Specifications
Page.
ALTERNATE ANNUITY OPTIONS Instead of settlement in accordance with the
Annuity Options described above, you may
choose an alternate form of settlement
acceptable to us. Once Annuity Payments
commence, the form of settlement may not be
changed.
13.1
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XXXX XXXXXXX LIFE INSURANCE COMPANY OF NEW YORK [XXXX XXXXXXX LOGO]
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