EMPIRE FIDELITY INVESTMENTS LIFE INSURANCE COMPANY NEW YORK, NEW YORK DEFERRED ANNUITY Flexible Purchase Payments Variable Accumulation Values Fixed Annuity Income Payments Nonparticipating
EMPIRE FIDELITY INVESTMENTS LIFE INSURANCE COMPANY
NEW YORK, NEW YORK
DEFERRED ANNUITY
Flexible Purchase Payments
Variable Accumulation Values
Fixed Annuity Income Payments
Nonparticipating
Empire Fidelity Investments Life Insurance Company (also referred to as "EFILI", "we" or "us") agrees to pay monthly fixed annuity income to the Annuitant(s) starting on the Annuity Date.
These agreements are subject to all the provisions of this Contract. This Contract has been issued in consideration of the Initial Purchase Payment.
We assess a daily Mortality and Expense Risk Charge against each Contract's assets at an annual rate of 0.20% and a daily Administrative Charge against each Contract's assets at an annual rate of 0.05%.
ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. (SEE CONTRACT VALUE, PAGE 9).
Signed for the Company at its Executive Offices in New York, New York.
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Secretary |
RIGHT TO RETURN THE CONTRACT
When this Contract is issued, You have 10 days after You receive it from us to examine it, unless state law requires a longer period of time. Within those 10 days You can return the Contract to us at our Annuity Service Center for any reason. If You do, the Contract will be canceled and will be void from the beginning. We will promptly refund the amount of your Initial Purchase Payment, including any fees and charges, plus or minus the investment performance of the Contract. If your free look period ends on a non-business day, the next business day will be used.
PLEASE READ YOUR CONTRACT CAREFULLY
This is a legal contract between you and us.
ANNUITY SERVICE CENTER
[P.O. Box 770001, Cincinnati, OH 45277-0051]
For customer assistance or inquiries, please call [▇▇▇-▇▇▇-▇▇▇▇].
EDVA-2005
GUIDE TO CONTRACT PROVISIONS
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CONTRACT SCHEDULE |
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GLOSSARY |
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CHARGES UNDER THE CONTRACT |
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RESERVED RIGHTS |
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PURCHASE PAYMENTS |
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Application and Initial Purchase Payment |
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Additional Purchase Payments |
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Purchase Payments Made With Returned Checks or Unfunded |
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Electronic Funds Transfers |
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Investment Allocation of Your Purchase Payments |
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CONTRACT VALUE |
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Contract Value |
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THE VARIABLE ACCOUNT |
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Variable Account |
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Investment Options |
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MAKING EXCHANGES AMONG INVESTMENT OPTIONS |
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In General |
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Market Timing |
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Short-Term Trading Risk |
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EFILI Policies Regarding Frequent Trading |
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Frequent Trading Monitoring and Restriction Procedures |
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Effective Date of Exchanges Among Investment Options |
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VALUATION PERIOD, TOTAL RETURN, ACCUMULATION UNITS AND ACCUMULATION UNIT VALUE |
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Valuation Period |
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Total Return for an Investment Option |
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Accumulation Units and Accumulation Unit Value |
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WITHDRAWALS |
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Complete Withdrawal |
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Partial Withdrawals |
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Postponement of Payment |
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Automatic Transfer to Money Market Investment Option Upon Due |
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Proof of Death |
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EDVA-2005
GUIDE TO CONTRACT PROVISIONS
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REQUIRED DISTRIBUTIONS UPON DEATH OF OWNER |
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SPECIAL RULES FOR CONTRACT HELD BY REVOCABLE GRANTOR TRUST |
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ANNUITY DATE |
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ANNUITY INCOME |
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Guaranteed Annuity Income Purchase Rates |
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OWNERS, ANNUITANTS AND BENEFICIARIES |
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Owners |
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Annuitants |
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Beneficiaries |
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GENERAL PROVISIONS |
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Entire Contract |
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Written Notice to the Annuity Service Center |
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Misstatement of Age or Sex |
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Reports to Owners |
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Protection of Proceeds |
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Basis of Values |
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Nonparticipating |
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Assignment |
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Notification of Death |
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Proof of Survival |
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Voting Rights |
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Termination |
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ANNUITY TABLES |
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EDVA-2005
Contract Schedule
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Contract Number: |
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[Z0000000] |
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Contract Date: |
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[January 1, 2005] |
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Annuity Date: |
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[June 1, 2025] |
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Owner(s): |
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[▇▇▇▇ ▇▇▇] |
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[▇▇▇▇ ▇▇▇] |
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Annuitant(s): |
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[▇▇▇▇ ▇▇▇] |
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[▇▇▇▇ ▇▇▇] |
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Initial Purchase Payment: |
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[$5,000] |
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Annual Mortality and Expense |
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Risk Charge: |
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0.20% |
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Annual Administrative Charge: |
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0.05% |
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Minimum Additional Purchase |
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Payment: |
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$250 |
CONTRACT SCHEDULE (cont.)
INVESTMENT OPTIONS
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[Money Market] |
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[Asset Manager] |
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[Natural Resources] |
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[Asset Manager: Growth] |
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[Overseas] |
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[Balanced] |
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[Real Estate] |
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[Consumer Industries] |
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[Strategic Income] |
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[Contrafund] |
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[Technology] |
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[Cyclical Industries] |
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[Telecommunications & Utilities Growth] |
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[Dynamic Capital Appreciation] |
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[Value] |
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[Equity-Income] |
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[Value Leaders] |
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[Financial Services] |
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[Value Strategies] |
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[Freedom 2005] |
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[Freedom 2010] |
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[Freedom 2015] |
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[Freedom 2020] |
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[Freedom 2025] |
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[Freedom 2030] |
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[Freedom Income] |
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[Growth] |
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[Growth & Income] |
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[Growth Opportunities] |
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[Growth Stock] |
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[Health Care] |
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[High Income] |
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[Index 500] |
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[International Capital Appreciation] |
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[Investment Grade Bond] |
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[Mid Cap] |
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EDVA-2005
GLOSSARY
Accumulation Unit - A unit of interest in an Investment Option.
Accumulation Unit Value - The value of a particular Accumulation Unit at a particular time.
Annuitant or Annuitants - The person(s) designated by the Owner(s) to receive monthly annuity income payments.
Annuity Date - A date selected by the Owner(s) for annuity income payments to begin. This date can be as late as the first day of the month following the oldest Owner's 90th birthday. Once annuity income payments begin, Owners have no rights in the Contract.
Beneficiary or Beneficiaries - The person or persons who receive proceeds from the Contract if all the Owners die before the Annuity Date.
Code - The Internal Revenue Code of 1986, as amended.
Contract Anniversary - The same month and day as the Contract Date in each later year.
Contract Date - The date your Contract becomes effective. We show this date on the schedule page.
Contract Value - The total amount attributable to a Contract at any time before annuity income payments begin.
Contract Year - A year that starts on the Contract Date or a Contract Anniversary and ends at the close of business on the day before the next Contract Anniversary.
Exchanges - Transfers of values among the Investment Options.
Funds - The mutual fund portfolios in which the Investment Options invest.
Investment Options - The Subaccounts of the Variable Account to which you may allocate Contract Value. Each Subaccount invests exclusively in the shares of one Fund.
Owner(s) - also "You" or "you" - The one or two persons who have the ownership rights and privileges under the Contract before the Annuity Date.
Purchase Payment(s) - The amount(s) you invest in a Contract before any deduction for premium taxes. This term includes the Initial Purchase Payment in return for which we issue your Contract and any additional Purchase Payments you make later.
Subaccounts - The divisions of the Variable Account, each of which invests exclusively in the shares of one Fund.
Total Return - A measure of the investment performance for an Investment Option from one Valuation Period to the next.
EDVA-2005
Valuation Period - The period of time between one determination of the value of Accumulation Units to the next determination. We make determinations as of the close of business of the New York Stock Exchange (normally 4 p.m. Eastern Time) each day that the Exchange is open for trading.
Variable Account - Empire Fidelity Investments Variable Annuity Account A.
You or you - The one or two persons who own a Contract. Once the Contract is issued, the Owner(s) may not be changed, except that if a Contract has one Owner at the time of issue, that Owner may add a second Owner. This may be done only once. You may not remove an Owner.
EDVA-2005
CHARGES UNDER THE CONTRACT
The following are all the charges we make under your Contract.
(1) Mortality and Expense Risk Charges. We assess a daily charge against each Contract's assets at the annual rate shown on your Contract Schedule page.
(2) Administrative Charge. We assess a daily charge against each Contract's assets at the annual rate shown on your Contract Schedule page.
(3) Premium Taxes. We deduct a charge equal to any premium taxes we are required to pay in connection with your Contract.
(4) Charge for Exchanges Among Investment Options. We reserve the right to charge you if you make Exchanges among the Investment Options on more than six days during a calendar year. The charge will be not more than $15 for each additional day on which you make an Exchange. If your only Exchange on a given day results from Dollar Cost Averaging or Automatic Rebalancing, or because of a transfer from the Money Market Investment Option at the end of the Free Look Period, this will not count against the six day limit.
(5) Other Taxes. We reserve the right to charge for any other taxes (in addition to premium taxes) that we may have to pay.
In addition to the charges that we make, the Funds incur monthly management fees and other expenses. Also, some Investment Options may invest in Funds that impose a short-term redemption fee. Your Contract Value will be reduced by the amount of any short-term redemption fee that we collect for a Fund. Any short-term redemption fees that we pay are retained by the Funds and are part of the Funds' assets.
RESERVED RIGHTS
We reserve the right to:
1. Reject Purchase Payments made with cash-like instruments including, but not limited to money orders, cashier's checks, bank drafts, postal money orders and Traveler's Express international money orders.
2. Limit the number of days on which you can make Exchanges, but you will always be able to make Exchanges on at least five days each calendar year.
3. Impose a charge if you make Exchanges on more than six days during a calendar year. The charge will be not more than $15 for each additional day on which you make an Exchange.
4. Reject Exchanges communicated to us by anyone acting under a power of attorney on behalf of more than one Owner.
5. Reject specific transactions or impose restrictions in respect of any Contract owned or controlled commonly with a Contract subject to restrictions imposed as the result of frequent trading, or in respect of any Contract owned or controlled commonly by a person who as the result of frequent trading is the subject of complex-wide block by the Fidelity Investments family of mutual funds. We may alter our policies, in any manner not inconsistent with the terms of the Contract, at any time without notice to Owners.
EDVA-2005
6. Charge for any other taxes (in addition to premium taxes) that we may have to pay.
7. Modify the Contract as necessary to attempt to prevent Contract Owners from being considered the owners of the assets of the Variable Account, in order to preserve the tax-favored nature of the Contract.
8. Reject any Beneficiary designation that we deem to be unadministerable.
9. Modify the manner in which we calculate the weight to be given to your voting instructions where such a change is necessary to comply with then current federal regulations or interpretations of those regulations.
10. Combine the Variable Account with other variable accounts.
11. Deregister the Variable Account under the Investment Company Act of 1940 if registration is no longer required.
12. Operate the Variable Account as a management investment company under the Investment Company Act of 1940 or in any other form allowed by law.
13. Make any changes required by any change in the Investment Company Act of 1940.
14. Make any changes required to conform to the provisions of the Internal Revenue Code and the regulations thereunder.
15. Interpret the provisions of the Contract so that all distributions are made in accordance with the requirements of the Internal Revenue Code and the regulations thereunder.
EDVA-2005
PURCHASE PAYMENTS
Application and Initial Purchase Payment
Once we receive your completed application in a form acceptable to us, we will apply the Initial Purchase Payment to the purchase of a Contract within two business days after we receive the application and Initial Purchase Payment at our Annuity Service Center. The date that we credit your Initial Purchase Payment and your Contract becomes effective is called the Contract Date.
If we receive an incomplete application, or one that is not in an acceptable form, we will request the information needed to complete the application. If your application remains incomplete or otherwise unacceptable for five business days, we will return your Initial Purchase Payment unless we obtain your specific permission to retain it pending completion or revision of your application.
Additional Purchase Payments
You may add money to your Contract before the Annuity Date if all the Owners are still living. If your Contract is issued to two owners and one Owner dies before the Annuity Date, we will not accept additional Purchase Payments unless the surviving Owner was the spouse of the deceased Owner at the time of death and elected to continue the Contract as his or her own.
The smallest additional Purchase Payment we will accept is $250.
An additional Purchase Payment that you invest in any Investment Option(s) will be credited to your contract based on the next computed Accumulation Unit Value(s) for those Investment Option(s) after we receive your payment at our Annuity Service Center.
We reserve the right to reject Purchase Payments made with cash-like instruments including, but not limited to money orders, cashier's checks, bank drafts, postal money orders and Traveler's Express international money orders.
Purchase Payments Made With Returned Checks Or Unfunded Electronic Funds Transfers
If you make a Purchase Payment with a check that is returned to us unpaid due to insufficient funds or for any other reason, or if your Purchase Payment is made by an electronic funds transfer that is later reversed due to lack of funds in the bank account from which the transfer was made or for any other reason, we will (1) reverse the transaction; and (2) if the reversal results in a loss of more than $1,000 to us, redeem a sufficient number of Accumulation Units from the Investment Options at the current Accumulation Unit Values to provide us with an amount equal to the loss. Money will be taken proportionately from all of the Investment Options in which you are invested. If there is not sufficient value in the Investment Options we may take legal action against you to recover any remaining losses we have incurred.
EDVA-2005
Investment Allocation of Your Purchase Payments
You choose how to allocate your Purchase Payments among the Investment Options and the percentage to be allocated to each.
For the Initial Purchase Payment, you choose the allocation on the application. Depending on the state in which your Contract is delivered, amounts may be invested solely in the Money Market Investment Option for a short period of time after the Contract Date. Then we will transfer to the other Investment Options in accordance with your most recent allocation instructions.
For any additional Purchase Payment, you may send written allocation instructions to us at our Annuity Service Center. You may also provide instructions through our website, ▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇, but only if they are in accordance with our then current rules. We do not accept instructions by fax. You may indicate whether your allocation instructions apply (1) only to the current additional Purchase Payment or (2) to the current additional Purchase Payment and all future additional Purchase Payments. If you do not indicate that your instructions apply to all future additional Purchase Payments then we will apply them only to the current additional Purchase Payment.
Instructions may be expressed in dollars or in percentages. All instructions must be in whole numbers, not decimals or fractions. If you give us instructions that in our judgment are unclear or incomplete, your Purchase Payment and any future Purchase Payments to which those instructions apply will be allocated to the Money Market Investment Option until we receive instructions that are clear and complete. Instructions may be unclear or incomplete if percentage allocations do not total 100% or for some other reason. You will be notified in the case of incomplete or unclear instructionsand we will not be responsible for changes in unit values or for lost market opportunities.
At the time any Purchase Payment is invested in an Investment Option, we credit a number of Accumulation Units to your Contract based on each Investment Option's current Accumulation Unit Value.
You should verify the accuracy of your transaction confirmations and statements immediately after you receive them. If you find a discrepancy with regard to a particular transaction you should notify the Annuity Service Center promptly. We will not be responsible for losses unless you notify us within fifteen calendar days from the first time we mail a confirmation or statement with details of the transaction.
EDVA-2005
CONTRACT VALUE
Contract Value
The Contract Value is the total amount attributable to your Contract at any time before the Annuity Date. It is the sum of the values in the Investment Options. The amount of the Contract Value is not guaranteed, and will vary with the investment performance of the Investment Options in which your Contract is invested.
THE VARIABLE ACCOUNT
Variable Account
Empire Fidelity Investments Variable Annuity Account A (the "Variable Account") is a separate investment account of EFILI established on July 15, 1991. It is used to support the operation of this Contract and other variable annuity contracts the Company may offer.
The Variable Account is registered with the Securities and Exchange Commission as a unit investment trust under the Investment Company Act of 1940.
We are the legal owner of the assets in the Variable Account. As required by law, however, the assets of the Variable Account are kept separate from our general account assets and from any other separate accounts we may have, and may not be charged with liabilities from any other business we conduct. The assets in the Variable Account will always be at least equal to the reserves and other liabilities of the Variable Account. If the assets exceed the required reserves and other liabilities, we may transfer the excess to our general account. We are obligated to pay all benefits provided under the Contracts.
Investment Options
Each Investment Option is a part of the Variable Account. Each Investment Option invests in a single underlying Fund. On the Contract Date the Investment Options are those listed on the Contract Schedule page.
We may make additional Investment Options available to you from time to time. These Investment Options will invest in mutual funds that we find suitable for the Contract. You bear the full investment risk for amounts invested in the Investment Options.
We reserve the right to eliminate Investment Options, to combine two or more Investment Options, or to substitute a new mutual fund for the mutual fund in which an Investment Option invests.
A substitution may become necessary if, in our judgment, a Fund no longer suits the purposes of the Contracts. This may happen due to a change in laws or regulations, a change in a Fund's investment objectives or restrictions, because the Fund is no longer available for investment, or for some other reason. We would obtain prior approval from the SEC and any other required approvals before making such a substitution.
EDVA-2005
We also reserve the right to operate the Variable Account as a management investment company under the 1940 Act or any other form permitted by law or to deregister the Variable Account under such Act in the event such registration is no longer required.
MAKING EXCHANGES AMONG INVESTMENT OPTIONS
In General
Before the Annuity Date, you may make Exchanges among the Investment Options by providing instructions to the Annuity Service Center. We do not accept instructions by fax or electronic mail.
We do not currently impose any charges when you make an Exchange but we reserve the right to impose a charge if you make Exchanges on more than six days during a calendar year. The charge will be not more than $15 for each additional day on which you make an Exchange.
We reserve the right to limit the number of days on which you can make Exchanges, but you will always be able to make Exchanges on at least five days each calendar year.
Your request to make an Exchange may be expressed in terms of dollars, such as a request to move $5,000 from one Investment Option to another. You may also request a percentage reallocation among Investment Options. Percentage requests must be made in whole numbers. You cannot move less than $250 from any Investment Option except that if you have less than $250 in an Investment Option you may move the entire amount.
Market Timing
Some Owners use firms or individuals who engage in market timing. Such firms or individuals usually obtain authorization from Owners to make Exchanges among the Investment Options on the basis of perceived market trends. Large Exchanges resulting from market timing activity may disrupt the management of the Funds and become a detriment to other Owners.
To protect Owners not engaging in market timing, we reserve the right to reject Exchanges communicated to us by anyone acting under a power of attorney on behalf of more than one Owner. We will exercise these rights only if we believe that doing so will prevent harm to other Owners.
Short-Term Trading Risk
Frequent Exchanges among Investment Options by Contract Owners can reduce the long-term returns of the Funds. The reduced returns could adversely affect the owners, annuitants, insureds or beneficiaries of any variable annuity or variable life insurance contract issued by any insurance company with respect to values allocated to the Fund. Frequent Exchanges may reduce a Fund's performance by increasing costs paid by the Fund (such as brokerage commissions); they can disrupt portfolio management strategies; and they can have the effect of diluting the value of the shares of long term shareholders in cases in which fluctuations in markets are not fully priced into the Fund's net asset value.
EDVA-2005
The Funds are also available in products issued by other insurance companies. There is a significant risk that short-term trading in the Funds may go undetected. The Funds themselves generally cannot detect individual contract owner exchange activity, because they are owned primarily by insurance company separate accounts that aggregate exchange orders from owners of individual contracts. Accordingly, the Funds are dependent in large part on the rights, ability and willingness of all participating insurance companies to detect and deter short-term trading by contract owners.
As outlined below, EFILI has adopted policies regarding frequent trading, but can provide no assurance that other insurance companies using the same mutual funds have adopted comparable procedures. There is also the risk that these policies and procedures concerning short-term trading will prove ineffective in whole or in part to detect or prevent frequent trading.
EFILI Policies Regarding Frequent Trading
EFILI does not authorize market timing. EFILI has adopted policies and procedures designed to discourage frequent Exchanges as described below. If requested by a Fund, EFILI will consider additional steps to discourage frequent Exchanges in that Fund, not inconsistent with the policies and procedures described below.
Contract Owners who engage in frequent Exchanges may be subjected to temporary or permanent restrictions on future purchases or Exchanges in a Fund. Further, Contract Owners who have engaged in frequent trading in the Funds, or in other mutual funds managed by FMR, may be subjected to temporary or permanent restrictions on purchases or exchanges in those funds.
Although there is no minimum holding period and Contract Owners can make withdrawals or Exchanges out of any Investment Option at any time, Contract Owners may comply with EFILI's policies regarding frequent trading by allowing 90 days to pass after each purchase or allocation into an Investment Option before they withdraw or Exchange out of that Investment Option.
Frequent Trading Monitoring and Restriction Procedures
We have adopted policies and procedures related to exchanges among Investment Options that are set out below. Frequent trading activity is measured by the number of roundtrip transactions you make. A roundtrip transaction occurs when you make an allocation or Exchange into an Investment Option followed by a withdrawal or Exchange out of the same Investment Option within 30 days. You are limited to one roundtrip transaction per Investment Option within any rolling 90 day period, subject to an overall limit of four roundtrip transactions in the Contract over a rolling 12 month period.
If you make two or more roundtrip transactions in one Investment Option within a rolling 90 day period you will be blocked from making additional allocations or Exchanges into that Investment Option, through any means, for 85 days.
In addition, if you complete a fourth (or higher) roundtrip transaction within any rolling 12 month period, at least two of which are completed on different business days, you will have a U.S. Mail-Only Trade Restriction imposed on all contracts/policies you own that are issued by us or our affiliates. This rule will apply even if the four or more round trips occur in two or more different Investment Options. This restriction will stay in effect for 12 months. If you make another round trip in a contract that is currently subject to a U.S. Mail-Only Trade Restriction, then the U.S. Mail-Only Trade Restriction period (12 months) is restarted and all purchase transactions will be permanently blocked in the violated Investment Option across all contracts you own.
EDVA-2005
We reserve the right to reject specific transactions or impose restrictions as described above in respect of any Contract owned or controlled commonly with a Contract subject to the above restrictions, or in respect of any Contract owned or controlled commonly by a person who is the subject of complex-wide block by the mutual funds managed by Fidelity Management & Research Company.
Exceptions. We have approved the following exceptions to the frequent trading policy:
(1) Transactions in the Money Market Investment Option;
(2) Dollar cost averaging, Automatic Rebalancing, Automatic Annuity Builder and annuity payments will not count toward an Investment Option's roundtrip limits;
(3) We may suspend the frequent trading policy and make exceptions to the policy for transactions made during periods of severe market turbulence or national emergency. There is no assurance that we will do so or that, if that if we do, the underlying mutual funds will make any necessary exceptions to their frequent trading policies.
No other exceptions will be allowed.
Effective Date of Exchanges Among Investment Options
Any redemption from an Investment Option that is part of an Exchange among Investment Options will be effected as of the end of the Valuation Period in which we receive the request at our Annuity Service Center, or receive it by telephone or through the Internet. Generally the purchase of Accumulation Units in other Investment Options with the proceeds of the redemption will occur at the same time. However, if your Exchange involves (1) moving from an Investment Option that invests in an equity Fund that is in an illiquid position due to substantial redemptions or exchanges that require it to sell portfolio securities in order to make funds available, and (2) moving to an Investment Option that invests in a Fund that accrues dividends on a daily basis and requires federal funds before accepting a purchase order, then there may be a delay in crediting the amount that is moving to the new Investment Option. The delay will last until the Investment Option from which the Exchange is being made obtains liquidity, or for seven days, whichever is shorter. During this period, the amount transferred will be uninvested.
VALUATION PERIOD, TOTAL RETURN, ACCUMULATION UNITS AND ACCUMULATION UNIT VALUE
Valuation Period
The period of time between one determination of the value of Accumulation Units to the next determination. We make determinations as of the close of business of the New York Stock Exchange (normally 4 p.m. Eastern Time) each day that the Exchange is open for trading.
Total Return for an Investment Option
The Total Return for an Investment Option is a measure of the investment performance for an Investment Option from one Valuation Period to the next.
EDVA-2005
An Investment Option's Total Return depends on the performance of the Fund in which the Investment Option invests. We determine the Total Return for an Investment Option at the end of each Valuation Period. Such determinations are made as of the close of business each day the New York Stock Exchange is open for business. The Total Return reflects the investment performance for the Investment Option for the Valuation Period and is net of the asset charges to the Investment Option.
The Total Return for an Investment Option can be greater or less than one. Therefore, the value of a unit in an Investment Option may increase or decrease.
The Total Return for an Investment Option for a Valuation Period is determined by adding (a) and (b), subtracting (c) and dividing the result by (a) where:
(a) is the value of the assets of the Investment Option at the end of the preceding Valuation Period;
(b) is the investment income and capital gains, realized or unrealized, credited to the Investment Option during the current Valuation Period;
(c) is the sum of:
(1) the capital losses, realized or unrealized, charged during the current Valuation Period plus any amount charged or set aside for taxes during the current Valuation Period;
PLUS
(2) the deduction from the Investment Option during the current Valuation Period representing a daily charge equivalent to an effective annual rate equal to the sum of the Mortality and Expense Risk Charge and the Administrative Charge shown on your Contract Schedule page.
Accumulation Units and Accumulation Unit Value
When a Purchase Payment is invested in an Investment Option we credit a number of Accumulation Units to your Contract. An Accumulation Unit is a unit of measure used before the Annuity Date to calculate the value of your Contract in the Investment Option. The Accumulation Unit Value for an Investment Option is the value of one Accumulation Unit of that Investment Option at a particular time.
We determine the number of Accumulation Units to credit by dividing the dollar amount allocated to an Investment Option by the value of one Accumulation Unit for that Investment Option as of the end of the Valuation Period in which the Purchase Payment is received at our Annuity Service Center. The value of each Investment Option's Accumulation Units changes with the Total Return of the Investment Option each day that there is trading on the New York Stock Exchange.
Any withdrawal you make will reduce the number of Accumulation Units in the Investment Option(s) from which you make the withdrawal. Any transfer out of an Investment Option will reduce the number of Accumulation Units in that Investment Option, and any transfer into an Investment Option will increase the number of Accumulation Units in that Investment Option.
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WITHDRAWALS
Complete Withdrawal
Any time before the Annuity Date, you may make a complete withdrawal of your entire Contract Value. We will send you the Contract Value less any taxes withheld, any applicable Fund short-term redemption fee. You must send us written instructions from all the Owners to make a complete withdrawal. Your Contract will terminate once the withdrawal has been processed.
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Partial Withdrawals
You may also make partial withdrawals of $500 or more before the Annuity Date. You may not make a partial withdrawal that would reduce your Contract Value to less than $5,000.
If you do not specify where we should take the money for a partial withdrawal, we will take it proportionately from all the Investment Options.
If you request a partial withdrawal in an amount that is less than the total you have in all the Investment Options, you may choose the dollar amount or percentage to be withdrawn from each Investment Option. If you do not specify where we should take the money for a partial withdrawal, we will take it proportionately from all the Investment Options.
You may request partial withdrawals by providing instructions to the Annuity Service Center.
We will normally pay you the net amount of any complete or partial withdrawal within seven days after we receive the withdrawal request at the Annuity Service Center. The net amount is the amount of the withdrawal less any taxes withheld and any applicable Fund short-term redemption fee.
We may defer payment from the Investment Options for longer than seven days under certain limited circumstances.
Postponement of Payment
In conformity with the Investment Company Act of 1940, we will generally pay any withdrawal within seven days after we receive the request. We may delay payment if (a) the disposal or valuation of the assets in an Investment Option is not reasonably practicable because the New York Stock Exchange is closed for other than a regular holiday or weekend, trading is restricted by the SEC, or the SEC declares that an emergency exists; or (b) the SEC by order permits the postponement of payment to protect our Owners.
We will generally send : (1) any withdrawal amount on the first business day after the end of the Valuation Period during which we receive the withdrawal request: (2) each annuity income payment on the first business day after the Annuity Income Date; and (3) any lump sum distributions to Beneficiaries within seven days of the day we receive proper notice. Payments delayed for 10 days or longer will be credited with interest at a rate at least equal to the minimum rate required by applicable law.
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Automatic Transfer to Money Market Investment Option Upon Due Proof of Death
At the close of the Valuation Period in which we receive due proof of death of the last surviving Owner, we will transfer to the Money Market Investment Option any portion of the Contract Value in the other Investment Options. Once we have determined the number of Beneficiaries who will share in the Contract Value, a Beneficiary who has returned all required documentation to us (including tax withholding and other forms) will be able to transfer his or her share of the Contract Value among the Investment Options. If the Contract Value for any one Beneficiary is less than $5,000, then we will send that Beneficiary their entire portion of the Contract Value as soon as we have received all required documentation.
REQUIRED DISTRIBUTIONS UPON DEATH OF OWNER
Federal tax law requires that if any Owner dies before the Annuity Date, the entire Contract Value must be distributed within five years after the Owner's death. However, this requirement does not apply to a surviving Owner or to any Beneficiary designated by the Owner if (1) the Beneficiary's or surviving Owner's entire interest is payable over the Beneficiary's or surviving Owner's lifetime (or a period not extending beyond the life expectancy of the Beneficiary or surviving Owner) by electing annuitization within 60 days of the date of death with distributions beginning within one year of the date of death, or (2) the Beneficiary or surviving Owner is the surviving spouse of the deceased Owner, in which case the spouse may elect to continue the Contract as the Owner.
In the event of the death of an Owner who is also an Annuitant, the provisions of the Contract regarding the death of the Owner control and override any inconsistent provisions regarding the death of the Annuitant.
SPECIAL RULES FOR CONTRACT HELD BY REVOCABLE GRANTOR TRUST
The following rules apply if the Contract is held by a revocable grantor trust, and any conflicting provisions of this Contract are superseded.
A second Owner cannot be added. At issue, the grantor of the trust must be the sole Annuitant, and the Annuitant may not be changed. The Annuity Date will be the first day of the first calendar month after the grantor's 90th birthday, or an earlier date chosen by the Owner. The trust must be the sole Beneficiary.
Death of the grantor before the Annuity Date will trigger the provisions set forth immediately above in Required Distributions on Death of Owner, with the Annuitant treated as the equivalent of the Owner for purposes of those provisions.
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ANNUITY DATE
At issue the Annuity Date is the first day of the calendar month following the oldest Owner's 90th birthday. You may change the Annuity Date to an earlier date by sending written notice to the Annuity Service Center. We must receive the notice at least 30 days before the Annuity Date you select. Any Annuity Date you choose must be the first day of a month.
ANNUITY INCOME
Annuity income payments begin on the Annuity Date if all the Owners are still living. Annuity income will also begin on the Annuity Date if an Owner dies before the Annuity Date if (1) the Contract was jointly owned by spouses, and (2) the surviving spouse/Beneficiary elected to continue the Contract as his or her own. A surviving spouse who elects to continue the Contract as his or her own may change the Annuity Date to be as late as the first day of the calendar month following his or her 90th birthday.
In all other cases involving the death of an Owner, the Contract must be distributed in accordance with the applicable provisions of the Code described in Required Distributions on Death of Owner, and the Annuitant(s) will not receive annuity income even if the Contract Value has not been distributed by the Annuity Date.
Annuity income payments continue until all Annuitants have died, or for 120 monthly payments, whichever is longer.
The Owner(s) may change the Annuitant(s) before the Annuity Date.
Before the Annuity Date you may withdraw all (but not a part)of your Contract Value to make a tax-free exchange in which you purchase any immediate annuity contract we then offer.
If no Owner dies before the Annuity Date and there has not been a complete withdrawal, we will provide monthly fixed annuity income payments to the Annuitant or Annuitants who are living on the Annuity Date unless the Contract Value on the Annuity Date is not enough to provide an initial monthly annuity income payment of at least $20. In that case we may pay you the Contract Value in a lump sum instead of providing monthly annuity income.
To provide annuity income, on the Annuity Date, all Accumulation Units in the Investment Options will be redeemed and the money will be transferred to our general account. All money used to support annuity income payments will be held in our general account thereafter.
The first monthly annuity income payment will be made on the Annuity Date. We will determine the amount of monthly annuity income based upon the age(s) and sex(es) of the Annuitant(s) living on the Annuity Date and the annuity income purchase rate. The annuity income purchase rate will be the greater of:
(a) The guaranteed annuity income purchase rates set forth in this Contract; and
(b) The annuity rates in effect on the Annuity Date for the same payment option.
The monthly annuity income generated by this Contract is determined by applying the applicable annuity income purchase rate to the Contract Value after deductions for any applicable taxes and any applicable Fund short-term redemption fees.
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Guaranteed Annuity Income Purchase Rates
The interest and mortality basis for the guaranteed annuity income purchase rates is as follows:
A. The interest rate used to determine the guaranteed annuity income purchase rates will be an annual rate of interest that is the lesser of:
1. Three percent (3%); and
2. The five-year Constant Maturity Treasury Rate reported by the U.S. Federal Reserve, rounded to the nearest 1/20th of one percent, as of the Annuity Date, less one and one quarter percent (1.25%). This resulting interest rate cannot be less than one percent (1%).
B. The mortality rates will be based on the sex(es) and adjusted age(s) of the Annuitant(s) on the Annuity Date using the Society of Actuaries' Annuity 2000 Mortality Table. The adjusted age for an Annuitant is the Annuitant's age on his or her last birthday minus seven years.
The guaranteed annuity income purchase rates will never be lower than those shown in the table on page 29 and may be higher depending on the applicable interest rate on the Annuity Date as calculated in (A) above.
Contracts with No Annuitants on the Annuity Date
If no Annuitant is living on the Annuity Date, the oldest Owner will be the Annuitant and the Contract will be administered according to the rules for Contracts with one Annuitant immediately below, unless the Owner is not a natural person.
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Contracts with One Annuitant on the Annuity Date
If there is one Annuitant living on the Annuity Date, all annuity income payments will be made to the Annuitant. Annuity income payments will stop at the death of the Annuitant or after 120 monthly payments, whichever is longer. The estate of the Annuitant will be responsible to notify us of the Annuitant's death and to repay any annuity income payments we have made after that date and before we have been notified of the death of the Annuitant.
If the Annuitant dies before receiving all annuity income due under the Contract, the remaining monthly annuity income payments will be paid to the Annuitant's estate. The estate may choose instead to receive the present value of the remaining annuity income payments in a lump sum. The lump sum amount will generally be the present value of the remaining guaranteed annuity income payments, if any.
Contracts with Two Annuitants on the Annuity Date
If there are two living Annuitants on the Annuity Date, we will make annuity income payments jointly to both Annuitants while they are both alive. After the death of one of the Annuitants we will continue to make monthly annuity income payments in the same amount to the surviving Annuitant. The surviving Annuitant is responsible to notify us of the death of the first Annuitant.
Annuity income payments will stop at the death of the surviving Annuitant, or after we have made 120 monthly payments, whichever is longer.
The estate of the last surviving Annuitant will be responsible to notify us of the death of the last surviving Annuitant and to repay any annuity income payments we have made after that date and before we have been notified of the death of the last surviving Annuitant.
If the surviving Annuitant dies before we have made all annuity income payments due under the Contract, any remaining annuity income will be paid to the surviving Annuitant's estate. The estate may choose instead to receive the present value of the remaining annuity income payments in a lump sum. The lump sum amount will generally be the present value of the remaining guaranteed annuity income payments, if any.
OWNERS, ANNUITANTS AND BENEFICIARIES
Owners
Before the Contract is issued, the Owners have the right on the application to (a) name the Annuitant(s) and Beneficiary(ies); and (b) allocate the Initial Purchase Payment among the Investment Options. The Owner(s) can change the Annuitant(s) before annuity income payments begin.
If you are the only Owner when your Contract is issued, you may later add a second Owner, but you may do this only once, and the second Owner must be younger than you. You may not add a second Owner if the Owner is a trust, or the Contract is held under a UGMA or UTMA arrangement. You may not remove an Owner. There may be special income tax issues if you add a second Owner who is not your spouse.
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After the Contract Date and before annuity income payments begin, the Owners have the right to (a) cancel the Contract during the Free Look Period; (b) allocate Purchase Payments among the Investment Options; (c) reallocate the Contract Value among the Investment Options; (d) make withdrawals; (e) name a second Owner (subject to the limitations in the previous paragraph) if the Contract has only one Owner; (f) change Annuitant(s) and Beneficiary(ies) (except that a Beneficiary designated as irrevocable may not be changed without the Beneficiary's consent); and (g) instruct us how to vote shares of the Funds attributable to the Contract.
For Contracts with two Owners, after the Contract Date and before annuity income payments begin, withdrawals, changes of Annuitants and changes of Beneficiaries can be made only by both Owners acting together. Either Owner may exercise any other right under the Contract.
Beginning on the first day we provide annuity income to the Annuitant(s), the Owners have no rights.
Annuitants
You name one or two Annuitants in the application for the Contract. You may change the Annuitant(s) by sending us a written notice. A deceased ▇▇▇▇▇▇▇▇▇ may be replaced. You may also add an Annuitant, but there can never be more than two Annuitants at the same time. We must receive any notice adding or changing the Annuitant(s) at our Annuity Service Center at least 30 days before the Annuity Date.
If the Contract is owned by a trust, the Annuitant may not be changed and no Annuitant may be added.
Annuitants have no rights before the Annuity Date. Annuitants have the right to receive monthly annuity income payments beginning on the Annuity Date, unless an Owner has died before the Annuity Date, or unless the amount of annuity income would be less than $20 per month.
The amount of monthly annuity income payments depends on a number of factors, including each Annuitant's age and sex. If an Annuitant's age or sex has been misstated we will adjust the amount of monthly annuity income to reflect the actual age and/or sex. If we have previously overpaid monthly annuity income, we will withhold monthly annuity income until we have recovered the amount of the overpayment. If annuity income payments have ended, we will recover the amount of any overpayment from the estate(s) of the Annuitant(s). If we have previously underpaid monthly annuity income, we will make a lump sum payment equal to the amount previously underpaid, plus interest at 6% per annum, compounded annually.
If a Contract has one Owner and that Owner dies before the Annuity Date, then the Beneficiary(ies), not the Annuitant(s), will have the right to the Contract Value, and the Annuitant(s) will not receive any monthly annuity income.
If a Contract has two Owners and one Owner dies before the Annuity Date, then the surviving Owner, not the Annuitants, will have the right to the Contract Value. When the Annuity Date is later reached, the Annuitant(s) will not receive any monthly annuity income, subject to one exception. The exception is that if a surviving spouse/Beneficiary continues the Contract as his or her own, and the Annuity Date is reached, then the Annuitant(s) will receive monthly annuity income.
EDVA-2005
Beneficiaries
The Owner(s) name(s) a Beneficiary or Beneficiaries in the application, and can change Beneficiaries later. If all the Owners die before the Annuity Date, we will pay the Contract Value, less any applicable taxes, to the Beneficiary or Beneficiaries who survive all the Owners. If a Beneficiary survives all the Owners but does not live long enough to receive payment from us, we will pay the Beneficiary's estate.
For a Contract owned by a trust, the trust must be named as the sole Beneficiary.
Owner(s) must indicate in percentages what portion of the Contract each Beneficiary is to receive. If the total does not equal 100%, each Beneficiary's share will be determined by using a fraction, the numerator of which is the stated percentage for that Beneficiary, and the denominator of which is the total of the percentages indicated by the Owner(s).
Beneficiary designations must be in a form acceptable to us.
After the death of all the Owners, each Beneficiary has the right to withdraw their share of the Contract Value, as detailed below.
Before we make a payment to any Beneficiary, we must receive at our Annuity Service Center due proof of death (generally a death certificate) for each Owner and any required tax withholding and other forms. We may seek to obtain a death certificate directly from the appropriate governmental body if we believe that any Owner may have died.
At the close of the Valuation Period in which we receive the death certificate(s), we will transfer any portion of the Contract Value that is in the Investment Options to the Money Market Investment Option. Once we have determined the number of Beneficiaries who will share in the Contract Value, a Beneficiary who has returned all required documentation to us (including tax withholding and other forms) will be able to transfer his or her share of the Contract Value among the Investment Options.
We will not pay any Beneficiary until we have determined the number of Beneficiaries entitled to receive payment. This is to prevent us from overpaying one Beneficiary before making payment to other Beneficiaries.
Once we have received due proof of death and have determined the number of Beneficiaries to be paid, we will, upon written request received at our Annuity Service Center, pay any Beneficiary who has provided us with required tax withholding and other forms. We will then have no further obligations to that Beneficiary. If a Beneficiary has been designated to receive a specified fraction of the Contract Value, we will pay that fraction as determined on the date of payment. For example, if there are two Beneficiaries and each is designated to receive 50%, the first Beneficiary to receive payment would receive 50% of the Contract Value on the date the payment is made, and the other Beneficiary would later receive the remainder, which might be worth more or less than what was paid to the first Beneficiary.
EDVA-2005
GENERAL PROVISIONS
Entire Contract
This Contract is the entire contract between You and us. No change in or waiver of the provisions of the Contract is valid unless the change or waiver is signed by the President or the Secretary or Assistant Secretary of Empire Fidelity Investments Life Insurance Company.
Written Notice to the Annuity Service Center
You may send any required notices in writing to our Annuity Service Center. Some notices may also be made through our website, ▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇. However, our website may not be able to accept all types of notice. If the website is not available to receive a particular type of notice, you will need to send it to the Annuity Service Center. Whenever any notice is required under the Contract, we will not be liable for any action we take before proper notice is received at our Annuity Service Center or through our website.
Misstatement of Age or Sex
If an Annuitant's age or sex has been misstated we will adjust the amount of monthly annuity income to reflect the actual age and/or sex. If we have previously overpaid monthly annuity income, we will withhold monthly annuity income until we have recovered the amount of the overpayment. If annuity income payments have ended, we will recover the amount of any overpayment from the estate(s) of the Annuitant(s). If we have previously underpaid monthly annuity income, we will make a lump sum payment equal to the amount previously underpaid, plus interest at 6% per annum, compounded annually.
Reports to Owner(s)
Before the Annuity Date, we will send you a statement showing your Contract Value four times each year. Each quarterly statement will also contain a summary of all transactions in your Contract since the previous statement.
You should immediately verify the accuracy of the information contained in these statements, and in the confirmations you may receive for individual transactions. If you find a discrepancy with respect to any transaction, you should notify us at our Annuity Service Center immediately. We will not be responsible for losses after fifteen calendar days from the first time we mail any statement or confirmation containing details of the transaction.
Also, twice each year we will send you semiannual reports for the Variable Account containing financial information for the Variable Account and lists of securities held by the Funds, as required by the Investment Company Act of 1940.
Protection of Proceeds
Payments under this Contract may not be assigned by any Beneficiary before they become payable. To the extent allowed by law, payments are not subject to the claims of creditors or to legal process.
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Basis of Values
All values are at least as great as those required by the law of the state in which this Contract is delivered.
Non-participating
This Contract does not participate in the profits or surplus of Empire Fidelity Investments Life Insurance Company.
Assignment
The Contract may not be sold, gifted, transferred, or assigned, and any purported gift, transfer or assignment will be void, except as follows: (a) the Contract may be assigned to an insurance company, regulated as such under the insurance laws of one of the United States, solely for the purpose of effecting a tax-free exchange under section 1035 of the Internal Revenue Code; (b) a Contract owned by a revocable grantor trust may be transferred to the grantor; and (c) a Contract owned by one individual may be transferred to a revocable grantor trust of which the individual is the grantor.
EDVA-2005
Notification of Death
We are not responsible for any action we take before we are notified of a death. If there are two Owners, the survivor is responsible for informing us of the other Owner's death. Both owners are responsible for notifying us of the death of any Annuitant if the Annuitant's death occurs before the Annuity Date. If all the Owners die, the Beneficiaries are responsible for notifying us of the death(s). If there are two Annuitants, each is responsible for notifying us of the death of the other if death occurs after the Annuity Date. The executor of the estate of the last surviving Annuitant is responsible for notifying us of that ▇▇▇▇▇▇▇▇▇'s death, and to return any overpayment. If we provide too much annuity income because we are not notified of a death, we may take legal action to recover the overpayment.
Proof of Survival
If any payment under this Contract depends on an Annuitant or other recipient being alive on a given date, we may require proof of survival before making the payment.
Voting Rights
We currently vote shares of the Funds owned by the Variable Account according to your instructions. However, if the Investment Company Act of 1940 or any related regulations or interpretations should change, and we decide that we are permitted to vote the shares of the Funds in our own right, we will do so.
Before the Annuity Date, we calculate the number of shares that you may instruct us to vote by dividing your Contract Value in an Investment Option by the net asset value of one share of the corresponding Fund. Fractional votes are counted. We reserve the right to modify the manner in which we calculate the weight to be given to your voting instructions where such a change is necessary to comply with then current federal regulations or interpretations of those regulations.
We will determine the number of shares you can instruct us to vote 90 days or less before the applicable Fund shareholder meeting. At least 14 days before the meeting we will send you material by mail for providing us with your voting instructions.
If we do not receive your voting instructions in time, we will vote the shares in the same proportion as the instructions we receive from other Owners. We will also vote in the same proportionate manner any shares we hold in the Variable Account that are not attributable to Owners.
Under certain circumstances, we may be required by state regulatory authorities to disregard voting instructions. This may happen if following such instructions would change the sub-classification or investment objectives of a Fund, or result in the approval or disapproval of an investment advisory contract.
Under federal regulations, we may also disregard instructions to vote for Owner-initiated changes in investment policies or the investment advisor if we disapprove of the proposed changes. We would disapprove a proposed change only if it were contrary to state law, prohibited by state regulatory authorities, or if we decided that the change would result in overly speculative or unsound investments. If we ever disregard voting instructions, we will include a summary of our actions in the next semiannual report.
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Termination
We have the right to cancel your Contract if all of the following conditions exist at the same time: (1) no Purchase Payments have been made during the previous 36 months; (2) the total Purchase Payments credited to the Contract minus total withdrawals are less than $2,000; and (3) the Contract Value is less than $2,000. We will give you 30 days' notice before canceling your Contract, during which you may make an additional Purchase Payment to bring your Contract Value to $2,000 or more. If we cancel your Contract under this provision, we will pay you your Contract Value in a lump sum.
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ANNUITY TABLES
DOLLAR AMOUNT OF THE ANNUITY INCOME
FOR EACH $1,000 APPLIED
Guaranteed Monthly Fixed Income
SINGLE LIFE ANNUITY WITH 120 MONTHS GUARANTEED
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ANNUITANT AGE |
MALE |
FEMALE |
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ANNUITANT AGE |
MALE |
FEMALE |
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60 |
3.18 |
2.93 |
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76 |
5.03 |
4.59 |
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61 |
3.26 |
2.99 |
|
77 |
5.20 |
4.75 |
|
62 |
3.34 |
3.07 |
|
78 |
5.37 |
4.92 |
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63 |
3.43 |
3.14 |
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79 |
5.54 |
5.10 |
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64 |
3.52 |
3.22 |
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80 |
5.72 |
5.28 |
|
65 |
3.61 |
3.30 |
|
81 |
5.90 |
5.47 |
|
66 |
3.71 |
3.39 |
|
82 |
6.08 |
5.67 |
|
67 |
3.82 |
3.49 |
|
83 |
6.26 |
5.87 |
|
68 |
3.93 |
3.58 |
|
84 |
6.45 |
6.07 |
|
69 |
4.05 |
3.69 |
|
85 |
6.63 |
6.28 |
|
70 |
4.17 |
3.80 |
|
86 |
6.81 |
6.49 |
|
71 |
4.30 |
3.91 |
|
87 |
6.99 |
6.70 |
|
72 |
4.44 |
4.03 |
|
88 |
7.16 |
6.90 |
|
73 |
4.58 |
4.16 |
|
89 |
7.33 |
7.10 |
|
74 |
4.72 |
4.30 |
|
90 |
7.49 |
7.29 |
|
75 |
4.88 |
4.44 |
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JOINT AND SURVIVOR LIFE ANNUITY WITH 120 MONTHS GUARANTEED
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MALE ANNUITANT |
FEMALE ANNUITANT AGE |
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AGE |
60 |
65 |
70 |
75 |
80 |
85 |
90 |
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60 |
2.62 |
2.77 |
2.90 |
3.01 |
3.08 |
3.13 |
3.16 |
|
65 |
2.72 |
2.93 |
3.12 |
3.29 |
3.43 |
3.52 |
3.57 |
|
70 |
2.80 |
3.06 |
3.33 |
3.59 |
3.81 |
3.98 |
4.08 |
|
75 |
2.85 |
3.16 |
3.50 |
3.87 |
4.21 |
4.50 |
4.70 |
|
80 |
2.88 |
3.22 |
3.63 |
4.09 |
4.58 |
5.04 |
5.38 |
|
85 |
2.90 |
3.26 |
3.71 |
4.25 |
4.88 |
5.52 |
6.05 |
|
90 |
2.92 |
3.29 |
3.76 |
4.35 |
5.08 |
5.88 |
6.60 |
Basis = Annuity 2000 Mortality Table, 1.0% annual interest.
The amount of annuity income for any age or combination of ages not shown in the Annuity Tables will be furnished on request.
EMPIRE FIDELITY INVESTMENTS LIFE INSURANCE COMPANY
NEW YORK, NEW YORK
DEFERRED ANNUITY
Flexible Purchase Payments
Variable Accumulation Values
Fixed Annuity Income Payments
Nonparticipating
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One World Financial Center |
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New York, NY 10281 |
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Customer Assistance: |
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Annuity Service Center |
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[P.O. Box 770001] |
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[Cincinnati, OH 45277-0051] |
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ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT.
EDVA-2005