FIRST SUNAMERICA LIFE INSURANCE COMPANY
A STOCK COMPANY NEW YORK, NEW YORK
CONTRACT NUMBER [P9999999999]
OWNER [XXXX XXX]
EXECUTIVE OFFICE ANNUITY SERVICE CENTER
000 XXXXX XXXXXX, 0xx XXXXX XX XXX 00000
XXX XXXX, XXX XXXX 00000 XXX XXXXXXX, XX 00000-0000
FIRST SUNAMERICA LIFE INSURANCE COMPANY ("We", "Us", the "Company", or "First
SunAmerica") agrees to provide benefits to the Owner in accordance with the
provisions set forth in this Contract and in consideration of the Application
and/or confirmation thereof and Purchase Payments We receive.
THE VALUE OF AMOUNTS ALLOCATED TO THE SEPARATE ACCOUNT DURING THE ACCUMULATION
AND ANNUITY PERIODS IS NOT GUARANTEED, AND WILL INCREASE OR DECREASE BASED UPON
THE INVESTMENT EXPERIENCE OF THE VARIABLE PORTFOLIOS YOU CHOOSE.
THE SEPARATE ACCOUNT CHARGE IS CHARGED AGAINST THE ASSETS OF THE SEPARATE
ACCOUNT. THIS CHARGE INCLUDES FEES FOR MORTALITY AND EXPENSE RISK AND THE
DISTRIBUTION EXPENSE. ON AN ANNUALIZED BASIS THE CHARGE EQUALS 1.55% FOR
CONTRACT YEARS 1-5 AND 1.30% FOR CONTRACT YEARS 6 AND THEREAFTER. THESE CHARGES
ARE ASSESSED, ON A SIMPLE INTEREST BASIS, AS A PERCENTAGE OF THE AVERAGE DAILY
ENDING VALUE OF THE ASSETS ATTRIBUTABLE TO THE ACCUMULATION UNITS OF THE
VARIABLE PORTFOLIOS TO WHICH YOUR CONTRACT VALUE IS ALLOCATED. THE DAILY CHARGE
IS 1/365TH OF THE ANNUALIZED CHARGE. THUS, THE SMALLEST ANNUAL EFFECTIVE RATE OF
THE INVESTMENT RETURN THAT WOULD HAVE TO BE EARNED ON ASSETS OF THE SEPARATE
ACCOUNT SO THAT THE DOLLAR AMOUNT OF VARIABLE ANNUITY PAYMENTS WILL NOT DECREASE
IS 5.12% FOR CONTRACT YEARS 1-5 AND 4.85% FOR CONTRACT YEARS 6 AND THEREAFTER,
COMPOUNDED DAILY. THE CONTRACT'S RATE OF RETURN IS BASED ON COMPOUND INTEREST.
THE FIXED ACCOUNT OPTIONS, DOLLAR COST AVERAGING (DCA) FIXED ACCOUNT OPTION(s)
OR ONE OR MORE FIXED ACCOUNT GUARANTEE PERIODS MAY NOT BE AVAILABLE ON THE ISSUE
DATE. PLEASE CHECK WITH YOUR REGISTERED REPRESENTATIVE FOR AVAILABILITY OF THESE
OPTIONS.
RIGHT TO EXAMINE -- IF, WITHIN 10 DAYS OF RECEIPT OF THIS CONTRACT (60 DAYS IF
THE CONTRACT REPLACED ANY OTHER LIFE INSURANCE OR ANNUITY CONTRACT(s)) YOU ARE
NOT SATISFIED WITH IT, YOU MAY RETURN THIS CONTRACT OR YOUR WRITTEN REQUEST TO
CANCEL TO OUR ANNUITY SERVICE CENTER OR TO THE AGENT THROUGH WHOM THE CONTRACT
WAS PURCHASED. THE COMPANY WILL REFUND THE PURCHASE PAYMENT OR THE CONTRACT
VALUE, WHICHEVER IS GREATER, COMPUTED AS OF THE BUSINESS DAY DURING WHICH WE
RECEIVE THE CONTRACT OR YOUR WRITTEN REQUEST TO CANCEL IS RECEIVED BY US IN GOOD
ORDER. UPON SUCH REFUND, THE CONTRACT SHALL BE VOID.
For Individual Retirement Annuities, or if a refund of the Purchase Payment(s)
is otherwise required, We reserve the right to allocate Your Purchase Payment(s)
to the Cash Management Portfolio until the end of the Right To Examine period.
With 30 days advance notice, we may cease offering Fixed Account Guarantee
Period Options and/or Dollar Cost Averaging Options if market conditions are
such that we are not able to credit the Minimum Guarantee Rate shown on the
Contract Data Page.
THIS IS A LEGAL DOCUMENT. READ IT CAREFULLY.
/s/ XXXXX X. XXXXXX
-------------------------
XXXXX X. XXXXXX
PRESIDENT
FOR INQUIRIES CALL:
[0-000-000-0000]
INDIVIDUAL FIXED AND
VARIABLE ANNUITY CONTRACT
Nonparticipating
1
FS-998 (6/11)
TABLE OF CONTENTS
CONTRACT DATA PAGE......................................................PAGE 3-4
DEFINITIONS...............................................................PAGE 5
PURCHASE PAYMENT PROVISIONS...............................................PAGE 8
ACCUMULATION PROVISIONS...................................................PAGE 8
CHARGES AND DEDUCTIONS...................................................PAGE 10
TRANSFER PROVISIONS......................................................PAGE 10
WITHDRAWAL PROVISIONS....................................................PAGE 11
DEATH PROVISIONS.........................................................PAGE 12
ANNUITY PROVISIONS.......................................................PAGE 16
GENERAL PROVISIONS.......................................................PAGE 17
ANNUITY INCOME PAYMENT OPTIONS ..........................................PAGE 20
FIXED ANNUITY INCOME PAYMENT OPTIONS TABLE...............................PAGE 21
VARIABLE ANNUITY INCOME PAYMENT OPTIONS TABLE............................PAGE 24
2
CONTRACT DATA PAGE
CONTRACT NUMBER: [P9999999999] CONTRACT DATE: [May 2, 2011]
OWNER: [XXXX XXX] [DATE OF BIRTH: [March 1, 1976] AGE AT ISSUE: [35]]
[OWNER: [XXXX XXX] DATE OF BIRTH: [June 10, 1976] AGE AT ISSUE: [34]]
ANNUITANT: [XXXX XXX] DATE OF BIRTH: [March 1, 1976] AGE AT ISSUE: [35]
[ANNUITANT: [XXXX XXX] DATE OF BIRTH: [June 10, 1976] AGE AT ISSUE: [34]]
BENEFICIARY: As named by You
INITIAL PURCHASE PAYMENT: [$10,000.00]
PURCHASE PAYMENT AGE LIMIT: [Prior to the 86th birthday]
MINIMUM SUBSEQUENT PURCHASE PAYMENT: $500
FIXED ACCOUNT OPTIONS -- MINIMUM GUARANTEE RATE: 1.0% - 3.0%
With 30 days advance notice, we may cease offering the Fixed Account Options,
Fixed Account Guarantee Period Options and/or Dollar Cost Averaging Account
Options if market conditions are such that we are not able to credit the Minimum
Guarantee Rate Shown on this page.
FIXED ACCOUNT OPTIONS: 1 Year Fixed, 6 Month DCA Fixed, 1 Year DCA Fixed, 2 Year
DCA Fixed
MINIMUM PARTIAL WITHDRAWAL AMOUNT: $1,000
MAXIMUM PENALTY-FREE WITHDRAWAL PERCENTAGE: 10%
MINIMUM SYSTEMATIC WITHDRAWAL AMOUNT: $100
MINIMUM AMOUNT REMAINING AFTER A PARTIAL WITHDRAWAL: $2,500
WITHDRAWAL CHARGE SCHEDULE:
--------------------------------------------------------------------------------
Number of Full Years Elapsed Withdrawal Charge as a
Between Purchase Payment Contribution Percentage of Withdrawn
And Date of Withdrawal Purchase Payment
--------------------------------------------------------------------------------
0 8%
--------------------------------------------------------------------------------
1 7%
--------------------------------------------------------------------------------
2 6%
--------------------------------------------------------------------------------
3 5%
--------------------------------------------------------------------------------
4 4%
--------------------------------------------------------------------------------
5+ 0%
--------------------------------------------------------------------------------
See Page 11 for Withdrawal Provisions.
CONTRACT DATA PAGE (CONT'D.)
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MINIMUM TRANSFER AMOUNT: $100
SEPARATE ACCOUNT CHARGE (including guaranteed death benefit risk charge of
0.10%):
Contract Years 1-5: 1.55%
Contract Years 6 & Thereafter: 1.30%
ANNUAL CONTRACT MAINTENANCE FEE: $50
TRANSFER FEE: $25
EARLIEST ANNUITY DATE AFTER THE CONTRACT DATE: 13 months
LATEST ANNUITY DATE: 1st day of the month following Age 90 or 10 years after the
Contract Date
SEPARATE ACCOUNT: [FS VARIABLE SEPARATE ACCOUNT]
OPTIONAL ELECTIONS: OPTIONAL ELECTION DETAILS:
SunAmerica Income Plus See Attached Endorsement FSE-6248
Maximum Anniversary Value See Attached Endorsement FSE-6235
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DEFINITIONS
Defined in this section are some of the words and phrases used in this Contract.
These terms are capitalized when used in the Contract with the meaning set forth
below.
ACCUMULATION UNIT
A unit of measure used to compute the Contract Value in a Variable Portfolio
before the Annuity Date.
AGE
Age as of last birthday. In the case of Joint Owners/Annuitants, the age of the
[older] person will be used to determine any age-driven benefit.
ANNUITANT
The natural person or persons (collectively, Joint Annuitants) whose life or
lives is/are used to determine the benefits under the Contract. If the Contract
is in force and the Annuitant(s) is/are alive on the Annuity Date, We will begin
annuity income payments to the Payee. This Contract cannot have Joint Annuitants
if it is issued in connection with a tax-qualified retirement plan.
ANNUITY DATE
The date on which annuity income payments to the Payee begin. This date cannot
be later than the Latest Annuity Date.
ANNUITY SERVICE CENTER
The location shown on Page 1 of this Contract where all requests and Purchase
Payments regarding this Contract are to be sent.
ANNUITY UNIT
A unit of measure determined on or after the Annuity Date used to compute
annuity income payments from the Variable Portfolio(s).
BENEFICIARY
The Beneficiary You name at issue to receive the death benefit under this
Contract upon Your death. You may later change Your Beneficiary in a written
request to Us at Our Annuity Service Center.
CONTINUATION DATE
The date on which We receive, at Our Annuity Service Center: (a) the Spousal
Beneficiary's written request to continue the Contract in a form satisfactory to
Us; and (b) Due Proof of Death of the Owner. If We receive (a) and (b) on
different dates, the Continuation Date will be the later date.
CONTRACT DATE
The date Your Contract is issued, as shown on the Contract Data Page. It is the
date from which Contract Years and Contract anniversaries are measured.
CONTRACT VALUE
The sum of: (1) Your share of the Variable Portfolios' Accumulation Unit Values;
and (2) the value of amounts if any, allocated to any available Fixed Account
Option(s).
CONTRACT YEAR
The one year period starting from the Contract Date in one calendar year and
ending on the day preceding the anniversary in the following calendar year, and
every year thereafter.
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DOLLAR COST AVERAGING (DCA)
An optional program under which You authorize the systematic transfer of
specified amounts or percentages from any Variable Portfolio(s) [or any
available Fixed Account Option] into any Variable Portfolio(s) other than the
source account.
FIXED ACCOUNT OPTION(S)
The investment options, if available under this Contract, that become part of
the Company's general asset account and are credited with a fixed rate of
interest declared by the Company. The general asset account contains all the
assets of the Company except for the Separate Account and other segregated asset
accounts. The amount You have in any Fixed Account Option at a given time is a
result of Purchase Payment(s) You have allocated to it or any part of Your
Contract Value You have transferred to it.
FIXED ANNUITIZATION
A series of periodic annuity income payments of predetermined amounts that do
not vary with investment experience. Such payments are made from the Company's
general asset account. This Contract provides several fixed annuity income
payment options.
GUARANTEE PERIOD
The period for which interest is credited to amounts allocated to any available
Fixed Account Option(s). We determine in Our sole discretion the periods, if
any, that will be offered.
IRC
The Internal Revenue Code of 1986 or as it may be amended or superseded.
JOINT OWNER
Any person named as Joint Owner on the Application and/or confirmation thereof
and listed on the Contract Data Page, unless subsequently changed. The Joint
Owner, if any, possesses an undivided interest in this Contract in conjunction
with the Owner. All references within this Contract to Owner will also apply to
the Joint Owner.
LATEST ANNUITY DATE
The later of first day of the month following Age 90 of the Owner or ten years
after the Contract Date. If the Owner is a non-natural person, the Latest
Annuity Date is the later of the first day of the month following Age 90 of the
Annuitant or ten years after the Contract Date.
MAXIMUM ANNUAL WITHDRAWAL AMOUNT
Guaranteed withdrawals applicable only if You have elected an optional living
benefit or guaranteed minimum withdrawal benefit and have not terminated the
benefit under this Contract.
NET PURCHASE PAYMENT
The sum of all Purchase Payment(s), reduced for each Withdrawal in the same
proportion that the Contract Value is reduced by each such Withdrawal.
NYSE
New York Stock Exchange.
OWNER
The person or entity named in the Contract who is entitled to exercise all
rights and privileges of ownership under the Contract. Owner means both Joint
Owners, if applicable.
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PAYEE
The person receiving annuity income payments under this Contract.
PURCHASE PAYMENTS
Payments in U.S. currency made by or on behalf of the Owner to the Company to
fund the Contract.
REQUIRED DOCUMENTATION
Is: (a) Due Proof of Death that the Owner or the Spousal Beneficiary died before
the Annuity Date; (b) an election form specifying the annuity income payment
options; and (c) any other documentation We may require.
SEPARATE ACCOUNT
A segregated asset account named on the Contract Data Page. The Separate Account
consists of several Variable Portfolios, each investing in shares of the
Underlying Fund(s). The assets of the Separate Account are not commingled with
the general assets and liabilities of the Company. The value of amounts
allocated to the Variable Portfolios of the Separate Account is not guaranteed.
SPOUSAL BENEFICIARY
The original deceased Owner's surviving spouse who is designated as the primary
Beneficiary at the time of the Owner's death and may continue the Contract as
the Owner on the Continuation Date.
SUBSEQUENT PURCHASE PAYMENTS
Purchase Payments made after the initial Purchase Payment.
UNDERLYING FUND
The underlying investment portfolios in which the Variable Portfolio(s) invest.
VARIABLE ANNUITIZATION
A series of periodic annuity income payments which vary in amount according to
the investment experience of one or more Variable Portfolios, as selected by
You. Such payments are made from the Company's Separate Account. This Contract
provides several variable annuity income payment options.
VARIABLE PORTFOLIO
One or more divisions of the Separate Account which provides for the variable
investment options available under this Contract. Each Variable Portfolio has
its own investment objective and is invested in the Underlying Fund(s). A
Variable Portfolio is not chargeable with liabilities arising out of any other
Variable Portfolio.
WE, OUR, US, THE COMPANY
First SunAmerica Life Insurance Company.
WITHDRAWAL(S)
Amount(s) withdrawn from the Contract Value including any charges and fees
applicable to each such Withdrawal.
WITHDRAWAL ADJUSTMENTS
The term used to calculate how the amount of the death benefit will be adjusted
for Withdrawals depending on the amount of the Withdrawal and whether a living
benefit or guaranteed minimum withdrawal benefit is elected and has not been
terminated.
YOU, YOUR
The Owner.
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PURCHASE PAYMENT PROVISIONS
PURCHASE PAYMENTS
Purchase Payments are flexible. This means that, subject to Company disclosed
restrictions, You may change the amounts, frequency and/or timing of Purchase
Payments. Purchase Payments can be made at any time after the Contract Date, but
must be received before the Purchase Payment Age Limit as shown on the Contract
Data Page. With instructions from You, Purchase Payments will be allocated to
the Variable Portfolio(s) and/or Fixed Account Option(s), if available. We
reserve the right to limit the maximum amount of Purchase Payments.
DOLLAR COST AVERAGING (DCA) FIXED ACCOUNT OPTION(S)
Any portion of a Purchase Payment allocated to the DCA Fixed Account Option(s)
must be transferred out to the Variable Portfolio(s) within the specified DCA
Fixed Account Option period. Upon termination of the DCA program, any amounts
remaining in the DCA Fixed Account Option(s) will be transferred to the DCA
target allocation(s) for the program being terminated. Upon annuitization, any
amounts remaining in the DCA Fixed Account Option(s) will be applied to a Fixed
Annuitization. The unit values credited and applied to Your Contract are
determined on each date of transfer. The minimum contribution amount that may be
allocated to the DCA Fixed Account Option(s) is $600 for the 6 month DCA, $1,200
for the 1 year DCA and $2,400 for the 2 year DCA
CHANGES TO VARIABLE PORTFOLIO OFFERINGS
If the shares of an Underlying Fund should no longer be available for investment
by the Separate Account, then We may substitute shares of another Underlying
Fund, for shares already purchased, or to be purchased in the future. At any
given time, some Variable Portfolios may not be available for receipt of
Purchase Payment(s) or transfer(s). Substitutions may be necessary and will be
carried out in accordance with any applicable state and/or federal laws or
regulations.
ACCUMULATION PROVISIONS
Before the Annuity Date, the Contract Value is the sum of the Separate Account
Accumulation Value and the Fixed Account Accumulation Value. If Your Contract
Value falls below $2,500 as a result of taking partial Withdrawals, subject to
applicable state and federal laws, rules and regulations, We may terminate Your
Contract and send You the remaining dollar amount.
SEPARATE ACCOUNT ACCUMULATION VALUE
The Separate Account Accumulation Value under the Contract is the sum of the
Accumulation Unit Values held in the Variable Portfolios for You.
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NUMBER OF ACCUMULATION UNITS
Your Contract is credited with Accumulation Units of the Separate Account when
amounts are allocated to the Variable Portfolio(s). For that portion of each
Purchase Payment and/or transfer amount allocated to a Variable Portfolio, the
number of Accumulation Units credited is equal to:
The sum of each Purchase Payment and/or transfer amount allocated to the
Variable Portfolio reduced by premium taxes, if any:
Divided by
The Accumulation Unit Value for that Variable Portfolio for the NYSE business
day in which the Purchase Payment or transfer amount is received.
The number of Accumulation Units will be reduced for Withdrawals of Contract
Value, annuitizations, amounts transferred out of a Variable Portfolio, the
Contract Maintenance Fee, if applicable, and applicable charges for any elected
features as set forth in Endorsements to this Contract. Any reduction to the
Contract Value will be made as of the NYSE business day in which We receive all
requirements for the transaction, as appropriate.
ACCUMULATION UNIT VALUE (AUV)
The AUV of a Variable Portfolio for any NYSE business day is calculated by
subtracting (2) from (1) and dividing the result by (3) where:
(1) is the total value at the end of the given NYSE business day
of the assets attributable to the Variable Portfolio minus any
applicable liabilities other than those owed to You;
(2) is the amount equal to the daily Separate Account Charge plus
the daily charge for any optional features that impose a daily
charge;
(3) is the number of Accumulation Units outstanding at the end of
the given NYSE business day.
FIXED ACCOUNT ACCUMULATION VALUE
The Fixed Account Accumulation Value, if any, is the sum of all amounts
allocated or transferred to the Fixed Account Option(s), if available, reduced
by any applicable premium taxes, plus all interest credited on the Fixed Account
Option(s) during the period that You have Contract Value allocated to the Fixed
Account Option(s). This amount will be adjusted for Withdrawals, annuitizations,
transfers, the deduction of the Contract Maintenance Fee and applicable charges
for any elected features as set forth in Endorsements to this Contract. The
Fixed Account Accumulation Value will not be less than the minimum values
required by law in the state where this Contract is issued.
FIXED ACCOUNT GUARANTEE PERIOD OPTIONS AND INTEREST CREDITING
The portion of Your Contract Value within the Fixed Account Option(s), if any,
is credited with interest at rates guaranteed by Us for the Guarantee Period(s)
selected. Interest is credited on a daily basis at the then applicable effective
interest rate for the applicable Guarantee Period. You may select from one or
more Guarantee Periods which We may offer at any particular time. We reserve the
right at any time to add or delete Guarantee Periods. A written notification
will be provided to the Owner [at least 30] days prior to the discontinuation of
a Guarantee Period. If You have allocated any part of Your initial Purchase
Payment to a Guarantee Period, the percentage allocated, as well as the duration
of the Guarantee Period, is shown on the election form and/or confirmation
thereof as completed by You.
The interest rate applicable to the allocation of a Purchase Payment or transfer
of Contract Value to a Guarantee Period is the rate in effect for that Guarantee
Period at the time of the allocation or transfer. If You have allocated or
transferred amounts at different times to the Fixed Account Option(s), each
allocation or transfer may have a unique effective interest rate associated with
that amount. We guarantee that the
9
effective annual rate of interest for the Fixed Account Option(s), including any
of the available Guaranteed Periods, will not be less than the Minimum Guarantee
Rate as mandated by Your state, and shown on the Contract Data Page. The minimum
guarantee rate under Your Contract as referenced on the Contract Data Page is at
least equal to the lesser of: (a) 3% per annum; or (b) the three-month average
value of the five-year Constant Maturity Treasury Rate reported by the Federal
Reserve, rounded up to the nearest 1/4th of 1%, for the second, third and fourth
month preceding the first day of the calendar quarter during which the Contract
is issued, reduced by 1.25% and where the resulting interest rate is not less
than 1%.
CHARGES AND DEDUCTIONS
We will deduct the following charges from the Contract:
CONTRACT MAINTENANCE FEE
The charge as shown on the Contract Data Page, if applicable, will be deducted
on each Contract anniversary on or prior to the Annuity Date. It will also be
deducted when the Contract Value is withdrawn in full if the Withdrawal is not
on the Contract anniversary. We reserve the right to waive the fee for Contract
Values of $75,000.00 and up.
WITHDRAWAL CHARGE
The charge, as shown on the Contract Data Page, if any, may be deducted upon
Withdrawal of any portion of the Contract Value that is not considered a
Penalty-Free Withdrawal. See WITHDRAWAL PROVISIONS.
SEPARATE ACCOUNT CHARGE
This charge, as shown on the Contract Data Page, on an annualized basis equals a
percentage of the average daily ending value of the assets attributable to the
Accumulation Units of the Variable Portfolio(s) to which the Contract Value is
allocated. This charge compensates Us for the mortality and expense risk and the
costs of contract distribution assumed by Us. We subtract this charge daily.
TRANSFER FEE
We permit 15 free transfers between Variable Portfolios and/or available Fixed
Account Option(s) each Contract Year. We may charge You a fee, as shown on the
Contract Data Page, for each additional transfer that Contract Year, except for
transfers made as part of an automated transfer program.
TRANSFER PROVISIONS
Subject to applicable restrictions, You may transfer all or part of Your
Contract Value amongst the Variable Portfolios and/or available Fixed Account
Option(s) (unless otherwise noted). The minimum amount that can be transferred
and the amount that can remain in a Variable Portfolio and/or available Fixed
Account Option are subject to Company limits. We reserve the right to restrict
Your transfer privileges, including but not limited to possible termination of
those privileges.
Furthermore, the Underlying Funds, may have their own transfer policies that are
applicable to this Contract as a result of investment in the Variable
Portfolios. These policies, likewise, may include termination of Your transfer
privileges and/or penalty fees resulting from transfer activity that is defined
as excessive according to the Underlying Funds' policies.
TRANSFERS BEFORE THE ANNUITY DATE
Before the Annuity Date, transfers are subject to certain restrictions. You may
transfer all or a portion of Your Contract Value from one Variable Portfolio to
another Variable Portfolio(s) or any available Fixed Account Option(s) other
than the DCA Fixed Account Options. You may also transfer from any available
10
Fixed Account Option(s) to the Variable Portfolio(s) and/or any available Fixed
Account Option(s) of the Contract. A transfer will result in the redemption of
Accumulation Units in a Variable Portfolio and the purchase of Accumulation
Units in the other Variable Portfolio. Transfers will be effected at the end of
the NYSE business day in which We receive Your completed request for the
transfer.
TRANSFERS AFTER THE ANNUITY DATE
On and after the Annuity Date, transfers into and out of any available Fixed
Account Option(s) are not allowed. You may transfer all or a portion of Your
Annuity Units from one Variable Portfolio to another Variable Portfolio(s). A
transfer will result in the redemption of Annuity Units in a Variable Portfolio
and the purchase of Annuity Units in the other Variable Portfolio. Transfers
will be effected for the last NYSE business day of the month in which We receive
Your request for the transfer.
WITHDRAWAL PROVISIONS
On or before the Annuity Date and while You are living, You may withdraw all or
part of Your Contract Value under this Contract by informing Us in writing in a
form satisfactory to Us at Our Annuity Service Center. For a full Withdrawal,
this Contract must be returned to Our Annuity Service Center. The minimum amount
that can be withdrawn and the amount remaining after Withdrawal are as shown on
the Contract Data Page, subject to minimums set forth by the laws of the State
of New York. If the amount of a partial Withdrawal request reduces Your Contract
Value below the Minimum Amount Remaining After a Partial Withdrawal, as shown on
the Contract Data Page, We may treat Your request as a request for a full
Withdrawal.
Unless You tell Us otherwise in writing, Withdrawals will be deducted from the
Contract Value in proportion to their allocation among any available Fixed
Account Option(s) and the Variable Portfolios. Withdrawals will be based on
values for the NYSE business day in which the request for Withdrawal is received
at Our Annuity Service Center. In the case of a full Withdrawal, the Withdrawal
will be based on values for the NYSE business day in which the request for
Withdrawal and the Contract are received at Our Annuity Service Center. Unless
the SUSPENSION OF PAYMENTS or DEFERMENT OF PAYMENTS sections are in effect,
payment of Withdrawals will be made within seven calendar days.
WITHDRAWAL CHARGE
Withdrawals of all or a portion of the Contract Value may be subject to a
Withdrawal Charge as shown on the Contract Data Page. The Withdrawal Charge
percentage applied to any withdrawal will depend on how long the Purchase
Payment to which the Withdrawal is attributed has been in the Contract. No
Withdrawal Charge is deducted on an amount which is considered a Penalty-Free
Withdrawal or a Purchase Payment no longer subject to a Withdrawal Charge.
For the purpose of determining the Withdrawal Charge applicable to a partial
Withdrawal, the Withdrawal will be attributed to amounts in the following order:
(1) any remaining Penalty-Free Withdrawal amount (except in the case of a full
Withdrawal); (2) Purchase Payments not yet withdrawn and no longer subject to
Withdrawal Charges; (3) Purchase Payments not yet withdrawn and still subject to
Withdrawal Charges; and (4) any remaining Contract Value. A Purchase Payment, or
portion thereof, is considered withdrawn when the Withdrawal incurs a Withdrawal
Charge, and are assumed to be withdrawn on a first-in-first-out (FIFO) basis.
You will not receive the benefit of a Penalty-Free Withdrawal if You take a full
Withdrawal.
The Withdrawal Charge will be assessed against the Variable Portfolio(s) and the
available Fixed Account Option(s) in the same proportion as the remaining
Contract Value is allocated unless You request that the Withdrawal come from a
particular Variable Portfolio or available Fixed Account Option. If the amount
of a partial Withdrawal request causes the Contract Value to be less than the
Minimum Amount Remaining After
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a Partial Withdrawal, as shown on the Contract Data Page, We may treat Your
partial Withdrawal request as a request for a full Withdrawal.
PENALTY-FREE WITHDRAWALS
On any day in a Contract Year before the Annuity Date, You may make a partial
Withdrawal of up to the Penalty-Free Withdrawal amount as of that day without
incurring a Withdrawal Charge. The Maximum Penalty-Free Withdrawal Percentage,
the Minimum Partial Withdrawal Amount and the Minimum Amount Remaining After a
Partial Withdrawal are shown on the Contract Data Page.
Each Contract Year, the Penalty-Free Withdrawal amount is calculated as the
Maximum Penalty-Free Withdrawal Percentage multiplied by the remaining Purchase
Payments not yet withdrawn and still subject to Withdrawal Charges.
Although amounts withdrawn as Penalty-Free Withdrawals reduce the Contract
Value, they do not reduce the remaining Purchase Payments for purposes of
calculating future Penalty-Free Withdrawal amounts and Withdrawal Charges.
Partial Withdrawals in a Contract Year that are in excess of the Penalty-Free
Withdrawal amount incur a Withdrawal Charge applicable to the remaining Purchase
Payments and reduce those Purchase Payments on a first-in-first-out (FIFO)
basis. If You choose to take less than the Penalty-Free Withdrawal amount during
a Contract Year, You may not carry over the unused Penalty-Free Withdrawal
amount in any subsequent Contract Years. A Penalty-Free Withdrawal is not
available to You if You take a full Withdrawal.
SYSTEMATIC WITHDRAWAL PROGRAM
Prior to the Annuity Date, You may elect to participate in a Systematic
Withdrawal Program by informing Us at Our Annuity Service Center. The Systematic
Withdrawal Program allows You to make automatic Withdrawals from Your Contract
monthly, quarterly, semiannually or annually. The minimum systematic withdrawal
amount is shown on the Contract Data Page. Any amount withdrawn through the
Systematic Withdrawal Program may be subject to a Withdrawal Charge as discussed
in the WITHDRAWAL CHARGE and PENALTY-FREE WITHDRAWALS provisions. You may
terminate Your participation in the Systematic Withdrawal Program at any time by
sending Us a written request.
DEATH PROVISIONS
Notwithstanding any provision of this Contract to the contrary, all payments of
benefits under this Contract will be made in a manner that satisfies the
requirements of IRC Section 72(s), as amended from time to time. If the Contract
is owned by a trust or other non-natural person, We will treat the death of any
Annuitant as the death of the "Primary Annuitant" and as the death of any Owner.
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DUE PROOF OF DEATH
Due Proof of Death means:
1. a certified copy of a death certificate; or
2. a certified copy of a decree of a court of competent
jurisdiction as to the finding of death; or
3. a written statement by a medical doctor who attended the
deceased Owner at the time of death; or
4. any other proof satisfactory to Us.
DEATH OF OWNER BEFORE THE ANNUITY DATE
We will pay a death benefit to the Beneficiary upon Our receiving all Required
Documentation at Our Annuity Service Center. Unless You have previously
designated a payment option on behalf of the Beneficiary, the Beneficiary must
select one of the following options:
1. Immediately collect the death benefit in a lump sum payment.
If a lump sum payment is elected, payment will be in
accordance with any applicable laws and regulations governing
payments on death; or
2. Collect the death benefit in the form of one of the Annuity
Income Payment Options. If an Annuity Income Payment Option is
desired, an option must be elected within 60 days of Our
receipt of all Required Documentation. The annuity income
payments must be over the life of the Beneficiary or over a
period not extending beyond the life expectancy of the
Beneficiary. Consistent with applicable tax rules, payments
under this option generally must begin within one year after
the Owner's death, otherwise, the death benefit will be paid
in accordance with option 1 above; or
3. If eligible, continue the Contract as the Spousal Beneficiary.
On the Continuation Date, We will contribute to the Contract
any amount by which the Death Benefit exceeds the Contract
Value, calculated based on the Owner's date of death. This
amount is not considered a Purchase Payment except in the
calculation of certain death benefits upon the death of the
Spousal Beneficiary. If this option is elected, no death
benefit is paid out to the Spousal Beneficiary on the
Continuation Date; or
4. A payment option that is mutually agreeable between You and
Us.
The entire interest in the Contract will be distributed within the five year
period specified under applicable laws and regulations, commencing with the date
of death of the Owner unless option 2 or 3 was selected under DEATH OF OWNER
BEFORE THE ANNUITY DATE.
You cannot change any elected death benefit option specified on the Contract
Data Page. Upon Spousal Continuation, Your Spousal Beneficiary cannot change any
death benefit elected by You. Upon the Spousal Beneficiary's death, the entire
interest of the Contract must be distributed immediately under option 1 or 2 as
provided under DEATH OF OWNER BEFORE THE ANNUITY DATE.
AMOUNT OF DEATH BENEFIT
Upon Our receipt of all Required Documentation at Our Annuity Service Center,
the Death Benefit payable upon the death of the Owner will be calculated. The
death benefit calculation is different depending on whether a living benefit or
guaranteed minimum withdrawal benefit has been elected and if the benefit has
been terminated.
13
If You did not elect a living benefit or guaranteed minimum withdrawal benefit,
We will calculate the Death Benefit as the greater of:
1. The Contract Value for the NYSE business day during which We
receive all Required Documentation at Our Annuity Service
Center; or
2. Net Purchase Payment(s) received prior to the Owner's 86th
birthday.
NOTE: In declining market environments, the death benefit payable may be less
than the Net Purchase Payments received.
If You elected a living benefit or guaranteed minimum withdrawal benefit, We
will calculate the Death Benefit as the greater of:
1. The Contract Value for the NYSE business day during which We
receive all Required Documentation at Our Annuity Service
Center; or
2. Purchase Payment(s) received prior to the Owner's 86th
birthday reduced by:
(a) any Withdrawal Adjustments if the benefit has not
been terminated; or
(b) any Withdrawal Adjustments prior to the date the
benefit is terminated, and reduced proportionately by
any Withdrawals on and after the date the benefit is
terminated.
SPOUSAL BENEFICIARY CONTINUATION
If the Spousal Beneficiary continues the Contract on the Continuation Date and
upon Our receipt of all Required Documentation at Our Annuity Service Center,
the Death Benefit payable upon the death of the Spousal Beneficiary will be
calculated. The death benefit calculation is different depending on whether a
living benefit or a guaranteed minimum withdrawal benefit has been elected and
if the benefit has been terminated.
If the Spousal Beneficiary was Age 85 or younger on the Continuation Date, and
if the Owner did not elect a living benefit or a guaranteed minimum withdrawal
benefit, We will calculate the Death Benefit as the greater of:
1. The Contract Value for the NYSE business day during which We
receive all Required Documentation at Our Annuity Service
Center; or
2. The Contract Value on the Continuation Date, plus Purchase
Payment(s) received since the Continuation Date and prior to
the Spousal Beneficiary's 86th birthday, and reduced
proportionately by any Withdrawals after the Continuation
Date.
If the Spousal Beneficiary was Age 85 or younger on the Continuation Date, and
if the Owner elected a living benefit or guaranteed minimum withdrawal benefit,
We will calculate the Death Benefit as the greater of:
1. The Contract Value for the NYSE business day during which We
receive all Required Documentation at Our Annuity Service
Center; or
2. The Contract Value on the Continuation Date, plus Purchase
Payment(s) received since the Continuation Date and prior to
the Spousal Beneficiary's 86th birthday, and reduced by:
14
(a) any Withdrawal Adjustments after the Continuation
Date if the benefit has not been terminated; or
(b) any Withdrawal Adjustments after the Continuation
Date and prior to the date the benefit is terminated,
and reduced proportionately by any Withdrawals after
the Continuation Date and on and after the date the
benefit is terminated.
WITHDRAWAL ADJUSTMENTS
If a living benefit or guaranteed minimum withdrawal benefit is elected and the
benefit has not been terminated, the amount of the Death Benefit will be
adjusted for Withdrawals as follows:
1. If the current Contract Year's cumulative Withdrawals,
including the current Withdrawal, are taken prior to your 81st
birthday and are less than or equal to the Maximum Annual
Withdrawal Amount, the amount of adjustment will be the amount
of each Withdrawal; or
2. If the current Contract Year's cumulative Withdrawals,
including the current Withdrawal, are taken on and/or after
your 81st birthday and/or are in excess of the Maximum Annual
Withdrawal Amount, the amount of adjustment is equal to the
proportion that the amount of each Withdrawal in excess of the
Maximum Annual Withdrawal Amount reduces the Contract Value.
If the Spousal Beneficiary was age 86 or older on the Continuation Date, the
Death Benefit will be the Contract Value for the NYSE business day during which
We receive all Required Documentation at Our Annuity Service Center.
DEATH OF OWNER OR ANNUITANT ON OR AFTER THE ANNUITY DATE
If any Owner or Annuitant dies on or after the Annuity Date and before the
entire interest in the Contract has been distributed, We will pay any remaining
portion of the annuity income payment(s) to the Beneficiary upon Our receipt of
all Required Documentation. For further information pertaining to death of the
Annuitant, see ANNUITY INCOME PAYMENT OPTIONS.
BENEFICIARY
The Beneficiary is selected by the Owner. While the Owner is living and before
the Annuity Date, the Owner may change the Beneficiary by written notice. A
change in Beneficiary will take effect on the date We receive the written notice
in a form satisfactory to Us at Our Annuity Service Center. If two or more
persons are named as Beneficiaries under the Contract, those surviving the Owner
will share equally unless otherwise specified by the Owner and each must elect
to receive their respective portions of the death benefit according to the
options listed under DEATH OF OWNER BEFORE THE ANNUITY DATE. If the Annuitant
survives the Owner, and there are no surviving Beneficiaries, the Annuitant will
be deemed the Beneficiary.
Joint Owners, if applicable, shall be each other's primary Beneficiary. Joint
Annuitants, if any, when the Owner is a non-natural person, shall be each
other's primary Beneficiary. Any other Beneficiary designation will be treated
as a contingent Beneficiary.
If the Owner is also the Annuitant and there are no surviving Beneficiaries,
upon Our receipt of all Required Documentation, We will pay the Death Benefit to
the estate of the Owner in accordance with option 1, under DEATH OF OWNER BEFORE
THE ANNUITY DATE.
15
ANNUITY PROVISIONS
ANNUITY DATE
You may specify an anticipated Annuity Date. You may change the Annuity Date at
any time, at least seven days prior to the Annuity Date, by written notice to Us
at Our Annuity Service Center. The Annuity Date must always be the first day of
the calendar month. The Earliest Annuity Date After the Contract Date is shown
on the Contract Date Page. The Annuity Date must not be beyond the Latest
Annuity Date shown on the Contract Data Page. If no Annuity Date is specified by
You, the Annuity Date will be the Latest Annuity Date.
PAYMENTS TO OWNER
Unless You request otherwise, We will make annuity income payments to You. If
You want the annuity income payments to be made to some other Payee, We will
make such annuity income payments subject to receipt of a written request signed
by You and filed at the Annuity Service Center no later than [thirty (30)] days
before the due date of the first annuity income payment or subsequent annuity
income payment.
Any such request is subject to the rights of any assignee. No annuity income
payments available to or being paid to the Payee while the Annuitant is alive
can be transferred, commuted, anticipated or encumbered.
BETTERMENT OF RATES
The amount of the Owner's monthly payment will be at least equal to the monthly
payment produced by the application of an amount equal to the Contract Value of
this Contract to purchase any single consideration immediate annuity contract
offered by the Company at the same time to the same class of annuitants. We are
not currently offering any single premium immediate annuity contracts.
FIXED ANNUITIZATION
If a Fixed Annuitization has been elected, the proceeds payable under this
Contract less any applicable premium taxes, shall be applied to the payment of
the fixed annuity income payment option elected at rates which are at least
equal to the annuity rates based upon the applicable tables in the Contract. In
no event will the Fixed Annuitization be changed once it begins.
AMOUNT OF FIXED ANNUITY INCOME PAYMENTS
The amount of each fixed annuity income payment will be determined by applying
the portion of the Contract Value allocated by You for Fixed Annuitization on
the Annuity Date, less any applicable premium taxes, to the annuity factor
applicable to the fixed annuity income payment option chosen. In no event will
the Fixed Annuitization be changed once it begins.
AMOUNT OF VARIABLE ANNUITY INCOME PAYMENTS
(a) FIRST VARIABLE ANNUITY INCOME PAYMENT: The dollar amount of the first
Variable Annuitization payment will be determined by applying the
portion of the Contract Value allocated to the Variable Portfolio(s) on
the Annuity Date, less any applicable premium taxes, to rates which are
at least equal to the annuity rates based upon the annuity factor
applicable to the variable annuity income payment option chosen. If the
Contract Value is allocated to more than one Variable Portfolio, the
value of Your interest in each Variable Portfolio is applied separately
to the variable annuity income payment option table to determine the
amount of the first annuity income payment attributable to each
Variable Portfolio.
(b) NUMBER OF VARIABLE ANNUITY UNITS: The number of Annuity Units for each
applicable Variable Portfolio is the amount of the first annuity income
payment attributable to that Variable Portfolio divided by the value of
the applicable Annuity Unit for that Variable Portfolio as of the
Annuity Date. The number of Annuity Units will not change as a result
of investment experience.
16
(c) VALUE OF EACH VARIABLE ANNUITY UNIT: The value of an Annuity Unit may
increase or decrease from one month to the next. For any month, the
value of an Annuity Unit of a particular Variable Portfolio is the
value of that Annuity Unit as of the last NYSE business day of the
preceding month, multiplied by the Net Investment Factor for that
Variable Portfolio for the last NYSE business day of the current month.
The Net Investment Factor for any Variable Portfolio for a certain month is
determined by dividing (1) by (2) and multiplying by (3) where:
(1) is the Accumulation Unit Value of the Variable
Portfolio determined as of the last business day at
the end of that month, and
(2) is the Accumulation Unit Value of the Variable
Portfolio determined as of the last business day at
the end of the preceding month, and
(3) is a factor that neutralizes the assumed investment
rate of 3.5%.
(d) SUBSEQUENT VARIABLE ANNUITY INCOME PAYMENTS: After the first Variable
Annuitization payment, subsequent Variable Annuitization payments will
vary in amount according to the investment performance of the
applicable Variable Portfolio(s) in which You are invested. The amount
may change from month to month. The amount of each subsequent payment
for each Variable Portfolio is (1) multiplied by (2) where:
(1) Is the number of Annuity Units for each Variable
Portfolio as determined for the first annuity income
payment
(2) Is the value of an Annuity Unit for that Variable
Portfolio at the end of the month immediately
preceding the month in which payment is due.
We guarantee that the amount of each Variable Annuitization payments
will not be affected by variations in expenses or mortality experience.
GENERAL PROVISIONS
ENTIRE CONTRACT
The Entire Contract between You and Us consists of this Contract, this
Application and/or confirmation thereof, and any attached endorsement(s) or
rider(s). An agent cannot change the terms or conditions of this Contract. Any
change must be in writing and approved by Us. Only Our President, Secretary, or
one of Our Vice-Presidents can give Our approval.
CHANGE OF ANNUITANT
If the Owner is an individual, the Owner may change the Annuitant(s) at any time
prior to the Annuity Date. To make a change, the Owner must send a written
notice to Us at least 30 days before the Annuity Date. If the Owner is a
non-natural person, the Owner may not change the Annuitant.
DEATH OF ANNUITANT
If the Owner is a natural person, the Owner and Annuitant are different, and the
Annuitant dies before the Annuity Date, the Owner becomes the Annuitant until
the Owner elects a new Annuitant. If there are Joint Annuitants, upon the death
of any Annuitant prior to the Annuity Date, the Owner may elect a new Joint
17
Annuitant. However, if the Owner is a non-natural person, We will treat the
death of any Annuitant as the death of the "Primary Annuitant" as defined in the
IRC, and as the death of the Owner, as explained in the DEATH PROVISIONS.
MISSTATEMENT OF AGE OR SEX
If the Age or sex of any Annuitant has been misstated, future annuity payments
will be adjusted using the correct Age and sex, according to Our rates in effect
on the date that annuity payments were determined. Any overpayment, plus
interest at the rate of 4% per year, will be deducted from the next payment(s)
due. Any underpayment, plus interest at the rate of 4% per year, will be paid in
full with the next payment due.
With respect to Contract issue Age and other age driven features in the
Contract, should We discover a misstatement of Age, We reserve the right to
fully pursue Our remedies including possible termination of the Contract and/or
revocation of any Age driven benefits.
PROOF OF AGE, SEX, OR SURVIVAL
We may require satisfactory proof of correct Age or sex at any time. If any
payment under this Contract depends on the Annuitant being alive, We may require
satisfactory proof of survival.
DEFERMENT OF PAYMENTS
We may defer making payments, subject to state requirements, from the available
Fixed Account Option(s) for up to six (6) months. Interest, subject to state
requirements, will be credited during the deferral period.
SUSPENSION OF PAYMENTS
We may suspend or postpone any payments from the Variable Portfolios if any of
the following occur:
(a) the NYSE is closed;
(b) trading on the NYSE is restricted;
(c) an emergency exists such that it is not reasonably practical to dispose
of securities in the Variable Portfolios or to determine the value of
its assets;
(d) the United States Securities and Exchange Commission, by order, so
permits for the protection of Owners; or
(e) We are on notice that this Contract is the subject of a court
proceeding, an arbitration, a regulatory matter or other legal action.
Conditions in (b) and (c) will be decided by or in accordance with rules of the
United States Securities and Exchange Commission.
CONFORMITY WITH STATE LAWS
The provisions of this Contract will be interpreted by the laws of the State of
New York, the state in which this Contract is delivered. Any provision which, on
the Contract Date, is in conflict with the law of such state is amended to
conform to the minimum requirements of such law.
CHANGES IN LAW
If the laws governing this Contract or the taxation of benefits under the
Contract change, We will amend this Contract, subject to New York Insurance
Department approval, to comply with any changes.
ASSIGNMENT / CHANGE OF OWNER
Unless restricted by federal tax law, You may assign this Contract before the
Annuity Date, but We will not be bound by an assignment unless the request for
assignment is signed by You and received by Us. Your rights and those of any
other person referred to in this Contract will be subject to the assignment.
Certain assignments may be taxable. We do not assume any responsibility for the
validity or tax consequences of
18
any assignment. We reserve the right to not recognize assignments if it changes
the risk profile of the Owner of the Contract as determined in Our sole
discretion.
INSURABLE INTEREST
Evidence must exist that the Owner(s), Annuitant(s) or Beneficiary(ies) will
suffer a financial loss at the death of the life that triggers the death
benefit. Generally, We consider an interest insurable if a familial relationship
and/or economic interest exists. A familial relationship generally includes
those persons related by blood or by law. An economic interest exists when the
Owner has a lawful and substantial economic interest in having the life, health
or bodily safety of the insured life preserved.
CLAIMS OF CREDITORS
To the extent permitted by law, no right or proceeds payable under this Contract
will be subject to claims of creditors or legal process.
PREMIUM TAXES OR OTHER TAXES
We may deduct from Your Contract Value any premium tax or other taxes payable to
a state or other government entity, if applicable. Should We advance any amount
so due, We are not waiving any right to collect such amount at a later date. We
will deduct any withholding taxes required by applicable law.
WRITTEN NOTICE
Any notice We send to You will be sent to Your address shown in the Application
and/or confirmation thereof unless You request otherwise. Any written request or
notice to Us must be sent to Our Annuity Service Center, as specified on the
Contract Data Page.
PERIODIC REPORTS
At least once during each Contract Year, We will send You a statement of the
account activity of the Contract. The statement will include all transactions
which have occurred during the accounting period shown on the statement.
INCONTESTABILITY
This Contract will be incontestable after it has been in force for a period of
two years from the Contract Date during the lifetime of any Owner who is
required to provide Us with information concerning their Age, sex and identity.
Accurate statements as to any Owner's Age, sex and identity are required as a
condition of issuing this Contract. The Incontestability of this Contract
applies to any statements any Owner makes, except as otherwise stated in the
Misstatement of Age or Sex Provision.
NONPARTICIPATING
This Contract does not share in Our surplus.
WAIVER
Our waiver of any of the terms and conditions under this Contract will not be
deemed to constitute waiver of the right to enforce strict compliance.
ANNUITY INCOME PAYMENT OPTIONS
During the Annuitant's life, upon written election and the return of this
Contract to Us at Our Annuity Service Center, the Contract Value may be applied
to provide one of the following annuity income payment options or any annuity
income payment option that is mutually agreeable. Prior to the Annuity Date but
not before the Earliest Annuity Date After The Contract Date shown on the
Contract Data Page, You can choose one of the options described below. If no
option has been selected by the Annuity Date, You will
19
automatically receive option 4, below, with 120 monthly payments guaranteed; for
Joint Owners, You will automatically receive Option 3, below, with 120 monthly
payments guaranteed.
OPTIONS 1 & 1v - LIFE ANNUITY, LIFETIME PAYMENTS GUARANTEED
Payments payable to a Payee during the lifetime of the Annuitant. No further
annuity income payments are payable after the death of the Annuitant.
OPTIONS 2 & 2v - JOINT AND SURVIVOR LIFE ANNUITY
Payments payable to the Payee during the lifetime of the Annuitant and during
the lifetime of a designated second person. No further annuity income payments
are payable after the deaths of both the Annuitant and the designated second
person.
OPTIONS 3 & 3v - JOINT AND SURVIVOR LIFE ANNUITY - WITH 120 OR 240 MONTHLY
PAYMENTS GUARANTEED
Payments payable to the Payee during the lifetime of the Annuitant and during
the lifetime of a designated second person. If, at the death of the survivor,
annuity income payments have been made for less than 120 or 240 monthly periods,
the remaining guaranteed annuity income payments will be continued to the
Beneficiary. If, at the death of the survivor, annuity income payments have been
made for at least 120 or 240 monthly periods, as selected at the time of
annuitization, no further annuity income payments will be made.
OPTIONS 4 & 4v - LIFE ANNUITY WITH - 120 OR 240 MONTHLY PAYMENTS GUARANTEED
Payments payable to the Payee during the lifetime of the Annuitant. If, at the
death of the Annuitant, annuity income payments have been made for less than the
120 or 240 monthly periods, as selected at the time of annuitization, the
remaining guaranteed annuity income payments will be continued to the
Beneficiary. If, at death of the Annuitant, annuity income payments have been
made for at least 120 or 240 monthly periods, no further payments will be made.
OPTIONS 5 & 5v - FIXED PAYMENTS FOR A SPECIFIED PERIOD CERTAIN
Payments payable to the Payee for any specified period of time for five (5)
years or more, but not exceeding thirty (30) years, as selected at the time of
annuitization. The selection must be made for full twelve month periods. In the
event of death of the Annuitant during the specified period of time, any
remaining annuity income payments will be continued to the Beneficiary. If the
Annuitant dies after the end of the specific period of time, no further annuity
income payments will be made. If Variable Annuity Income Payments are elected
under this Annuity Income Payment Option, any remaining guaranteed Variable
Annuity Income Payments may be redeemed for a discounted value determined by Us.
Any applicable Withdrawal Charges will be deducted from the discounted value as
if Your Contract was fully withdrawn.
20
FIXED ANNUITY INCOME PAYMENT OPTIONS TABLE
BASIS OF COMPUTATION
The actuarial basis for the Table of Annuity Rates is the Annuity 2000 Mortality
Table with a guaranteed interest rate of 1.50%, with quinquennial age setbacks.
For every five years that the Contract has been in effect at the time of
annuitization, the Annuitant's age will be set back by one year to determine the
applicable factors. The Fixed Annuity Income Payment Options Table does not
include any applicable premium tax.
OPTIONS 1 & 4 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
OPTION 1 OPTION 4 OPTION 4
LIFE ANNUITY LIFE ANNUITY
AGE OF (W/120 PAYMENTS (W/240 PAYMENTS
ANNUITANT LIFE ANNUITY GUARANTEED) GUARANTEED)
--------- ---------------- ------------------------ -------------------------
MALE FEMALE MALE FEMALE MALE FEMALE
---- ------ ---- ------ ---- ------
55 3.68 3.38 3.64 3.35 3.48 3.27
56 3.77 3.46 3.73 3.43 3.55 3.34
57 3.87 3.54 3.82 3.51 3.62 3.40
58 3.98 3.63 3.92 3.60 3.69 3.47
59 4.09 3.73 4.02 3.69 3.76 3.54
60 4.21 3.83 4.13 3.78 3.83 3.62
61 4.34 3.93 4.24 3.89 3.90 3.69
62 4.47 4.05 4.36 3.99 3.97 3.77
63 4.62 4.17 4.49 4.10 4.04 3.84
64 4.77 4.30 4.62 4.22 4.10 3.92
65 4.93 4.44 4.76 4.35 4.17 4.00
66 5.11 4.58 4.90 4.48 4.24 4.07
67 5.30 4.74 5.05 4.62 4.30 4.15
68 5.49 4.91 5.20 4.76 4.36 4.22
69 5.71 5.09 5.36 4.92 4.41 4.29
70 5.93 5.29 5.53 5.08 4.47 4.36
71 6.17 5.50 5.70 5.25 4.51 4.42
72 6.43 5.73 5.87 5.43 4.56 4.48
73 6.70 5.98 6.05 5.62 4.60 4.53
74 6.99 6.24 6.23 5.81 4.63 4.58
75 7.31 6.53 6.41 6.01 4.67 4.62
76 7.64 6.84 6.59 6.21 4.69 4.65
77 8.00 7.18 6.78 6.41 4.72 4.69
78 8.38 7.55 6.96 6.62 4.74 4.71
79 8.79 7.94 7.13 6.83 4.75 4.74
80 9.23 8.37 7.31 7.03 4.77 4.75
81 9.70 8.84 7.47 7.23 4.78 4.77
82 10.20 9.34 7.63 7.42 4.79 4.78
83 10.73 9.88 7.78 7.60 4.80 4.79
84 11.30 10.47 7.93 7.77 4.80 4.80
85 11.90 11.10 8.06 7.93 4.81 4.80
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OPTION 2 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
JOINT & 100% SURVIVOR LIFE ANNUITY
AGE OF
MALE
ANNUITANT AGE OF FEMALE ANNUITANT
--------- --------------------------------------------------------------------------------------
55 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
55 3.01 3.18 3.33 3.45 3.54 3.60 3.64
60 3.12 3.36 3.59 3.78 3.94 4.05 4.12
65 3.21 3.51 3.83 4.13 4.40 4.61 4.75
70 3.27 3.63 4.03 4.46 4.89 5.26 5.53
75 3.32 3.70 4.18 4.74 5.35 5.95 6.45
80 3.34 3.76 4.29 4.95 5.75 6.62 7.45
85 3.36 3.79 4.35 5.09 6.05 7.20 8.44
OPTION 3 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT & 100% SURVIVOR LIFE ANNUITY (W/120 PAYMENTS GUARANTEED)
AGE OF
MALE
ANNUITANT AGE OF FEMALE ANNUITANT
--------- --------------------------------------------------------------------------------------
55 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
55 3.01 3.18 3.33 3.45 3.53 3.59 3.62
60 3.12 3.36 3.58 3.78 3.93 4.03 4.09
65 3.21 3.51 3.82 4.12 4.38 4.56 4.67
70 3.27 3.62 4.02 4.44 4.84 5.16 5.36
75 3.31 3.70 4.16 4.70 5.26 5.76 6.11
80 3.33 3.74 4.25 4.88 5.59 6.28 6.80
85 3.35 3.77 4.31 4.99 5.81 6.66 7.35
OPTION 3 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT & 100% SURVIVOR LIFE ANNUITY (W/240 PAYMENTS GUARANTEED)
AGE OF
MALE
ANNUITANT AGE OF FEMALE ANNUITANT
--------- --------------------------------------------------------------------------------------
55 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
55 3.00 3.16 3.30 3.39 3.45 3.47 3.48
60 3.11 3.33 3.53 3.68 3.77 3.81 3.82
65 3.18 3.46 3.72 3.94 4.08 4.15 4.17
70 3.23 3.54 3.86 4.14 4.33 4.43 4.46
75 3.26 3.59 3.94 4.27 4.50 4.62 4.66
80 3.27 3.61 3.98 4.33 4.58 4.71 4.76
85 3.27 3.62 3.99 4.35 4.61 4.75 4.80
22
OPTION 5 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
FIXED PAYMENT FOR SPECIFIED PERIOD
NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY
OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT
-------- ------- -------- ------- -------- ------- -------- -------
10 8.96 17 5.55 24 4.13
11 8.21 18 5.27 25 3.99
5 17.28 12 7.58 19 5.03 26 3.86
6 14.51 13 7.05 20 4.81 27 3.75
7 12.53 14 6.59 21 4.62 28 3.64
8 11.04 15 6.20 22 4.44 29 3.54
9 9.89 16 5.85 23 4.28 30 3.44
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VARIABLE ANNUITY INCOME PAYMENT OPTIONS TABLE
BASIS OF COMPUTATION
The actuarial basis for the Table of Annuity Rates is the Annuity 2000 Mortality
Table with an effective annual Assumed Investment Rate of 3.50%, with
quinquennial age setbacks. For every five years that the Contract has been in
effect at the time of annuitization, the Annuitant's age will be set back by one
year to determine the applicable factors. The Variable Annuity Income Payment
Options Table does not include any applicable premium tax.
OPTIONS 1v& 4v - TABLE OF MONTHLY INSTALLMENTS PER $1,000
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
OPTION 1v OPTION 4v OPTION 4v
LIFE ANNUITY LIFE ANNUITY
AGE OF (W/120 PAYMENTS (W/240 PAYMENTS
ANNUITANT LIFE ANNUITY GUARANTEED) GUARANTEED)
--------- ----------------- ------------------------- -------------------------
MALE FEMALE MALE FEMALE MALE FEMALE
---- ------ ---- ------ ---- ------
55 4.80 4.48 4.74 4.45 4.54 4.34
56 4.89 4.56 4.82 4.52 4.60 4.40
57 4.99 4.64 4.91 4.60 4.67 4.46
58 5.09 4.73 5.01 4.68 4.73 4.53
59 5.21 4.82 5.11 4.77 4.79 4.59
60 5.33 4.92 5.21 4.86 4.86 4.66
61 5.45 5.03 5.32 4.96 4.92 4.73
62 5.59 5.14 5.44 5.06 4.98 4.80
63 5.73 5.26 5.56 5.17 5.05 4.87
64 5.89 5.39 5.69 5.29 5.11 4.94
65 6.06 5.53 5.83 5.41 5.17 5.01
66 6.24 5.68 5.97 5.54 5.23 5.08
67 6.43 5.84 6.11 5.67 5.29 5.14
68 6.63 6.01 6.26 5.82 5.34 5.21
69 6.84 6.19 6.42 5.97 5.39 5.28
70 7.07 6.39 6.57 6.12 5.44 5.34
71 7.32 6.60 6.74 6.29 5.48 5.39
72 7.58 6.84 6.91 6.46 5.52 5.45
73 7.86 7.09 7.08 6.64 5.56 5.49
74 8.16 7.36 7.25 6.83 5.59 5.54
75 8.47 7.65 7.42 7.02 5.62 5.57
76 8.82 7.97 7.59 7.22 5.64 5.61
77 9.18 8.31 7.77 7.41 5.67 5.64
78 9.57 8.69 7.94 7.61 5.68 5.66
79 9.99 9.09 8.11 7.81 5.70 5.68
80 10.43 9.53 8.27 8.00 5.71 5.70
81 10.91 10.00 8.43 8.19 5.72 5.71
82 11.42 10.51 8.58 8.38 5.73 5.72
83 11.96 11.07 8.72 8.55 5.74 5.73
84 12.53 11.67 8.85 8.71 5.74 5.74
85 13.15 12.31 8.98 8.86 5.75 5.74
24
OPTION 2v - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
JOINT & 100% SURVIVOR LIFE ANNUITY
AGE OF
MALE
ANNUITANT AGE OF FEMALE ANNUITANT
--------- -----------------------------------------------------------------------------------------
55 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
55 4.09 4.25 4.40 4.52 4.62 4.69 4.74
60 4.20 4.42 4.64 4.84 5.00 5.13 5.21
65 4.29 4.56 4.87 5.17 5.45 5.67 5.83
70 4.35 4.68 5.07 5.49 5.92 6.30 6.60
75 4.40 4.77 5.23 5.78 6.38 6.99 7.50
80 4.43 4.83 5.34 6.00 6.79 7.66 8.50
85 4.45 4.87 5.42 6.15 7.10 8.25 9.49
OPTION 3v - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT AND 100% SURVIVOR LIFE ANNUITY (W/120 PAYMENTS GUARANTEED)
AGE OF
MALE
ANNUITANT AGE OF FEMALE ANNUITANT
--------- -----------------------------------------------------------------------------------------
55 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
55 4.08 4.25 4.40 4.52 4.61 4.68 4.71
60 4.19 4.41 4.63 4.83 4.99 5.10 5.16
65 4.28 4.56 4.86 5.15 5.41 5.61 5.73
70 4.35 4.68 5.05 5.46 5.86 6.18 6.40
75 4.39 4.76 5.20 5.72 6.27 6.76 7.11
80 4.42 4.81 5.30 5.91 6.60 7.26 7.77
85 4.44 4.84 5.36 6.03 6.82 7.63 8.29
OPTION 3v - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT AND 100% SURVIVOR LIFE ANNUITY (W/240 PAYMENTS GUARANTEED)
AGE OF
MALE
ANNUITANT AGE OF FEMALE ANNUITANT
--------- -----------------------------------------------------------------------------------------
55 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
55 4.07 4.22 4.36 4.45 4.51 4.53 4.54
60 4.17 4.38 4.56 4.71 4.80 4.84 4.85
65 4.25 4.50 4.74 4.95 5.08 5.14 5.17
70 4.30 4.58 4.88 5.14 5.31 5.40 5.43
75 4.32 4.63 4.96 5.25 5.46 5.57 5.61
80 4.34 4.65 4.99 5.31 5.54 5.66 5.70
85 4.34 4.66 5.00 5.33 5.57 5.69 5.74
25
OPTION 5V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
PAYMENTS FOR A SPECIFIED PERIOD
NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY
OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT
-------- ------- -------- ------- -------- ------- -------- -------
10 8.96 17 5.55 24 4.13
11 8.21 18 5.27 25 3.99
5 17.28 12 7.58 19 5.03 26 3.86
6 14.51 13 7.05 20 4.81 27 3.75
7 12.53 14 6.59 21 4.62 28 3.64
8 11.04 15 6.20 22 4.44 29 3.54
9 9.89 16 5.85 23 4.28 30 3.44
26
FIRST SUNAMERICA LIFE INSURANCE COMPANY
A STOCK COMPANY NEW YORK, NEW YORK
INDIVIDUAL FIXED AND
VARIABLE ANNUITY CONTRACT
Nonparticipating
27
