EXHIBIT (4)(b)
FORM OF THE CONTRACT FOR THE ONE INCOME ANNUITY
PFL Life Insurance Company
A Stock Company
(Hereafter, We, Our, Us, the Company)
Administrative Office: 0000 Xxxxxxxx Xxxx X. X., Xxxxx Xxxxxx, Xxxx 00000
Telephone: [(000) 000-0000]
Our Annuity Agreement
We will pay, subject to the conditions and limitations of this Contract, the
Annuity Payments to the Payee, if living on the First Payment Date. We will
make these payments in accordance with the Payment Option described in Section
1, Contract Specifications.
Our Company and You, the Owner, are bound by the conditions and provisions of
this Contract. We issue this Contract in consideration of the Single Premium
paid.
Right to Cancel Your Contract
After You receive this Contract, You have 10 days to examine it. Within that
period, You can return the Contract to the Company or its agent for any reason.
If You return the Contract, it will be canceled and We will consider the
Contract void from the beginning. We will refund Your premium plus or minus the
investment performance of the Subaccounts on the date of cancellation less any
Annuity Payments made.
Benefits based on the performance of the Separate Account are variable. Values
may increase or decrease and are not guaranteed as to dollar amount.
Signed for the Company at Our Home Office, Cedar Rapids, Iowa.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxx X. Xxxxxx
Secretary President
This Contract is a legal Contract between You and the Company.
READ YOUR CONTRACT CAREFULLY
FIXED AND VARIABLE
SINGLE PREMIUM IMMEDIATE INCOME ANNUITY
NONPARTICIPATING
AV1200 1 0100
CONTRACT CONTENTS
PAGE SECTION DESCRIPTION
------ ------- -----------
3 1 CONTRACT SPECIFICATIONS
4 2 DEFINITIONS
6 3 PAYMENT OF PREMIUM
6 4 ANNUITY PAYMENTS
9 5 TRANSFERS
9 6 SEPARATE ACCOUNT
11 7 GENERAL PROVISIONS
13 8 DEATH PROCEEDS
2
SECTION 1---CONTRACT SPECIFICATIONS
Contract Number: [10001]
Contract Issue Date: [12/01/1999]
Parties to the Contract:
Owner(s): [Xxxx Xxx]
Payee(s): [Xxxx Xxx]
Primary Annuitant: [Xxxx Xxx]
Primary Annuitant [Issue Age or Date of Birth] and Sex: [35 or 1/1/1965],
[Male or Female]
Secondary Annuitant: [N/A]
Secondary Annuitant Issue Age and Sex: [N/A]
Beneficiary(ies): [Xxxx Xxx]
Single Premium:
Single Premium Amount: [$40,000.00]
Initial Allocation to: Fixed Annuity Payments: [10%] Variable Annuity
Payments: [90%]
Annuity Payments:
First Payment Date: [01/01/2000]
Frequency of Payments: [Monthly]
Fixed Payment Amount on First Payment Date: [$19.00]
Estimated First Variable Payment Amount: [$142.05]
Assumed Investment Return for Variable Payment: [3.5% Annually]
The Single Premium allocated to variable Annuity Payments will be invested as
shown below:
[Diversified Equity Portfolio 40% Diversified Mid Cap Portfolio 50%
Equity Index Portfolio % Government Bond Portfolio %
Large Cap Growth Portfolio % Bond Portfolio %
Mid Cap Growth Portfolio % Balanced Portfolio %]
Mid Cap Value Portfolio %
Charges Applicable to Variable Payments:
Separate Account Charge: [1.50%]
[Surrender Charge] [[4%, 3%, 2%, 1%] of premium for the first 4 years]
[[7,7,6,6,5,4,3,2,1%] of premium for the first 9 years.]
Or
[Initial Payment Guarantee Rider Fee] [1.50%]
[Step-up Payment Guarantee Rider Fee] [3.00%]
Payment Option:
[CERTAIN ONLY PAYMENT OPTION:
We will make payments for [NN Years] Certain Only beginning on the First
Payment Date. With Stabilized Payments, Your last payment will equal the
current Supportable Payment. The final payment will be made on [Mmmmmm, Dd,
Yyyy] (that is the last guaranteed payment date).
3
SECTION 1---CONTRACT SPECIFICATIONS (Continued)
Payment Option (Continued):
[CERTAIN ONLY PAYMENT OPTION (Continued):
If the Annuitant dies prior to the last guaranteed payment date, We will
continue payments as they become due, or pay the present value of the remaining
guaranteed payments in a lump sum to the Beneficiary when We receive written
notice and due proof of the Annuitant's death. The present value of the
variable Annuity Payments is calculated as of the date we receive written notice
and due proof of death. The present value is calculated using the Assumed
Investment Return and the current Supportable Payment. The present value of the
fixed Annuity Payments is calculated using Company determined interest rates in
effect on the date we receive written notice and due proof of the Annuitant's
death.
No additional Payments will be made after all guaranteed payments have been
made.
Surrender of Benefits
You may surrender Your fixed or variable Annuity Payments prior to the last
guaranteed payment date. The minimum surrender amount is $2,500.00.
For fixed Annuity Payments, the surrender value is equal to 98% of the present
value of remaining payments. The present value of the fixed Annuity Payments is
calculated using Company determined interest rates in effect at the time We
receive Your request. For variable Annuity Payments, the surrender value is
equal to the present value of future payments less a surrender charge. The
present value is calculated using the AIR and the current Supportable Payment.
The surrender charge is included on the Contract Specifications page.
If the full surrender value is paid, no further payments will be due under the
Contract. Partial surrenders will reduce future payments.
You should consult Your tax advisor prior to making withdrawals.]
3A
SECTION 2---DEFINITIONS
This section contains the standard meaning of terms used in Your Contract.
Allocation Date
The date on which a transfer is made from one Subaccount to another.
Annuitant
The person upon whose life the Annuity Payments are based. For joint options,
Annuity Payments are based upon the lives of both the Primary and Secondary
Annuitant.
Annuity Payments
Payments made by Us pursuant to the Payment Option chosen. We may require
evidence that any Annuitant and/or Payee are alive on the due date of each
Annuity Payment. Annuity Payments may be either variable or a combination of
fixed and variable. We guarantee fixed Annuity Payments to be a specific
amount. Variable Annuity Payments fluctuate in amount based on the investment
performance of the Subaccount relative to the Assumed Investment Return.
Payments are determined no greater than seven business days before the date of
Your Annuity Payment. Your fixed and variable Annuity Payment options are
explained in Section 1, Contract Specifications.
Annuity Payment Frequency
The payment frequency is either monthly, quarterly, semiannual or annual.
Assumed Investment Return (AIR)
The annual effective rate shown in Section 1, Contract Specifications, that is
used in the calculation of variable Annuity Payments. If the performance (minus
all expenses) of the Subaccount(s) matches the AIR, the variable Annuity
Payments will remain constant. If the performance exceeds the AIR, the variable
Annuity Payments will increase. If the performance falls below the AIR, the
variable Annuity Payments will decrease.
Beneficiary
The person(s) to whom We will pay a death benefit or other guaranteed payments,
if any, when the Annuitant (or last Annuitant for joint options) dies.
Contract Issue Date
The date, as shown on the Contract Specifications Page, on which the Single
Premium is allocated to the Subaccounts and the Contract becomes effective.
Contract Year
The 12-month period following the Contract Issue Date shown in Section 1,
Contract Specifications. The first Contract Year starts on the Contract Issue
Date. Each subsequent Contract Year starts on the anniversary of the Contract
Issue Date.
Issue Age
The Annuitant's age at the nearest birthday on the Contract Issue Date.
Owner
"You", "Your", and "Yours". The person or entity, as named in Section 1,
Contract Specifications, who may, while any Annuitant is living, exercise all
rights granted by this Contract.
Payee
The person or entity to whom We will pay the Annuity Payments.
4
SECTION 2---DEFINITIONS (Continued)
Right to Cancel Period
The period during which this Contract can be canceled by the Owner.
Separate Account Charge
An expense that is deducted from each subaccount for Our assumption of mortality
and expense risk, and for Our administration and distribution expenses. (This
charge is commonly referred to as M&E, or mortality and expense charge.)
Stabilized Payment
The variable Annuity Payment You receive from Us. Stabilized Payments are
determined annually at your Contract anniversary and are paid according to the
Annuity Payment Frequency You selected. You can choose not to stabilize Your
variable Annuity Payment in which case each payment will fluctuate based on the
performance of the selected Subaccounts.
Subaccounts
The portfolios of the Separate Account, as described in Section 6, Separate
Account. Section 1, Contract Specifications, lists the allocation to the
Subaccounts You selected.
Supportable Payment
The Supportable Payment is the sum of each selected subaccount's Variable
Annuity Unit value times the number of Variable Annuity Units. The Variable
Annuity Units are adjusted to reflect the year-to-date difference between the
Stabilized Payment and the payment had they not been stabilized. Supportable
Payments are used to determine surrender values, death benefits and transfers.
Valuation Day
Each day the New York Stock Exchange is open for trading and any other day when
the Securities and Exchange Commission requires mutual funds or unit investment
trusts to be valued.
Valuation Period
The period of time beginning at the close of business each Valuation Day and
ending at the close of business on the next Valuation Day.
Variable Annuity Unit
Variable Annuity Payments are expressed in terms of Variable Annuity Units, the
value of which fluctuates in relation to the selected Subaccounts. The value of
Variable Annuity Units is determined at the end of each Valuation Day.
Written Request
A request in a form suitable to Us, signed by You and delivered to Us.
5
SECTION 3---PAYMENT OF PREMIUM
Single Premium
You purchase this Contract with a Single Premium. You may not make additional
premium payments.
The Single Premium will be reduced by any applicable Premium Taxes required by
federal, state or local authorities.
Allocation of Your Single Premium
The amount of the Single Premium You allocated to fixed and/or variable Annuity
Payments is shown in Section 1, Contract Specifications. The initial allocation
of Your premium for variable Annuity Payments to the Subaccounts is also shown
in Section 1, Contract Specifications.
SECTION 4---ANNUITY PAYMENTS
General Payment Provisions
Annuity Payments may be variable or a combination of fixed and variable. Your
elections are shown in Section 1, Contract Specifications. Your Annuity
Payments will be made according to the provisions detailed in Section 1,
Contract Specifications.
Your First Payment Date is shown in Section 1, Contract Specifications.
If at any time the amount of a payment to a Payee is less than $100 (Our minimum
payment), We may change the Annuity Payment Frequency so that the payment is at
least equal to the minimum.
Determination of the Variable Annuity Payments
If at Contract Issue, You chose to receive Stabilized Payments, then Your
initial Stabilized Payment is set equal to the Estimated First Variable Payment
Amount. Stabilized Payments do not vary within a Contract Year. On each
subsequent Contract anniversary, the Stabilized Payment is set equal to the
current Supportable Payment.
If at Contract Issue, You did not choose Stabilized Payments, then Your Variable
Annuity Payments will fluctuate with each payment.
6
SECTION 4---ANNUITY PAYMENTS (Continued)
Variable Annuity Units
The portion of the Single Premium allocated to variable Annuity Payments will
initially purchase Variable Annuity Units in the Subaccount(s) which You elect.
We determine the number of Variable Annuity Units based upon:
a. the Single Premium reduced by any applicable Premium Taxes;
b. the age and sex of the Annuitant and Secondary Annuitant, if any;
c. the Payment Option You chose;
d. the Annuity Payment Frequency You chose;
e. the First Payment Date You chose;
f. the Assumed Investment Return You chose; and
g. the Variable Annuity Unit value of the Subaccount(s) on the date that We
receive the entire single premium.
On the date that We receive the entire single premium, the initial number of
Variable Annuity Units in each selected Subaccount is determined by dividing the
Estimated First Payment Amount by the Variable Annuity Unit value of that
Subaccount. The value of the Variable Annuity Unit in Your chosen Subaccounts
will increase or decrease reflecting the investment experience of those
Subaccounts.
Variable Annuity Unit Adjustment
The number of Variable Annuity Units allocated to each Subaccount will change if
You request:
1. A transfer from one Subaccount to another;
2. A transfer from variable Annuity Payments to fixed Annuity Payments;
3. A partial or full surrender that may be available under Your Payment
Option.
Additionally,
- If You chose a joint life payment option, We will reduce the number of
Variable Annuity Units if payments are to be reduced upon the death of either
joint Annuitant.
- With Stabilized Payments, Your number of Variable Annuity Units will be
adjusted on your contract anniversary.
7
SECTION 4---ANNUITY PAYMENTS (Continued)
Variable Annuity Unit Adjustment (Continued)
For surrenders and transfers, the number of Variable Annuity Units surrendered
or transferred from the Subaccounts will be determined by dividing the amount
withdrawn or transferred by the Variable Annuity Unit value for that Subaccount
on the applicable withdrawal or Allocation Date.
The Variable Annuity Unit value in a particular Subaccount on any Valuation Day
is equal to (a) multiplied by (b) multiplied by (c), where:
(a) is the Variable Annuity Unit value for that Subaccount on the immediately
preceding Valuation Day;
(b) is the net investment factor for that Subaccount for the Valuation Period;
and
(c) is the daily factor for the Valuation Period.
The daily factor for the Valuation Period is a discount factor that reflects the
Assumed Investment Return.
The net investment factor used to calculate the Variable Annuity Unit value in
each Subaccount for the Valuation Period is determined by dividing (a) by (b)
and subtracting (c) from the result, where:
(a) is the net result of:
(1) the net asset value of a fund share held in that Subaccount determined
as of the end of the current Valuation Period, plus
(2) the per share amount of any dividend or capital gain distributions made
by the fund for shares held in that Subaccount if the ex-dividend date
occurs during the Valuation Period; plus or minus
(3) a per share credit or charge for any taxes reserved for, which We
determine to have resulted from the investment operation of the
Subaccount.
(b) is the net asset value of a fund share held in that Subaccount as
determined at the end of the immediately preceding Valuation Period.
(c) is an amount representing the Separate Account Charge. The percentages are
shown in Section 1, Contract Specifications.
8
SECTION 5---TRANSFERS
Transfers Among Subaccounts
You may transfer the value of the Variable Annuity Units from one Subaccount to
another. If You want to transfer the value of the Variable Annuity Units, You
must tell Us in a Written Request or by an electronic notice that gives Us the
information that We need.
You may currently transfer among Subaccounts as often as You wish without
charge. We have the right to charge an administrative fee of $15 for each
transfer after the first six transfers made in any Contract Year. All transfers
made simultaneously will be treated as a single request.
Transfers from Variable Annuity Payments to Fixed Annuity Payments
You may transfer all or a part of the value of variable Annuity Payments to
fixed Annuity Payments.
If You have chosen the Life with Emergency Cash payment option and You transfer
variable Annuity Payments to fixed Annuity Payments, the fixed Annuity Payment
option must be life contingent. For all other variable Annuity Payment options
Your fixed Annuity Payment option will be a continuation of the payment option
under which the variable Annuity Payments were being made. For example, if You
were receiving variable Annuity Payments for two years under a 10-Year Period
Certain and Life Option and elect to transfer to a fixed Annuity Payment, Your
fixed Annuity Payment would be an 8-Year Period Certain and Life Option.
The amount of the fixed Annuity Payment will be based on Our fixed annuity rates
at the time of the transfer.
You may not transfer from fixed Annuity Payments to variable Annuity Payments.
SECTION 6---SEPARATE ACCOUNT
The Separate Account
We have established, and will maintain, a Separate Account under the laws of the
state of Iowa. Any realized or unrealized income, net gains or losses from the
assets of the Separate Account are credited to or charged against it without
regard to Our other income, gains or losses. Assets are put in the Separate
Account for this Contract, as well as for other variable annuity policies and
life insurance. The Separate Account may invest assets in shares of one or more
mutual funds. Fund shares are purchased, redeemed and valued on behalf of the
Separate Account.
The Separate Account is divided into Subaccounts. Each Subaccount invests
exclusively in shares of one of the portfolios of an underlying fund. We
reserve the right to add or remove any Subaccount of the Separate Account.
The assets of the Separate Account are Our property. These Assets will equal or
exceed the reserves and other Contract liabilities of the Separate Account.
These assets will not be chargeable with liabilities arising out of any other
business We conduct. We reserve the right to transfer assets of a Subaccount,
in excess of the reserves and other Contract liabilities with respect to that
Subaccount, to another Subaccount or to Our General Account.
9
SECTION 6---SEPARATE ACCOUNT (Continued)
The Separate Account (Continued)
We will determine the fair market value of the assets of the Separate
Account in accordance with a method of valuation, which We establish in
good faith. Valuation Period means the period of time from one
determination of the value of each Subaccount to the next. Such
determinations are made when the value of the assets and liabilities of
each Subaccount is calculated. This is generally each day on which the New
York Stock Exchange is open.
We also reserve the right to transfer assets of the Separate Account, which
We determine to be associated with the class of policies to which this
Contract belongs, to another Separate Account. If this type of transfer is
made, the term "Separate Account," as used in this Contract, shall then
mean the Separate Account to which the assets were transferred.
We also reserve the right, when permitted by law, to:
(a) deregister the Separate Account under the Investment Company Act of
1940;
(b) manage the Separate Account under the direction of a committee at any
time;
(c) restrict or eliminate any voting rights of Contract Owners or other
persons who have voting rights as to the Separate Account; and
(d) combine the Separate Account with one or more other Separate Accounts;
(e) create new Separate Accounts;
(f) add new Subaccounts to, or remove existing Subaccounts from, the
Separate Account, or combine Subaccounts;
(g) add new underlying mutual funds, remove existing mutual funds, or
substitute a new fund for an existing fund.
Change in Investment Objective or Policy of the Separate Account
If required by law or regulation, an investment policy of the Separate
Account will only be changed if approved by the appropriate insurance
official of the state of Iowa or deemed approved in accordance with such
law or regulation. If so required, the process for obtaining such approval
is filed with the insurance official of the state or district in which this
Contract is delivered.
10
SECTION 7---GENERAL PROVISIONS
Entire Contract
The entire Contract is made up of this Contract, and any riders,
endorsements, and application. No change in or waiver of any provision of
this Contract is valid unless the change or waiver is signed by the
President or Secretary of the Company.
Assignment
Only You may make an assignment of this contract. You must notify Us by
Written Request to assign this Contract. No change will apply to any action
taken by Us before the Written Request was received by Us. We are not
responsible for the validity or the effect of an assignment. You should
consult Your tax advisor prior to making an assignment.
Beneficiary
The Beneficiary is named in Section 1, Contract Specifications, or if
applicable, in a subsequent endorsement. More than one Beneficiary may be
named. The rights of any Beneficiary will be subject to all the provisions
of this Contract.
If any primary or contingent Beneficiary dies before the Annuitant, that
Beneficiary's interest in this Contract ends with that Beneficiary's death.
Only those Beneficiaries living at the time of the Annuitant's death will
be eligible to receive their share of the death benefits. Payment will be
made to the named contingent Beneficiary(ies) only if all primary
Beneficiaries have died before the death benefits become payable. In the
event no contingent Beneficiaries have been named and all primary
Beneficiaries have died when the death benefits become payable, the
Owner(s) or Estate of the Owner(s) will become the Beneficiary(ies) unless
elected otherwise. If both primary and contingent Beneficiaries have been
named, payment will be made to the named primary Beneficiaries living at
the time the death benefits become payable. If there is more than one
Beneficiary and You failed to specify their interest, they will share
equally. If any primary Beneficiary is alive at the time the death benefits
become payable, but dies before receiving their payment, their share will
be paid to their estate.
Change of Beneficiary
You may change the Beneficiary while the Annuitant is living, unless an
irrevocable one has been named. Change is made by Written Notice. The
change takes effect on the date the Written Request was signed, and the
Written Request must have been postmarked on or before the date of the
Annuitant's death. Annuity Payment(s) made before the Written Request was
received will not be reissued. We may require return of this Contract for
endorsement before making a change.
Incontestability
This Contract is incontestable from the Contract Issue Date.
11
SECTION 7---GENERAL PROVISIONS (Continued)
Misstatement of Age or Sex
If the age or sex of any Annuitant has been misstated, the Annuity Payments
will be those which the Single Premium paid would have purchased for the
correct age and sex. Any underpayment made by Us will be paid with the next
Annuity Payment. Any overpayment made by Us will be deducted from future
Annuity Payments. Any underpayment or overpayment will include interest at
5% per year, from the date of the incorrect payment to the date of the
adjustment.
Modification of Contract
No change in this Contract is valid unless made in writing by Us and
approved by one of Our officers. No agent has authority to change or waive
any provision of Your Contract.
Nonparticipating
Your Contract is nonparticipating. This means We do not pay dividends on
it. Your Contract will not share in Our profits or surplus earnings.
Owner
You, the Owner, are named in Section 1, Contract Specifications. You may,
while any Annuitant is living, exercise all rights granted by this
Contract. These rights are subject to the rights of any assignee or living
irrevocable Beneficiary. "Irrevocable" means that You have given up Your
right to change the Beneficiary named.
If You die, the rights of Ownership will vest in the executors,
administrators or assigns of the Owner.
Unless We have been notified of a community or marital property interest in
this Contract, We will rely on Our good faith belief that no such interest
exists and will assume no responsibility for inquiry.
Annuity Payments are generally taxable to the Owner.
Proof of Death
Any Beneficiary claiming an interest in the Contract must provide the
Company in writing with due proof of death of the Payee/Annuitant and/or
Secondary Annuitant (if any). If payments have been paid prior to receiving
due proof of death, We will deduct the payment(s) from the calculated death
benefit.
Proof of Survival
If Annuity Payments under this Contract depend on a person being alive on a
given date, proof of survival may be required by the Company prior to
making the payments.
Protection Of Proceeds
Unless You so direct by filing Written Request with Us, no Beneficiary may
assign payments under this Contract before the same are due. To the extent
permitted by law, no payments under this Contract will be subject to the
claims of creditors of any Beneficiary.
12
SECTION 7---GENERAL PROVISIONS (Continued)
Reserves
The reserves held by Us for this Contract shall not be less than the
minimum required by the laws and regulations of the state in which this
Contract is delivered.
Reports To Owner
You will receive a confirmation statement each time You transfer Annuity
Units among the Subaccounts, make transfers from variable Annuity Payments
to fixed Annuity Payments, or take a partial or full surrender (if
available under Your payment option).
We will also send you reports containing financial statements for the
Funds, and a list of portfolio securities of the Funds, as required by the
Investment Company Act of 1940.
Successor Owner
The person named by the Owner to whom ownership of this Contract passes
upon the Owner's death, unless the Owner was also the Annuitant, in which
case the Annuitant's Beneficiary is entitled to benefits described in
Section 8, Death Proceeds.
Tax Qualification
This Contract is intended to qualify as an annuity Contract for federal
income tax purposes. The provisions of this Contract are to be interpreted
to maintain such qualification, notwithstanding any other provisions to the
contrary. To maintain such tax qualification, We reserve the right to amend
this Contract to reflect any clarifications that may be needed or are
appropriate to maintain such tax qualification or to conform this Contract
to any applicable changes in the tax qualification requirements. We will
send a copy to You in the event of any such amendment. If You refuse such
an amendment, it must be by giving Us Written Request, and Your refusal may
result in adverse tax consequences.
SECTION 8---DEATH PROCEEDS
If an Owner, who is also an Annuitant, dies before the First Payment Date,
the amount of the death proceeds is the premium plus or minus the
investment performance of the Subaccounts. If an Owner, who is not an
Annuitant, dies before the First Payment Date, the Successor Owner may
direct the Owner's interest in the Contract to be distributed as follows:
(i) one cash lump sum to be distributed within five years of the
deceased owner's death;
(ii) annuitize the death proceeds over the lifetime of the Successor
Owner; or
(iii) annuitize the death proceeds over a period that does not exceed
the life expectancy of the Successor Owner as defined by the
Code.
Subparagraphs (ii) and (iii) apply only to individuals, and such payments
must start within one year of the date of the Owner's death.
If the owner, who may or may not also be an Annuitant, dies, on or after
the First Payment Date, the remaining portion of the Annuity Payments due
under the Contract, if any, will be distributed in the same manner and
frequency (at least as rapidly) as under the method of distribution used
before the Owner's death.
13
SECTION 8---DEATH PROCEEDS (Continued)
If the Owner's surviving spouse, if any, is the Successor Owner, then on
the Owner's death he or she may elect to become the Owner under the
Contract and to continue the Contract as his or her own. If no such
election is made, the rules outlined in the foregoing paragraphs of this
section will apply.
If the Owner, who is also the Annuitant, dies and no Beneficiary is named
or the Beneficiary has predeceased the Owner/Annuitant, the Owner's estate
shall be deemed the Beneficiary.
If at any time the Annuitant, or last Annuitant for a joint contract, dies,
the Beneficiary will receive the remaining portion of the Annuity Payments
due under the contract, if any. Payments will be made in the same manner
and frequency (at least as rapidly) as under the method of distribution
used before the Annuitant's death.
If a non-natural person is named as an Owner, then the primary Annuitant
shall be treated as an Owner solely for the purposes of this Section 8. The
entire interest in the Contract must be distributed upon the Annuitant's
death, if the Annuitant dies prior to the First Payment Date.
In all events, notwithstanding anything to the contrary in this Contract,
distributions on the death of an Owner shall conform to the requirements of
Section 72(s) of the Code.
14
PFL Life Insurance Company
Administrative Office: 0000 Xxxxxxxx Xxxx X. X., Xxxxx Xxxxxx, Xxxx 00000
FIXED AND VARIABLE
SINGLE PREMIUM IMMEDIATE INCOME ANNUITY
NONPARTICIPATING
PFL Life Insurance Company
Administrative Office: 0000 Xxxxxxxx Xxxx X. X., Xxxxx Xxxxxx, Xxxx 00000
Initial Payment Guarantee Rider
Guaranteed Minimum Payment [$500.00]
Initial Payment Guarantee Rider Fee [1.25%]
Investment Limitations [None]
You have selected the Initial Payment Guarantee Option. This Rider, which
is issued as part of Your Contract, explains the guarantees, terms and
conditions under the Option. The Initial Payment Guarantee Rider applies
only to stabilized variable Annuity Payments.
Definitions
Guaranteed Minimum Payment - the minimum payment We guarantee. Your
Stabilized Payments will never be less than this amount, shown at the top
of this page.
Initial Payment Guarantee Option and First-Year Stabilized Payment
With the Initial Payment Guarantee Option, Your Stabilized Payments will
never be less than the Guaranteed Minimum Payment. For the first year, Your
Stabilized Payment is equal to the Estimated First Variable Annuity
Payment.
How Subsequent Stabilized Payments are Determined
On each Contract anniversary, We will determine a new Stabilized Payment.
The new Stabilized Payment will equal the greater of the Guaranteed Minimum
Payment or the Supportable Payment.
IF the Supportable Payment is greater than the Guaranteed Minimum
Payment,
THEN the Supportable Payment becomes Your new Stabilized Payment for
the following year; or
IF the Supportable Payment is less than or equal to the Guaranteed
Minimum Payment,
THEN the Guaranteed Minimum Payment becomes Your new Stabilized
Payment for the following year.
Other Terms and Conditions
We reserve the right to limit allocations to certain subaccounts.
Limitations, if any, are described in the Investment Limitations section at
the top of the first page of this Rider.
Form No. XXXX IP 0100
Rider Fee
The annual fee for this Option is shown at the top of the first page of
this Rider. We will deduct the fee in addition to and in the same manner as
We deduct the Separate Account Charge.
Surrender Values and Death Benefits
With the Initial Payment Guarantee Option, the surrender values and death
benefits available with the Certain Only or Life with Emergency Cash
payment options are determined using the current Supportable Payment, not
the Stabilized Payment.
Reductions to the Guaranteed Minimum Payment and Stabilized Payment
If You transfer from variable Annuity Payments to fixed Annuity Payments,
the amount of the Guaranteed Minimum Payment and the Stabilized Payment
will be reduced pro rata. For example, if You transfer 25% of Your variable
Annuity Payment to fixed Annuity Payments the Guaranteed Minimum Payment
and the Stabilized Payment will also be reduced by 25%. The reductions will
be reflected in the first payment following the transfer.
If You select a Joint and Survivor payment option with reduced payments to
the survivor and one of the annuitants dies, the Guaranteed Minimum Payment
and the Stabilized Payment will be reduced pro-rata. For example, if You
selected the Joint and 75% Survivor payment option and one of the
annuitants dies, the Guaranteed Minimum Benefit and the Stabilized Payment
will be reduced to 75%. The reductions will be reflected in the first
payment following the annuitant's death.
Payment Notice
On each Contract anniversary, We will send You a notice informing You of
the Stabilized Payment for the following year.
Signed for the Company at Our Home Office, Cedar Rapids, Iowa.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
Secretary President
2
PFL Life Insurance Company
Administrative Office: 0000 Xxxxxxxx Xxxx X. X., Xxxxx Xxxxxx, Xxxx 00000
Step -Up Payment Guarantee Rider
Initial Stabilized Payment [$500.00]
Step-Up Payment Guarantee Rider Fee [2.50%]
Immediate Payment Increase Allocation [60%]
Investment Limitations [None]
You have selected the Step-Up Payment Guarantee Option. This Rider, which is
issued as part of Your Contract, explains the guarantees, terms and conditions
under the Option. The Step-Up Payment Guarantee Rider applies only to
stabilized variable Annuity Payments.
Step-Up Payment Guarantee Option and First-Year Stabilized Payment
With the Step-Up Payment Guarantee Option, Your payments will never decrease.
In other words, Your Stabilized Payment may increase or stay the same from year
to year, but it is guaranteed to never decrease. The amount of the Stabilized
Payment for the first year is shown at the top of this page.
How Subsequent Stabilized Payments are Determined
On each Contract anniversary, We will determine a new Stabilized Payment. The
new stabilized payment will equal the greater of (((a-b)*c)+b) or b,
Where: (a) is the current Supportable Payment;
(b) is the current Stabilized Payment; and
(c) is the immediate payment increase allocation (which determines how
much of the gain in the variable annuity unit values is applied to
the new Stabilized Payment and how much is used to purchase
additional variable annuity units).
Other Terms and Conditions
We reserve the right to limit allocations to certain subaccounts. Limitations,
if any, are described in the Investment Limitations section at the top of the
first page of this Rider.
Rider Fee
The annual fee for this Option is shown at the top of the first page of this
Rider. We will deduct the fee in addition to and in the same manner as We
deduct the Separate Account Charge.
Form No. XXXX SUP 0100
Surrender Values and Death Benefits
With the Step-Up Payment Guarantee Option, the surrender values and death
benefits available with the Certain Only or Life with Emergency Cash payment
options are determined using the current Supportable Payment, not the Stabilized
Payment.
Reductions to the Stabilized Payment
If You transfer from variable Annuity Payments to fixed Annuity Payments, the
amount of the Stabilized Payment will be reduced pro rata. For example, if You
transfer 25% of Your variable Annuity Payment to fixed Annuity Payments the
Stabilized Payment will also be reduced by 25%. The reductions will be
reflected in the first payment following the transfer.
If You select a Joint and Survivor payment option with reduced payments to the
survivor and one of the annuitants dies, the Stabilized Payment will be reduced
pro rata. For example, if You selected the Joint and 75% Survivor payment
option and one of the annuitants dies, the Stabilized Payment will be reduced to
75%. The reductions will be reflected in the first payment following the
annuitant's death.
Payment Notice
On each Contract anniversary, We will send You a notice informing You of the
Stabilized Payment for the following year.
Signed for the Company at Our Home Office, Cedar Rapids, Iowa.
/s/ Xxxxx X. Xxxxxx Xxxxxxx X. Xxxxxx
Secretary President
2
PFL LIFE INSURANCE COMPANY
LIFE WITH EMERGENCY CASH RIDER
This rider is issued as part of Your non-qualified Contract. It explains the
Life with Emergency Cash payment option You selected. With the Life with
Emergency Cash option, payments are made for the Annuitant's lifetime. You also
have the right to surrender the Contract for the Emergency Cash Benefit, and
there is a death benefit up to certain ages. This payment option is available
only with variable Annuity Payments.
DEFINITIONS
Emergency Cash Benefit
The Emergency Cash Benefit is the amount You will receive if You elect to
surrender Your Contract after the Right to Cancel Period. The Emergency Cash
Benefit is available through age 100 of the Annuitant, or age 100 of the
youngest Annuitant if joint. The Emergency Cash Benefit is determined at any
time by multiplying the current Supportable Payment by the Surrender Factor
provided on the attached Emergency Cash Benefit Schedule, less any applicable
surrender charges.
Death Benefit
A death benefit will be paid upon the death of the Annuitant or last surviving
Annuitant, if joint. The death benefit will be paid if the Annuitant, or last
surviving Annuitant, if joint, dies before age 101. The amount of the death
benefit is determined the same way as the Emergency Cash Benefit, by multiplying
the current Supportable Payment by the applicable Surrender Factor, however
there is no surrender charge. The Surrender Factor should be the one
immediately preceding the last annuitant's death. No additional payments will
be made after payment of the death benefit.
Surrender Factor
The Surrender Factor is used to determine the amount that is available to
surrender and is included on the Emergency Cash Benefit Schedule. As each
variable Annuity Payment is made, the Surrender Factor is reduced by one. There
are certain ages of the youngest Annuitant where We guarantee a minimum factor
shown in the table below.
Age Minimum Factor Guarantee
--- ------------------------
[Current to age 80 [48]
Age 80 to age 85 [36]
Age 85 to age 90 [24]
Age 90 to age 101 [12]
Age 101 [0]]
Emergency Cash Benefit Schedule
This schedule includes the Surrender Factor used to calculate Your actual
Emergency Cash Benefit.
RECN 1 0100
PROVISIONS
Surrenders
You may withdraw or surrender all or part of the Emergency Cash Benefit.
Partial surrenders must be at least $2,500. If You withdraw all of the
Emergency Cash Benefit, Your contract will be terminated, no further payments
will be made and there will be no remaining death benefit. If You withdraw only
a portion of Your Emergency Cash Benefit, Your Variable Annuity Units will be
reduced by the same percentage. This in turn reduces the amount of future
variable Annuity Payments. Partial withdrawals also reduce the amount available
for future withdrawals and the death benefit. For example, if You withdraw 25%
of Your Emergency Cash Benefit, all future payments will be reduced by 25%.
Partial withdrawals will be made from the Subaccounts on a pro-rata basis.
Surrender Charge
The following surrender charges are applicable to surrenders in the first 4
years:
Surrenders in Charge
------------- ------
Year 1 [4%] of premium
Year 2 [3%] of premium
Year 3 [2%] of premium
Year 4 [1%] of premium
Year 5 and thereafter [No surrender charge]
You should consult Your tax advisor prior to making any withdrawals.
2
Emergency Cash Benefit Schedule
Owner: Xxxx Xxxxx Date of Illustration: July 15,1997
Annuitants: Xxxx Xxxxx, date of birth June 21, 1933
Xxxx Xxxxx, date of birth July 21, 1930
Premium Allocated to Life with Emergency Cash: $100,000
First Payment Date: January 1, 1998
Annuity Payment Frequency: Monthly
Surrender Surrender
Date of Payment Factor Date of Payment Factor
--------------- ------ --------------- ------
January 1998 148 July 2011 48
February 1998 147 July 2012 48
March 1998 146 July 2013 48
April 1998 145 July 2014 36
May 1998 144 July 2015 36
June 1998 143 July 2016 36
July 1998 142 July 2017 36
August 1998 141 July 2018 36
September 1998 140 July 2019 24
October 1998 139 July 2020 24
November 1998 138 July 2021 24
December 1998 137 July 2022 24
July 2023 24
July 1999 130 July 2024 12
July 2000 118 July 2025 12
July 2001 106 July 2026 12
July 2002 94 July 2027 12
July 2003 82 July 2028 12
July 2004 70 July 2029 12
July 2005 58 July 2030 12
July 2006 48 July 2031 12
July 2007 48 July 2032 12
July 2008 48 July 2033 12
July 2009 48 June 2034 12
July 2010 48 July 2034 0
Signed for the Company at Our Home Office, Cedar Rapids, Iowa.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
Secretary President
3
PFL LIFE INSURANCE COMPANY
LIFE WITH EMERGENCY CASH RIDER
This rider is issued as part of Your qualified Contract. It explains the Life
with Emergency Cash payment option You selected. With the Life with Emergency
Cash option, payments are made for the Annuitant's lifetime. You also have the
right to surrender the Contract for the Emergency Cash Benefit, and there is a
death benefit up to certain ages. This payment option is available only with
variable Annuity Payments.
DEFINITIONS
Emergency Cash Benefit
The Emergency Cash Benefit is the amount You will receive if You elect to
surrender Your Contract after the Right to Cancel Period. The Emergency Cash
Benefit is available through age 100 of the Annuitant, or age 100 of the
youngest Annuitant, if joint. The Emergency Cash Benefit is determined at any
time by multiplying the current Supportable Payment by the Surrender Factor
provided on the attached Emergency Cash Benefit Schedule, less any applicable
surrender charges.
Death Benefit
A death benefit will be paid upon the death of the Annuitant or last surviving
Annuitant, if joint. The death benefit will be paid if the Annuitant, or last
surviving Annuitant, if joint, dies before the IRS Age Limitation Date shown on
the Emergency Cash Benefit Schedule. The amount of the death benefit is
determined the same way as the Emergency Cash Benefit, by multiplying the
current Supportable Payment by the applicable Surrender Factor, however there is
no surrender charge. The Surrender Factor should be the one immediately
preceding the last Annuitant's death. No additional payments will be made after
payment of the death benefit.
Surrender Factor
The Surrender Factor is used to determine the amount that is available to
surrender and is included on the Emergency Cash Benefit Schedule. As each
variable Annuity Payment is made, the Surrender Factor is reduced by one. There
are certain ages of the youngest Annuitant where We guarantee a minimum factor
shown in the table below.
Age Minimum Factor Guarantee
--- ------------------------
[Current to age 80 [48]
Age 80 to age 85 [36]
Age 85 to age 90 [24]
Age 90 to age 101 [12]
Age 101 [0]]
Emergency Cash Benefit Schedule
This schedule includes the Surrender Factor used to calculate Your actual
Emergency Cash Benefit.
RECQ 1 0100
PROVISIONS
Surrenders
You may withdraw or surrender all or part of the Emergency Cash Benefit.
Partial surrenders must be at least $2,500. If You withdraw all of the
Emergency Cash Benefit, Your contract will be terminated, no further payments
will be made and there will be no remaining death benefit. If You withdraw only
a portion of Your Emergency Cash Benefit, Your Variable Annuity Units will be
reduced by the same percentage. This in turn reduces the amount of future
variable Annuity Payments. Partial withdrawals also reduce the amount available
for future withdrawals and the death benefit. For example, if You withdraw 25%
of Your Emergency Cash Benefit, all future payments will be reduced by 25%.
Partial withdrawals will be made from the Subaccounts on a pro-rata basis.
Surrender Charge
The following surrender charges are applicable to surrenders in the first 4
years:
Surrenders in Charge
------------- ------
Year 1 [4%] of premium
Year 2 [3%] of premium
Year 3 [2%] of premium
Year 4 [1%] of premium
Year 5 and thereafter [No surrender charge]
You should consult Your tax advisor prior to making any withdrawals.
2
Emergency Cash Benefit Schedule
Owner: Xxxx Xxxxx Date of Illustration: July 15,1997
Annuitants: Xxxx Xxxxx, date of birth June 21, 1933
Xxxx Xxxxx, date of birth July 21, 1930
IRS Age Limitation Date: June 1, 2020 (i)
Premium Allocated to Life with Emergency Cash: $100,000
First Payment Date: January 1, 1998
Annuity Payment Frequency: Monthly
Surrender Surrender
Date of Payment Factor (ii) Date of Payment Factor (ii)
--------------- ------------ --------------- -----------
January 1998 148 July 2011 48
February 1998 147 July 2012 48
March 1998 146 July 2013 48
April 1998 145 July 2014 36
May 1998 144 July 2015 36
June 1998 143 July 2016 36
July 1998 142 July 2017 36
August 1998 141 July 2018 36
September 1998 140 July 2019 24
October 1998 139 July 2020 24
November 1998 138 July 2021 24
December 1998 137 July 2022 24
July 2023 24
July 1999 130 July 2024 12
July 2000 118 July 2025 12
July 2001 106 July 2026 12
July 2002 94 July 2027 12
July 2003 82 July 2028 12
July 2004 70 July 2029 12
July 2005 58 July 2030 12
July 2006 48 July 2031 12
July 2007 48 July 2032 12
July 2008 48 July 2033 12
July 2009 48 June 2034 12
July 2010 48 July 2034 0
(i) There is no death benefit payable after this date. The IRS Age Limitation
Date is based on IRS Life Expectancy Tables V and VI.
Signed for the Company at Our Home Office, Cedar Rapids, Iowa.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
Secretary President
3
PFL LIFE INSURANCE COMPANY
FIXED ANNUITY PAYMENT
LIFE WITH EMERGENCY CASH RIDER
This rider is issued as part of Your non-qualified Contract. It explains the
Life with Emergency Cash payment option You selected. With the Life with
Emergency Cash option, payments are made for the Annuitant's lifetime. You also
have the right to surrender the Contract for the Emergency Cash Benefit, and
there is a death benefit up to certain ages.
DEFINITIONS
Emergency Cash Benefit
The Emergency Cash Benefit is the amount You will receive if You elect to
surrender Your Contract after the Right to Cancel Period. The Emergency Cash
Benefit is available through age 100 of the Annuitant, or age 100 of the younger
Annuitant, if joint. The Emergency Cash Benefit is determined at any time by
multiplying the current fixed Annuity Payment by the applicable Surrender Factor
provided on the attached Emergency Cash Benefit Schedule, less any applicable
surrender charges.
Death Benefit
A death benefit will be paid upon the death of the Annuitant or last surviving
Annuitant, if joint. The death benefit will be paid if the Annuitant, or last
surviving Annuitant, if joint, dies before age 101. The amount of the death
benefit is determined the same way as the Emergency Cash Benefit, by multiplying
the current fixed Annuity Payment by the applicable Surrender Factor, however
there is no surrender charge. The Surrender Factor should be the one
immediately preceding the last annuitant's death. No additional payments will
be made after payment of the death benefit.
Surrender Factor
The Surrender Factor is used to determine the amount that is available to
surrender and is included on the Emergency Cash Benefit Schedule. As each
Annuity Payment is made, the Surrender Factor is reduced by one. There are
certain ages of the youngest Annuitant where We guarantee a minimum factor shown
in the table below.
Age Minimum Factor Guarantee
--- ------------------------
[Current to age 80 [48]
Age 80 to age 85 [36]
Age 85 to age 90 [24]
Age 90 to age 101 [12]
Age 101 [0]]
Emergency Cash Benefit Schedule
This schedule includes the Surrender Factor used to calculate Your actual
Emergency Cash Benefit.
RECN FAP 1200
2
PROVISIONS
[Transfers
You may transfer all or part of your variable Annuity Payment to your fixed
Annuity Payment. If a transfer to Your fixed Annuity Payment is made, we will
adjust your Surrender Factor and issue a new Life with Emergency Cash Rider to
you.]
Surrenders
You may withdraw or surrender all or part of the Emergency Cash Benefit.
Partial surrenders must be at least $2,500. If You withdraw only a portion of
Your Emergency Cash Benefit, Your fixed Annuity Payment will be reduced by the
same percentage. For example, if You withdraw 25% of Your Emergency Cash
Benefit, all future payments will be reduced by 25%. Partial withdrawals also
reduce the amount available for future withdrawals and the death benefit.
Surrender Charge
The following surrender charges are applicable to surrenders in the first 4
years:
Surrenders in Charge
------------- ------
Year 1 [4%] of premium
Year 2 [3%] of premium
Year 3 [2%] of premium
Year 4 [1%] of premium
Year 5 and thereafter [No surrender charge]
You should consult Your tax advisor prior to making any withdrawals.
3
Fixed Annuity Payment
Emergency Cash Benefit Schedule
Owner: [Xxxx Xxxxx] Date of Illustration: [July 15,1997]
Annuitants: [Xxxx Xxxxx, date of birth June 21, 1933]
[Xxxx Xxxxx, date of birth July 21, 1930]
Premium Allocated to Life with Emergency Cash: [$100,000]
First Payment Date: [January 1, 1998]
Annuity Payment Frequency: [Monthly]
Surrender Surrender
Date of Payment Factor Date of Payment Factor
--------------- ------ --------------- ------
[January 1998 148 July 2011 48
February 1998 147 July 2012 48
March 1998 146 July 2013 48
April 1998 145 July 2014 36
May 1998 144 July 2015 36
June 1998 143 July 2016 36
July 1998 142 July 2017 36
August 1998 141 July 2018 36
September 1998 140 July 2019 24
October 1998 139 July 2020 24
November 1998 138 July 2021 24
December 1998 137 July 2022 24
July 2023 24
July 1999 130 July 2024 12
July 2000 118 July 2025 12
July 2001 106 July 2026 12
July 2002 94 July 2027 12
July 2003 82 July 2028 12
July 2004 70 July 2029 12
July 2005 58 July 2030 12
July 2006 48 July 2031 12
July 2007 48 July 2032 12
July 2008 48 July 2033 12
July 2009 48 June 2034 12
July 2010 48 July 2034 0]
Signed for the Company at Our Home Office, Cedar Rapids, Iowa.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxx X. Xxxxxx
Secretary President
3
PFL LIFE INSURANCE COMPANY
FIXED ANNUITY PAYMENT
LIFE WITH EMERGENCY CASH RIDER
This rider is issued as part of Your qualified Contract. It explains the Life
with Emergency Cash payment option You selected. With the Life with Emergency
Cash option, payments are made for the Annuitant's lifetime. You also have the
right to surrender the Contract for the Emergency Cash Benefit, and there is a
death benefit up to certain ages.
DEFINITIONS
Emergency Cash Benefit
The Emergency Cash Benefit is the amount You will receive if You elect to
surrender Your Contract after the Right to Cancel Period. The Emergency Cash
Benefit is available through age 100 of the Annuitant, or age 100 of the younger
Annuitant, if joint. The Emergency Cash Benefit is determined at any time by
multiplying the current fixed Annuity Payment by the applicable Surrender Factor
provided on the attached Emergency Cash Benefit Schedule, less any applicable
surrender charges.
Death Benefit
A death benefit will be paid upon the death of the Annuitant or last surviving
Annuitant, if joint. The death benefit will be paid if the Annuitant, or last
surviving Annuitant, if joint, dies before the IRS Age Limitation Date shown on
the Emergency Cash Benefit Schedule. The amount of the death benefit is
determined the same way as the Emergency Cash Benefit, by multiplying the
current fixed Annuity Payment by the applicable Surrender Factor, however there
is no surrender charge. The Surrender Factor should be the one immediately
preceding the last Annuitant's death. No additional payments will be made after
payment of the death benefit.
Surrender Factor
The Surrender Factor is used to determine the amount that is available to
surrender and is included on the Emergency Cash Benefit Schedule. As each
Annuity Payment is made, the Surrender Factor is reduced by one. There are
certain ages of the youngest Annuitant where We guarantee a minimum factor shown
in the table below.
Age Minimum Factor Guarantee
--- ------------------------
[Current to age 80 [48]
Age 80 to age 85 [36]
Age 85 to age 90 [24]
Age 90 to age 101 [12]
Age 101 [0]]
Emergency Cash Benefit Schedule
This schedule includes the Surrender Factor used to calculate Your actual
Emergency Cash Benefit.
RECQ FAP 1200
1
PROVISIONS
[Transfers
You may transfer all or part of your variable Annuity Payment to your fixed
Annuity Payment. If a transfer to Your fixed Annuity Payment is made, we will
adjust your Surrender Factor and issue a new Life with Emergency Cash Rider to
you.]
Surrenders
You may withdraw or surrender all or part of the Emergency Cash Benefit.
Partial surrenders must be at least $2,500. If You withdraw only a portion of
Your Emergency Cash Benefit, Your fixed Annuity Payment will be reduced by the
same percentage. For example, if You withdraw 25% of Your Emergency Cash
Benefit, all future payments will be reduced by 25%. Partial withdrawals also
reduce the amount available for future withdrawals and the death benefit.
Surrender Charge
The following surrender charges are applicable to surrenders in the first 4
years:
Surrenders in Charge
------------- ------
Year 1 [4%] of premium
Year 2 [3%] of premium
Year 3 [2%] of premium
Year 4 [1%] of premium
Year 5 and thereafter [No surrender charge]
You should consult Your tax advisor prior to making any withdrawals.
2
Fixed Annuity Payment
Emergency Cash Benefit Schedule
Owner: [Xxxx Xxxxx] Date of Illustration: [July 15,1997]
Annuitants: [Xxxx Xxxxx, date of birth June 21, 1933]
[Xxxx Xxxxx, date of birth July 21, 1930]
IRS Age Limitation Date: [June 1, 2020] (i)
Premium Allocated to Life with Emergency Cash: [$100,000]
First Payment Date: [January 1, 1998]
Annuity Payment Frequency: [Monthly]
Surrender Surrender
Date of Payment Factor Date of Payment Factor
--------------- ------ --------------- ------
[January 1998 148 July 2011 48
February 1998 147 July 2012 48
March 1998 146 July 2013 48
April 1998 145 July 2014 36
May 1998 144 July 2015 36
June 1998 143 July 2016 36
July 1998 142 July 2017 36
August 1998 141 July 2018 36
September 1998 140 July 2019 24
October 1998 139 July 2020 24
November 1998 138 July 2021 24
December 1998 137 July 2022 24
July 2023 24
July 1999 130 July 2024 12
July 2000 118 July 2025 12
July 2001 106 July 2026 12
July 2002 94 July 2027 12
July 2003 82 July 2028 12
July 2004 70 July 2029 12
July 2005 58 July 2030 12
July 2006 48 July 2031 12
July 2007 48 July 2032 12
July 2008 48 July 2033 12
July 2009 48 June 2034 12
July 2010 48 July 2034 0]
(i) There is no death benefit payable after this date. The IRS Age Limitation
Date is based on IRS Life Expectancy Tables V and VI.
Signed for the Company at Our Home Office, Cedar Rapids, Iowa.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxx X. Xxxxxx
Secretary President
3