VARIABLE IMMEDIATE ANNUITY CONTRACT
THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES
This is a legal contract between its owner and us. Please read it carefully.
In this Contract, "you" and "your" refer to the owner, and "we," "us," and "our"
refer to Equitable.
We agree to pay an annuity based on the terms shown on the Data Pages. Other
important terms are described in the various parts of this Contract.
THE AMOUNT OF EACH VARIABLE INCOME ANNUITY PAYMENT MAY INCREASE OR DECREASE,
DEPENDING ON INVESTMENT RESULTS OF THE SEPARATE ACCOUNT INVESTMENT FUNDS, AND IS
NOT GUARANTEED AS TO DOLLAR AMOUNT.
TEN DAY RIGHT TO EXAMINE CONTRACT: You may return this Contract to us within 10
days from the date you receive it. Return it to the Processing Office shown
below. If you return it within the 10-day period, your Contract will be canceled
from the Contract Date. We will refund any premium made, less any distribution
payable. After this 10-day period, this Contract may not be surrendered.
Processing Office: [Annuity Benefits Division, X.X. Xxx 0000, Xxx Xxxx, X.X.
00000-0000]
NEW YORK,
THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES
/s/ Xxxxxx X. Xxxxxx /s/ Xxxxx X. Xxxxxx
Chairman and Chief Executive Officer President and Chief Operating
Officer
Vice President and Secretary
VIA95JSL 1
VARIABLE IMMEDIATE ANNUITY CONTRACT. Non-participating (no dividends payable).
Non-assignable. Non-transferable.
VIA95JSL 2
DATA PAGES
OWNER [Xxxx Xxx] [September 1, 1995] CONTRACT DATE
ANNUITY FORM [Joint and [XXXXX] CONTRACT NUMBER
Survivor Life Annuity]
ANNUITANT [Xxxx Xxx] [70-1/2 - M] ISSUE AGE AND SEX
Xxxx Xxx, Joint Annuitant] [69-1/2 F]
PREMIUM [$10,000] [October 1, 1995] DATE OF FIRST PAYMENT
[PREMIUM ALLOCATION]
[Fixed Income] [xx%]
[Variable Income] [yy%]
ANNUITY OPTIONS:
[ o FIXED INCOME ANNUITY Amount of Fixed Income Annuity Payment $50.00]
o VARIABLE INCOME ANNUITIES: NUMBER OF
INVESTMENT FUNDS* ANNUITY UNITS
[MONEY MARKET XX.XXX
INTERMEDIATE GOVERNMENT XX.XXX
SECURITIES
QUALITY BOND XX.XXX
HIGH YIELD XX.XXX
GROWTH & INCOME XX.XXX
EQUITY INDEX XX.XXX
COMMON STOCK XX.XXX
GLOBAL XX.XXX
INTERNATIONAL XX.XXX
AGGRESSIVE STOCK XX.XXX
CONSERVATIVE INVESTORS XX.XXX
BALANCED XX.XXX
GROWTH INVESTORS] XX.XXX
[Dollar amount of Variable Annuity Payment [$50.00]
Total Initial Payment Amount [$100.00]
* These are Funds of our Separate Account [A.]
SUCCESSOR OWNER [Xxxx Xxx], for the purposes of item 3, Part C.
VIA95JSL 3
DATE OF ISSUE [September 1, 1995]
VIA95JSL 4
DATA PAGES (CONT'D.)
ASSUMED BASE RATE OF NET INVESTMENT RETURN: [5.0%][3.5%] PER YEAR
ADJUSTMENT FACTOR [.00013366]
[.00009425] for
each day in the
Valuation Period.
[ADMINISTRATIVE EXPENSE CHARGE: [$200] FOR CONTRACT AT ISSUE]
DAILY SEPARATE ACCOUNT CHARGE: [Annual rate of: .50%. This charge
is in addition to investment advisory fees and direct operating expenses
charged with respect to an Investment Fund as described in item 2.b. of
Part B.]
[INTEREST RATE (FOR FIXED INCOME
ANNUITY):] [6.0%]
[TRANSFERS AMONG [Not permitted]
INVESTMENT FUNDS:]
VIA95JSL 5
PART A. BASIC TERMS
--------------------
1. ANNUITANT:
"Annuitant" is the person or persons shown as such on the Data Pages and
during whose lifetime an income will be payable to the Owner, unless the
Owner specifies otherwise. If there is a Joint Annuitant, the Joint
Annuitant's name is shown on the Data Pages and this term will also mean
such Joint Annuitant.
2. ANNUITY BENEFIT:
"Annuity Benefit" means the benefit payable by us pursuant to the annuity
options provided under this Contract.
"Fixed Income Annuity" means an annuity option under which the monthly
payments are payable in a specified dollar amount. "Variable Income
Annuity" means an annuity option under which the dollar amount of such
monthly payment may increase or decrease depending on whether the actual
rate of net investment return (after charges) of the applicable
Investment Fund is higher or lower than the Assumed Base Rate of Net
Investment Return shown on the Data Pages.
3. ANNUITY UNIT:
"Annuity Unit" applies to the Variable Income Annuity only and is a unit
of measurement used in determining the amount of each Variable Income
Annuity payment. The number of Annuity Units is calculated by dividing
the first monthly Variable Income Annuity payment amount by the unit
value for the Valuation Period which includes the due date of the first
monthly payment.
4. ANNUITY UNIT VALUE:
"Annuity Unit Value" means the dollar value of any given date of each
Annuity Unit in each applicable Investment Fund of the Separate Account.
5. BUSINESS DAY:
A Business Day is any day on which we are open and the New York Stock
Exchange is open for trading.
6. CONTRACT DATE:
"Contract Date" is the date we receive the properly completed application
and the premium for which annuity payments are made under this Contract.
7. INVESTMENT FUNDS:
"Investment Funds" are sub-funds of the Separate Account. Each Investment
Fund may invest its assets in a separate class (or series) of a specified
trust or investment company where each class (or
VIA95JSL 6
series) represents a separate portfolio in such trust or investment
company. The Data Pages show the available Investment Funds on the
Contract Date. We will notify you of any changes in the Investment Funds
available.
8. OWNER:
"Owner" is the person shown on the Data Pages, or any Successor Owner,
who has the rights and options described in this Contract. The Owner may
be changed, if you notify us in writing in a form we accept; the changes
will, upon recording at the Processing Office, take effect as of the date
the written form was signed, but without further liability as to any
payment made by us before recording the change.
9. PREMIUM:
"Premium" is the amount received by us under this Contract, before
deduction of the Administrative Expense Charge shown on the Data Pages
and any other charges, including state premium tax, which may apply. The
Premium is shown on the Data Pages.
10. PROCESSING OFFICE:
"Processing Office" is the administrative office shown on the cover page
of this Contract. If we change it, we will notify you.
11. SUCCESSOR OWNER:
"Successor Owner" is the person or persons who succeeds as Owner in the
event of your death before the Annuitant. The Successor Owner may be
changed, if you notify us in writing in a form we accept; the change
will, upon recording at the Processing Office, take effect as of the date
the written form was signed, but without further liability as to any
payment made by us before recording the change.
12. VALUATION PERIOD:
A "Valuation Period" is each Business Day together with any consecutive
preceding non-Business Days. For example, for each Monday which is a
Business Day, the preceding Saturday and Sunday will be included to equal
a three-day Valuation Period.
VIA95JSL 7
PART B. ANNUITY OPTIONS
------------------------
1. FIXED INCOME ANNUITY:
The amount of Fixed Income Annuity, if applicable, provided by allocation
of a portion of the Premium is determined taking into account Interest
Rate shown on the Data Pages. Fixed Income Annuity payments are
guaranteed without regard to any investment results or to future changes
in interest rates.
2. VARIABLE INCOME ANNUITY:
The initial payment amount of the Variable Income Annuity, if applicable,
provided by allocation of a portion of the Premium is determined taking
into account the Assumed Base Rate of Net Investment Return shown on the
Data Pages. Variable Income Annuity payments will vary based on the
investment results of the applicable Separate Account Investment Funds.
A. SEPARATE ACCOUNT:
We have established the Separate Account shown on the Data Pages
and maintain it in accordance with the laws of New York State.
Income and realized and unrealized gains and 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
placed in the Separate Account to support this Contract and other
variable annuity contracts and certificates. Assets may be placed
in the Separate Account for other purposes, but not to support
contracts or policies other than variable annuities and variable
life insurance. A Separate Account may be subdivided into
Investment Funds, also as shown on the Data Pages.
The assets of the Separate Account are our property. The portion
of such assets equal to the reserves and other contract
liabilities will not be chargeable with liabilities which arise
out of any other business we conduct. We may transfer assets of
the Separate Account or Investment Fund in excess of the reserves
and other liabilities with respect to such Account or Fund to
another Separate Account or Investment Fund or to our general
account.
We may, at our discretion, invest Separate Account assets in any
investment permitted by applicable law. We may rely conclusively
on the opinion of counsel (including counsel in our employ) as to
what investments we may make as law permits.
B. SEPARATE ACCOUNT ANNUITY UNIT VALUES:
We determine the Annuity Unit Value for the Separate Account for
each Valuation Period as described below.
The Net Investment Factor for a Valuation Period is (i) divided by
(ii) minus (iii), where
(i) is the net asset value of the Investment Fund's shares of
the related portfolio of the specified trust or investment
company at the end of the Valuation Period (before taking
into account any amounts allocated to or withdrawn from the
Investment Fund for the
VIA95JSL 8
Valuation Period and after deduction of investment advisory
fees and direct operating expenses of the specified trust
or investment company; for this purpose, we use the share
value reported to us by the specified trust or investment
company);
(ii) is the net asset value of the Investment Fund's shares of
the related portfolio of the specified trust or investment
company at the end of the preceding Valuation Period
(taking into account any amounts allocated or withdrawn for
that Valuation Period);
(iii) is the daily Separate Account charge (see item c. below)
for the expenses and risks of the Contract, times the
number of calendar days in the Valuation Period, plus any
charge for taxes or amounts set aside as a reserve for
taxes.
The Annuity Unit Value for a Valuation Period is the Annuity Unit
Value for the immediately preceding Valuation Period multiplied by
the Adjusted Net Investment Factor for such subsequent Valuation
Period. The Adjusted Net Investment Factor for a Valuation Period
is the Net Investment Factor for such Period reduced for each
calendar day in such subsequent Valuation Period by the Adjustment
Factor (shown on the Data Pages) times the Net Investment Factor
in order to recognize the Assumed Base Rate of Net Investment
Return (also shown on the Data Pages) used in the determination of
the number of Annuity Units. Because of this adjustment, the
Annuity Unit Value rises and falls depending on whether the actual
rate of investment return (after charges) is higher or lower than
the Assumed Base Rate of Net Investment Return.
The Average Annuity Unit Value for a calendar month is equal to
the average of the Annuity Unit Values for such month. We will
notify you or the person to whom payment is being made of the
Average Annuity Unit Value used in determining the amount of each
variable annuity payment.
C. DAILY SEPARATE ACCOUNT CHARGE:
Assets of the Investment Funds will be subject to a daily asset
charge. This daily asset charge is for mortality risk, expenses
and expense risk that we assume, as well as for financial
accounting. The charge will be made pursuant to item (iii) of
"Net Investment Factor" as defined in item b. above. Such charge
will be applied after any deductions to provide for taxes. The
amount of the charge is shown on the Data Pages.
D. CHANGES WITH RESPECT TO SEPARATE ACCOUNT:
We have the right, subject to compliance with applicable law,
and, if required, approval of Contract Owners:
(a) to add Investment Funds (or sub-funds of Investment
Funds) to, or to remove Investment Funds (or sub-funds)
from, the Separate Account, or to add other separate
accounts in addition to or in place of the Separate
Account;
(b) to combine any two or more Investment Funds or sub-funds
thereof;
VIA95JSL 9
(c) to transfer the assets we determine to be the share of
the class of contract to which this Contract belongs from
any Investment Fund to another Investment Fund, or from
the Separate Account to another separate account, if such
other Investment Fund or separate account has, in our
judgment, the same investment objectives;
(d) to operate the Separate Account or any Investment Fund as
a management investment company under the Investment
Company Act of 1940, in which case charges and expenses
that otherwise would be assessed against an underlying
mutual fund would be assessed against the Separate
Account;
(e) to operate the Separate Account or any Investment Fund as
a unit investment trust under the Investment Company Act
of 1940;
(f) to register or deregister the Separate Account under the
Investment Company Act of 1940, provided that such action
conforms with the requirements of applicable law;
(g) to restrict or eliminate any voting rights as to the
Separate Account;
(h) to cause one or more Investment Funds to invest some or
all of their assets in one or more other trusts or
investment companies.
A portfolio might, in our judgment, become unsuitable for
investment by the Separate Account or Investment Funds, in view
of legal, regulatory, or federal income tax restrictions. In such
event, shares of another series or shares of another investment
trust may be substituted for shares already purchased with
respect to the Separate Account or as the security to be
purchased in the future, provided that such substitution meets
applicable federal income tax guidelines and, to the extent
required by law, has been approved by the Securities and Exchange
Commission and such other regulatory authorities as may be
necessary.
If the exercise of these rights results in a material change in
the underlying investments of the Separate Account, you will be
notified of such exercise, as required by law.
VIA95JSL 10
PART C. ANNUITY BENEFITS
-------------------------
1. MONTHLY PAYMENTS:
We will pay a monthly life income commencing on the Date of First Payment
shown on the Data Pages and thereafter for the remaining lifetime of the
Annuitant and Joint Annuitant, with payments continued for the lifetime
of the survivor after the death of either the Annuitant or Joint
Annuitant. Monthly payments will continue to be made until the last
payment due before the death of the survivor.
2. AMOUNT OF EACH PAYMENT:
The amount of the first payment is shown on the Data Pages as the Total
Initial Payment Amount; the Total Initial Payment Amount shown is the sum
of the Fixed Income Annuity payment amount and the first Variable Income
Annuity payment amount. With respect to later payments, each monthly
payment will be the sum of the Fixed Income Annuity payment and the
Variable Income Annuity payment, determined as follows:
(a) Each Fixed Income Annuity payment will be made at the amount shown
on the Data Pages.
(b) The amount of the second and third monthly Variable Income Annuity
payments with respect to each applicable Investment Fund will be the
same as the amount of the first payment. The amount of the fourth
and each subsequent monthly payment will be the number of Annuity
Units for each Investment Fund multiplied by the Average Annuity
Unit Value for the second calendar month immediately preceding the
due date of the payment.
The fourth and subsequent monthly Variable Income Annuity payments
may increase or decrease in amount, depending on whether the actual
rate of net investment return (after charges) of the applicable
Investment Fund is higher or lower than the Assumed Base Rate of Net
Investment Return shown on the Data Pages. Payments will not be
increased or decreased in amount because of mortality or expense
experience.
3. DEATH OF OWNER:
If you are not the Annuitant and you die before the Annuitant, upon the
date of receipt by us at the Processing Office of proof satisfactory to
us of your death, the Successor Owner becomes the Owner with all rights
under this Contract. If you die before the Annuitant and if no Successor
Owner is alive, your estate becomes the Owner.
VIA95JSL 11
PART D. TRANSFERS
------------------
Transfers among Investment Funds are permitted only if so stated on the Data
Pages. If the Data Pages do not state that transfers are permitted, and if after
the Contract Date we change our rules to permit such transfers, we will notify
you in writing. The notice will specify any restrictions which apply.
VIA95JSL 12
PART E. GENERAL TERMS
----------------------
1. CONTRACT:
This Contract, the related application and any endorsement(s) constitute
the entire Contract between the parties, and their terms alone will
govern with respect to our rights and obligations. The Contract may not
be modified, nor may any of our rights or requirements be waived, except
in writing signed by one of our authorized officers.
2. ASSIGNMENT:
This Contract may not be sold, assigned, discounted or pledged as
collateral for a loan or as security for the performance of an obligation
or for any other purpose, and except as otherwise permitted by law, no
sum payable under this Contract may be transferred, assigned or
encumbered, or will in any way be subject to any legal process to subject
the same to the payment of any claim against the person to whom such sum
is payable.
3. PAYMENT:
All payments by us under this Contract will be made by check (or, if so
agreed by you and us, by wire transfer or other form).
4. EVIDENCE OF SURVIVAL:
We may require satisfactory evidence of survival of the Annuitant on the
due date of each payment. If the check for the payment is drawn to the
order of the Annuitant, the personal endorsement of such Annuitant on the
check will be accepted as evidence of survival, subject to our right to
require evidence of the authority of any person who makes claim to
receive any payment.
5. AGE AND SEX:
If the Annuitant's age or, if applicable, sex has been misstated, any
benefits will be such as the Contract would have provided if the first
payment amount had been based on the correct age and sex. Any
overpayments or underpayments made by us will be charged or credited with
interest at [6% per year] (or such other rate which applies under our
rules at any time) to benefits falling due thereafter.
6. CONTRACT CHANGES - APPLICABLE LAW:
For you (and the Annuitant) to receive the tax treatment accorded to
annuities under Federal law, this Contract must qualify initially and
continue to qualify as an annuity under the Internal Revenue Code or
successor law. Therefore, to assure this qualification, we reserve in
this Contract the right to defer acceptance of or to return any payment
that would cause the Contract to fail to qualify as an annuity under
applicable tax law as interpreted by us. Furthermore, we reserve the
right to make changes in this Contract to the extent we deem it necessary
to continue to qualify this Contract as
VIA95JSL 13
an annuity. Any such changes will apply uniformly to all Contracts that
are affected. You will be given advance written notice of such changes.
In addition, payments under this Contract must comply with any applicable
requirements of Section 401(a)(9) of the Internal Revenue Code and the
Treasury regulations which apply.
VIA95JSL 14
ENDORSEMENT
NOTICE OF RIGHT TO CANCEL
-------------------------
This Contract provides a ten day right to cancel. See the cover page. If you
cancel the Contract according to this right, you will receive a refund of any
premium made, plus or minus any investment gain or loss which applies to the
Separate Account Investment Funds from the date the premium or portion thereof
was allocated to any such Investment Fund, if applicable, to the date the
Contract is canceled.
ENDVIA95
VARIABLE IMMEDIATE ANNUITY CONTRACT
THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES
This is a legal contract between its owner and us. Please read it carefully.
In this Contract, "you" and "your" refer to the owner, and "we," "us," and "our"
refer to Equitable.
We agree to pay an annuity based on the terms shown on the Data Pages. Other
important terms are described in the various parts of this Contract.
THE AMOUNT OF EACH VARIABLE INCOME ANNUITY PAYMENT MAY INCREASE OR DECREASE,
DEPENDING ON INVESTMENT RESULTS OF THE SEPARATE ACCOUNT INVESTMENT FUNDS, AND IS
NOT GUARANTEED AS TO DOLLAR AMOUNT.
TEN DAY RIGHT TO EXAMINE CONTRACT: You may return this Contract to us within 10
days from the date you receive it. Return it to the Processing Office shown
below. If you return it within the 10-day period, your Contract will be canceled
from the Contract Date. We will refund any premium made, less any distribution
payable. After this 10-day period, this Contract may not be surrendered.
Processing Office: [Annuity Benefits Division, X.X. Xxx 0000, Xxx Xxxx, X.X.
00000-0000]
NEW YORK,
THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES
/s/ Xxxxxx X. Xxxxxx /s/ Xxxxx X. Xxxxxx
Chairman and Chief Executive Officer President and
Chief Operating Officer
Vice President and Secretary
VARIABLE IMMEDIATE ANNUITY CONTRACT. Non-participating (no dividends payable).
Non-assignable. Non-transferable.
VIA95JSLPC 1
DATA PAGES
OWNER [Xxxx Xxx] [September 1, 1995] CONTRACT DATE
ANNUITY FORM [Joint and Survivor Life Annuity] [XXXXX] CONTRACT NUMBER
10 Year Certain]
ANNUITANT [Xxxx Xxx] [70-1/2 - M] ISSUE AGE AND SEX
[Xxxx Xxx, Joint Annuitant] [69-1/2 F]
PREMIUM [$10,000] [October 1, 1995] DATE OF FIRST PAYMENT
[PREMIUM ALLOCATION]
[Fixed Income] [xx%]
[Variable Income] [yy%]
ANNUITY OPTIONS:
[ o FIXED INCOME ANNUITY Amount of Fixed Income Annuity Payment $50.00]
o VARIABLE INCOME ANNUITIES: NUMBER OF
INVESTMENT FUNDS* ANNUITY UNITS
[MONEY MARKET XX.XXX
INTERMEDIATE GOVERNMENT XX.XXX
SECURITIES
QUALITY BOND XX.XXX
HIGH YIELD XX.XXX
GROWTH & INCOME XX.XXX
EQUITY INDEX XX.XXX
COMMON STOCK XX.XXX
GLOBAL XX.XXX
INTERNATIONAL XX.XXX
AGGRESSIVE STOCK XX.XXX
CONSERVATIVE INVESTORS XX.XXX
BALANCED XX.XXX
GROWTH INVESTORS] XX.XXX
[Dollar amount of Variable Annuity Payment [$50.00]
Total Initial Payment Amount [$100.00]
* These are Funds of our Separate Account [A.]
VIA95JSLPC 2
BENEFICIARY [Xxxx Xxx]
DATE OF ISSUE [September 1, 1995]
VIA95JSLPC 3
DATA PAGES (CONT'D.)
ASSUMED BASE RATE OF NET INVESTMENT RETURN: [5.0%][3.5%] PER YEAR
ADJUSTMENT FACTOR [.00013366]
[.00009425] for
each day in the
Valuation Period.
[ADMINISTRATIVE EXPENSE CHARGE: [$200] FOR CONTRACT AT ISSUE]
DAILY SEPARATE ACCOUNT CHARGE: [Annual rate of .50%. This charge is in
addition to investment advisory fees and direct operating expenses
charged with respect to an Investment Fund as described in item 2.b. of
Part B.]
[INTEREST RATE (FOR FIXED INCOME
ANNUITY):] [6.0%]
[TRANSFERS AMONG [Not permitted.]
INVESTMENT FUNDS:]
VIA95JSLPC 4
PART A. BASIC TERMS
--------------------
1. ANNUITANT:
"Annuitant" is the person or persons shown as such on the Data Pages and
during whose lifetime an income will be payable to the Owner, unless the
Owner specifies otherwise. If there is a Joint Annuitant, the Joint
Annuitant's name is shown on the Data Pages and this term will also mean
such Joint Annuitant.
2. ANNUITY BENEFIT:
"Annuity Benefit" means the benefit payable by us pursuant to the annuity
options provided under this Contract.
"Fixed Income Annuity" means an annuity option under which the monthly
payments are payable in a specified dollar amount. "Variable Income
Annuity" means an annuity option under which the dollar amount of such
monthly payment may increase or decrease depending on whether the actual
rate of net investment return (after charges) of the applicable
Investment Fund is higher or lower than the Assumed Base Rate of Net
Investment Return shown on the Data Pages.
3. ANNUITY UNIT:
"Annuity Unit" applies to the Variable Income Annuity only and is a unit
of measurement used in determining the amount of each Variable Income
Annuity payment. A number of Annuity Units is calculated by dividing the
first monthly Variable Income Annuity payment amount by the unit value
for the Valuation Period which includes the due date of the first monthly
payment.
4. ANNUITY UNIT VALUE:
"Annuity Unit Value" means the dollar value of any given date of each
Annuity Unit in each applicable Investment Fund of the Separate Account.
5. BENEFICIARY:
"Beneficiary" is the person or persons (a) you name in the application
for this Contract and to whom the death benefit, if any, is payable when
the Annuitant dies or (b) who succeeds as Owner in the event of your
death before the Annuitant. As Owner, you may name a contingent
beneficiary to become the beneficiary if all the beneficiaries die before
all amounts due have been paid. If no beneficiary or contingent
beneficiary is named, or if none is alive when the Annuitant dies, we
will pay as described in Part E, item 2.
6. BUSINESS DAY:
VIA95JSLPC 5
A Business Day is any day on which we are open and the New York Stock
Exchange is open for trading.
7. CONTRACT DATE:
"Contract Date" is the date we receive the properly completed application
and the premium for which annuity payments are made under this Contract.
8. INVESTMENT FUNDS:
"Investment Funds" are sub-funds of the Separate Account. Each Investment
Fund may invest its assets in a separate class (or series) of a specified
trust or investment company where each class (or series) represents a
separate portfolio in such trust or investment company. The Data Pages
show the available Investment Funds on the Contract Date. We will notify
you of any changes in the Investment Funds available.
9. OWNER:
"Owner" is the person shown on the Data Pages who has the rights and
options described in this Contract. The Owner may be changed, if you
notify us in writing in a form we accept; the changes will, upon
recording at the Processing Office, take effect as of the date the
written form was signed, but without further liability as to any payment
made by us before recording the change.
10. PREMIUM:
"Premium" is the amount received by us under this Contract, before
deduction of the Administrative Expense Charge shown on the Data Pages
and any other charges, including state premium tax, which may apply. The
Premium is shown on the Data Pages.
11. PROCESSING OFFICE:
"Processing Office" is the administrative office shown on the cover page
of this Contract. If we change it, we will notify you.
12. VALUATION PERIOD:
A "Valuation Period" is each Business Day together with any consecutive
preceding non-Business Days. For example, for each Monday which is a
Business Day, the preceding Saturday and Sunday will be included to equal
a three-day Valuation Period.
VIA95JSLPC 6
PART B. ANNUITY OPTIONS
------------------------
1. FIXED INCOME ANNUITY:
The amount of Fixed Income Annuity, if applicable, provided by allocation
of a portion of the Premium is determined taking into account Interest
Rate shown on the Data Pages. Fixed Income Annuity payments are
guaranteed without regard to any investment results or to future changes
in interest rates.
2. VARIABLE INCOME ANNUITY:
The initial payment amount of the Variable Income Annuity, if applicable,
provided by allocation of a portion of the Premium is determined taking
into account the Assumed Base Rate of Net Investment Return shown on the
Data Pages. Variable Income Annuity payments will vary based on the
investment results of the applicable Separate Account Investment Funds.
A. SEPARATE ACCOUNT:
We have established the Separate Account shown on the Data Pages
and maintain it in accordance with the laws of New York State.
Income and realized and unrealized gains and 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
placed in the Separate Account to support this Contract and other
variable annuity contracts and certificates. Assets may be placed
in the Separate Account for other purposes, but not to support
contracts or policies other than variable annuities and variable
life insurance. A Separate Account may be subdivided into
Investment Funds, also as shown on the Data Pages.
The assets of the Separate Account are our property. The portion
of such assets equal to the reserves and other contract
liabilities will not be chargeable with liabilities which arise
out of any other business we conduct. We may transfer assets of
the Separate Account or Investment Fund in excess of the reserves
and other liabilities with respect to such Account or Fund to
another Separate Account or Investment Fund or to our general
account.
We may, at our discretion, invest Separate Account assets in any
investment permitted by applicable law. We may rely conclusively
on the opinion of counsel (including counsel in our employ) as to
what investments we may make as law permits.
B. SEPARATE ACCOUNT ANNUITY UNIT VALUES:
We determine the Annuity Unit Value for the Separate Account for
each Valuation Period as described below.
The Net Investment Factor for a Valuation Period is (i) divided by
(ii) minus (iii), where
VIA95JSLPC 7
(i) is the net asset value of the Investment Fund's shares of
the related portfolio of the specified trust or investment
company at the end of the Valuation Period (before taking
into account any amounts allocated to or withdrawn from the
Investment Fund for the Valuation Period and after
deduction of investment advisory fees and direct operating
expenses of the specified trust or investment company; for
this purpose, we use the share value reported to us by the
specified trust or investment company);
(ii) is the net asset value of the Investment Fund's shares of
the related portfolio of the specified trust or investment
company at the end of the preceding Valuation Period
(taking into account any amounts allocated or withdrawn for
that Valuation Period);
(iii) is the daily Separate Account charge (see item c. below)
for the expenses and risks of the Contract, times the
number of calendar days in the Valuation Period, plus any
charge for taxes or amounts set aside as a reserve for
taxes.
The Annuity Unit Value for a Valuation Period is the Annuity Unit
Value for the immediately preceding Valuation Period multiplied by
the Adjusted Net Investment Factor for such subsequent Valuation
Period. The Adjusted Net Investment Factor for a Valuation Period
is the Net Investment Factor for such Period reduced for each
calendar day in such subsequent Valuation Period by the Adjustment
Factor (shown on the Data Pages) times the Net Investment Factor
in order to recognize the Assumed Base Rate of Net Investment
Return (also shown on the Data Pages) used in the determination of
the number of Annuity Units. Because of this adjustment, the
Annuity Unit Value rises and falls depending on whether the actual
rate of investment return (after charges) is higher or lower than
the Assumed Base Rate of Net Investment Return.
The Average Annuity Unit Value for a calendar month is equal to
the average of the Annuity Unit Values for such month. We will
notify you or the person to whom payment is being made of the
Average Annuity Unit Value used in determining the amount of each
variable annuity payment.
C. DAILY SEPARATE ACCOUNT CHARGE:
Assets of the Investment Funds will be subject to a daily asset
charge. This daily asset charge is for mortality risk, expenses
and expense risk that we assume, as well as for financial
accounting. The charge will be made pursuant to item (iii) of
"Net Investment Factor" as defined in item b. above. Such charge
will be applied after any deductions to provide for taxes. The
amount of the charge is shown on the Data Pages.
D. CHANGES WITH RESPECT TO SEPARATE ACCOUNT:
We have the right, subject to compliance with applicable law,
and, if required, approval of Contract Owners:
VIA95JSLPC 8
(a) to add Investment Funds (or sub-funds of Investment
Funds) to, or to remove Investment Funds (or sub-funds)
from, the Separate Account, or to add other separate
accounts in addition to or in place of the Separate
Account;
(b) to combine any two or more Investment Funds or sub-funds
thereof;
(c) to transfer the assets we determine to be the share of
the class of contract to which this Contract belongs from
any Investment Fund to another Investment Fund, or from
the Separate Account to another separate account, if such
other Investment Fund or separate account has, in our
judgment, the same investment objectives;
(d) to operate the Separate Account or any Investment Fund as
a management investment company under the Investment
Company Act of 1940, in which case charges and expenses
that otherwise would be assessed against an underlying
mutual fund would be assessed against the Separate
Account;
(e) to operate the Separate Account or any Investment Fund as
a unit investment trust under the Investment Company Act
of 1940;
(f) to register or deregister the Separate Account under the
Investment Company Act of 1940, provided that such action
conforms with the requirements of applicable law;
(g) to restrict or eliminate any voting rights as to the
Separate Account;
(h) to cause one or more Investment Funds to invest some or
all of their assets in one or more other trusts or
investment companies.
A portfolio might, in our judgment, become unsuitable for
investment by the Separate Account or Investment Funds, in view
of legal, regulatory, or federal income tax restrictions. In such
event, shares of another series or shares of another investment
trust may be substituted for shares already purchased with
respect to the Separate Account or as the security to be
purchased in the future, provided that such substitution meets
applicable federal income tax guidelines and, to the extent
required by law, has been approved by the Securities and Exchange
Commission and such other regulatory authorities as may be
necessary.
If the exercise of these rights results in a material change in
the underlying investments of the Separate Account, you will be
notified of such exercise, as required by law.
VIA95JSLPC 9
PART C. ANNUITY BENEFITS
-------------------------
1. MONTHLY PAYMENTS:
We will pay a monthly life income commencing on the Date of First Payment
shown on the Data Pages and thereafter for the remaining lifetime of the
Annuitant and Joint Annuitant, with payments continued for the lifetime
of the survivor after the death of either the Annuitant or Joint
Annuitant. If both the Annuitant and Joint Annuitant die before the
certain period shown in the Annuity Form on the Data pages, monthly
payments will continue to be made to the Beneficiary until the end of the
certain period.
2. AMOUNT OF EACH PAYMENT:
The amount of the first payment is shown on the Data Pages as the Total
Initial Payment Amount; the Total Initial Payment Amount shown is the sum
of the Fixed Income Annuity payment amount and the first Variable Income
Annuity payment amount. With respect to later payments, each monthly
payment will be the sum of the Fixed Income Annuity payment and the
Variable Income Annuity payment, determined as follows:
(a) Each Fixed Income Annuity payment will be made at the amount shown
on the Data Pages.
(b) The amount of the second and third monthly Variable Income Annuity
payments with respect to each applicable Investment Fund will be the
same as the amount of the first payment. The amount of the fourth
and each subsequent monthly payment will be the number of Annuity
Units for each Investment Fund multiplied by the Average Annuity
Unit Value for the second calendar month immediately preceding the
due date of the payment.
The fourth and subsequent monthly Variable Income Annuity payments
may increase or decrease in amount, depending on whether the actual
rate of net investment return (after charges) of the applicable
Investment Fund is higher or lower than the Assumed Base Rate of Net
Investment Return shown on the Data Pages. Payments will not be
increased or decreased in amount because of mortality or expense
experience.
3. DEATH OF OWNER:
If you are not the Annuitant and you die before the Annuitant, upon the
date of receipt by us at the Processing Office of proof satisfactory to
us of your death, the Beneficiary becomes the Owner with all rights under
this Contract. If you die before the Annuitant and if no Beneficiary is
alive, your estate becomes the Owner.
VIA95JSLPC 10
PART D. TRANSFERS
------------------
Transfers among Investment Funds are permitted only if so stated on the Data
Pages. If the Data Pages do not state that transfers are permitted, and if after
the Contract Date we change our rules to permit such transfers, we will notify
you in writing. The notice will specify any restrictions which apply.
VIA95JSLPC 11
PART E. GENERAL TERMS
----------------------
1. CONTRACT:
This Contract, the related application and any endorsement(s) constitute
the entire Contract between the parties, and their terms alone will
govern with respect to our rights and obligations. The Contract may not
be modified, nor may any of our rights or requirements be waived, except
in writing signed by one of our authorized officers.
2. BENEFICIARY:
You may change the Beneficiary from time to time by written notice to us,
but any change will be effective only if it is approved by us. The change
will, upon recording at the Processing Office, take effect as of the date
the written notice was signed, but without further liability as to any
payment or other settlement made by us before recording the change. If
amounts become payable to a Beneficiary, such Beneficiary may designate
(with the right to change such designation) a person or persons to
receive any amount payable after the death of the Beneficiary, if the
absence of such a designation would result in a single sum payment to
such Beneficiary's executors or administrators. Such a designation or
change will be made and will take effect in the same manner as a change
of Beneficiary.
If no Beneficiary (or contingent Beneficiary) is named, or if none is
alive when you die, we will make any payment due to (a) your surviving
spouse, if any, (b) your surviving children in equal shares or, should
none survive, then (c) in a single sum to your estate. If more than one
Beneficiary is alive when you die, we will pay them in equal shares
unless you have chosen otherwise.
3. ASSIGNMENT:
This Contract may not be sold, assigned, discounted or pledged as
collateral for a loan or as security for the performance of an obligation
or for any other purpose, and except as otherwise permitted by law, no
sum payable under this Contract may be transferred, assigned or
encumbered, or will in any way be subject to any legal process to subject
the same to the payment of any claim against the person to whom such sum
is payable.
4. PAYMENT:
All payments by us under this Contract will be made by check (or, if so
agreed by you and us, by wire transfer or other form).
5. EVIDENCE OF SURVIVAL:
We may require satisfactory evidence of survival of the Annuitant or
Beneficiary on the due date of each payment. If the check for the payment
is drawn to the order of the Annuitant or Beneficiary, the personal
endorsement of such Annuitant or Beneficiary on the check will be
accepted as
VIA95JSLPC 12
evidence of survival, subject to our right to require evidence of the
authority of any person who makes claim to receive any payment.
6. AGE AND SEX:
If the Annuitant's age or, if applicable, sex has been misstated, any
benefits will be such as the Contract would have provided if the first
payment amount had been based on the correct age and sex. Any
overpayments or underpayments made by us will be charged or credited with
interest at [6% per year] (or such other rate which applies under our
rules at any time) to benefits falling due thereafter.
7. CONTRACT CHANGES - APPLICABLE LAW:
For you (and the Annuitant) to receive the tax treatment accorded to
annuities under Federal law, this Contract must qualify initially and
continue to qualify as an annuity under the Internal Revenue Code or
successor law. Therefore, to assure this qualification, we reserve in
this Contract the right to defer acceptance of or to return any payment
that would cause the Contract to fail to qualify as an annuity under
applicable tax law as interpreted by us. Furthermore, we reserve the
right to make changes in this Contract to the extent we deem it necessary
to continue to qualify this Contract as an annuity. Any such changes will
apply uniformly to all Contracts that are affected. You will be given
advance written notice of such changes.
In addition, payments under this Contract must comply with any applicable
requirements of Section 401(a)(9) of the Internal Revenue Code and the
Treasury regulations which apply.
VIA95JSLPC 13
ENDORSEMENT
NOTICE OF RIGHT TO CANCEL
-------------------------
This Contract provides a ten day right to cancel. See the cover page. If you
cancel the Contract according to this right, you will receive a refund of any
premium made, plus or minus any investment gain or loss which applies to the
Separate Account Investment Funds from the date the premium or portion thereof
was allocated to any such Investment Fund, if applicable, to the date the
Contract is canceled.
ENDVIA95
VARIABLE IMMEDIATE ANNUITY CONTRACT
THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES
This is a legal contract between its owner and us. Please read it carefully.
In this Contract, "you" and "your" refer to the owner, and "we," "us," and "our"
refer to Equitable.
We agree to pay an annuity based on the terms shown on the Data Pages. Other
important terms are described in the various parts of this Contract.
THE AMOUNT OF EACH VARIABLE INCOME ANNUITY PAYMENT MAY INCREASE OR DECREASE,
DEPENDING ON INVESTMENT RESULTS OF THE SEPARATE ACCOUNT INVESTMENT FUNDS, AND IS
NOT GUARANTEED AS TO DOLLAR AMOUNT.
TEN DAY RIGHT TO EXAMINE CONTRACT: You may return this Contract to us within 10
days from the date you receive it. Return it to the Processing Office shown
below. If you return it within the 10-day period, your Contract will be canceled
from the Contract Date. We will refund any premium made, less any distribution
payable. After this 10-day period, this Contract may not be surrendered.
Processing Office: [Annuity Benefits Division, X.X. Xxx 0000,
Xxx Xxxx, X.X. 00000-0000]
NEW YORK,
THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES
/s/ Xxxxxx X. Xxxxxx /s/ Xxxxx X. Xxxxxx
Chairman and Chief Executive Officer President and Chief Operating
Officer
Vice President and Secretary
VIA95LPC 1
VARIABLE IMMEDIATE ANNUITY CONTRACT. Non-participating (no dividends payable).
Non-assignable. Non-transferable.
VIA95LPC 2
DATA PAGES
OWNER [Xxxx Xxx] [September 1, 1995] CONTRACT DATE
ANNUITY FORM [Life Annuity-10 [XXXXX] CONTRACT NUMBER
Year Certain]
ANNUITANT [Xxxx Xxx] [70-1/2 - M] ISSUE AGE AND SEX
PREMIUM [$10,000] [October 1, 1995] DATE OF FIRST PAYMENT
[PREMIUM ALLOCATION]
[Fixed Income] [xx%]
[Variable Income] [yy%]
ANNUITY OPTIONS:
[ o FIXED INCOME ANNUITY Amount of Fixed Income Annuity Payment $50.00]
o VARIABLE INCOME ANNUITIES: NUMBER OF
INVESTMENT FUNDS* ANNUITY UNITS
[MONEY MARKET XX.XXX
INTERMEDIATE GOVERNMENT XX.XXX
SECURITIES
QUALITY BOND XX.XXX
HIGH YIELD XX.XXX
GROWTH & INCOME XX.XXX
EQUITY INDEX XX.XXX
COMMON STOCK XX.XXX
GLOBAL XX.XXX
INTERNATIONAL XX.XXX
AGGRESSIVE STOCK XX.XXX
CONSERVATIVE INVESTORS XX.XXX
BALANCED XX.XXX
GROWTH INVESTORS] XX.XXX
[Dollar amount of Variable Annuity Payment [$50.00]
Total Initial Payment Amount [$100.00]
* These are Funds of our Separate Account [A.]
BENEFICIARY [Xxxx Xxx] [Husband]
VIA95LPC 3
[Xxxx Xxx] [Wife]
DATE OF ISSUE [September 1, 1995]
VIA95LPC 4
DATA PAGES (CONT'D.)
ASSUMED BASE RATE OF NET INVESTMENT RETURN: [5.0%][3.5%] PER YEAR
ADJUSTMENT FACTOR [.00013366]
[.00009425] for
each day in the
Valuation Period.
[ADMINISTRATIVE EXPENSE CHARGE: [$200] FOR CONTRACT AT ISSUE]
DAILY SEPARATE ACCOUNT CHARGE: [Annual rate of .50%. This charge is in
addition to investment advisory fees and direct operating expenses
charged with respect to an Investment Fund as described in item 2.b of
Fund B.]
[INTEREST RATE (FOR FIXED INCOME
ANNUITY):] [6.0%]
[TRANSFERS AMONG [Not permitted.]
INVESTMENT FUNDS:]
VIA95LPC 5
PART A. BASIC TERMS
--------------------
1. ANNUITANT:
"Annuitant" is the person or persons shown as such on the Data Pages and
during whose lifetime an income will be payable to the Owner, unless the
Owner specifies otherwise.
2. ANNUITY BENEFIT:
"Annuity Benefit" means the benefit payable by us pursuant to the annuity
options provided under this Contract.
"Fixed Income Annuity" means an annuity option under which the monthly
payments are payable in a specified dollar amount. "Variable Income
Annuity" means an annuity option under which the dollar amount of such
monthly payment may increase or decrease depending on whether the actual
rate of net investment return (after charges) of the applicable
Investment Fund is higher or lower than the Assumed Base Rate of Net
Investment Return shown on the Data Pages.
3. ANNUITY UNIT:
"Annuity Unit" applies to the Variable Income Annuity only and is a unit
of measurement used in determining the amount of each Variable Income
Annuity payment. A number of Annuity Units is calculated by dividing the
first monthly Variable Income Annuity payment amount by the unit value
for the Valuation Period which includes the due date of the first monthly
payment.
4. ANNUITY UNIT VALUE:
"Annuity Unit Value" means the dollar value of any given date of each
Annuity Unit in each applicable Investment Fund of the Separate Account.
5. BENEFICIARY:
"Beneficiary" is the person or persons (a) you name in the application
for this Contract and to whom the death benefit, if any, is payable when
the Annuitant dies or (b) who succeeds as Owner in the event of your
death before the Annuitant. As Owner, you may name a contingent
beneficiary to become the beneficiary if all the beneficiaries die before
all amounts due have been paid. If no beneficiary or contingent
beneficiary is named, or if none is alive when the Annuitant dies, we
will pay as described in Part E, item 2.
6. BUSINESS DAY:
A Business Day is any day on which we are open and the New York Stock
Exchange is open for trading.
VIA95LPC 6
7. CONTRACT DATE:
"Contract Date" is the date we receive the properly completed application
and the premium for which annuity payments are made under this Contract.
8. INVESTMENT FUNDS:
"Investment Funds" are sub-funds of the Separate Account. Each Investment
Fund may invest its assets in a separate class (or series) of a specified
trust or investment company where each class (or series) represents a
separate portfolio in such trust or investment company. The Data Pages
show the available Investment Funds on the Contract Date. We will notify
you of any changes in the Investment Funds available.
9. OWNER:
"Owner" is the person shown on the Data Pages who has the rights and
options described in this Contract. The Owner may be changed, if you
notify us in writing in a form we accept; the changes will, upon
recording at the Processing Office, take effect as of the date the
written form was signed, but without further liability as to any payment
made by us before recording the change.
10. PREMIUM:
"Premium" is the amount received by us under this Contract, before
deduction of the Administrative Expense Charge shown on the Data Pages
and any other charges, including state premium tax, which may apply. The
Premium is shown on the Data Pages.
11. PROCESSING OFFICE:
"Processing Office" is the administrative office shown on the cover page
of this Contract. If we change it, we will notify you.
12. VALUATION PERIOD:
A "Valuation Period" is each Business Day together with any consecutive
preceding non-Business Days. For example, for each Monday which is a
Business Day, the preceding Saturday and Sunday will be included to equal
a three-day Valuation Period.
VIA95LPC 7
PART B. ANNUITY OPTIONS
------------------------
1. FIXED INCOME ANNUITY:
The amount of Fixed Income Annuity, if applicable, provided by allocation
of a portion of the Premium is determined taking into account Interest
Rate shown on the Data Pages. Fixed Income Annuity payments are
guaranteed without regard to any investment results or to future changes
in interest rates.
2. VARIABLE INCOME ANNUITY:
The initial payment amount of the Variable Income Annuity, if applicable,
provided by allocation of a portion of the Premium is determined taking
into account the Assumed Base Rate of Net Investment Return shown on the
Data Pages. Variable Income Annuity payments will vary based on the
investment results of the applicable Separate Account Investment Funds.
A. SEPARATE ACCOUNT:
We have established the Separate Account shown on the Data Pages
and maintain it in accordance with the laws of New York State.
Income and realized and unrealized gains and 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
placed in the Separate Account to support this Contract and other
variable annuity contracts and certificates. Assets may be placed
in the Separate Account for other purposes, but not to support
contracts or policies other than variable annuities and variable
life insurance. A Separate Account may be subdivided into
Investment Funds, also as shown on the Data Pages.
The assets of the Separate Account are our property. The portion
of such assets equal to the reserves and other contract
liabilities will not be chargeable with liabilities which arise
out of any other business we conduct. We may transfer assets of
the Separate Account or Investment Fund in excess of the reserves
and other liabilities with respect to such Account or Fund to
another Separate Account or Investment Fund or to our general
account.
We may, at our discretion, invest Separate Account assets in any
investment permitted by applicable law. We may rely conclusively
on the opinion of counsel (including counsel in our employ) as to
what investments we may make as law permits.
B. SEPARATE ACCOUNT ANNUITY UNIT VALUES:
We determine the Annuity Unit Value for the Separate Account for
each Valuation Period as described below.
The Net Investment Factor for a Valuation Period is (i) divided by
(ii) minus (iii), where
VIA95LPC 8
(i) is the net asset value of the Investment Fund's shares of
the related portfolio of the specified trust or investment
company at the end of the Valuation Period (before taking
into account any amounts allocated to or withdrawn from the
Investment Fund for the Valuation Period and after
deduction of investment advisory fees and direct operating
expenses of the specified trust or investment company; for
this purpose, we use the share value reported to us by the
specified trust or investment company);
(ii) is the net asset value of the Investment Fund's shares of
the related portfolio of the specified trust or investment
company at the end of the preceding Valuation Period
(taking into account any amounts allocated or withdrawn for
that Valuation Period);
(iii) is the daily Separate Account charge (see item c. below)
for the expenses and risks of the Contract, times the
number of calendar days in the Valuation Period, plus any
charge for taxes or amounts set aside as a reserve for
taxes.
The Annuity Unit Value for a Valuation Period is the Annuity Unit
Value for the immediately preceding Valuation Period multiplied by
the Adjusted Net Investment Factor for such subsequent Valuation
Period. The Adjusted Net Investment Factor for a Valuation Period
is the Net Investment Factor for such Period reduced for each
calendar day in such subsequent Valuation Period by the Adjustment
Factor (shown on the Data Pages) times the Net Investment Factor
in order to recognize the Assumed Base Rate of Net Investment
Return (also shown on the Data Pages) used in the determination of
the number of Annuity Units. Because of this adjustment, the
Annuity Unit Value rises and falls depending on whether the actual
rate of investment return (after charges) is higher or lower than
the Assumed Base Rate of Net Investment Return.
The Average Annuity Unit Value for a calendar month is equal to
the average of the Annuity Unit Values for such month. We will
notify you or the person to whom payment is being made of the
Average Annuity Unit Value used in determining the amount of each
variable annuity payment.
C. DAILY SEPARATE ACCOUNT CHARGE:
Assets of the Investment Funds will be subject to a daily asset
charge. This daily asset charge is for mortality risk, expenses
and expense risk that we assume, as well as for financial
accounting. The charge will be made pursuant to item (iii) of
"Net Investment Factor" as defined in item b. above. Such charge
will be applied after any deductions to provide for taxes. The
amount of the charge is shown on the Data Pages.
D. CHANGES WITH RESPECT TO SEPARATE ACCOUNT:
We have the right, subject to compliance with applicable law,
and, if required, approval of Contract Owners:
VIA95LPC 9
(a) to add Investment Funds (or sub-funds of Investment
Funds) to, or to remove Investment Funds (or sub-funds)
from, the Separate Account, or to add other separate
accounts in addition to or in place of the Separate
Account;
(b) to combine any two or more Investment Funds or sub-funds
thereof;
(c) to transfer the assets we determine to be the share of
the class of contract to which this Contract belongs from
any Investment Fund to another Investment Fund, or from
the Separate Account to another separate account, if such
other Investment Fund or separate account has, in our
judgment, the same investment objectives;
(d) to operate the Separate Account or any Investment Fund as
a management investment company under the Investment
Company Act of 1940, in which case charges and expenses
that otherwise would be assessed against an underlying
mutual fund would be assessed against the Separate
Account;
(e) to operate the Separate Account or any Investment Fund as
a unit investment trust under the Investment Company Act
of 1940;
(f) to register or deregister the Separate Account under the
Investment Company Act of 1940, provided that such action
conforms with the requirements of applicable law;
(g) to restrict or eliminate any voting rights as to the
Separate Account;
(h) to cause one or more Investment Funds to invest some or
all of their assets in one or more other trusts or
investment companies.
A portfolio might, in our judgment, become unsuitable for
investment by the Separate Account or Investment Funds, in view
of legal, regulatory, or federal income tax restrictions. In such
event, shares of another series or shares of another investment
trust may be substituted for shares already purchased with
respect to the Separate Account or as the security to be
purchased in the future, provided that such substitution meets
applicable federal income tax guidelines and, to the extent
required by law, has been approved by the Securities and Exchange
Commission and such other regulatory authorities as may be
necessary.
If the exercise of these rights results in a material change in
the underlying investments of the Separate Account, you will be
notified of such exercise, as required by law.
VIA95LPC 10
PART C. ANNUITY BENEFITS
-------------------------
1. MONTHLY PAYMENTS:
We will pay a monthly life income commencing on the Date of First Payment
shown on the Data Pages and thereafter for the remaining lifetime of the
Annuitant. If the Annuitant dies before the certain period shown in the
Annuity Form on the Data Pages, monthly payments will continue to be made
to the Beneficiary until the end of the certain period.
2. AMOUNT OF EACH PAYMENT:
The amount of the first payment is shown on the Data Pages as the Total
Initial Payment Amount; the Total Initial Payment Amount shown is the sum
of the Fixed Income Annuity payment amount and the first Variable Income
Annuity payment amount. With respect to later payments, each monthly
payment will be the sum of the Fixed Income Annuity payment and the
Variable Income Annuity payment, determined as follows:
(a) Each Fixed Income Annuity payment will be made at the amount shown on
the Data Pages.
(b) The amount of the second and third monthly Variable Income Annuity
payments with respect to each applicable Investment Fund will be the
same as the amount of the first payment. The amount of the fourth
and each subsequent monthly payment will be the number of Annuity
Units for each Investment Fund multiplied by the Average Annuity
Unit Value for the second calendar month immediately preceding the
due date of the payment.
The fourth and subsequent monthly Variable Income Annuity payments
may increase or decrease in amount, depending on whether the actual
rate of net investment return (after charges) of the applicable
Investment Fund is higher or lower than the Assumed Base Rate of Net
Investment Return shown on the Data Pages. Payments will not be
increased or decreased in amount because of mortality or expense
experience.
3. DEATH OF OWNER:
If you are not the Annuitant and you die before the Annuitant, upon the
date of receipt by us at the Processing Office of proof satisfactory to
us of your death, the Beneficiary becomes the Owner with all rights under
this Contract. If you die before the Annuitant and if no Beneficiary is
alive, your estate becomes the Owner.
VIA95LPC 11
PART D. TRANSFERS
------------------
Transfers among Investment Funds are permitted only if so stated on the Data
Pages. If the Data Pages do not state that transfers are permitted, and if after
the Contract Date we change our rules to permit such transfers, we will notify
you in writing. The notice will specify any restrictions which apply.
VIA95LPC 12
PART E. GENERAL TERMS
----------------------
1. CONTRACT:
This Contract, the related application and any endorsement(s) constitute
the entire Contract between the parties, and their terms alone will
govern with respect to our rights and obligations. The Contract may not
be modified, nor may any of our rights or requirements be waived, except
in writing signed by one of our authorized officers.
2. BENEFICIARY:
You may change the Beneficiary from time to time by written notice to us,
but any change will be effective only if it is approved by us. The change
will, upon recording at the Processing Office, take effect as of the date
the written notice was signed, but without further liability as to any
payment or other settlement made by us before recording the change. If
amounts become payable to a Beneficiary, such Beneficiary may designate
(with the right to change such designation) a person or persons to
receive any amount payable after the death of the Beneficiary, if the
absence of such a designation would result in a single sum payment to
such Beneficiary's executors or administrators. Such a designation or
change will be made and will take effect in the same manner as a change
of Beneficiary.
If no Beneficiary (or contingent Beneficiary) is named, or if none is
alive when you die, we will make any payment due to (a) your surviving
spouse, if any, (b) your surviving children in equal shares or, should
none survive, then (c) in a single sum to your estate. If more than one
Beneficiary is alive when you die, we will pay them in equal shares
unless you have chosen otherwise.
3. ASSIGNMENT:
This Contract may not be sold, assigned, discounted or pledged as
collateral for a loan or as security for the performance of an obligation
or for any other purpose, and except as otherwise permitted by law, no
sum payable under this Contract may be transferred, assigned or
encumbered, or will in any way be subject to any legal process to subject
the same to the payment of any claim against the person to whom such sum
is payable.
4. PAYMENT:
All payments by us under this Contract will be made by check (or, if so
agreed by you and us, by wire transfer or other form).
5. EVIDENCE OF SURVIVAL:
We may require satisfactory evidence of survival of the Annuitant or
Beneficiary on the due date of each payment. If the check for the payment
is drawn to the order of the Annuitant or Beneficiary, the personal
endorsement of such Annuitant or Beneficiary on the check will be
accepted as
VIA95LPC 13
evidence of survival, subject to our right to require evidence of the
authority of any person who makes claim to receive any payment.
6. AGE AND SEX:
If the Annuitant's age or, if applicable, sex has been misstated, any
benefits will be such as the Contract would have provided if the first
payment amount had been based on the correct age and sex. Any
overpayments or underpayments made by us will be charged or credited with
interest at [6% per year] (or such other rate which applies under our
rules at any time) to benefits falling due thereafter.
7. CONTRACT CHANGES - APPLICABLE LAW:
For you (and the Annuitant) to receive the tax treatment accorded to
annuities under Federal law, this Contract must qualify initially and
continue to qualify as an annuity under the Internal Revenue Code or
successor law. Therefore, to assure this qualification, we reserve in
this Contract the right to defer acceptance of or to return any payment
that would cause the Contract to fail to qualify as an annuity under
applicable tax law as interpreted by us. Furthermore, we reserve the
right to make changes in this Contract to the extent we deem it necessary
to continue to qualify this Contract as an annuity. Any such changes will
apply uniformly to all Contracts that are affected. You will be given
advance written notice of such changes.
In addition, payments under this Contract must comply with any applicable
requirements of Section 401(a)(9) of the Internal Revenue Code and the
Treasury regulations which apply.
VIA95LPC 14
ENDORSEMENT
NOTICE OF RIGHT TO CANCEL
-------------------------
This Contract provides a ten day right to cancel. See the cover page. If you
cancel the Contract according to this right, you will receive a refund of any
premium made, plus or minus any investment gain or loss which applies to the
Separate Account Investment Funds from the date the premium or portion thereof
was allocated to any such Investment Fund, if applicable, to the date the
Contract is canceled.
ENDVIA95
VARIABLE IMMEDIATE ANNUITY CONTRACT
THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES
This is a legal contract between its owner and us. Please read it carefully.
In this Contract, "you" and "your" refer to the owner, and "we," "us," and "our"
refer to Equitable.
We agree to pay an annuity based on the terms shown on the Data Pages. Other
important terms are described in the various parts of this Contract.
THE AMOUNT OF EACH VARIABLE INCOME ANNUITY PAYMENT MAY INCREASE OR DECREASE,
DEPENDING ON INVESTMENT RESULTS OF THE SEPARATE ACCOUNT INVESTMENT FUNDS, AND IS
NOT GUARANTEED AS TO DOLLAR AMOUNT.
TEN DAY RIGHT TO EXAMINE CONTRACT: You may return this Contract to us within 10
days from the date you receive it. Return it to the Processing Office shown
below. If you return it within the 10-day period, your Contract will be canceled
from the Contract Date. We will refund any premium made, less any distribution
payable. After this 10-day period, this Contract may not be surrendered.
Processing Office: [Annuity Benefits Division, X.X. Xxx 0000, Xxx Xxxx, X.X.
00000-0000]
NEW YORK,
THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES
/s/ Xxxxxx X. Xxxxxx /s/ Xxxxx X. Xxxxxx
Chairman and Chief Executive Officer President and Chief Operating
Officer
Vice President and Secretary
VARIABLE IMMEDIATE ANNUITY CONTRACT. Non-participating (no dividends payable).
Non-assignable. Non-transferable.
VIA95L 1
VIA95L 2
DATA PAGES
OWNER [Xxxx Xxx] [September 1, 1995] CONTRACT DATE
ANNUITY FORM [Life Annuity] [XXXXX] CONTRACT NUMBER
ANNUITANT [Xxxx Xxx] [70-1/2 - M] ISSUE AGE AND SEX
PREMIUM [$10,000] [October 1, 1995] DATE OF FIRST PAYMENT
[PREMIUM ALLOCATION]
[Fixed Income] [xx%]
[Variable Income] [yy%]
ANNUITY OPTIONS:
[ o FIXED INCOME ANNUITY Amount of Fixed Income Annuity Payment $50.00]
o VARIABLE INCOME ANNUITIES: NUMBER OF
INVESTMENT FUNDS* ANNUITY UNITS
[MONEY MARKET XX.XXX
INTERMEDIATE GOVERNMENT XX.XXX
SECURITIES
QUALITY BOND XX.XXX
HIGH YIELD XX.XXX
GROWTH & INCOME XX.XXX
EQUITY INDEX XX.XXX
COMMON STOCK XX.XXX
GLOBAL XX.XXX
INTERNATIONAL XX.XXX
AGGRESSIVE STOCK XX.XXX
CONSERVATIVE INVESTORS XX.XXX
BALANCED XX.XXX
GROWTH INVESTORS] XX.XXX
[Dollar amount of Variable Annuity Payment [$50.00]
Total Initial Payment Amount [$100.00]
* These are Funds of our Separate Account [A.]
SUCCESSOR OWNER [Xxxx Xxx], for the purposes of item 3, Part C.
VIA95L 3
DATE OF ISSUE [September 1, 1995]
VIA95L 4
DATA PAGES (CONT'D.)
ASSUMED BASE RATE OF NET INVESTMENT RETURN: [5.0%][3.5%] PER YEAR
ADJUSTMENT FACTOR [.00013366] [.00009425] for each
day in the Valuation Period.
[ADMINISTRATIVE EXPENSE CHARGE: [$200] FOR CONTRACT AT ISSUE]
DAILY SEPARATE ACCOUNT CHARGE: [Annual rate of .50%. This charge
is in addition to investment
advisory fees and direct operating
expenses charged with respect to an
Investment Fund as described in
item 2.b. of Part B.]
[INTEREST RATE (FOR FIXED INCOME
ANNUITY):][6.0%]
[TRANSFERS AMONG [Not permitted.]
INVESTMENT FUNDS:]
VIA95L 5
PART A. BASIC TERMS
--------------------
1. ANNUITANT:
"Annuitant" is the person or persons shown as such on the Data Pages and
during whose lifetime an income will be payable to the Owner, unless the
Owner specifies otherwise.
2. ANNUITY BENEFIT:
"Annuity Benefit" means the benefit payable by us pursuant to the annuity
options provided under this Contract.
"Fixed Income Annuity" means an annuity option under which the monthly
payments are payable in a specified dollar amount. "Variable Income
Annuity" means an annuity option under which the dollar amount of such
monthly payment may increase or decrease depending on whether the actual
rate of net investment return (after charges) of the applicable
Investment Fund is higher or lower than the Assumed Base Rate of Net
Investment Return shown on the Data Pages.
3. ANNUITY UNIT:
"Annuity Unit" applies to the Variable Income Annuity only and is a unit
of measurement used in determining the amount of each Variable Income
Annuity payment. A number of Annuity Units is calculated by dividing the
first monthly Variable Income Annuity payment amount by the unit value
for the Valuation Period which includes the due date of the first monthly
payment.
4. ANNUITY UNIT VALUE:
"Annuity Unit Value" means the dollar value of any given date of each
Annuity Unit in each applicable Investment Fund of the Separate Account.
5. BUSINESS DAY:
A Business Day is any day on which we are open and the New York Stock
Exchange is open for trading.
6. CONTRACT DATE:
"Contract Date" is the date we receive the properly completed application
and the premium for which annuity payments are made under this Contract.
7. INVESTMENT FUNDS:
"Investment Funds" are sub-funds of the Separate Account. Each Investment
Fund may invest its assets in a separate class (or series) of a specified
trust or investment company where each class (or series) represents a
separate portfolio in such trust or investment company. The Data Pages
show
VIA95L 6
the available Investment Funds on the Contract Date. We will notify you
of any changes in the Investment Funds available.
8. OWNER:
"Owner" is the person shown on the Data Pages who has the rights and
options described in this Contract. The Owner, or any Successor Owner,
may be changed, if you notify us in writing in a form we accept; the
changes will, upon recording at the Processing Office, take effect as of
the date the written form was signed, but without further liability as to
any payment made by us before recording the change.
9. PREMIUM:
"Premium" is the amount received by us under this Contract, before
deduction of the Administrative Expense Charge shown on the Data Pages
and any other charges, including state premium tax, which may apply. The
Premium is shown on the Data Pages.
10. PROCESSING OFFICE:
"Processing Office" is the administrative office shown on the cover page
of this Contract. If we change it, we will notify you.
11. SUCCESSOR OWNER:
"Successor Owner" is the person or persons who succeeds as Owner in the
event of your death before the Annuitant. The Successor Owner may be
changed, if you notify us in writing in a form we accept; the change
will, upon recording at the Processing Office, take effect as of the date
the written form was signed, but without further liability as to any
payment made by us before recording the change.
12. VALUATION PERIOD:
A "Valuation Period" is each Business Day together with any consecutive
preceding non-Business Days. For example, for each Monday which is a
Business Day, the preceding Saturday and Sunday will be included to equal
a three-day Valuation Period.
VIA95L 7
PART B. ANNUITY OPTIONS
------------------------
1. FIXED INCOME ANNUITY:
The amount of Fixed Income Annuity, if applicable, provided by allocation
of a portion of the Premium is determined taking into account Interest
Rate shown on the Data Pages. Fixed Income Annuity payments are
guaranteed without regard to any investment results or to future changes
in interest rates.
2. VARIABLE INCOME ANNUITY:
The initial payment amount of the Variable Income Annuity, if applicable,
provided by allocation of a portion of the Premium is determined taking
into account the Assumed Base Rate of Net Investment Return shown on the
Data Pages. Variable Income Annuity payments will vary based on the
investment results of the applicable Separate Account Investment Funds.
A. SEPARATE ACCOUNT:
We have established the Separate Account shown on the Data Pages
and maintain it in accordance with the laws of New York State.
Income and realized and unrealized gains and 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
placed in the Separate Account to support this Contract and other
variable annuity contracts and certificates. Assets may be placed
in the Separate Account for other purposes, but not to support
contracts or policies other than variable annuities and variable
life insurance. A Separate Account may be subdivided into
Investment Funds, also as shown on the Data Pages.
The assets of the Separate Account are our property. The portion
of such assets equal to the reserves and other contract
liabilities will not be chargeable with liabilities which arise
out of any other business we conduct. We may transfer assets of
the Separate Account or Investment Fund in excess of the reserves
and other liabilities with respect to such Account or Fund to
another Separate Account or Investment Fund or to our general
account.
We may, at our discretion, invest Separate Account assets in any
investment permitted by applicable law. We may rely conclusively
on the opinion of counsel (including counsel in our employ) as to
what investments we may make as law permits.
B. SEPARATE ACCOUNT ANNUITY UNIT VALUES:
We determine the Annuity Unit Value for the Separate Account for
each Valuation Period as described below.
The Net Investment Factor for a Valuation Period is (i) divided by
(ii) minus (iii), where
(i) is the net asset value of the Investment Fund's shares of
the related portfolio of the specified trust or investment
company at the end of the Valuation Period (before taking
into account any amounts allocated to or withdrawn from the
Investment Fund for the
VIA95L 8
Valuation Period and after deduction of investment advisory
fees and direct operating expenses of the specified trust
or investment company; for this purpose, we use the share
value reported to us by the specified trust or investment
company);
(ii) is the net asset value of the Investment Fund's shares of
the related portfolio of the specified trust or investment
company at the end of the preceding Valuation Period
(taking into account any amounts allocated or withdrawn for
that Valuation Period);
(iii) is the daily Separate Account charge (see item c. below)
for the expenses and risks of the Contract, times the
number of calendar days in the Valuation Period, plus any
charge for taxes or amounts set aside as a reserve for
taxes.
The Annuity Unit Value for a Valuation Period is the Annuity Unit
Value for the immediately preceding Valuation Period multiplied by
the Adjusted Net Investment Factor for such subsequent Valuation
Period. The Adjusted Net Investment Factor for a Valuation Period
is the Net Investment Factor for such Period reduced for each
calendar day in such subsequent Valuation Period by the Adjustment
Factor (shown on the Data Pages) times the Net Investment Factor
in order to recognize the Assumed Base Rate of Net Investment
Return (also shown on the Data Pages) used in the determination of
the number of Annuity Units. Because of this adjustment, the
Annuity Unit Value rises and falls depending on whether the actual
rate of investment return (after charges) is higher or lower than
the Assumed Base Rate of Net Investment Return.
The Average Annuity Unit Value for a calendar month is equal to
the average of the Annuity Unit Values for such month. We will
notify you or the person to whom payment is being made of the
Average Annuity Unit Value used in determining the amount of each
variable annuity payment.
C. DAILY SEPARATE ACCOUNT CHARGE:
Assets of the Investment Funds will be subject to a daily asset
charge. This daily asset charge is for mortality risk, expenses
and expense risk that we assume, as well as for financial
accounting. The charge will be made pursuant to item (iii) of
"Net Investment Factor" as defined in item b. above. Such charge
will be applied after any deductions to provide for taxes. The
amount of the charge is shown on the Data Pages.
D. CHANGES WITH RESPECT TO SEPARATE ACCOUNT:
We have the right, subject to compliance with applicable law,
and, if required, approval of Contract Owners:
(a) to add Investment Funds (or sub-funds of Investment
Funds) to, or to remove Investment Funds (or sub-funds)
from, the Separate Account, or to add other separate
accounts in addition to or in place of the Separate
Account;
(b) to combine any two or more Investment Funds or sub-funds
thereof;
VIA95L 9
(c) to transfer the assets we determine to be the share of
the class of contract to which this Contract belongs from
any Investment Fund to another Investment Fund, or from
the Separate Account to another separate account, if such
other Investment Fund or separate account has, in our
judgment, the same investment objectives;
(d) to operate the Separate Account or any Investment Fund as
a management investment company under the Investment
Company Act of 1940, in which case charges and expenses
that otherwise would be assessed against an underlying
mutual fund would be assessed against the Separate
Account;
(e) to operate the Separate Account or any Investment Fund as
a unit investment trust under the Investment Company Act
of 1940;
(f) to register or deregister the Separate Account under the
Investment Company Act of 1940, provided that such action
conforms with the requirements of applicable law;
(g) to restrict or eliminate any voting rights as to the
Separate Account;
(h) to cause one or more Investment Funds to invest some or
all of their assets in one or more other trusts or
investment companies.
A portfolio might, in our judgment, become unsuitable for
investment by the Separate Account or Investment Funds, in view
of legal, regulatory, or federal income tax restrictions. In such
event, shares of another series or shares of another investment
trust may be substituted for shares already purchased with
respect to the Separate Account or as the security to be
purchased in the future, provided that such substitution meets
applicable federal income tax guidelines and, to the extent
required by law, has been approved by the Securities and Exchange
Commission and such other regulatory authorities as may be
necessary.
If the exercise of these rights results in a material change in
the underlying investments of the Separate Account, you will be
notified of such exercise, as required by law.
VIA95L 10
PART C. ANNUITY BENEFITS
-------------------------
1. MONTHLY PAYMENTS:
We will pay a monthly life income commencing on the Date of First Payment
shown on the Data Pages. Monthly payments will continue to be made until
the last payment due before the Annuitant dies.
2. AMOUNT OF EACH PAYMENT:
The amount of the first payment is shown on the Data Pages as the Total
Initial Payment Amount; the Total Initial Payment Amount shown is the sum
of the Fixed Income Annuity payment amount and the first Variable Income
Annuity payment amount. With respect to later payments, each monthly
payment will be the sum of the Fixed Income Annuity payment and the
Variable Income Annuity payment, determined as follows:
(a) Each Fixed Income Annuity payment will be made at the amount shown
on the Data Pages.
(b) The amount of the second and third monthly Variable Income Annuity
payments with respect to each applicable Investment Fund will be the
same as the amount of the first payment. The amount of the fourth
and each subsequent monthly payment will be the number of Annuity
Units for each Investment Fund multiplied by the Average Annuity
Unit Value for the second calendar month immediately preceding the
due date of the payment.
The fourth and subsequent monthly Variable Income Annuity payments
may increase or decrease in amount, depending on whether the actual
rate of net investment return (after charges) of the applicable
Investment Fund is higher or lower than the Assumed Base Rate of Net
Investment Return shown on the Data Pages. Payments will not be
increased or decreased in amount because of mortality or expense
experience.
3. DEATH OF OWNER:
If you are not the Annuitant and you die before the Annuitant, upon the
date of receipt by us at the Processing Office of proof satisfactory to
us of your death, the Successor Owner becomes the Owner with all rights
under this Contract. If you die before the Annuitant and if no Successor
Owner is alive, your estate becomes the Owner.
VIA95L 11
PART D. TRANSFERS
------------------
Transfers among Investment Funds are permitted only if so stated on the Data
Pages. If the Data Pages do not state that transfers are permitted, and if after
the Contract Date we change our rules to permit such transfers, we will notify
you in writing. The notice will specify any restrictions which apply.
VIA95L 12
PART E. GENERAL TERMS
----------------------
1. CONTRACT:
This Contract, the related application and any endorsement(s) constitute
the entire Contract between the parties, and their terms alone will
govern with respect to our rights and obligations. The Contract may not
be modified, nor may any of our rights or requirements be waived, except
in writing signed by one of our authorized officers.
2. ASSIGNMENT:
This Contract may not be sold, assigned, discounted or pledged as
collateral for a loan or as security for the performance of an obligation
or for any other purpose, and except as otherwise permitted by law, no
sum payable under this Contract may be transferred, assigned or
encumbered, or will in any way be subject to any legal process to subject
the same to the payment of any claim against the person to whom such sum
is payable.
3. PAYMENT:
All payments by us under this Contract will be made by check (or, if so
agreed by you and us, by wire transfer or other form).
4. EVIDENCE OF SURVIVAL:
We may require satisfactory evidence of survival of the Annuitant on the
due date of each payment. If the check for the payment is drawn to the
order of the Annuitant, the personal endorsement of such Annuitant on the
check will be accepted as evidence of survival, subject to our right to
require evidence of the authority of any person who makes claim to
receive any payment.
5. AGE AND SEX:
If the Annuitant's age or, if applicable, sex has been misstated, any
benefits will be such as the Contract would have provided if the first
payment amount had been based on the correct age and sex. Any
overpayments or underpayments made by us will be charged or credited with
interest at [6% per year] (or such other rate which applies under our
rules at any time) to benefits falling due thereafter.
6. CONTRACT CHANGES - APPLICABLE LAW:
For you (and the Annuitant) to receive the tax treatment accorded to
annuities under Federal law, this Contract must qualify initially and
continue to qualify as an annuity under the Internal Revenue Code or
successor law. Therefore, to assure this qualification, we reserve in
this Contract the right to defer acceptance of or to return any payment
that would cause the Contract to fail to qualify as an annuity under
applicable tax law as interpreted by us. Furthermore, we reserve the
right to make changes in this Contract to the extent we deem it necessary
to continue to qualify this Contract as an annuity. Any such changes will
apply uniformly to all Contracts that are affected. You will be given
advance written notice of such changes.
VIA95L 13
In addition, payments under this Contract must comply with any applicable
requirements of Section 401(a)(9) of the Internal Revenue Code and the
Treasury regulations which apply.
VIA95L 14
ENDORSEMENT
NOTICE OF RIGHT TO CANCEL
-------------------------
This Contract provides a ten day right to cancel. See the cover page. If you
cancel the Contract according to this right, you will receive a refund of any
premium made, plus or minus any investment gain or loss which applies to the
Separate Account Investment Funds from the date the premium or portion thereof
was allocated to any such Investment Fund, if applicable, to the date the
Contract is canceled.
ENDVIA95
January 1996
THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES
Description of Illustrative and Variable Text
For Contract Form Nos. VIA95L,
VIA95LPC, VIA95JSL,
and VIA95JSLPC
= = = = = = = = = = = = = = = = = = = = = = = = = = == = = = = = = = = = = = = =
The following comments describe the nature and scope of the illustrative and
variable material in the forms and are numbered to correspond to the numbers
that, on the forms filed for approval, have been placed adjacent to the
underscored or bracketed areas on the forms that may change.
1. These are illustrative numbers, dates, and names that reflect the facts
in a given case.
2. The definition of Processing Office reflects our current administrative
office. If we change this to a different address, the definition will be
changed accordingly.
3. As provided in Part B, Section 2 of each Contract, the Separate Account
and applicable Investment Funds then available from Equitable will be
listed here. Any Separate Account and Investment Fund available at any
time will be one which has been approved by the New York Insurance
Department. The Investment Funds which currently apply are Investment
Funds of Equitable's Separate Account A.
If Equitable at any time adds, removes or limits Investment Funds or
changes the Separate Account pursuant to Part B, Section 2.d. of each
Contract, the list of Investment Funds and/or the reference to the
Separate Account to be included in the Data Pages will be changed
accordingly.
4. The appropriate Assumed Base Rate of Investment Return to apply with
respect to a variable annuity, pursuant to Part B, Section 2 of each
Contract, will be shown here. The rate of 5.00% applies currently to
Contracts to be issued in New York and most other states. Where required
(currently Florida, New Mexico, Texas and West Virginia), the rate of
3.5% will be shown. In addition, we are considering the possibility at a
future date of permitting the annuitant to choose the rate to apply,
subject to applicable state requirements.
5. The Adjustment Factor to apply pursuant to Part B, Section 2.c. of each
Contract will be shown. The rate of .00013366 will apply if the Assumed
Base Rate of Investment Return is 5.0%; the rate of .00009425 will apply
if the Assumed Base Rate of Investment Return is 3.5%.
6. Equitable has the right to charge an Administrative Expense Charge,
deducted from the premium paid. Currently, this Charge is $200, but we
reserve the right to increase this charge in the future for new
contracts; however, any change to an amount which exceeds $500 will be
filed with the Department for approval.
7. The Daily Separate Account Charge may change for Contracts issued in the
future in order to reflect changes in administrative expenses, death
benefit and mortality experience, and mortality and expense risks,
subject to any
1
regulatory approvals that apply. Any change to an amount which exceeds
2.0% will be filed with the Department for approval.
8. Pursuant to Part B, Section 1 of each Contract, the Interest Rate which
applies to a fixed income annuity will be shown in the Data Pages. This
Rate will vary based on the date of issue of the Contract and will be
determined on a uniform basis to apply consistently to like Contracts
issued as of the same date.
9. Currently, transfers among Investment Funds are not permitted under the
Contract. At a future date, if our administrative systems can accommodate
such transfers, they will be permitted. If so, the transfer frequency
(e.g., one transfer permitted in each month) will be reflected in the
Data Pages.
2
