[XXXX XXXXXXX(R) LOGO] XXXX XXXXXXX LIFE INSURANCE COMPANY (U.S.A.)
HOME OFFICE: Bloomfield Hills, MI
THIS IS A LEGAL CONTRACT - READ IT CAREFULLY.
This Contract is issued in consideration of the Payments. Xxxx Xxxxxxx Life
Insurance Company (U.S.A.), a stock company, agrees to pay the benefits of this
Contract in accordance with its terms.
VARIABLE ACCOUNT PROVISIONS
ANNUITY PAYMENTS AND OTHER VALUES PROVIDED BY THIS CONTRACT WHEN BASED ON THE
INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT ARE VARIABLE AND NOT GUARANTEED AS
TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE ACCOUNT PROVISIONS BEGIN ON PAGE
6.
RIGHT TO REVIEW
You may cancel the Contract by returning it to our Annuities Service Center or
the registered representative who sold it to you at any time within [10] days
after receipt of the Contract. Within 7 days of receipt of the Contract by us,
we will pay the Contract Value computed at the end of the Business Day on which
the Contract is received by us plus the sum of all fees and charges deducted
from the gross Payments to the Owner.
When the Contract is issued as an individual retirement annuity, during the
first 7 days of this [10] day period, we will return the greater of (i) Contract
Value computed at the end of the Business Day on which the Contract is received
by us plus the sum of all fees and charges deducted from the gross Payments or
(ii) sum of all Payments less any Withdrawals.
SIGNED FOR THE COMPANY at its Main Administration Office in Boston,
Massachusetts, on the Contract Date.
[/s/ Xxxxx X. Xxxxx] [/s/ Xxxxxxx Xxxxx]
[Xxxxx X. Xxxxx], President [Xxxxxxx Xxxxx], Secretary
FLEXIBLE PAYMENT DEFERRED VARIABLE ANNUITY
Variable Accumulation prior to Annuity Commencement Date
Variable and Fixed Annuity Options
Death Benefit Proceeds Payable prior to Annuity Commencement Date
Withdrawal Charge Waiver Benefit
Non-Participating
ANNUITIES SERVICE CENTER:
[P.O. Box 9505 Portsmouth, NH 03802-9505] [0-000-000-0000] [xxx.xxxxxxxxxxx.xxx]
OVERNIGHT MAILING ADDRESS:
[000 Xxxxxxxxx Xxxxx Xxxxxxxxxx, XX 00000-0000]
[ISSUE STATE] INSURANCE DEPARTMENT TELEPHONE NUMBER: [XXX-XX-XXXX]
ICC11-VENTURE.11 SAMPLE
Table of Contents
Specifications Pages..................................................... S.1
Part 1 - Definitions.................................................... 1
Part 2 - Parties to the Contract........................................ 4
Part 3 - Payments....................................................... 5
Part 4 - Fees And Deductions............................................ 6
Part 5 - Variable Account Provisions.................................... 6
Part 6 - Transfers...................................................... 8
Part 7 - Withdrawal Provisions.......................................... 9
Part 8 - Death Benefits................................................. 10
Part 9 - Contract Maturity.............................................. 12
Part 10 - Annuity Payments............................................... 13
Part 11- Annuity Options................................................. 14
Part 12 - General Provisions............................................. 14
Part 13 - Contract Termination........................................... 16
INTRODUCTION
This is a flexible payment deferred variable annuity contract. This Contract
provides that, prior to the Annuity Commencement Date, the Contract Value will
accumulate on a variable basis. You allocate Payments among one or more
Investment Options. The initial Investment Options are identified on the
Specifications Pages. The Contract Value will vary with the investment
performance of your Investment Account. Subject to the provisions of the
Contract, you may take withdrawals and transfer amounts among the Investment
Options.
After the Annuity Commencement Date, Annuity Payments may be either fixed or
variable, or a combination of fixed and variable. If you select Annuity Payments
on a variable basis, the payment amount will vary with the investment
performance of the Variable Account.
If the Owner (Annuitant if the Owner is not an individual) dies while this
Contract is in effect prior to the Annuity Commencement Date, we will pay a
Death Benefit to the Beneficiary upon receipt of all required claim forms and
proof of death of the Owner at the Annuities Service Center.
ICC11-VENTURE.11 SAMPLE
PART 1 DEFINITIONS
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WE AND YOU "We", "us" and "our" means the Company. "You" or "your" means
the Owner of this Contract.
ACCUMULATION UNIT A unit of measure that is used to calculate the value of the
Variable Account of this Contract before the Annuity
Commencement Date.
ANNUITANT Any individual person or persons whose life is used to
determine the duration of Xxxxxxx Payments involving life
contingencies. The Annuitant is as designated on the
Specifications Pages, unless changed.
ANNUITIES SERVICE CENTER Any office designated by us for the receipt of Payments and
processing of Owner requests.
ANNUITY COMMENCEMENT DATE The date Annuity Payments begin. This date may not be earlier
than six months following the Contract Date or later than the
Maturity Date.
ANNUITY OPTION The method selected by you for Annuity Payments made by us.
ANNUITY PAYMENT(S) Payment(s) by us to you, in accordance with the Annuity Option
elected under the terms of this Contract.
ANNUITY UNIT A unit of measure that is used after the Annuity Commencement
Date to calculate Variable Annuity payments.
BENEFICIARY The person, persons or entity to whom certain benefits are
payable following the death of an Owner, or in certain
circumstances, an Annuitant.
BUSINESS DAY Any date on which the New York Stock Exchange is open for
business and the net asset value of a Portfolio is determined.
COMPANY The insurance company named on the first page of this Contract
(or any successor insurance company named by endorsement to
this Contract) that will pay benefits in accordance with this
Contract.
CONTRACT ANNIVERSARY The annual anniversary of the Contract beginning twelve months
from the Contract Date and each year thereafter.
CONTRACT DATE The date of issue of this Contract as designated on the
Specifications Pages.
CONTRACT VALUE The total of your Investment Account Values.
CONTRACT YEAR The period of time measured twelve consecutive months from the
Contract Date or any Contract Anniversary thereafter.
CONTINGENT BENEFICIARY The person, persons or entity who becomes the Beneficiary if
the Beneficiary is not alive.
CUMULATIVE VALUE The Contract Value of this Contract plus the contract value of
any other variable annuity contract issued by the Company or
any of its affiliates that is in its accumulation phase and
has the same owner or annuitant as this Contract.
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ENDORSEMENT An Endorsement modifies the contract to which it is attached.
Endorsements must be signed by an officer of the Company in
order to be effective.
FIXED ANNUITY An Annuity Option with payments which are predetermined and
guaranteed as to dollar amount.
GOOD ORDER The standard we apply when we determine whether an instruction
is satisfactory. An instruction will be considered in Good
Order if it is received at our Annuities Service Center: (a)
in a manner that is satisfactory to us such that it is
sufficiently complete and clear that we do not need to
exercise any discretion to follow such instruction and
complies with all relevant laws and regulations and Company
requirements; (b) on specific forms, or by other means we then
permit (such as via telephone or electronic submission);
and/or (c) with any signatures and dates we may require. We
will notify you if an instruction is not in Good Order.
INTERNAL REVENUE CODE (IRC) The Internal Revenue Code of 1986, as amended from time to
time, and any successor statute of similar purpose.
INVESTMENT ACCOUNT An account established by us which represents your interest in
an Investment Option prior to the Annuity Commencement Date.
INVESTMENT ACCOUNT VALUE The value of your investment in an Investment Account.
INVESTMENT OPTIONS The Subaccount(s) of the Variable Account. The Investment
Options available under this Contract at issue are shown on
the Specifications Pages.
MATURITY DATE The latest date on which annuity benefits may commence. It is
the date listed on the Specifications Pages, unless changed.
In no event shall the Maturity Date be later than age 105 of
the oldest Annuitant.
NET PAYMENT The Payment less the amount of premium tax, if any, deducted
from the Payment.
NET SURRENDER VALUE The Surrender Value less any amount withheld by us for income
taxes.
NON-QUALIFIED CONTRACTS Contracts which are not issued under Qualified Plans.
OWNER The person, persons or entity entitled to the ownership rights
under this Contract. The Owner is as designated on the
Specifications Pages, unless changed.
PORTFOLIO The investment choices available to the Variable Account.
PAYMENT An amount paid to us by you as consideration for the benefits
provided by this Contract.
QUALIFIED CONTRACTS Contracts issued under Qualified Plans.
QUALIFIED PLANS Retirement plans which receive favorable tax treatment under
sections 401, 403, 408 or 457, of the Internal Revenue Code of
1986, as amended.
RIDER A rider provides an optional benefit, which may result in an
additional charge to the Contract. A rider supplements the
contract to which it is attached. Riders must be signed by an
officer of the Company in order to be effective.
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SEPARATE ACCOUNT A segregated account of the Company that is not commingled
with our general assets and obligations.
SUBACCOUNT(S) A division of the Variable Account. Each Subaccount is
invested in shares of a different Portfolio.
SURRENDER VALUE The Contract Value on any Valuation Date, less, if applicable,
any contract fees, any rider charges, any deduction for
premium taxes or similar taxes, and any Withdrawal Charge.
VALUATION PERIOD Any period from one Business Day to the next, measured from
the time on each such day that the net asset value of each
Portfolio is determined.
VARIABLE ACCOUNT The Company's Separate Account as shown on the Specifications
Pages.
VARIABLE ANNUITY An Annuity Option with payments which: (1) are not
predetermined or guaranteed as to dollar amount; and (2) vary
in relation to the investment experience of one or more
specified variable Subaccounts.
WITHDRAWAL AMOUNT The amount deducted from the Contract Value when you take a
withdrawal. This amount is the total of the amount paid to
you plus the following, if applicable: any contract fees, any
rider charges, any deduction for premium taxes or similar
taxes, any amount for income taxes resulting from the
withdrawal, and any Withdrawal Charges. The Withdrawal Amount
may not exceed the Contract Value.
WRITTEN REQUEST A notice provided in a form acceptable to Us based on the type
of request and received in Good Order at our Annuities Service
Center.
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PART 2 PARTIES TO THE CONTRACT
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OWNER Before the Annuity Commencement Date, the Owner of this
Contract shall be the person, persons or entity designated
on the Specifications Pages or the latest change filed with
us. A co-Owner is not permitted under this Contract if any
Owner is an entity. On the Annuity Commencement Date the
Annuitant will become the Owner of this Contract, unless
the Owner is a trust or custodian. If amounts become
payable to the Beneficiary under this Contract, the
Beneficiary becomes the Owner of this Contract. Unless
indicated otherwise, references to the Owner will also
include the co-Owner.
ANNUITANT The Annuitant is the person designated as such on the
Specifications Pages or the latest change filed with us.
If you name more than one Xxxxxxxxx, the second Annuitant
is referred to as the co-Annuitant. Unless indicated
otherwise, references to the Annuitant will also include
the co-Annuitant.
BENEFICIARY The Beneficiary is as designated on the Specifications
Pages, unless changed. However, if there is a surviving
Owner, that person will be treated as the Beneficiary. If
no such Beneficiary is living, the Beneficiary is the
Contingent Beneficiary. If no Beneficiary or Contingent
Beneficiary is living, the Beneficiary is the estate of the
deceased Owner.
CHANGE OF OWNER, ANNUITANT, Subject to the rights of an irrevocable Beneficiary, you
BENEFICIARY may change the Owner, Annuitant, or Beneficiary by Written
Request. Any change will take effect on the date the
request is signed. Any change of Owner or Annuitant is
subject to our issue age limitations based on age at the
date of the change. The Annuitant may not be changed after
the Annuity Commencement Date. You need not send us the
Contract unless we request it. We will not be liable for
any payments or actions we take before the Written Request
is received.
The addition of any Owner may result in the resetting of
the Guaranteed Minimum Death Benefit to an amount equal to
the Contract Value as of the date of such change. For
purposes of subsequent calculations of the Guaranteed
Minimum Death Benefit, we will treat the Contract Value on
the date of the change as a Payment made on that date. In
addition, all anniversary values, all Payments made and all
amounts deducted in connection with partial withdrawals
prior to the date of the addition of the Owner will not be
considered in the determination of the Guaranteed Minimum
Death Benefit.
The substitution of any Owner will result in the resetting
of the Death Benefit to an amount equal to the Contract
Value and the Guaranteed Minimum Death Benefit will no
longer apply. This paragraph will not apply if:
(a) the new Owner is a guardian, a custodian or a trust
established for the sole benefit of the previous Owner;
or
(b) the new Owner is an individual and the previous Owner
was a guardian, a custodian or a trust established for
the sole benefit of that individual; or
(c) the change is from one guardian, custodian or trust
established for the sole benefit of an individual to
another guardian, custodian or trust established for the
sole benefit of that individual; or
(d) Ownership is transferred to the Owner's spouse
following the death of the Owner.
If any Annuitant is changed and any Owner is not an
individual, the entire interest in the Contract must be
distributed to the Owner within five years of the change.
ICC11-VENTURE.11 SAMPLE
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ASSIGNMENT You may assign this Contract, except as otherwise provided,
at any time prior to the Annuity Commencement Date. No
assignment will be binding on us unless it is in the form
of a Written Request. We will not be liable for any
payments made or actions we take before the assignment is
accepted by us. An absolute assignment will revoke the
interest of any revocable Beneficiary. We will not be
responsible for the validity of any assignment.
An assignment of the Contract will result in the resetting
of the Death Benefit to an amount equal to the Contract
Value. Any Payments made and amounts deducted in
connection with partial withdrawals will not be considered
in the determination of the Death Benefit, except for the
impact of those transactions on the Contract Value. This
paragraph will not apply if:
(a) the Contract is assigned to a guardian, a custodian
or a trust established for the sole benefit of the
previous Owner; or
(b) the assignment is for purposes of a tax qualified
exchange.
If this Contract is issued in a Qualified Plan, this
Contract is subject to assignment restrictions for Federal
Income Tax purposes. In such event, this Contract shall
not be sold, assigned, discounted, or pledged as collateral
for a loan or as security for the performance of an
obligation or for any other purpose, to any person other
than us.
PART 3 PAYMENTS
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GENERAL The Contract is not effective until the Initial Payment is
received by us at our Annuities Service Center or such
other place designated by us. All Payments under this
Contract are payable at our Annuities Service Center or
such other place as we may designate.
PAYMENT LIMITS The Initial Payment is shown on the Specifications Pages.
Each additional Payment must be at least equal to the
Minimum Additional Payment Amount shown on the
Specifications Pages. If a Payment would cause the
Cumulative Value on the date of such Payment to exceed the
Maximum Amount shown on the Specifications Pages, or the
Cumulative Value on the date of such Payment already exceeds
the Maximum Amount, no additional Payments will be accepted
without our prior approval. Additional limits may apply
based on your election of an optional Rider or optional
benefit. Any such limits are described in the Rider or on
the Specifications Pages.
Upon notice, we have the right to refuse or limit
subsequent Payments after the first Contract Year in a
manner that is not discriminatory.
ALLOCATION OF NET PAYMENTS When we receive Payments, the Net Payments will be
allocated among Investment Options in accordance with the
allocation percentages shown on the Specifications Pages.
You may change the allocation of subsequent Net Payments at
any time, without charge, by Written Request.
ICC11-VENTURE.11 SAMPLE
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PART 4 FEES AND DEDUCTIONS
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CONTRACT ASSET FEE To compensate us for assuming mortality and expense risks,
and administration expenses, we deduct from each variable
Investment Option a fee each Valuation Period at an annual
rate set forth on the Specifications Pages. A portion of
this Asset Fee may also be used to reimburse us for
distribution expenses. This fee is reflected in the Net
Investment Factor used to determine the value of
Accumulation Units and Annuity Units of the Contract.
ANNUAL CONTRACT FEE To compensate us for assuming administration expenses, we
charge an Annual Contract Fee as set forth on the
Specifications Pages. Prior to the Annuity Commencement
Date, the Annual Contract Fee is deducted on each Contract
Anniversary. We withdraw the Annual Contract Fee from each
Investment Option in the same proportion that the value of
the Investment Accounts of each Investment Option bears to
the Contract Value. If the Contract Value is totally
withdrawn on any date other than the Contract Anniversary,
we will deduct the total amount of the Annual Contract Fee
from the amount paid. After the Annuity Commencement Date,
we deduct the Annual Contract Fee on a pro rata basis from
each Annuity Payment.
TAXES We reserve the right to charge certain taxes against your
Payments (either at the time of payment or liquidation due
to withdrawals, annuitization or death benefit), or against
the Contract Value, Death Benefit proceeds, or Annuity
Payments, as appropriate. Such taxes may include premium
taxes or other taxes levied by any government entity which
we, in our sole discretion, determine have resulted from
the establishment or maintenance of the Variable Account,
or from the receipt by us of Payments, or from the issuance
of this Contract, or from the commencement or continuance
of Annuity Payments under this Contract.
RIDER FEE(S) We charge an additional fee to compensate us for the
additional benefits provided by any optional benefit riders
elected by you. The Rider Fee for each rider you elect is
shown on the Specifications Pages or in the Rider. Rider
Fees are deducted as described in the applicable benefit
Rider issued by us.
PART 5 VARIABLE ACCOUNT PROVISIONS
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INVESTMENT ACCOUNT We will establish a separate Investment Account for you for
each variable Investment Option to which you allocate
amounts. The Investment Account represents the number of
your Accumulation Units in an Investment Option.
INVESTMENT ACCOUNT VALUE The Investment Account Value of an Investment Account is
determined by (a) times (b) where:
(a) equals the number of Accumulation Units credited to the
Investment Account; and;
(b) equals the value of the appropriate Accumulation Unit.
ACCUMULATION UNITS We will credit Net Payments to your Investment Accounts in
the form of Accumulation Units. The number of Accumulation
Units we will credit to each Investment Account of the
Contract will be determined by dividing the Net Payment
allocated to that Investment Account by the Accumulation
Unit value for that Investment Account.
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Accumulation Units will be adjusted for any transfers and
will be canceled on payment of a death benefit, withdrawal,
maturity or assessment of certain charges based on their
value for the Business Day on which such transaction occurs.
VALUE OF ACCUMULATION UNIT We will determine the Accumulation Unit value for a
particular Investment Account for any Business Day by
multiplying the Accumulation Unit value for the immediately
preceding Business Day by the net investment factor for the
Valuation Period for which the value is being determined.
The value of an Accumulation Unit may increase, decrease or
remain the same from one Business Day to the next.
NET INVESTMENT FACTOR The net investment factor is an index that measures the
investment performance of a Subaccount from one Business
Day to the next (" the Valuation Period"). The net
investment factor for any Valuation Period is determined by
dividing (a) by (b) and subtracting (c) from the result
where:
(a) is the net result of:
(i) the net asset value per share of a Portfolio share
held in the Subaccount determined as of the end of
the current Valuation Period, plus
(ii) the per share amount of any dividend or capital gain
distributions made by the Portfolio on shares held
in the Subaccount and received during the current
Valuation Period; and
(b) is the net asset value per share of a Portfolio share
held in the Subaccount determined as of the end of the
immediately preceding Valuation Period; and
(c) is the Contract Asset Fee shown on the Specifications
Pages divided by 365 and multiplied by the number of
calendar days in the Valuation Period.
The net investment factor may be greater or less than, or
equal to, one.
ADDITION, DELETION, We reserve the right, subject to compliance with applicable
SUBSTITUTION OR RESTRICTION law, to make additions to, deletions from, or substitutions
OF INVESTMENT OPTIONS for the Portfolio shares that are held by the Variable
Account or that the Variable Account may purchase. We
reserve the right to eliminate the shares of any of the
eligible Portfolios and to substitute shares of another
Portfolio. We will not substitute any shares attributable
to your interest in a Subaccount without notice to you and
prior approval of the Securities and Exchange Commission to
the extent required by the Investment Company Act of 1940.
Nothing contained herein shall prevent the Variable Account
from purchasing other securities for other series or
classes of contracts, or from effecting a conversion
between shares of another open-end investment company.
We reserve the right, subject to compliance with applicable
law, to establish additional Subaccounts which would invest
in shares of a new Portfolio. We also reserve the right to
eliminate existing Subaccounts, to restrict or prohibit
additional allocations to a Subaccount, to combine
Subaccounts or to transfer assets in a Subaccount to
another Separate Account established by us or an affiliated
company. In the event of any such substitution or change,
we may, by appropriate endorsement, make such changes in
this and other Contracts as may be necessary or appropriate
to reflect such substitutions or change. If deemed by us
to be in the best interests of persons having voting rights
under the Contracts, the Variable Account may be operated
as a management company under the Investment Company Act of
1940 or it may be de-registered under such Act in the event
such registration is no longer required.
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INSULATION The portion of the assets of the Variable Account equal to
the reserves and other contract liabilities with respect to
such account shall not be charged with liabilities arising
out of any other business we may conduct. Moreover, the
income, gains and losses, realized or unrealized, from
assets allocated to the Variable Account shall be credited
to or charged against such account without regard to our
other income, gains or losses.
PART 6 TRANSFERS
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TRANSFERS BEFORE ANNUITY While this Contract is in effect prior to the Annuity
COMMENCEMENT DATE Commencement Date, you may transfer amounts among the
Investment Accounts of the Contract, subject to the
limitations below. Amounts will be canceled from the
Investment Accounts from which amounts are transferred and
credited to the Investment Account to which amounts are
transferred. We will effect such transfers so that the
Contract Value on the date of transfer will not be affected
by the transfer.
You must transfer at least the Minimum Transfer Amount
shown on the Specifications Pages or, if less, the entire
amount in the Investment Account each time you make a
transfer. If, after the transfer, the amount remaining in
the Investment Account from which the transfer is made is
less than Minimum Investment Account Value shown on the
Specifications Pages, then we will transfer the entire
amount instead of the requested amount.
We reserve the right, upon notice, to limit the number of
transfers that can be made per Contract Year. Should we
limit the number of transfers, such limit will be no less
than the Minimum Number of Transfers Per Contract Year
shown in the Transfers Before Annuity Commencement Date
section on the Specifications Pages.
We also reserve the right, upon notice, to impose a
transaction charge for transfers. Such charge will not
exceed the Transfer Charge shown on the Specifications
Pages.
TRANSFERS ON OR AFTER Once variable Annuity Payments have begun, you may transfer
ANNUITY COMMENCEMENT DATE all or part of the investment upon which your variable
Annuity Payments are based from one Subaccount to another.
To do this, we will convert the number of variable Annuity
Units you hold in the Subaccount from which you are
transferring to a number of variable Annuity Units of the
Subaccount to which you are transferring so that the next
Annuity Payment, if it were made at that time, would be the
same amount that it would have been without the transfer.
After the transfer, the variable Annuity Payments will
reflect changes in the values of your new variable Annuity
Units. You must give us notice at least 30 days before the
due date of the first variable Annuity Payment to which the
transfer will apply.
We reserve the right, upon notice, to limit the number of
transfers that can be made after variable annuity payments
have begun. If such a limit is imposed, the number of
transfers per Contract Year will be no less than the
Minimum Number of Transfers Per Contract Year shown in the
Transfers On Or After Annuity Commencement Date section on
the Specifications Pages.
After the Annuity Commencement Date, transfers will not be
allowed from a fixed to a variable Annuity Option, or from
a variable to a fixed Annuity Option.
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DEFERRAL, MODIFICATION OR We reserve the right to defer, modify or terminate the
TERMINATION OF TRANSFER transfer privilege at any time that we are unable to
PRIVILEGE purchase or redeem shares of the Portfolios or when a
portfolio requires us to impose restrictions due to
violation of its short term trading policy. Transfer
charges and limitations are identified above and in the
Suspension of Payments provision in the Withdrawals
Provisions section.
PART 7 WITHDRAWAL PROVISIONS
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PAYMENTS OF WITHDRAWALS You may withdraw part or all of the Surrender Value, at any
time before the earlier of the death of an Owner, the
Annuity Commencement Date or the Maturity Date, by sending
us a Written Request. We will pay all withdrawals within
seven days of receipt at the Annuities Service Center
subject to postponement in certain circumstances, as
specified below.
TOTAL WITHDRAWAL Upon receipt of your request to withdraw the entire
Contract Value, we will terminate the Contract and pay you
the Surrender Value.
PARTIAL WITHDRAWAL If you request to withdraw an amount less than the
Surrender Value, we will pay you the amount requested and
deduct the Withdrawal Amount from the Contract Value.
Unless you specify the amount to be withdrawn from each
Investment Option, the Withdrawal Amount will be withdrawn
from each Investment Option on a pro rata basis.
Partial withdrawals will reduce the Death Benefit, as
described in the Death Benefit section.
FREQUENCY AND AMOUNT OF You may make as many partial withdrawals as you wish.
PARTIAL WITHDRAWALS Limitations on the amount of partial withdrawals are as
follows.
(a) Any withdrawal from an Investment Account must be at
least equal to the Minimum Amount of Partial Withdrawal
shown on the Specifications Pages or the entire balance
in the Investment Account, if less.
(b) If after the withdrawal, the amount remaining in the
Investment Account is less than the Minimum Investment
Account Balance shown on the Specifications Pages, then
we will consider the withdrawal request to be a request
for withdrawal of the entire amount held in the
Investment Account.
(c) If a partial withdrawal reduces the Contract Value to
less than the Minimum Remaining Contract Value shown on
the Specifications Pages, or if the amount requested is
greater than or equal to the amount available as a total
withdrawal, then we will treat the partial withdrawal as
a total withdrawal of the Contract Value.
SUSPENSION OF PAYMENTS We may defer the right of withdrawal from, or postpone the
date of payments from, the variable Investment Accounts for
any period when: (1) the New York Stock Exchange is closed
(other than customary weekend and holiday closings); (2)
trading on the New York Stock Exchange is restricted; (3)
an emergency exists as a result of which disposal of
securities held in the Variable Account is not reasonably
practicable or it is not reasonably practicable to
determine the value of the Variable Account's net assets;
or (4) the Securities and Exchange Commission, by order, so
permits for the protection of security holders; provided
that applicable rules and regulations of the Securities and
Exchange Commission shall govern as to whether the
conditions described in (2) and (3) exist.
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WITHDRAWAL CHARGE If a withdrawal is made from the Contract we may assess a
Withdrawal Charge against Payments. The amount of the
Withdrawal Charge and when it is assessed is discussed
below.
(a) A Free Withdrawal Amount may be withdrawn free of a
Withdrawal Charge. The Free Withdrawal Amount is the
greater of:
(i) Earnings, which for purposes of these Withdrawal
Charge provisions, means the excess of the
Contract Value on the date of withdrawal over the
unliquidated Payments; or
(ii) the excess of a. over b. where
a. equals 10% times the total Payments; and
b. equals 100% of all prior partial
withdrawals in that Contract Year.
(b) Amounts will be withdrawn from the Contract in the
following order for purposes of calculating the
Withdrawal Charge:
(i) Earnings; then
(ii) any Free Withdrawal Amount in excess of Earnings;
then
(iii) Payments not previously liquidated, in the order
such Payments were received.
(c) Payments are liquidated when the Withdrawal Amount
exceeds Earnings. The amount of Payments liquidated
equals
(i) the lesser of the Withdrawal Amount or the total
unliquidated Payments; minus
(ii) Earnings.
(d) A total withdrawal will liquidate all unliquidated
Payments. Any Payments liquidated may be subject to a
Withdrawal Charge based on the length of time the
Payment has been in the Contract. The Withdrawal Charge
is determined by multiplying the amount of the Payment
being liquidated by the applicable Withdrawal Charge
percentage obtained from the table shown on the
Specifications Pages.
(e) The total Withdrawal Charge will be the sum of the
Withdrawal Charges for the Payments being liquidated.
WAIVER OF WITHDRAWAL CHARGE A Withdrawal Charge is not applied if the withdrawal is:
(a) payment of the Death Benefit; or
(b) due to the application of the Contract Value to an
Annuity Option; or
(c) taken at the Maturity Date of the Contract; or
(d) a distribution required to satisfy Federal Income Tax
minimum distribution requirements that apply to this
Contract; or
(e) a withdrawal guaranteed under certain riders attached
to the Contract, as specified in the rider.
PART 8 DEATH BENEFITS
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DEATH BENEFIT BEFORE ANNUITY Prior to the Maturity Date or Annuity Commencement Date, if
COMMENCEMENT DATE earlier, we will determine the Death Benefit as of the date
on which written notice and proof of death and all required
claim forms are received in Good Order at the Company's
Annuities Service Center as follows:
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The Death Benefit will be determined as the greater of the
Contract Value or the Guaranteed Minimum Death Benefit.
The Guaranteed Minimum Death Benefit is the sum of all
Payments made, less any amount deducted in connection with
partial withdrawals. For purposes of calculating the
Guaranteed Minimum Death Benefit, the amount deducted in
connection with partial withdrawals will be equal to (i)
times (ii), where (i) is equal to the Guaranteed Minimum
Death Benefit prior to the withdrawal, and (ii) is equal to
the amount of the partial withdrawal divided by the
Contract Value prior to the partial withdrawal.
We will permit the Owner to limit the Death Benefit
option(s) to be offered any named Beneficiary, if the Owner
provides written notice to the Company prior to death and
the desired option(s) is one provided for in this Contract.
Death benefit distributions prior to the Annuity
Commencement Date are governed by Internal Revenue Code
Section 72(s). Pursuant to Section 72(s) any reference in
this provision to "spouse" means a spouse as defined in
Section 3 of the federal Defense of Marriage Act ("DOMA").
Therefore a same-sex partner is not a "spouse" for purposes
of the distribution provisions of this section.
DEATH OF ANNUITANT: On the death of the last surviving
Annuitant, the Owner becomes the new Annuitant, if the
Owner is an individual. If the Owner is not an individual
the death of any Annuitant is treated as the death of an
Owner and the Death Benefit will be determined by
substituting the Annuitant for the Owner as described below.
DEATH OF OWNER: We will pay the Death Benefit to the
Beneficiary if any Owner dies prior to the Maturity Date or
Annuity Commencement Date, if earlier. The Death Benefit
may be taken in one sum immediately, in which case the
Contract will terminate. If the Death Benefit is not taken
in one sum immediately, the Contract will continue subject
to the following provisions:
(a) The Beneficiary becomes the Owner.
(b) The excess, if any, of the Death Benefit over the
Contract Value will be allocated to and among the
Investment Accounts in proportion to their values as of
the date on which the Death Benefit is determined.
(c) No additional Payments may be applied to the Contract.
(d) If the Beneficiary is not the deceased Owner's spouse,
the entire interest in the Contract must be distributed
under one of the following options:
(i) The entire interest in the Contract must be
distributed over the life of the Beneficiary, or
over a period not extending beyond the life
expectancy of the Beneficiary, with distributions
beginning within one year of the Owner's death; or
(ii) the entire interest in the Contract must be
distributed within 5 years of the Owner's Death,
or
(iii) as Annuity Payments under one of the options
described in the Annuity Options section.
If the Beneficiary dies before the distributions
required by (i) or (ii) are complete, the entire
remaining Contract Value must be distributed in a lump
sum immediately.
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(e) If the Beneficiary is the deceased Owner's spouse, the
Contract will continue with the surviving spouse as the
new Owner, subject to the provisions of Internal
Revenue Code Section 72(s). The surviving spouse may
name a new Beneficiary (and, if no Beneficiary is so
named, the surviving spouse's estate will be the
Beneficiary).
The spouse may also elect distributions under one of
the following options:
(i) the entire interest in the Contract may be
distributed over the life of the Beneficiary, or
over a period not extending beyond the life
expectancy of the Beneficiary, with distributions
beginning within one year of the Owner's death; or
(ii) as Annuity Payments under one of the options
described in the Annuity Options section.
(f) We will waive Withdrawal Charges on any withdrawals.
If there is more than one Beneficiary, the foregoing
provisions will independently apply to each Beneficiary, to
the extent of that Beneficiary's share.
DEATH BENEFIT ON OR AFTER If Annuity Payments have been selected based on an Annuity
ANNUITY COMMENCEMENT DATE Option providing for payments for a guaranteed period, and
the Annuitant dies on or after the Annuity Commencement
Date, we will make the remaining guaranteed payments to the
Beneficiary. Any remaining payments will be made at least
as rapidly as under the method of distribution being used
as of the date of the Annuitant's death. If no Beneficiary
is living, we will commute any unpaid guaranteed payments
to a single sum (on the basis of the interest rate used in
determining the payments) and pay that single sum to the
estate of the last to die of the Annuitant and the
Beneficiary.
PROOF OF DEATH We will require Proof of death upon the death of the
Annuitant or the Owner. Proof of death is one of the
following received at the Annuities Service Center:
(a) A certified copy of a death certificate;
(b) A certified copy of a decree of a court of competent
jurisdiction as to the finding of death; or
(c) Any other proof satisfactory to us.
PART 9 CONTRACT MATURITY
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CHANGE IN MATURITY DATE Prior to the Maturity Date, an Owner may make a Written
Request to change the Maturity Date. Any extension of the
Maturity Date will be subject to our prior approval and any
applicable law or regulation then in effect.
OPTIONS AT MATURITY DATE We will send You information about Your available options
prior to the Maturity Date. If by the Maturity Date, you
do not choose an Annuity Option, make a total withdrawal of
the Surrender Value, or ask us to change the Maturity Date,
we will automatically pay you Annuity Payments under the
Annuity Option shown on the Specifications Pages and the
Annuity Commencement Date is considered to be the Maturity
Date.
We will provide variable Annuity Payments unless otherwise
elected. You can change the Annuity Option at any time
before the Annuity Commencement Date.
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PART 10 ANNUITY PAYMENTS
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GENERAL The entire Contract Value or the entire amount of the
Beneficiary's portion of the Death Benefit may be applied
in accordance with one or more of the Annuity Options
described below, subject to any restrictions of Internal
Revenue Code section 72(s). Once Annuity Payments
commence, the Annuity Option may not be changed.
You may select a Fixed or Variable Annuity. We will
provide variable Annuity Payments unless otherwise elected.
Once Annuity Payments commence, the Annuity Option may not
be changed.
The method used to calculate the amount of the initial and
subsequent Annuity Payments is described below.
We may pay the Contract Value or Death Benefit, on the
Annuity Commencement Date in one lump sum if the
corresponding monthly income is less than $20.
VARIABLE ANNUITY PAYMENTS We will determine the amount of the first Variable Annuity
Payment by applying the portion of the Contract Value used
to effect a Variable Annuity (minus any applicable premium
taxes) to the Annuity Option elected based on the mortality
table and assumed interest rate shown in the Specifications
Pages. We will provide a table of the annuity factors upon
Written Request. If the current rates in use by us on the
Annuity Commencement Date are more favorable to you, we
will use the current rates. The portion of the Contract
Value used to effect a Variable Annuity will be measured as
of a date not more than 10 business days prior to the
Annuity Commencement Date.
Subsequent payments will be based on the investment
performance of one or more Subaccounts as you select. The
amount of such payments is determined by the number of
Annuity Units credited for each Subaccount. Such number is
determined by dividing the portion of the first payment
allocated to that Subaccount by the Annuity Unit value for
that Subaccount determined as of the same date that the
Contract Value used to effect Annuity Payments was
determined. We then multiply this number of Annuity Units
for each Subaccount by the appropriate Annuity Unit value
for each subsequent determination date, which is a
uniformly applied date not more than 10 business days
before the payment is due.
MORTALITY AND EXPENSE We guarantee that the dollar amount of each Variable
GUARANTEE Annuity payment will not be affected by changes in
mortality and expense experience.
ANNUITY UNIT VALUE The value of an Annuity Unit for each Subaccount for any
Business Day is determined as follows:
(a) The net investment factor for the Subaccount for the
Valuation Period ending on the Business Day for which
the Annuity Unit value is being calculated is
multiplied by the value of the Annuity Unit for the
preceding Business Day; and
(b) The result is adjusted to compensate for the interest
rate used to determine the first Variable Annuity
payment.
The dollar value of Annuity Units may increase, decrease or
remain the same from one Valuation Period to the next.
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FIXED ANNUITY PAYMENTS We will determine the amount of each Fixed Annuity payment
by applying the portion of the Contract Value used to
effect a Fixed Annuity measured as of a date not more than
10 business days prior to the Annuity Commencement Date
(minus any applicable premium taxes) to the Annuity Option
elected based on the mortality table and interest rate
shown on the Specifications Pages. The Fixed Annuity
payment will not be less than that available by applying
the Contract Value to purchase a single premium immediate
annuity then offered to the same class of annuitants by us
or a company affiliated with us.
We guarantee the dollar amount of Fixed Annuity payments.
PART 11 ANNUITY OPTIONS
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DESCRIPTION OF ANNUITY Option 1: Life Annuity
OPTIONS
a) Life Non-Refund. We will make Annuity Payments during
the lifetime of the Annuitant. No payments are due
after the death of the Annuitant.
b) Life with 10-Year Certain. We will make Annuity
Payments for 10 years and after that during the
lifetime of the Annuitant. No payments are due after
the death of the Annuitant or, if later, the end of the
10-year period.
Option 2: Joint and Survivor Life Annuity
The second Annuitant named shall be referred to as the
Co-Annuitant.
a) Joint and Survivor Non-Refund. We will make Annuity
Payments during the joint lifetime of the Annuitant and
Co-Annuitant. Payments will then continue during the
remaining lifetime of the survivor. No payments are due
after the death of the last survivor of the Annuitant
and Co-Annuitant.
b) Joint and Survivor with 10-Year Certain. We will make
Annuity Payments for 10 years and after that during the
joint lifetime of the Annuitant and Co-Annuitant.
Payments will then continue during the remaining
lifetime of the survivor. No payments are due after the
death of the survivor of the Annuitant and Co-Annuitant
or, if later, the end of the 10-year period.
ALTERNATE ANNUITY OPTIONS Instead of settlement in accordance with the Annuity
Options described above, you may choose an alternate form
of settlement acceptable to us. Once Annuity Payments
commence, the form of settlement may not be changed.
PART 12 GENERAL PROVISIONS
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ENTIRE CONTRACT The entire Contract consists of this Contract, Endorsements
and Riders, if any, and the application, if one is attached
to this Contract.
BENEFITS AND VALUES The benefits and values available under this Contract are
not less than the minimum required by the NAIC Model
Variable Annuity Regulation in effect on the Contract Date.
We have filed a detailed statement of the method used to
calculate the benefits and values with the Interstate
Insurance Product Regulation Commission.
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MODIFICATION Only the President, a Vice President, or the Secretary of
the Company has authority to agree on our behalf to any
alteration of the Contract or to any waiver of our rights
or requirements. The change or waiver must be in writing.
We will not change or modify this Contract without your
consent except as may be required to make it conform to any
applicable law or regulation or any ruling issued by a
government agency; or unless we have reserved the right to
change the terms herein.
CONFORMITY WITH INTERSTATE This Contract is approved under the authority of the
INSURANCE PRODUCT REGULATION Interstate Insurance Product Regulation Commission (IIPRC)
COMMISSION STANDARDS and issued under the Commission standards. Any provision
of this Contract that on the provision's effective date is
in conflict with the IIPRC standards for this product type
as of such date is hereby amended to conform with the IIPRC
standards for this product type as of the provision's
effective date.
CLAIMS OF CREDITORS All benefits and payments under this Contract shall be
exempt from the claims of creditors to the extent permitted
by law.
MISSTATEMENT AND PROOF OF We may require proof of age or survival of any person upon
AGE OR SURVIVAL whose age or survival any Annuity Payments or other
benefits provided by this Contract or any Rider attached
thereof depend. If the age of the Annuitant has been
misstated, the benefits will be those which would have been
provided for the correct age. If we have made incorrect
benefit payments, we will immediately pay the amount of any
underpayment. We will deduct the amount of any overpayment
from future benefit payments.
INCONTESTABILITY This Contract is not contestable.
NON-PARTICIPATING Your Contract is non-participating and will not share in
our profits or surplus earnings. We will pay no dividends
on your Contract.
REPORTS We provide periodic reports no less frequently than
annually without charge, containing the Investment Account
Value, the Contract Value and Death Benefit. The report
will include the number of Accumulation Units credited to
the Variable Account, the Accumulation Unit value and the
dollar value of the Accumulation Unit of the Variable
Account no more than 4 months prior to the date of the
delivery of the report. We will provide annual calendar
year reports concerning the status of the Contract and such
information concerning required minimum distributions as is
prescribed by the Commissioner of Internal Revenue. We
will provide additional status reports upon request for a
charge not to exceed $25 per request.
CURRENCY AND PLACE OF All payments made to or by us shall be made in the lawful
PAYMENTS currency of the United States of America at the Annuities
Service Center or elsewhere if we consent.
NOTICES AND ELECTIONS To be effective, all notices and elections you make under
this Contract must be in the form of a Written Request.
Unless otherwise provided in this Contract, all notices,
requests and elections will be effective when received by
us at our Annuities Service Center, complete with all
necessary information.
GOVERNING LAW This Contract will be governed by the authority of the
Interstate Insurance Product Regulation Commission and
issued under the Commission standards.
SECTION 72(S) The provisions of this Contract shall be interpreted so as
to comply with the requirements of Section 72(s) of the
Internal Revenue Code.
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PART 13 CONTRACT TERMINATION
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CANCELLATION FOR NONPAYMENT If, prior to the Annuity Commencement Date, no Payments
& MINIMUM ACCOUNT VALUE have been made for two consecutive Contract Years, and if
both:
(a) the total Payments made, less any partial withdrawals,
are less then $2,000; and
(b) the Contract Value at the end of such two year period
is less than $2,000;
we may cancel this Contract and pay you the Contract Value
(measured as of the Valuation Period during which the
cancellation occurs), less the Annual Contract Fee.
OTHER This Contract will terminate on the earliest of :
(a) receipt of your request to withdraw the entire Contract
Value;
(b) the date a Death Benefit is payable and the Beneficiary
takes the Death Benefit as a lump sum; or
(c) the date the Contract Value reduces to zero, subject to
the provisions of any benefit rider attached to this
Contract.
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XXXX XXXXXXX LIFE INSURANCE COMPANY (U.S.A.) (XXXX XXXXXXX(R) LOGO)
HOME OFFICE: Bloomfield Hills, MI
